Cultural adaptation of an appropriate tool for mental health among Kanien'keha:ka: a participatory action project based on the Growth and Empowerment Measure
Liliana Gómez CardonaKristyn BrownTaylor GoodleafMary McComberRebecca D’AmicoAllyson PhillipsCyndy BoyerCodey MartinBrooke SplicerSuzy GoodleafDarrell ThompsonMelissa HaswellArlène LalibertéOuti Mantere
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We present a cultural adaptation of the Growth and Empowerment Measure (GEM) from the Kanien'keha:ka people of Quebec (Canada). Our aim was to develop a culturally competent and safe tool to assess and promote well-being among this population. We followed a qualitative, collaborative, and participatory method that sought to benefit Indigenous participants and communities, while honouring their culture and philosophies. Twelve adults from health and community services of Kahnawa:ke participated in total five focus group meetings. We carried out a thematic analysis of the data collected through an advisory group that led a revision of the cultural and conceptual relevance of the tool and its content. The group integrated socio-culturally relevant elements and restructured the tool so that it reflected local well-being factors and showed its versatility of being an assessment tool and therapeutic support. A narrative and empowerement-driven approach, culturally based intervention, cultural safety and flexibility when using the instrument were considered successful strategies to improve wellness. This project provides valuable information about the perspectives of local Indigenous communities regarding mental health and factors of empowerment. Mutual understanding and integration of psychological and traditional knowledge can create a beneficial program to improve emotional, mental, spiritual, and physical well-being for the local population. It remains to be tested whether the Kanien'keha:ka Growth and Empowerment Measure (K-GEM) is clinically useful in psychological and psychiatric intervention, and social and community services.Keywords:
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The National Empowerment Project (NEP) is an innovative Aboriginal-led community-based project. Since 2012, it has been working with communities in 11 sites across Australia to develop a culturally appropriate health promotion and primary prevention intervention strategy to reduce the high rates of psychological distress and suicide among Aboriginal and Torres Strait Islander peoples. The NEP is built around the use of localized participatory action research (PAR) processes to support communities to identify key factors negatively impacting on their lives as well as strategies for promoting well-being and building resilience. This article details the application of the PAR approach by the NEP Aboriginal community-based researchers. It provides some unique insights into how PAR facilitated communities to have a voice and the ways in which it supported important change processes at both an individual and a community level.
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Abstract In recent years, cultural safety has been proposed as a transformative approach to health care allowing improved consideration of Indigenous patient needs, expectations, rights and identities. This community‐based participatory study aimed to identify potential barriers and enablers to cultural safety in health care provided to Atikamekw living with diabetes in Québec, Canada. Based on a qualitative descriptive design, the study uses talking circles as a data collection strategy. Three talking circles were conducted with Atikamekw living with diabetes and caregivers, as well as with health professionals of the family medicine teaching clinic providing services to the community. Two team members performed deductive thematic analysis based on key dimensions of cultural safety. Results highlight four categories of barriers and enablers to cultural safety for Atikamekw living with diabetes, related to social determinants of health (including colonialism), health services organization, language and communication, as well as Atikamekw traditional practices and cultural perspectives of health. This study is one of the few that provides concrete suggestions to address key aspects of diabetes care in a culturally respectful way. Our findings indicate that potential enablers of cultural safety reside at different (from individual to structural) levels of change. Solutions in this matter will require strong political will and policy support to ensure intervention sustainability. Patient or public contribution Partners and patients have been involved in identifying the need for this study, framing the research question, developing the data collection tools, recruiting participants and interpreting results.
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We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec. We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information. The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner. This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.
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There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.
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It has been acknowledged that the mental health of Aboriginal and Torres Strait Islander people has been 'bedevilled' by the inappropriate application of non- Indigenous models of mental health. Given the poor health outcomes of Indigenous people, another approach to mental health practice is perhaps required. In order to enhance Indigenous health and wellbeing, it is necessary for non-Indigenous practitioners to find a culturally safe way in which to enter the negotiated space of cross-cultural mental health. Such practice can be facilitated through understanding both the points of similarity and divergence in perspectives of mental health across cultures. While the majority of Indigenous people live in urban areas, understandings of Indigenous mental health have primarily been derived from research in rural and remote communities. It is unclear whether findings from rural and remote research are applicable in urban Indigenous communities. The aim of the current research is to address this gap and to explore understandings of mental health in an urban Indigenous sample. This study provided a voice for urban Aboriginal and Torres Strait Islander people to convey their understandings of mental health so that an accurate representation may be available for those who are engaged in health promotion and mental health treatment.
Using a positive psychology framework, a strengths-based approach was taken in this study in order to explore understandings of mental health. A qualitative research investigation was conducted with a sample of 19 Australian Aboriginal and Torres Strait Islander participants. Data was collected via individual semi-structured interviews and focus groups. Qualitative analysis was conducted using thematic analysis. A model of Indigenous mental health was developed taking an holistic perspective. Four themes emerged as reflecting health and wellbeing and are presented in a model of Indigenous mental health:-
• Coping Skills: emotional, behavioural and cognitive;
• Knowledge: regarding physical health and access to mental health care;
• Social Support: personal resources and help-seeking behaviours; and
• Connectedness: cultural, social and family and kinship.
The theme of connectedness emerged as reflecting a unique contribution to Indigenous health and wellbeing. The role of connectedness to country, family and kinship, knowledge and social networks was highlighted. Further, the theme of connectedness also emerged as central to supporting cultural identity. Not only did connectedness promote and protect mental health and cultural identity, factors that diminished cultural identity also negatively impacted upon mental health. The striking similarity between mental health and cultural identity, as seen in the common theme of connectedness, highlights the necessity of attending to cultural factors to facilitate positive health outcomes.
This model of Indigenous mental health begins to fill in the boundaries of the negotiated space that is cross-cultural psychology - the space where both Indigenous and non-Indigenous knowledge offers a path or guidelines to enhance health and wellbeing. It is essential to address those factors that are similar across cultures – coping skills, social support and knowledge, but also to engage at the cultural interface of connectedness to culture, kinship and social networks.
This information has implications for cross-cultural clinical practice, through providing a map for non-Indigenous practitioners to engage in culturally safe practice. Further, this information will support the development of culturally safe health and wellbeing programs that sustain and nurture the cultural identity and mental health of Indigenous people. In this way, meaningful contributions may be made by health professionals to 'close the gap' in health and mental health outcomes for Indigenous people.
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