International Journal of Circumpolar Health最新文献

Cancer screening is a high priority within the Métis community in Alberta. Despite comparable cancer incidence rates to non-Métis Albertans, Métis people face barriers to accessing cancer screening programs. This study used community-based research approaches informed by Métis ways of knowing to engage 31 individuals across Alberta about their experiences with accessing cancer screening services. Data collection was completed through two in-person Métis gatherings and six telephone interviews. Gatherings included talking circles and cultural activities, with discussions lasting approximately three hours. Topics discussed included experiences with accessing screening services, the quality of care received during appointments, and the supports needed to improve access to screening programs. Discussions were audio-recorded, transcribed, de-identified, and thematically analyzed using NVivo Software. Four prominent themes emerged from this study: (1) the impact of patient-provider communications on cancer experiences, (2) a broken healthcare system and access to care, (3) a need for support and safety, and (4) health promotion behaviours. An overarching theme of discrimination as a social determinant of health emerged throughout the findings. Tangible barriers, including geographical, transportation, and financial, were also identified by study participants. This study provides an increased understanding of Métis experiences related to cancer screening and offers direction for improvements.

Despite overall improvements in general health, the prevalence of mental illness continues to rise, underscoring the need for innovative approaches to health promotion. This study examines how purpose-driven small and medium-sized enterprises (SMEs) design and develop nature-based interventions (NBIs) as social innovations to promote mental health. Using a case study approach, the research draws on data from workshops, semi-structured interviews, and expert stakeholder discussions involving 28 SME practitioners, eight public actors from social and healthcare sectors, nine entrepreneurs, and four experienced stakeholders. The analysis reveals that the successful development of NBIs depends on five core dimensions: accessibility, acceptance, affordability, meaningfulness, and knowledge. In addition, the study identifies a range of strengths, weaknesses, opportunities, and threats that SMEs encounter when navigating the complex landscape of NBI implementation. The findings highlight the potential of NBIs to complement traditional healthcare by fostering empowerment and supporting tailored recovery, while also offering strategic insights into the collaboration required for sustainable social innovation.

Nunavik (Québec, Canada) has been inhabited by Inuit for over 4,000 years. Inuit midwives assisted in childbirth for centuries before colonization removed birth from our communities. In the 1980s, after years of evacuation for birth to southern hospitals, local women and Inuit leaders brought birth back to our remote Hudson Coast and Hudson Strait villages. As Inuit midwives, we have continuously offered local midwifery care to the population since that time, supported by southern midwives and an interprofessional team. Our midwifery service is nationally and internationally recognized as a model for returning childbirth to remote communities and reclaiming Indigenous midwifery. Inuulitsivik midwifery demonstrates that birth services and midwifery education can be integrated into health care systems in remote communities with safe outcomes. To understand the factors that contribute to our success and sustainability, we brought together experienced midwives and student midwives and met in person, by teleconference and online. Themes that emerged include Inuit values and language; Inuit leadership; local midwifery education; an adapted role for midwives in remote communities; flexibility in the organization and implementation of practice; midwifery-led interdisciplinary care and strategic collaboration with southern Canadian and international allies. We explore these themes and use common frameworks for policy analysis to consider effectiveness; impacts on the experience of pregnant women and families; health equity and access to services; costs; feasibility and acceptability. Our local midwifery service makes an important contribution to meeting the calls to Action of the Truth and Reconciliation Commission of Canada.

Chronic back pain (CBP) is a widespread public health issue. There is a lack of community-based care options for Indigenous Peoples with CBP. A virtual care clinic co-designed with community was implemented in the Cree Community of Pelican Narrows using remote presence (RPR) technology. Methods We used a community-based participatory action framework and pre-post design to evaluate this intervention. Pain, quality of life and experience outcomes were measured. An assessment was provided by a local nurse practitioner and a physical therapist joining over RPR. The physical therapist provided jp to four follow-up treatments per participant using RPR. Results Thirty-eight participants were assessed, and 78 follow-up treatments delivered. No significant differences between pre- and post- pain or quality of life were found. Thirteen patient participants and five health providers completed interviews. Patient themes included: (1) community and healthcare context, (2) community preferences for back pain care, and (3) experience with virtual back pain clinic. Health care provider themes included: (1) getting people to clinic, (2) experience with virtual back pain clinic, and (3) ways to enhance care. Conclusion Virtual CBP clinic enhanced access to therapy and was experienced positively. Participants suggested ways to address challenges, including a hybrid model of care.

Indigenous Sámi women in Norway are entitled to equitable and culturally safe maternity care. However, research on the Sámi perspectives in maternity care is limited. To explore midwives' experiences with Sámi women in birthing units in Northern Norway, we conducted 11 interviews, which were analysed using reflexive thematic analysis. The main theme, "We are all Norwegians: We are all the same," reflects a recurring perception that equality in care means treating all women equally, regardless of their cultural background. This approach, while well-intentioned, risked obscuring the specific cultural needs of Sámi women. The analysis showed tensions between sameness and difference: some midwives emphasised individualised, woman-centred care without reference to cultural identity, while others recognised that Sámi women's backgrounds could shape communication, expectations, and needs in childbirth. Midwives with Sámi heritage described their background as influencing their understanding, even when they did not self-identify as Sámi. While midwives strive to provide individualised and equal care, this may unintentionally reproduce assimilative norms and contribute to culturally unsafe care by under-communicating difference. The findings underscore the importance of enhancing cultural safety in Norwegian midwifery through education, reflection on historical injustices, and acknowledgement of Sámi women's cultural identities.

Lack of in-home water service remains a persistent challenge in rural Alaska due to underfunding, high construction and operating costs, extreme cold, and environmental change. Alaska has the highest proportion of households in the U.S. lacking complete plumbing, resulting in self-hauling of water and waste, reuse of limited supplies, and higher rates of water-washed disease than in plumbed homes. During the COVID-19 response, the Alaska Native Tribal Health Consortium (ANTHC) and Silverline LLC developed and installed the Miniature Portable Alternative Sanitation System (Mini-PASS) in 14 unplumbed Alaska Native communities. To evaluate its impact on hand hygiene, water-hauling behaviors, and system use, we conducted seasonal interviews with 147 households. Among 139 households reporting handwashing methods, 63% (n=93) used the in-home handwashing station (HWS) as their primary method. Longer ownership was associated with greater HWS use and increased water hauling. Analysis of 163 interviews from 52 households showed a monthly rise of 0.08 gal/c/d (0.30 L/c/d) in water use following installation. These findings indicate that in-home HWS interventions such as the Mini-PASS improve hand hygiene, reduce wash-basin water reuse, and modestly increase household water use over time. Longitudinal monitoring is critical to assess sustained behavioral and WASH outcomes in unpiped communities.

The Oskâyak (Youth) Power Program (YPP) at Pakitahaw Sākahikan Iýiniwak (Sturgeon Lake First Nation) was co-created by and with youth to strengthen miyo-ayāwin (wellness) among oskinîkiwak (young men) and napêsisak (boys). Using a participatory empowerment evaluation grounded in a braided framework of community-based participatory research (CBPR), transformative learning, and ethical space, guided conversations were held with 14 youth supported by Kēhtēyak (Elders) and Kayāsi Kistēyihtamow Kanawēyihcikēw (Traditional Knowledge Keepers). Oskâyak (Youth) described how cultural teachings, land-based activities, and mentorship nurtured confidence, identity, and connection, cultivating hope, belonging, purpose, and meaning. The findings show how Nation-led, strength-based programs grounded in Indigenous knowledge can foster holistic miyo-ayāwin, agency, and community connectedness. The YPP illustrates the power of Indigenous youth-led, culturally grounded approaches to address health inequities while honoring self-determination and Ownership, Control, Access, and Possession (OCAP®) principles.

In Nunavut, Inuit territory in Canada, young people have suicide rates nine times higher than the overall Canadian rates. However, mental health services struggle to reach young people. Regional suicide prevention organizations call for improved services and a better continuum of care. Yet little research has explored young people's experiences with the services currently available. As part of a larger study on resilience in Inuit youth, we asked them to explain their lack of use of mental health and suicide prevention services. The study was conducted in Arviat and Pangnirtung and followed the Inuit methodology Aajiiqatigiingniq Research Methodology (ARM), a cultural process for consensus building and solution-seeking compatible with a qualitative research approach. Advisory boards were created in each community. Interviews were conducted with thirty-one Inuit youths age 15 to 24. Data were analyzed by a thematic analysis. Young Inuit expressed a general discomfort with available services, including uneasiness with the health center and the way services are provided, they lacked information about services, lamented inadequate outreach methods and expressed a feeling of mistrust. Our findings support the value of several ongoing initiatives based upon cultural traditions, and may inform the continuum of care for suicide prevention .