Pimatisiwin最新文献

Objective: To inventory and describe currently available health performance measurement systems for First Nations, Inuit, and Métis people in Canada to identify why current measurement systems are inadequate to inform community or regional level health planning.

Methods: Inventory, classification, and synthesis of strengths and weaknesses among existing health system performance measures through systematic literature review and key informant interviews.

Results: Indigenous-specific health indicators are available at national, provincial, regional, and community levels, but there is a paucity of data for non-registered First Nations, Métis, and Inuit people. Barriers to the effective use of these indicators include: indicator selection driven by accountability rather than public health requirements; poor data quality; inadequate infrastructure and human resources; minimal information returned to communities; tension between agencies collecting universal indicators and Indigenous-determined processes; and, mistrust by Indigenous communities of externally imposed processes. The focus on national systems results in greater attention to disease-based measures and less focus on regional cultural diversity and Indigenous-specific values and priorities.

Conclusion: Indigenous health system performance measurement infrastructure in Canada is underdeveloped, particularly at the local level, and hence deficient in its ability to support community or regional health planning.

There is evidence that Aboriginal people may be at increased risk of HIV infection; they also experience higher rates of other blood-borne viral (BBV) and sexually transmitted infections (STI). This project will provide insights into the role of resilience and its impact on the health and well-being of Aboriginal youth, especially as it relates to sexual and injecting behaviour. The primary recipients of this information will be agencies that provide risk education related to BBVs and STIs.The project involves several phases. First, the framework for the research will be established, with Aboriginal leadership and involvement at every level. Next, both qualitative and quantitative methodologies will be used to identify factors that protect Aboriginal youth against blood-borne viral and sexually transmitted infections and their transmission within local communities. Finally, results from this project will be used to develop interventions and appropriate frameworks for their evaluation in Aboriginal communities.An important component of this project will involve the building of capacity within participating communities, with the goal of identifying strategies related to resilience that can be incorporated into public health and clinical practice. The project will run for five years.

The suicide prevention continuum illustrates a practical approach to the complex issue of suicide prevention. The continuum evolved from discussions with two Aboriginal communities in Atlantic Canada about suicide and the different types of interventions available. The continuum offers a framework and reference tool to differentiate between the different stages of suicide risk. It illustrates where the Aboriginal Community Youth Resilience Network (ACYRN) fits into suicide prevention and how it contributes to prevention knowledge, capacity building, and policy development.

The last decade or so of research in Canada, reflected in this special issue, has increased our understanding of the distinction between Indigenous resilience and the research into Indigenous resilience.Measurement offers glimpses of resilience, mostly from the potentially distorted view of how resilient youth face specific adversity - adversity that is set by the funding opportunity: tobacco, substance abuse, suicide, or HIV infection. The driving role of funding has obvious problems; the priorities of funders may not be the priorities of communities and results can tell more about the funding opportunity than about resilience itself. Even so, this problem-focussed research has the very practical advantage of producing results geared to solutions.A major lesson of this body of work is that we should allow ourselves the space (and the modesty) to recognize that Aboriginal resilience is greater than we have been able to measure under specific funding opportunities. Even with this limitation, our results shows a large degree of specificity - what strengthens youth resilience to one type of adversity in one setting might well not work in another. Five proposals emerge from the findings.

The Tłįchǫ Community Services Agency's (TCSA) Healing Wind Strategy identifies a number of activities and interventions to address the prevention of STI/HIV/AIDS in the Tłįchǫ region of the Northwest Territories of Canada. As a part of this strategy, the TCSA and CIET facilitated research to develop a foundation for interventions targeting sexually transmitted infections. The project recruited and trained community-based researchers who conducted a research survey on sexual health attitudes and behaviours in the four Tłįchǫ communities, covering 65% of the population above 9 years of age. The research process, outcomes, and the strategic plan that arose from the research findings produced a clear framework for interventions that are grounded in the community, but could also influence national and territorial policy. The approach may be relevant in other settings.

Social capital, as an asset or a resource for resilience, can be a characteristic of the community or the individual. As an individual asset, social capital consists of a person's relationships to available social resources. As a characteristic of communities, it consists of attributes such as trust, reciprocity, collective action, and participation. Closely related to community social capital is the concept of collective efficacy. Some social networks, however, can be violent, repressive, bigoted, or otherwise destructive.Resilience is also a characteristic of both individuals and communities. This means that the relationship between social capital and resilience is four-dimensional. In discussing each of these dimensions, we highlight the ability of resilience research to link evidence on community social capital with individual data and the recognition that individuals can be resilient even if the communities they live in have low or even negative social capital.Recommendations for future research include greater attention to the social capital potential of Aboriginal spirituality, more comparison of urban-rural differences in social capital, and a better understanding of the factors that underlie Aboriginal youth resilience where social capital is defective.

Resilience has been most frequently defined as positive adaptation despite adversity. Over the past 40 years, resilience research has gone through several stages. From an initial focus on the invulnerable or invincible child, psychologists began to recognize that much of what seems to promote resilience originates outside of the individual. This led to a search for resilience factors at the individual, family, community - and, most recently, cultural - levels. In addition to the effects that community and culture have on resilience in individuals, there is growing interest in resilience as a feature of entire communities and cultural groups. Contemporary researchers have found that resilience factors vary in different risk contexts and this has contributed to the notion that resilience is a process. In order to characterize the resilience process in a particular context, it is necessary to identify and measure the risk involved and, in this regard, perceived discrimination and historical trauma are part of the context in many Aboriginal communities. Researchers also seek to understand how particular protective factors interact with risk factors and with other protective factors to support relative resistance. For this purpose they have developed resilience models of three main types: "compensatory," "protective," and "challenge" models. Two additional concepts are resilient reintegration, in which a confrontation with adversity leads individuals to a new level of growth, and the notion endorsed by some Aboriginal educators that resilience is an innate quality that needs only to be properly awakened.The review suggests five areas for future research with an emphasis on youth: 1) studies to improve understanding of what makes some Aboriginal youth respond positively to risk and adversity and others not; 2) case studies providing empirical confirmation of the theory of resilient reintegration among Aboriginal youth; 3) more comparative studies on the role of culture as a resource for resilience; 4) studies to improve understanding of how Aboriginal youth, especially urban youth, who do not live in self-governed communities with strong cultural continuity can be helped to become, or remain, resilient; and 5) greater involvement of Aboriginal researchers who can bring a nonlinear world view to resilience research.

This paper is an interview between Carrielynn Lund and Cree Elder Ruth Gladue on research and community resilience in her semi-remote, northern Alberta community. Ruth is a Cree Elder born "during the war years." She is married and has two girls, one boy, and "a few grandchildren." Ruth has worked as a Community Health Representative (CHR) and Licensed Practical Nurse (LPN) for over forty years. She lives in a semi-remote First Nations community in northern Alberta.