Indigenous gender and wellness: a scoping review of Canadian research

Figures & data

Figure 1. PRISMA Flow diagram.

Table 1. Participant sex and gender as described in included articles.

Descriptions of Participant Genders	Number of Articles
Women	60
Men	5
Men and Women	18
Men, Women, Sex/Gender Diverse	2
Descriptions of Participant Sexes
Females	4
Males	1
Males and Females	19
Males, Females, Sex/Gender Diverse	3
Descriptions of Participant Genders and Sexes
Females and women referred to interchangeably	10
Women, Gender diverse	4
Females, gender diverse	1
Males and men referred to interchangeably	1
Men, Gender diverse	1
Males, Gender diverse	0
Men, women, males, females referred to interchangeably	8
Sex and Gender Diverse	7
Did not specify sex or gender	11

Table 2. Topics of included articles.

Topic^a	Number of Articles
Physical health issues	20
Perinatal	15
HIV	10
HPV/PAP-screening	7
Sexual health/sexual relationship	5
Diabetes	5
Cardiovascular disease	4
Cancer ^b	2
Dental	1
Menopause	20
Social issues
Social-emotional	10
Ethnic identity	7
Family violence	5
Gender identity	4
Intergenerational/historical trauma	4
Sexual abuse	4
Parenting	4
Culture/traditional way of life	4
Homelessness/housing	2
Aging	2
Language	1
Racial discrimination	1
Mental health issues
Substance abuse ^c/gambling/addiction	20
Mental problems	17
Suicide	4
Health policy and perception
Health promotion/health care/health policies	18
Perception of health and wellbeing	8
Global issues
Nutrition/food insecurity	7
Land use/water	2
Climate	1

Notes: ^aAn article may include more than one topic ^bIncludes 3 articles on breast cancer. ^cIncludes 4 articles on smoking and one on alcohol abuse.

Figure 2. Percentage of articles reporting the use of community-engaged research approaches.

Figure 3. Percentage of articles reporting community involvement at each stage of the research process.

Table 3. Objectives described in included articles.

Examine relationship between a community/ individual characteristic and a health/wellness issue (n = 33; 20%)

What is the link between culture-based practices and early childhood dental care? [22] What is known about the sustainability of livelihoods in an Indigenous community over time and the factors impacting men and women? (Ballard, 2012) What is the link between social support and thriving health among Indigenous Canadians? (Richmond et al., 2007)

Study incidence and determinants of a health/wellness issue (n = 18; 12%)

To study the incidence, persistence, and determinants of human papillomavirus (HPV) infection in a population of Inuit women from Nunavik, Quebec 23 What are the rate and determinants of exclusive breastfeeding in remote Northwest Territories? [24] To determine whether pre-existing diabetes is related to poorer survival after a breast cancer diagnosis in First Nation women [25].

Develop and evaluate an intervention (n = 19; 12%)

To initiate and understand how to deliver group-based heart health interventions to Indigenous women at risk of cardiovascular disease 26 To develop and pilot test an Indigenous health promotion intervention for interpersonal violence. (Varcoe et al., 2017) To develop a smoking cessation programme for Indigenous fathers. (Bottorff et al., 2019)

Understand experiences with health and wellness services (n = 12; 8%)

To explore the experiences of Indigenous mothers in selecting and using early childhood development services [27]. To address how the health care concerns of Aboriginal women are being met by urban Aboriginal health centres. (Benoit et al., 2003) To identify and validate known barriers and supports to HPV vaccination among First Nation people in Alberta. (Henderson et al., 2018)

Explore or critique a research method (n = 3; 2%)

To highlight the problems regarding conducting culturally appropriate research with Aboriginal women [28]. To examine three measures of mortality as proxies for inequalities in health status of Manitoba’s Registered First Nations people. (Martens et al., 2005) To discuss the value of group interviews as a methodological approach that challenges the privatisation of mothering and substance use. (Salmon, 2007)

Examine the impact of trauma, racism, discrimination on health and wellness (n = 6; 4%)

To examine the relationship between perceived discrimination and depressive symptoms among First Nations adults in Canada. (Bombay et al., 2010) To explore the impact of intergenerational historic trauma on HIV treatment adherence and health-promoting practices. (Chongo et al., 2020) To assess whether there were associations between oral health-related outcomes and self-reported racism. (Lawrence et al., 2016)

Understand perspectives on a health and wellness issue (n = 68; 44%)

How do urban Aboriginal women understand pregnancy-related weight gain and physical activity? (Vallianatos et al., 2006) To understand the context, issues, and beliefs around high STI rates in the Saddle Lake community from a nêhiyaw (Cree) perspective. (Gesink et al., 2016) To explore and begin to make visible Aboriginal women’s experiences with breast cancer. (Poudrier & Mac-Lean, 2009)

Table 4. Recommendations described in included articles.

Indigenous knowledge, identity, culture, and/or language should be integrated in research and health programmes with Indigenous peoples (n = 32; 21%)

The integration of gender, language and Anishinaabe Knowledge Systems in community planning is essential. (Ballard, 2014) The need for exquisite sensitivity to, and awareness of, culture and Aboriginal ways of being in the world and of knowing is essential in all encounters related to access and treatment. (Gorman, 2009) Strategies must address concurrent trauma and mental health, support connections to Indigenous cultural identity, and facilitate understanding of the impacts of the residential school system and intergenerational trauma on family relationships. (Pearce, 2014)

Health promotion and health education should be offered to address the health issues being investigated (n = 39; 25%)

Physical activity programmes and health promotion strategies which focus on providing affordable, nutritious foods are required to improve the diet and overall health of community members. (Bruner, 2008) Suicide prevention must include alcohol and drug prevention programmes and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities. (Fraser, 2015) Recommend a multidisciplinary outreach approach, where a team of professionals (geneticist, cardiologist (or specially trained primary healthcare provider), genetic counsellor, and nurse) provide ongoing care for patients in their own community. (Huisman, 2020)

Researchers and service providers should attend to social justice, socio-economic equity, and creating culturally safe spaces (n = 28; 18%)

Documenting inequities can help pave the way to redress exclusion in both health care access and delivery for a diverse array of marginalised people and communities and suggest new partnership models in order to bring about improved health and well-being. (Brotman, 2002) Programmes and policies should address racism’s insidious effects on both mothers’ and children’s oral health outcomes. (Lawrence, 2016) Culturally safe places are needed in urban areas, where knowledge and practices can be shared, contributing to identity safeguarding. (Kirby, 2007)

Researchers and service providers should consider gender and sex (n = 20; 13%)

It would be important for future research to analyse data with more detailed groupings and consideration of sex and gender in order to improve the understanding and unique needs regarding social support and health of these individuals. (Beswick, 2013) Gender and generational differences should be considered when planning mental health promotion strategies for this population. (Kirmayer, 2000) Indigenous culture-based services should be intentionally designed to recognise gender and racism as social determinants of health. (Reeves, 2017)

Research and services should focus on community strengths and use of a strength-based approach (n = 14; 9%)

It is important for health care professionals to adopt a strength-based approach to their clinical work. (Ames, 2015) Nursing education that focuses on strength-based and decolonising frameworks, as well as reflexive practices that promote culturally safe care, is needed. (Carter, 2017) Building on cultural strengths and acknowledging the history and context of mistrust and social exclusion are fundamental to effective HIV vaccine dissemination. (Newman, 2012)

More information should be collected on the topic/ further research should be conducted (n = 11; 7%)

Further research is needed to determine to what extent and how easily developmental and cultural assets can be increased in First Nations youth and the impact of such action on resilient outcomes. (Filbert, 2010) Additional data should be sought from parents and adolescents, giving voice to their collective stories and experiences. (Healey, 2014) Need for further investigation into the use of online health care. (Hoffman-Goetz, 2007)

No specific recommendations mentioned (n = 21; 14%)

Table 5. Knowledge mobilisation activities described in included articles.

Community implementing programmes or making changes to programmes (n = 4; 3%)

Researchers and community partners are developing, delivering, and evaluating community-led sexual health restoration activities. (Gesink et al., 2016)

Integrated knowledge mobilisation in the form of ongoing sharing of findings with community partners (n = 4; 3%)

Findings were shared on an ongoing basis with an advisory committee composed of community members. (Darroch et al., 2016)

Written material (n = 9; 6%)

Infographics related to traditional tobacco and the use of smoking cessation aids were created and distributed. (Bottorff et al., 2018)

Digital media (n = 6; 4%)

A local Indigenous artist created digital stories from study findings. (Kandasamy et al., 2017)

Policy work (n = 3; 2%)

As a result of the project, Status of Women Canada commissioned the writing of a position paper to be presented to bureaucrats and policymakers. (Kenny, 2006)

Community presentations or workshops (n = 14; 9%)

A dissemination gathering, feast, and community workshop were held. (Monchalin, 2019)

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