Indigenous Research | Family Medicine | School of Medicine

Aki Gimiinigonaa Mshkooziiwin (The Land Gives Us Strength): Culturally-grounded healing within the urban-Indigenous community during COVID-19

Principal Investigator: Indigenous Diabetes Health Circle

Co-Investigators: Dr. Eva Purkey & Dr. Imaan Bayoumi

Aki Gimiinigonaa Mshkooziiwin (The Land Gives Us Strength): Culturally-grounded healing within the urban-Indigenous community during COVID-19 is an urban Indigenous community-led knowledge mobilization project.

The Cost of COVID study was a prior research collaboration that looked at social and emotional impacts of the COVID pandemic among urban Indigenous community members around Kingston, ON. Study findings emphasized that reclaiming food systems and moving toward Indigenous food sovereignty (IFS), land access and cultural revitalization will contribute to the overall wellness and sustainable health goals of the urban Indigenous community during COVID and support long-term recovery.

The goal of the project is to share and action knowledge from the Cost of COVID study. We will do this by supporting IFS and building skills and awareness around cultural protocols, self-care and well-being.

The key objectives are:

To develop, implement, and evaluate strengths-based, Indigenous community-led COVID -19 pandemic recovery solutions to increase IFS, food security, and community belonging using land- and language-based activities rooted in Indigenous languages and cultures, and
To improve mental health among the Indigenous community during COVID-19 pandemic recovery using culturally grounded, land-based activities.

The knowledge mobilization program will include culturally grounded and socially supportive activities:

community foraging during forest walks;
growing medicines in community gardens and
working together to build Personal Bundles.

The Indigenous Diabetes Health Circle (IDHC), Queen’s University, and the Kingston Indigenous Languages Nest (KILN) have partnered to move the evidence from the Cost of Covid study into practice. They will work collaboratively, along with local urban Indigenous community members, to enhance programming to nurture health and well-being among urban Indigenous people in the current phase of the pandemic and into the future.

Katarokwi Indigenous Resilience during COVID-19 (KIRC-19) [aka: “Indigenous peoples living with chronic health issues during the COVID-19 era - examining experiences in Katarokwi (Kingston, Ontario area)”]

Team: Amrita Roy (Principal Investigator), Dionne Nolan, Amanda Sheppard, Autumn Watson, Mireille LaPointe, Laurel Claus-Johnson, Deb St. Amant, Kathy Brant, Mishiikenh / Vernon Altiman, Fran Chaisson, Sheldon Traviss, Sarah Funnell, Colleen Grady, Imaan Bayoumi, Michael Green, Meredith MacKenzie, Sheila Roewade, Sean Preston, Susan Stewart

Partner organizations: South East Regional Cancer Program (Cancer Care Ontario); Indigenous Cancer Care Unit (Ontario Health); Indigenous Diabetes Health Circle; Indigenous Wellness Council (formerly Indigenous Health Council); Street Health Centre (Kingston Community Health Centres); KFL&A Public Health; Addictions and Mental Health Services of KFL&A

Trainees: Kaitlyn Patterson (Graduate Research Associate)

Funder: Queen's University

Brief summary: Indigenous peoples have higher rates of chronic health issues compared to other groups in Canada. This is related to social disparities and barriers to accessing services, due to the ongoing impacts of colonization and racism. COVID-19 has created additional challenges around socioeconomic factors, social wellbeing, and access to services, over and above those already faced by Indigenous peoples. However, Indigenous individuals and communities also have remarkable strength and resilience in the face of challenges. This comes from factors such as traditional culture as a powerful force for wellness, and from a traditional worldview that values strong relational community connections.

Using two studies (constructivist grounded theory and qualitative case study) conducted simultaneously, this multi-methods, community-based project centered in the principles of Ownership, Control, Access, and Possession (OCAP) seeks to capture local experiences of both Indigenous individuals and Indigenous-focussed service groups in the Kingston area. Specifically, the objectives and associated products are as follows:

To understand the experiences of Indigenous individuals living with chronic physical or mental health issues, vis-à-vis access to health and social services, in the era of COVID-19 [PRODUCT: A framework summarizing barriers and facilitators to service access];
To understand the impact on holistic wellbeing of COVID-19-related stressors in Indigenous individuals already coping with chronic health issues [PRODUCT: A framework summarizing factors impacting wellness in the context of COVID-19-era stressors, as well protective factors that are sources of resilience and positive coping];
To understand the experiences of Indigenous-focussed service groups as they work to meet their mandate in the era of COVID-19 [PRODUCT: A framework summarizing challenges faced, opportunities recognized, and strategies used];
To highlight alternative program delivery methods being used by Indigenous-focussed service groups.

For more information:

E-mail Amrita Roy, Principal Investigator – amrita.roy@queensu.ca

KIRC-19 Facebook page

Report #1 Full Report

Report #1 Results in Brief

Report #2 is forthcoming - please visit the KIRC-19 Facebook page for updates.

Perinatal mental health in urban Indigenous women in Southeastern Ontario: A planning proposal

Team: Amrita Roy (Principal Investigator), Sarah Funnell, Morgan Slater, Michael Green, Mireille LaPointe, Jennie Hill, Annie Kingston-Miller

Partner organizations: Indigenous Wellness Council (formerly Indigenous Health Council); Ontario Native Women’s Association (ONWA) Indigenous Healthy Babies Healthy Children program; Minwaashin Lodge-Indigenous Women's Support Centre – Ottawa; KFL&A Public Health; Frontenac, Lennox, & Addington Ontario Health Team; Kingston Community Health Centres; Tsi Kanonhkhwatsheríyo Indigenous Interprofessional Primary Care Team

Trainees: Alysha Pelley (medical student / family medicine resident), Urvashi Beruar (MPH student), Nirmala Joseph (family medicine resident), Maryam Shah (MPH student), Astha Patel (MPH student); Graduate Research Associates TBD

Funder: Canadian Institutes of Health Research (CIHR)

Brief summary: Poor maternal mental health during the prenatal and postpartum periods can negatively affect the health of mothers, babies, and families. Indigenous women experience poorer health relative to other women in Canada; this is related to colonization and ongoing social disparities, as well as challenges in accessing health and social services that meet needs. However, Indigenous women also hold remarkable strength, with traditional culture and strong community serving as sources of healing. Good quality, diverse, and comprehensive data are required to support evidence-based development of policies, programs, and services that meet the needs of urban Indigenous women and families.

Research on this topic should be community-driven, participatory, culturally appropriate, culturally safe, and centered in respectful collaborative research partnerships with Indigenous peoples. Research on this topic should also create knowledge and data that will be useful for individuals, communities, healthcare and social service providers, and policymakers. This planning project will bring together key stakeholders to map out gaps in knowledge and data, and create a research action plan, to better understand and more effectively address perinatal mental health in urban Indigenous women in southeastern Ontario.

Academic researchers at Queen's University and University of Ottawa are partnering with local Indigenous peoples and with various community organizations in southeastern Ontario to do this project. In addition to producing a research action plan, the planning process itself will also bring together stakeholders and form a network for possible continued collaboration to improve Indigenous maternal-child health in the southeast Ontario region. Moreover, the insights gained and products created from this project can also be useful for understanding and addressing perinatal mental health in Indigenous women in other parts of Canada.

For more information: E-mail Amrita Roy, Principal Investigator – amrita.roy@queensu.ca

A case study of the Indigenous Wellness Council (southeast Ontario region): Indigenous self-determination in action

Team: Amrita Roy (Principal Investigator), Colleen Grady, Kaitlyn Patterson, Laurel Claus-Johnson, Mireille LaPointe, Dionne Nolan, Kathy Brant, Mishiikenh / Vernon Altiman

Partner organizations: Indigenous Wellness Council (formerly Indigenous Health Council)

Trainees: Lucas Gambacort (Graduate Research Associate)

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Brief summary: The harms of colonization manifest themselves in the present-day social and health disparities faced by Indigenous peoples in Canada. Healing from colonization for Indigenous peoples involves reconnecting with traditional culture and associated definitions of holistic wellness, and also reclaiming the path of self-determination. The Indigenous Wellness Council (IWC) of Kingston and surrounding area is a longstanding, grassroots, volunteer-run organization. Its members (almost all women) work to advance both holistic Indigenous wellness and Indigenous self-determination in the southeast Ontario region.

This research involves a partnership between the IWC and researchers from Queen’s University, guided by the principles of Ownership, Control, Access, and Possession (OCAP) in ethical community-based research with Indigenous peoples. Using focus groups, interviews, and document reviews, this case study involves an in-depth examination of IWC's past and present initiatives, use of resources, operational processes, governance structures, and partnership strategies used to advance its work on behalf of Indigenous peoples in the southeast Ontario region. This examination will help in identifying strengths and successes to highlight and emulate, and lessons learned from challenges faced and weaknesses or gaps recognized.

The case study analysis will help the IWC develop an organizational action plan, as it seeks to incorporate in order to optimize its work. Additionally, the case study will produce a framework on how Indigenous self-determination looks like in practice at an organizational level. This understanding can assist other Indigenous-led organizations in meeting their goals. It can also assist mainstream governmental and non-governmental organizations and policymakers in more meaningfully engaging with Indigenous-led organizations.

For more information: E-mail Amrita Roy, Principal Investigator – amrita.roy@queensu.ca

Centering Indigenous perspectives and priorities in a Learning Health System: a case study of the new Frontenac, Lennox & Addington Ontario Health Team

Team: Amrita Roy (Principal Investigator), Laurel Claus-Johnson, Kathy Brant, Dionne Nolan, Lynda Gerow, Mireille LaPointe, Catherine Donnelly, Michael Green, Colleen Grady, Jacqueline Galica, Joan Tranmer, Mike Bell, Kim Morrison, Theresa Macbeth, Alison Young

Partner organizations: Frontenac, Lennox, & Addington Ontario Health Team; Indigenous Wellness Council (formerly Indigenous Health Council)

Trainees: Samantha Lavallee (Graduate Research Associate), Niveditha Pattathil (medical student), Ishana Maini (MPH student), Natalie DiMaio (BSc student / MSc student)

Funder: Queen’s University

Brief summary: Ontario recently restructured its health system into Ontario Health Teams (OHTs). OHTs seek to provide coordinated, connected care that meets the needs of patients, providers, and populations through the Quintuple Aims: improving patient experience, improving care provider experience, improving population health outcomes, reducing costs, and addressing health equity.

The Frontenac, Lennox, & Addington (FLA) OHT was successfully created following an application that brought together numerous clinical and community partners in the region, including local Indigenous health groups such as the Indigenous Health Council and the Indigenous Interprofessional Care Team. Indigenous peoples face health inequities driven by colonization and systemic racism. Improving accessibility, cultural appropriateness, and cultural safety of health services and systems are thus essential.

To ensure that unique needs of Indigenous peoples are met, there should be a collaborative, participatory approach to planning and executing Indigenous-specific evaluation activities, with Indigenous-specific performance indicators. Involving a community-based approach centered in the principles of Ownership, Control, Access, and Possession (OCAP) in ethical Indigenous health research, this case study has the following two objectives:

To co-design, implement, and evaluate a governance process for collaboration with Indigenous communities, for Indigenous-focussed evaluation of activities of the FLA OHT;
To nest the above into a case study of the FLA OHT, examining processes for centering Indigenous perspectives and priorities in systems evaluation.

This project will enable incorporation of Indigenous-specific evaluation activities for FLA OHT projects. This will enable thoughtful and rigorous consideration of whether the needs of Indigenous patients/clients and communities are being met, and allow for modification of programs and services to better meet such needs – per the “learning health system” goal of iterative knowledge production and action to drive continuous improvement.

The key academic product from the case study analysis will be a framework to operationalize collaboration between Indigenous stakeholders and mainstream health systems, in the co-design and co-execution of health system evaluation approaches that reflect Indigenous perspectives and priorities. The framework from the case study will serve as a practical, operationalized guide to other mainstream health systems (including other OHTs in the province) and Indigenous groups seeking to meaningfully collaborate together.

For more information: E-mail Amrita Roy, Principal Investigator – amrita.roy@queensu.ca

Educating for Equity (E4E)

Principal Investigators: Dr. Linden Crowshoe and Dr. Michael Green

Co-Investigators: Dr. Rita Henderson, Dr. Kristen Jacklin, Dr. Betty Calam, Dr. Leah Walker, Dr. Ellen Toth, Dr. Han Han

Educating for Equity (E4E): Indigenous Patient Empowerment through Critical Education of Patients and Physicians in Addressing Social Pathways to Diabetes has been awarded $952,425 over 5 years through the CIHR Project Grant program, from April 2018 to March 2023. The project team is led by Dr. Linden Crowshoe (University of Calgary) and Dr. Michael Green (Queen’s University) and also includes investigators from the University of British Columbia, the University of Calgary, the University of Minnesota and Queen’s University.

This project is an extension of the “Educating for Equity” (E4E) CIHR International Collaborative Indigenous Health Research Team grant (2010-2016), in which the E4E Canada team used a rigorous research approach to develop and test the use of an E4E Care Framework © to assist physicians in their care of Indigenous patients with diabetes. The E4E Care Framework© was very well received by physicians and has been pilot tested in family medicine settings in Northern Ontario.

The new E4E project will explore the potential to apply the E4E Care Framework© to educational programs for healthcare professionals and the Indigenous patients. The research team is developing E4E Indigenous patient educational pedagogy through a series of realist reviews on the issues that phenomenally impact Indigenous health—racism, obesity, and diabetes. Topics and themes out of the realist reviews will be examined through the lens of the E4E Care Framework© before being translated into educational programs.

A mixed-method, multi-measure, controlled design will be used to evaluate the E4E Critical Education intervention to both Indigenous patients and physicians. Data collection includes patient chart audits, patient experience surveys and patient interviews. Primary outcomes include HbAIC and a summary patient experience score. Chart reviews prior to and post intervention will indicate impact of E4E Critical Education on clinical outcomes. Patient surveys and interviews will reflect changes in patient self-empowerment and in physician care delivery. Dr. Michael Green of Queen’s Family Medicine and the Centre for Studies in Primary Care (CSPC) will contribute to the development and evaluation of E4E patient critical education.

Enhancing Insomnia Care with Akwesasne Mohawk Nation. Waonkwenserontiio – ‘We are sleeping beautifully

Team: Judith Davidson (Lead), Amrita Roy (Co-Lead), Shayna Watson, Ojistoh Horn, Amber Montour, Tessa Jocko, Andrew Francis, Lisa Francis-Benedict, and community members of the Research Advisory Council

Partner organizations: Akwesasne Mohawk Nation (Department of Health)

Trainees: Atik Bird (PhD student), Scott McQain (PhD student), Katherine Fretz (post-doctoral fellow)

Funder: Canadian Institutes of Health Research (CIHR)

Brief summary: Insomnia, poor sleep, and mental health challenges are prevalent in Indigenous communities in North America and are often linked to the traumatic history of colonialism with displacements, residential schools, family separations, loss of language and traditions, and childhood adversity. Insomnia often occurs with mental health problems, especially depression and anxiety. Fortunately, effective solutions to address insomnia exist and sleep improvements are associated with positive effects on physical and mental health.

Cognitive Behavioural Therapy for Insomnia (CBT-I) is the treatment of choice for Insomnia Disorder in practice guidelines. CBT-I not only improves sleep, but it markedly reduces depression and anxiety, and provides a path for prevention and management of sleeping pill dependence. Due in large part to the shortage of trained providers, access to CBT-I is very limited, and Akwesasne, like other Indigenous communities, has had no access to this first-line insomnia treatment. The culture, history, and preferences of the community need to inform the design of treatment. This research involves collaboration between researchers from Queen’s University and Akwesasne Mohawk Nation, centered in the principles of Ownership, Control, Access, and Possession (OCAP). In addition to academic researchers, a Research Advisory Council involving representatives from the Akwesasne Department of Health and Akwesasne community members will guide the research process.

This research is seeking to revise an existing cognitive behavioural therapy (CBT-I) sleep intervention training program for healthcare providers working with patients/clients with insomnia, and tailor it to be culturally appropriate and contextually meaningful for use by healthcare providers in Akwesasne. Mixed-methods approaches will be used to understand healthcare provider and patient/client needs with respect to insomnia care, tailor the program, and then implement and evaluate the tailored program at Akwesasne. Additionally, there will be a qualitative constructivist grounded theory study to understand sleep experiences more broadly among community members in Akwesasne. In addition to providing insight on tailoring the CBT-I program, this qualitative study will also generate a stand-alone theoretical framework on sleep and insomnia in this First Nations community.

For more information: E-mail – judith.davidson@queensu.ca / amrita.roy@queensu.ca / lisa.francisbenedict@queensu.ca

Toppling Monuments: Colonial Trauma, Justice, Heritage, and Restorative Healing

Team: Christine Sypnowich (Principal Investigator), Amrita Roy (Co-Lead), Mark Walters, Sarah Funnell, Celeste Pedri-Spade, Colleen Davison, Nazanin Alavi, Elijah Bisung, Will Kymlicka, Margaret Moore, Jean Thomas, Gregoire Webber, Carol Ann Budd, Stacia Loft, Dionne Nolan, Greg Frankson, Howard Ng, Jaylene Cardinal, Maxine Clarke

Trainees: Aileen Editha (Graduate Research Associate)

Funders: Social Sciences and Humanities Research Council of Canada (SSHRC); Queen’s University

Brief summary: The term “heritage” is often used to refer to the historical buildings or monuments which were built by white settlers. Examples in Kingston are the statue of Sir John A Macdonald, the historic houses in the downtown, or Fort Henry. However, this “colonial” understanding of heritage is now being challenged. Many people in Kingston are pointing out that heritage can refer to all kinds of tangible and intangible artefacts, places, practices, narratives, and should include perspectives from racialized and Indigenous peoples.

Like many other communities worldwide, Kingston is at a historic juncture confronting legacies of racism and dispossession. Changing our understanding of heritage can play an important role in the work to address social exclusion and intergenerational trauma in order to address the health and wellbeing of Indigenous and racialized peoples. This project involves collaboration between an interdisciplinary group of academics from Queen’s University and a Community Advisory Circle composed of members of local Indigenous and racialized communities of the Kingston area.

In this community-based research project, we hope to stimulate public discussion on these issues. Our study will consider strategies to “decolonize” and broaden the idea of heritage in order to promote individual and community wellbeing. Through personal interviews in a qualitative constructivist grounded theory study, we will investigate the impact of colonial heritage on the wellbeing of Indigenous and racialized peoples in Kingston, Ontario.

We will also consider how to integrate new perspectives into Kingston’s own heritage stories. This will be done through community-engaged art practices, which would encourage healing for Indigenous and racialized people who have felt excluded from the culture of their city. At the final stage of our research, we will commission an artist residency to work through themes related to “Toppling Monuments” by engaging with local communities.

For more information: E-mail - toppling@queensu.ca

Full Circle Queen’s Indigenous Student Wellness Study

Team: Claire Lamothe (student investigator), Julia Moreau (student investigator), Caroline Instrum (student investigator), Kandice Baptiste, Lisa Doxtator, Aaron St. Pierre, Amrita Roy (faculty investigator / supervisor)

Partner organizations: Four Directions Queen’s Indigenous Student Centre; Queen’s University Student Wellness Services

Trainees: Claire Lamothe (BSc student), Julia Moreau (PhD student), Caroline Instrum (BSc student)

Funder(s): Studentship funding through Queen’s University Undergraduate Student Summer Research Fellowship (USSRF) program

Description: The purpose of this mixed-methods student-led research is to identify the holistic wellness needs of Indigenous students at Queen’s University and understand how well current campus resources, and the manner in which they are delivered, are supporting these needs. This project involves partnerships between Queen’s University, Four Directions Indigenous Student Center, and Student Wellness Services.

Using both quantitative (online survey) and qualitative (sharing circles) research methods, this project will generate a comprehensive understanding of:

the current wellness state of Indigenous students at Queen’s University;
whether or not current Queen’s campus health services are satisfying holistic wellness needs of Indigenous students;
the types of wellness services primarily being accessed by Indigenous students at Queen’s;
the perceived barriers that dissuade or prevent Indigenous students from accessing the wellness services offered by Student Wellness Services and Four Directions Indigenous Student Centres.

This project will help to identify possible points of intervention and areas of need for Indigenous students. The project will also help to highlight what is working well, and associated lessons to be learned from the strengths, successes, and stories of resilience of Indigenous students at Queen’s. While geared towards Queen’s University, the products of this research can also be useful to other universities across Canada.

For more information: E-mail – amrita.roy@queensu.ca