Heart work: Indigenous doulas responding to challenges of western systems and revitalizing Indigenous birthing care in Canada

Background In Canada, there has been a significant increase in the training of Indigenous doulas, who provide continuous, culturally appropriate support to Indigenous birthing people during pregnancy, birth, and the postpartum period. The purpose of our project was to interview Indigenous doulas across Canada in order to document how they worked through the logistics of providing doula care and to discern their main challenges and innovations. Population/setting Our paper analyzes interviews conducted with members of five Indigenous doula collectives across Canada, from the provinces of British Columbia, Manitoba, Ontario, Quebec and Nova Scotia. Methods Semi-structured interviews were conducted with members of the five Indigenous doula collectives across Canada in 2020 as part of the project, “She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas.” Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. Results Our paper examines two themes that emerged in interviews: the main challenges Indigenous doulas describe confronting when working within western systems, and how they navigate and overcome these obstacles. Specifically, interview participants described tensions with the biomedical approach to maternal healthcare and conflicts with the practice of Indigenous infant apprehension. In response to these challenges, Indigenous doulas are working to develop Indigenous-specific doula training curricula, engaging in collective problem-solving, and advocating for the reformation of a grant program in order to fund more Indigenous doulas. Conclusions Both the biomedical model of maternal healthcare and the crisis of Indigenous infant apprehension renders Canadian hospitals unsafe and uncomfortable spaces for many Indigenous birthing people and their families. Indigenous doulas are continually navigating these challenges and creatively and concertedly working towards the revitalization of Indigenous birthing care. Indigenous doula care is critical to counter systemic, colonial barriers and issues that disproportionately impact Indigenous families, as well as recentering birth as the foundation of Indigenous sovereignty and community health.

Exploring Barriers to Food Security Among Immigrants: A Critical Role for Public Health Nutrition

Upon moving to a new country and new food environment, 2 important public health issues may be experienced by immigrants as they adapt to their new country of residence, namely a higher prevalence of food insecurity and/or a decline in overall health over time postimmigration. Therefore, improving the food environment experienced by new migrants may be an effective strategy to reduce long-term health complications and improve well-being postimmigration. The aim of this paper is to discuss the potential barriers experienced by new immigrants in the access, availability, and utilization of familiar culturally appropriate foods and the subsequent impact on their food security status. Culturally appropriate foods are foods commonly consumed as part of cultural food traditions and are often staples within the diet; however, limited availability of and/or access to these foods can reduce food security. By understanding the barriers to food security and challenges that may be faced by immigrants and refugees, dietitians will be better equipped to assist these individuals in accessing culturally familiar foods and improve quality of life. In this capacity, dietitians can play a critical public health nutrition role by serving as a conduit for new immigrants to access community resources and navigate a new food environment.

Sources of Information and Communication About HPV Among Chinese Students Attending U.S. Colleges: Implications for Culturally Appropriate Strategies

Introduction: Little is known about human papillomavirus (HPV) information sources and communication among Chinese students attending U.S. colleges. We assessed information sources and communication about HPV and HPV vaccines among this population. Methodology: A cross-sectional design with 449 participants was conducted by using a questionnaire and snowball sampling. Summary statistics and multiple logistic regression were used. Results: The most common sources of HPV information included the internet and friends. Communication about HPV occurred most frequently among friends, family, and health professionals. Those who had better HPV knowledge and attitudes and were vaccinated against HPV were more likely to use internet, friends, family, and health professionals as their information sources. Discussion: Because the internet, friends, and families are likely sources for HPV information and communication, future internet-based culturally appropriate education should offer information not only to Chinese students but also to their social circles. Cultural beliefs may affect HPV prevention and should be examined.

The personal recovery movement in Singapore – past, present and future

The personal recovery movement is beginning to gain traction within Singapore’s mental healthcare systems. We believe it is timely to give a broad overview of how it developed and provide suggestions on how it can evolve further. From the early custodial care in the 1800s to the community-centric programmes of the 1900s and early 2000s, we now find ourselves at the forefront of yet another paradigm shift towards a more consumer-centric model of care. The following decades will allow personal recovery practitioners and researchers to innovate and identify unique but culturally appropriate care frameworks. We also discuss how the movement can continue to complement existing mental healthcare systems and efforts. Keywords: Asia, legislation, lived experience, mental health services, personal recovery

Staying moving, staying strong: Protocol for developing culturally appropriate information for Aboriginal people with osteoarthritis, rheumatoid arthritis, lupus and gout

Introduction Addressing disparities in arthritis care is an important yet unmet health need for Aboriginal and Torres Strait Islander people in Australia (respectfully Aboriginal people herewith). Despite the significant prevalence and burden of arthritis within Aboriginal communities, access to care for arthritis is low. One means to reduce existing disparities in health care is to address current challenges relating to the appropriateness and acceptability of health care information resources for Aboriginal people. Health information sources can help to empower patients and their families to have greater involvement in their care and to engage in self-management of their condition. Despite an extensive range of arthritis information resources being available, currently no resources have been culturally adapted and developed in collaboration with Aboriginal consumers with arthritis. This paper outlines the processes that will be undertaken within the Staying Moving, Staying Strong project. This project aims to develop culturally secure arthritis information for Aboriginal people with osteoarthritis, rheumatoid arthritis, lupus and gout. Methods and analysis The overarching principle guiding this project is cultural security, referring to the incorporation of processes such that the research will not compromise the cultural rights, values and expectations of Aboriginal people. This project will prioritise partnerships, community engagement, community benefit, sustainability, transferability, and capacity building and therefore uphold the cultural rights and values of Aboriginal people. In this six-phase project we will; 1) Establish a community reference group and advisory committee; 2) Explore the health information needs and preferences of Aboriginal people with arthritis; 3) Synthesise the existing key recommendations in high quality clinical practice guidelines on arthritis care; 4) Culturally adapt key clinical recommendations; 5) Develop culturally appropriate arthritis resources and; 6) Qualitatively evaluate the developed resources.

The effects of physical inactivity

Physical inactivity constitutes the basis of diseases that reduce life duration and quality and rank first among the causes of death in the world. Worldwide, it has been determined that 23 % of adults aged 18 and over are not active enough. According to the World Health Organization, sedentary life is among the main risk factors for deaths from non-communicable diseases worldwide and causes approximately 3.2 million deaths per year. For this reason, the issue of reducing inactivity has gained importance in the world today. As a solution, it is thought that increasing physical activity requires not only individual but also community-specific, multi-sectoral, multi-disciplinary and culturally appropriate approaches.

Ground penetrating radar investigations at the Lake Condah Mission Cemetery: Locating unmarked graves in areas with extensive subsurface disturbance

Ground penetrating radar (GPR) was used to non-invasively map the location of unmarkedgraves within the Lake Condah Mission Cemetery in western Victoria as a means of siting future interments. This cemetery was associated with the former Lake Condah Mission (established in 1869) and continues to be an important site for local Indigenous people. It is anecdotally thought to contain more than 100 graves however only 26 are currently marked. The GPR survey identified an additional 14 probable unmarked graves as well as 49 other areas that may contain one or more unmarked burials. The extensive subsurface disturbance present at the site and the presence of many extant tree roots made the effective interpretation of the GPR data difficult. Despite this, it was still possible to delineate areas where no unmarked graves are present. This is an important outcome for managing the cultural heritage of the cemetery because it identifies areas where new graves can be emplaced in a culturally appropriate fashion. This demonstrates the utility of GPR as a means of effectively managing heritage sites containing unmarked graves, even when substantial subsurface disturbance is present.

Bridging or breaking: An ethic of communication for missional engagement

Global workers must work toward an appropriate ethic of communication both corporately and personally to effectively engage all recipients of the gospel. Further, an ethic of communication for missional engagement must be biblically faithful and culturally appropriate in order to create ‘bridging encounters’ with potential recipients of the gospel (Kraft and Gilliland, 2005: 53). ‘Bridging encounters’ consist of communicative pathways that build common ground for engagement regardless of the level of agreement; they demonstrate cultural consideration, engagement, and respect of participants’ ideas, which works well in a postmodern age that values conversation. Since the 1920s, missiological characterization has provided a rhetoric of the ‘unsaved’, ‘unincorporated’, and ‘unreached’1 when describing people groups. This rhetoric of ‘un-’ may unintentionally cause breaking encounters instead of bridging encounters. Designating people groups as ‘in’ or ‘out’ can create a sense of ‘othering’ between global workers and recipients of the gospel. The consequent psychological friction proves detrimental to creating personal bridging encounters where individuals communicate the gospel in a more fluid manner (Bhargava and Manoli, 2015).