Identifying and understanding the health and social care needs of Indigenous older adults with multiple chronic conditions and their caregivers: a scoping review.

BACKGROUND: Indigenous people continue to experience high rates of multiple chronic conditions (MCC) at younger ages than other populations, resulting in an increase in health and social care needs. Those who provide services designed to address MCC for Indigenous communities require synthesized information to develop interventions that meet the needs of their older adult population. This review seeks to answer the research question: What are the health and social care needs, priorities and preferences of Indigenous older adults (living outside of long-term care settings) with MCC and their caregivers? METHODS: A scoping review, guided by a refinement of the Arksey & O'Malley framework, was conducted. Articles were included if the authors reported on health and social care needs and priorities of older Indigenous adults. We also included articles that focused on Indigenous conceptions of wellness, resilience, well-being, and/or balance within the context of aging, and articles where authors drew from Indigenous specific worldviews, ways of knowing, cultural safety, cultural competence, cultural appropriateness, cultural relevance and community needs. RESULTS: This scoping review included 9 articles that were examined using an Indigenous determinants of health (IDH) theoretical framework to analyze the needs of older adults and CGs. Five areas of needs were identified: accessible health services; building community capacity; improved social support networks; preservation of cultural values in health care; and wellness-based approaches. CONCLUSION: The review highlights key determinants of health that influenced older adults' needs: education and literacy, ethnicity, and social support/network (proximal); health promotion and health care (intermediate); and a combination of historical and contemporary structures (distal). The findings highlight the importance of local Indigenous knowledge and perspectives to improve accessibility of culturally relevant health and social services.

An Approach to Improve Dementia Health Literacy in Indigenous Communities.

This project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada's First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer's and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed "What is Dementia? Indigenous Perspectives and Cultural Understandings" and "Signs and Symptoms of Dementia: An Indigenous Guide." The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.

Exploring the Appropriateness of Culturally Safe Dementia Information with Indigenous People in an Urban Northern Ontario Community.

Ce projet en application de connaissances a exploré la pertinence d'une documentation en promotion de la santé élaborée pour une population autochtone nationale en vue de son utilisation dans une communauté autochtone urbaine du nord de l'Ontario. Une approche décolonisée et communautaire de recherche-action participative faisant appel à l'épistémologie tribale a été suivie pour former un groupe consultatif autochtone local et établir un partenariat avec le N'Swakamok Native Friendship Centre. Deux groupes de discussion (n=8) composés d'adultes autochtones et cinq entrevues individuelles avec des aidants autochtones soignant une personne atteinte de démence ont alimenté l'analyse thématique qualitative. Quatre thèmes sont ressortis des données: (1) la nécessité d'une compréhension commune des cultures autochtones et occidentales dans le cadre des soins de santé; (2) l'amélioration de la communication interculturelle dans les discussions sur la santé; (3) l'ancrage du matériel de promotion de la santé dans la culture, et (4) les stratégies autochtones de littératie en matière de santé et la sensibilisation aux maladies neurodégénératives. Considérant que les prestataires de soins de santé cherchent des moyens efficaces pour communiquer avec les peuples autochtones, il est important de fournir de l'information pertinente localement et sur le plan culturel afin d'améliorer l'adoption et l'efficacité chez ces populations.This knowledge translation project explored the appropriateness of utilizing health promotion materials developed for a national Indigenous population with Indigenous people living in a northern Ontario urban community. A de-colonized, community-based participatory action research approach using tribal epistemology assisted in establishing a local Indigenous advisory group and a partnership with the N'Swakamok Native Friendship Centre. Two focus groups (n = 8) with Indigenous adults and five one-on-one interviews with Indigenous caregivers of a person with dementia informed a qualitative thematic analysis. Four themes emerged from the data: (1) the need for shared understandings of Indigenous and Western cultures in health care; (2) improving cross-cultural communication within health-related encounters; (3) grounding health promotion materials in culture; and (4) Indigenous health literacy strategies for dementia awareness. As health care providers search for effective ways to communicate with Indigenous people, it is important to deliver locally and culturally relevant information to improve uptake and effectiveness by Indigenous people.Maanda enkiichigaadeg binda kenjigemgad gezhi nakaasang dibaajimowinan gaazhitoong giiwedinong anishinaabek endaajig nji. Enanchgwenzigwaa miinwaa N'swakamok Friendship Center maamwi giinaadmaadok nokiitmowaad wii maandonaa'aad waa nkwenmaagenjig. Niish we'aangizijig, kchi aak miinwaa enkiitaagejig gii nibwaachidook nenendamaawziwin nji wii rnkamwaad ge minodaapinigaadeg. Niiwin giibi zikaamgadoon ge naadmaagemgak. (1) Zhindawendaagwod nsastaadwin wiiteg Anishinaabe miinwaa Ewaabshkiiwed ezhi naagdawendiwaad; (2) Weweni wii ginoonding nokiitaageng; (3) Wii kinoomaading weweni dibaajimowinan waazhi giniwendizad bemaadzid; miinwaa (4) Anishinaabe ji nsastang enaabiisjigeng nenendamaawziwin nji. Epiichtaawaad bemiikgagejig wii mkamowaad gezhi ginoonaawaad Anishinaaben, kchi piitendaagwad weweni ji nsastamookiiwaad mii dash dani naawsek.