Challenging Health Service Delivery Models to Improve Access to Physical Therapy in Rural, Remote and Northern Communities.

Effective rural, remote and northern physical therapy services are an important component of health care. Providing these services with limited financial and human resources can present many challenges. Indigenous communities also have unique needs that must be considered when providing health care. Most current service delivery models are based in Western medicine practices and most often, do not account for the local, political, cultural and spiritual needs of communities. In this perspective article, I discuss the challenges of providing these services in rural Yukon to many small First Nation communities. Relationship building is paramount to effective and meaningful health care programs, and this means a change in current practice approaches. We need to challenge the delivery models and be open to other ways of knowing, beyond the Western biomedical approach that is the foundation of our profession. It is imperative that physical therapists, health care providers and funders seek new and innovative ways to provide services to the rural, remote and northern communities while ensuring a culturally humble approach.

Health promotion interventions supporting Indigenous healthy ageing: a scoping review.

Aging well is a priority in Canada and globally, particularly for older Indigenous adults experiencing an increased risk of chronic conditions. Little is known about health promotion interventions for older Indigenous adults and most literature is framed within Eurocentric paradigms that are not always relevant to Indigenous populations. This scoping review, guided by Arksey and O'Malley's framework and the PRISMA-ScR Checklist, explores the literature on Indigenous health promoting interventions across the lifespan, with specific attention to Indigenous worldview and the role of older Indigenous adults within these interventions. To ensure respectful and meaningful engagement of Indigenous peoples, articles were included in the Collaborate or Shared Leadership categories on the Continuum of Engagement. Fifteen articles used Indigenous theories and frameworks in the study design. Several articles highlighted engaging Elders as advisors in the design and/or delivery of programs however only five indicated Elders were active participants. In this scoping review, we suggest integrating a high level of community engagement and augmenting intergenerational approaches are essential to promoting health among Indigenous populations and communities. Indigenous older adults are keepers of essential knowledge and must be engaged (as advisors and participants) in intergenerational health promotion interventions to support the health of all generations.