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Planning for Your CANOE (Circumspect Awareness and Navigation of Outcomes and Expectations) Journey in Community-Engaged Research With Indigenous Communities
Community engagement has long been recognised as necessary for working with Indigenous communities. Although many researchers are excited to engage with communities and many articles describe the process of community engagement in research, almost none have addressed the foundational question of whether researchers should engage with Indigenous communities for research. In this Viewpoint, we will discuss the Circumspect Awareness and Navigation of Outcomes and Expectations (CANOE) approach, which describes what should be considered before embarking on a community-engaged research journey with Indigenous communities. We build on existing literature regarding understanding the need to recognise positionality, practise reflexivity, assess personal strengths and weaknesses, and consider abilities and skills that can be offered or promised to Indigenous partners. Our goal is to provide principles of being reflexive, intentional, and careful before launching into research with Indigenous communities. Drawing from our combined decades of experience as Indigenous, community-engaged scientists leading national and international community projects, we draw from the extant literature and lessons learned in the field to provide a guiding CANOE approach for community-engaged research. This Viewpoint provides researchers interested in community-engaged projects with the information they need to consider before embarking on their research journey. We provide a set of CANOE self-assessment questions designed to evaluate a researcher’s preparedness, suitability to invest in a research partnership, and adaptability to navigate a research journey with Indigenous communities. Not only should relationships be properly developed and nurtured, but researchers need to fundamentally understand their ability to develop research partnerships that prioritise Indigenous cultural worldviews and protocols in research design, development, testing, and implementation.
Read more“We don’t separate out these things. Everything is related”: Partnerships with Indigenous Communities to Design, Implement, and Evaluate Multilevel Interventions to Reduce Health Disparities
Figure 1. An overview of the partnerships in MLIs by building on the Indigenous Holistic Health and Wellness Multilevel Framework Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities’ diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: Collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; Inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and Relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.
Read morePublic Nature and Health for Homeless Populations: Professionals’ Perceptions of Contingent Human Benefits and Harms
Table 1. Characteristics of the overall homeless and unsheltered homeless population in Washington (statewide), and King and Snohomish counties (US Census, 2020; US HUD, 2022a; 2022b). Highlights Professionals observe benefits and harms of natural area use for homeless populations. Perceived harms include increased environmental exposures and social vulnerability. Perceived benefits include privacy, desired social conditions, and reduced stress. Relationships between nature and health were seen as variable and context dependent. This article investigates relationships between public nature and health for unsheltered homeless populations. It examines perceptions of health benefits and harms for people living in public natural areas including local, state, and national forests and parks in the Seattle metropolitan area (USA). Interviews with environmental, social service, and law enforcement professionals who regularly interact with this vulnerable population were conducted and thematically analyzed to understand perceptions of physical and mental health outcomes. Results show professionals’ perspectives on the health benefits and detriments of time spent in natural environments and the contextual factors perceived to influence health. Interviewees’ observations about the variability of personal circumstances and biophysical, social, and weather conditions encourage the nuanced consideration of how contingent therapeutic landscapes provide deeply needed benefits, but for a population with a diminished capacity to adapt when conditions change. We conclude with insights for future research that directly assesses homeless populations’ exposures and health outcomes of living in public natural areas.
Read moreAll Systems are Interrelated: Multilevel Interventions with Indigenous Communities
Figure 1. Indigenous Holistic Health and Wellness Multilevel Framework. Colonial historical trauma and ongoing structural racism have impacted Indigenous peoples for generations and explain the ongoing health disparities. However, Indigenous peoples have been engaging in multilevel, clinical trial interventions with Indigenous and allied research scientists resulting in promising success. In this paper, National Institutes of Health funded scientists in the field of Indigenous health have sought to describe the utility and need for multilevel interventions across Indigenous communities (Jernigan et al., 2020). We posit limitations to the existing socioecological, multilevel frameworks and propose a dynamic, interrelated heuristic framework, which focuses on the inter-relationships of the collective within the environment and de-centers the individual. We conclude with identified calls for action within multilevel clinical trial research.
Read moreLand as a Process of Reconciliation: Transforming Health Narratives Among Land-Based Healing Camp Facilitators
Colonialism has resulted in isolation, lack of services, and health disparities experienced by Indigenous peoples (IPs)1 which increased risk for COVID-19. Despite this, IPs have found ways to thrive. For example, they have implemented land-based healing (LBH) interventions2, 3, 4. Increasing cultural continuity through reconnecting to the land has broad implications for the health and wellbeing of IPs. As such, CIEDAR (CoVaRR-Net’s Indigenous Engagement, Development, and Research Pillar 7) partnered with Taché Waters Healing Society (TWHS) to achieve the following objectives. To co-develop a LBH camp grounded in culture to facilitate healing from the ongoing impacts of settler-colonialism, exacerbated by the pandemic. To evaluate the LBH camp pilot by asking the following question: How does being guided upon the land influence facilitators perspectives of health and wellbeing?
Read moreUnsheltered Homelessness in Public Natural Areas Across an Urban-to-Wildland System: Institutional Perspectives
Figure 1. Conceptual relationships and interactions among social and ecological subsystems related to unsheltered homelessness in public natural areas. This article conceptualizes homelessness on public lands within a social-ecological systems framework, exploring dynamics in public natural areas in the Seattle metropolitan area (USA), a system with a compact urban-to-wildland gradient. While prior research has studied the dynamics of unsheltered homelessness within particular parks or cities—often in areas where camping is prohibited—our interview-based study makes integrated considerations of these dynamics across a range of jurisdictions. We present a thematic analysis that examines professionally diverse perspectives on the dynamics, stressors, and outcomes of public natural area usage by unsheltered individuals. We found a generally uncoordinated system in continual motion, in which considerable resources were expended for short-term, site-specific solutions that yielded system-wide detrimental outcomes perceived for unsheltered individuals, social service and environmental institutions, and ecosystem health. We discuss how improved institutional coordination and mutual understanding about intersecting governance systems could sustain better public land, public health, and social outcomes.
Read moreAdvancing Sustainable Development and Protected Area Management with Social Media-Based Tourism Data
Figure 1. The Bahamian archipelago, including the network of marine protected areas (orange boundaries), geotagged Flickr photos (purple points), and Andros, the largest island in The Bahamas. Politically considered a single island, Andros is in fact comprised of three major landmasses, North Andros (which contains the districts of North Andros and Central Andros), Mangrove Cay, and South Andros. Sustainable tourism involves increasingly attracting visitors while preserving the natural capital of a destination for future generations. To foster tourism while protecting sensitive environments, coastal managers, tourism operators, and other decision-makers benefit from information about where tourists go and which aspects of the natural and built environment draw them to particular locations. Yet this information is often lacking at management-relevant scales and in remote places. We tested and applied methods using social media as data on tourism in The Bahamas. We found that visitation, as measured by numbers of geolocated photographs, is well correlated with counts of visitors from entrance surveys for islands and parks. Using this relationship, we predicted nearly 4 K visitor-days to the network of Bahamian marine protected areas annually, with visitation varying more than 20-fold between the most and least visited parks. Next, to understand spatial patterns of tourism for sustainable development, we combined social media-based data with entrance surveys for Andros, the largest island in The Bahamas. We estimated that tourists spend 125 K visitor-nights and more than US$45 M in the most highly visited district, five times that of the least visited district. We also found that tourists prefer accessible, natural landscapes—such as reefs near lodges—that can be reached by air, roads, and ferries. The results of our study are being used to inform development and conservation decisions, such as where to invest in infrastructure for visitor access and accommodation, siting new marine protected areas, and management of established protected areas. Our work provides an important example of how to leverage social media as a source of data to inform strategies that encourage tourism, while conserving the environments that draw visitors to a destination in the first place.
Read moreAssociations of Residential Brownness and Greenness with Fasting Glucose in Young Healthy Adults Living in the Desert
Figure 1. Aerial image showing examples of brownness, greenness, and grayness in a residential area of El Paso, Texas, in June, 2019. Image source: GoogleEarth®, © 2020 Google; © 2020 INEGI. Evolutionary psychology theories propose that contact with green, natural environments may benefit physical health, but little comparable evidence exists for brown, natural environments, such as the desert. In this study, we examined the association between “brownness” and “greenness” with fasting glucose among young residents of El Paso, Texas. We defined brownness as the surface not covered by vegetation or impervious land within Euclidian buffers around participants’ homes. Fasting glucose along with demographic and behavioral data were obtained from the Nurse Engagement and Wellness Study (n = 517). We found that residential proximity to brownness was not associated with fasting glucose when modeled independently. In contrast, we found that residential greenness was associated with decreased levels of fasting glucose, despite the relatively low levels of greenness within the predominantly desert environment of El Paso. A difference between the top and bottom greenness exposure quartiles within a 250 m buffer was associated with a 3.5 mg/dL decrease in fasting glucose levels (95% confidence interval: −6.2, −0.8). Our results suggest that within the understudied context of the desert, green vegetation may be health promoting to a degree that is similar to other, non-desert locations in the world that have higher baselines levels of green.
Read moreCasting a Wide Net and Making the Most of the Catch
Usha Varanasi describes lessons learned and the people and principles that influenced six decades of professional endeavours from graduate schools to ascending, often unexpectedly, the science and management ladder in National Oceanic and Atmospheric Administration (NOAA) Fisheries, which manages US living marine resources. For this woman chemist from India, the twists of fate and love of adventure presented amazing opportunities as well as challenges. Her research on cetacean biosonar as well as on the impact of fossil fuel pollution on seafood safety and the health of marine organisms taught her the value of multidisciplinary approaches and unusual alliances. Transitioning into management, and eventually as the director of Northwest Fisheries Science Center, Usha learned the value of transparency and empathy while communicating our results to impacted communities, and the resolve to support the science regardless of the consequences. Her advice to young professionals is that the journey should be as fulfilling as reaching the goalpost.
Read moreTaking the Long View for Oceans and Human Health Connection through Community-Driven Science
Figure 1. Olympic Region Harmful Algal Bloom (ORHAB) partners and sampling sites. The most proactive approach to resolving current health and climate crises will require a long view, focused on establishing and fostering partnerships to identify and eliminate root causes of the disconnect between humans and nature. We describe the lessons learned through a unique scientific partnership that addresses a specific crisis, harmful algal blooms (HABs), along the northeast Pacific Ocean coast, that blends current-day technology with observational knowledge of Indigenous communities. This integrative scientific strategy resulted in creative solutions for forecasting and managing HAB risk in the Pacific Northwest as a part of the US Ocean and Human Health (OHH) program. Specific OHH projects focused on: Understanding genetic responses of Tribal members to toxins in the marine environment Knowledge sharing by elders during youth camps Establishing an early warning program to alert resource managers of HABs are explicit examples of proactive strategies used to address environmental problems. The research and monitoring projects with Tribal communities taught the collaborating non-Indigenous scientists the value of reciprocity, highlighting both the benefits from and protection of oceans that promote our well-being. Effective global oceans and human health initiatives require a collective action that gives equal respect to all voices to promote forward thinking solutions for ocean health.
Read more“Being on the Walk put it Somewhere in my Body”: The Meaning of Place in Health for Indigenous Women
Relationship to place is integral to Indigenous health. A qualitative, secondary phenomenological analysis of in-depth interviews with four non-Choctaw Indigenous women participating in an outdoor, experiential tribally-specific Choctaw health leadership study uncovered culturally grounded narratives using thematic analysis as an analytic approach. Results revealed that physically being in historical trauma sites of other Indigenous groups involved a multi-faceted process that facilitated embodied stress by connecting participants with their own historical and contemporary traumas. Participants also experienced embodied resilience through connectedness to place and collective resistance. Implications point to the role of place in developing collective resistance and resilience through culturally and methodologically innovative approaches.
Read moreOde’imin Giizis: Proposing and Piloting Gardening as an Indigenous Childhood Health Intervention
Figure 1. Gardening by the moons as digitally interpreted by RICH Postdoctoral Fellow, Dr. LaPensee, who worked with local tribal members. The Research for Indigenous Community Health Center and the American Indian Housing Organization sought to reduce obesity among Indigenous children and families in a Northern Midwestern urban community who are at risk for homelessness by piloting a gardening health intervention. This community-based participatory research, mixed-methods study examined the feasibility of gardening as an obesity intervention among a school-aged Indigenous population at risk for homelessness through using focus groups, key informant interviews, and valid health measures. The program was found highly feasible and fulfilled a critical need among Indigenous youth and their families, who reportedly suffered from food insecurity and access. This intervention increased healthy food awareness and perceptions, cultural resources, and ancestral food knowledge skills through activities, mentorship, and multigenerational engagement. This study augments the literature on the feasibility of using tribal ecological knowledge and the environment in designing culturally appropriate health interventions.
Read moreResults From an 18 Country Cross-Sectional Study Examining Experiences of Nature for People with Common Mental Health Disorders
Figure 1. Estimated anxiety (unstandardized coefficients, 95% Confidence Intervals) during last nature visit as a function of perceived social pressure for each CMD group. Estimates are based on models controlling for: sex, age, perceived financial strain, employment status, marital status, number of children in household, having a long-term limiting illness, smoking status, alcohol use seasonal wave and country; and visit-related factors, number of companions, presence of dog, transport mode, travel time, visit duration, and anxiety ‘yesterday’. Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but ‘green prescription’ programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.
Read moreReturning to our Roots: Tribal Health and Wellness Through Land-Based Healing
Background Settler colonialism has severely disrupted Indigenous ancestral ways of healing and being, contributing to an onslaught of health disparities. In particular, the United Houma Nation (UHN) has faced large land loss and trauma, dispossession, and marginalization. Given the paucity of research addressing health for Indigenous individuals living in Louisiana, this study sought to co-identify a United Houma Nation health framework, by co-developing a community land-based healing approach in order to inform future community-based health prevention programs. Methods This pilot tested, co-designed and implemented a land-based healing pilot study among Houma women utilizing a health promotion leadership approach and utilized semi-structured interviews among 20 UHN women to identify a UHN health framework to guide future results. Results The findings indicated that RTOR was a feasible pilot project. The initial themes were Place Environmental/land trauma Ancestors Spirituality/mindfulness Cultural continuity Environment and health The reconnection to land was deemed feasible and seen as central to renewing relationships with ancestors (aihalia asanochi taha), others, and body. This mindful, re-engagement with the land contributed to subthemes of developing stronger tribal identities, recreating ceremonies, and increased cultural continuity, and transforming narratives of trauma into hope and resilience. Based on these findings a Houma Health (Uma Hochokma) Framework was developed and presented. Conclusions Overall, this study found that land can serve as a feasible therapeutic site for healing through reconnecting Houma tribal citizens to both ancestral knowledges and stories of resilience, as well as viewing self as part of a larger collective. These findings also imply that revisiting historically traumatic places encouraged renewed commitment to cultural continuity and health behaviors—particularly when these places are approached relationally, with ceremony, and traumatic events tied to these places, including climate change and environmental/land trauma, are acknowledged along with the love the ancestors held for future generations.
Read moreTrends and Knowledge Gaps in the Study of Nature-Based Participation by Latinos in the United States
Figure 1. Cumulative studies (n = 108) by publication year that relate to participation in nature-based activities by Latino communities. Studies include those that focused solely on Latino populations as well as cross-ethnic comparisons that included Latinos. Mounting evidence supports health and well-being benefits associated with nature experiences, while also highlighting race- and class-based inequalities in access and exposure. We synthesized the literature on nature contact by Latinos in the United States to assess the state of knowledge and strategically identify research needs to improve outcomes and reduce health disparities for this rapidly growing ethnic group. Our systematic review revealed 108 articles with a notable increase in number of papers over the past 3 decades. We noted that the body of research is focused on certain demographic targets (adults in urban areas) with a relative dearth of knowledge for others (children, seniors, and rural areas). Our analysis also revealed strong compartmentalizing of studies into research “clusters” based on nonoverlapping topics and types of outcomes that are measured. Although one-third of studies explored health outcomes, these studies rarely examined other outcomes or research topics. Moreover, less than 7% of studies reported on interventions. Given the potential for nature contact to enhance health and well-being, there is substantial need for multidisciplinary research that explores interactions between social, cultural, and economic factors, and how those ultimately relate to nature contact and outcomes for Latinos in the United States.
Read more“I’m Stronger than I Thought”: Native Women Reconnecting to Body, Health, and Place
This community-based research applied principles of wilderness experience programming and Indigenous knowledges in an exploratory intervention designed to address health disparities in a tribal community. Drawing on historical trauma frameworks, tribal members rewalked the Trail of Tears to consider its effect on contemporary tribal health. Qualitative data from tribal members suggest that engagement with place and experiential learning, particularly the physical and emotional challenge of the Trail, facilitated changes in health beliefs, attitudes, and behaviors. Deep engagement outside of traditional health service settings should be considered in interventions and may be particularly effective in promoting positive health behaviors in Native communities.
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