Dramatic growth in Canada’s urban Aboriginal population has led to high rates of Aboriginal mobility. Despite much quantitative data, very little is known about the mobility experiences of Aboriginal peoples or its impacts. Furthermore, while mobility may present barriers for shaping social connections important to individual health, research in this area is minimal, especially among Aboriginal youth. Using community-­‐based participatory research (CBPR) the purpose of this thesis is to examine how mobility shapes the social networks and health of Aboriginal youth in the city of Winnipeg, Manitoba. While highlighting the use and valuableness of CBPR methods, the research demonstrates that mobility impacts both the development and maintenance of social relationships among Aboriginal youth as well as influences the types and qualities of these relationships. Additionally, mobility indirectly shapes health through its effect on social support, which was shown to impact health positively and negatively through direct and indirect pathways.

Dramatic growth in Canada’s urban Aboriginal population has led to high rates of Aboriginal mobility. Despite much quantitative data, very little is known about the mobility experiences of Aboriginal peoples or its impacts. Furthermore, while mobility may present barriers for shaping social connections important to individual health, research in this area is minimal, especially among Aboriginal youth. Using community-­‐based participatory research (CBPR) the purpose of this thesis is to examine how mobility shapes the social networks and health of Aboriginal youth in the city of Winnipeg, Manitoba. While highlighting the use and valuableness of CBPR methods, the research demonstrates that mobility impacts both the development and maintenance of social relationships among Aboriginal youth as well as influences the types and qualities of these relationships. Additionally, mobility indirectly shapes health through its effect on social support, which was shown to impact health positively and negatively through direct and indirect pathways.

Background: Cancer incidence is increasing among Aboriginal peoples in Canada. The semi-isolated conditions of Northern Saskatchewan provide challenges for both health care workers and patients receiving cancer care. Since limited information exists on the way cancer is perceived and experienced, the purpose of this study was to explore the views of cancer, health and illness among the Woodland Cree in Northern Saskatchewan. </p><p>Methodology: Woodland Cree participants from the Lac La Ronge Band included 6 Elders, 8 cancer survivors, and 12 family members from five northern communities. Being a member of the band and fluent in the traditional language, the principal investigator used a narrative inquiry approach. Perceptions of cancer, health and illness were elicited through 18 personal interviews and two group interviews. Composite story creation and thematic analysis were the two methods used to analyze the data. </p> <p>Findings: Four broad themes were generated from the data. The concepts of health and illness among the Woodland Cree show that there is a complex intertwining of Western and traditional belief systems. Knowledge systems of the Woodland Cree represent the ways of knowing and being, including the seminal role Elders have within the communities as teachers and knowledge keepers. Cancer as experienced by the Woodland Cree reflects the physical, emotional, intellectual and spiritual aspects of having cancer or having a family member with cancer, including the challenges of receiving timely diagnoses and cancer care in isolated northern communities. Straddling both worlds was a theme that meandered throughout the data. The Woodland Cree have the capacity to pick the best from both the Western and traditional worlds, by accessing their inherent survival mechanisms. </p> <p>Discussion: Reluctance to talk about cancer seemed to be a deterrent from participating in the study. Family members need specific support mechanisms apart from the cancer patient and this may not be readily available. Challenges and opportunities for more culturally sensitive ways of providing cancer prevention and care are discussed. Further research is needed to investigate if the findings are reflected among other First Nations.

Tuberculosis is a major public health problem in Aboriginal populations. Studies are lacking to evaluate incidence of tuberculosis across residence status. The incidence of tuberculosis in Saskatchewans Aboriginal population was investigated to determine whether differences existed between off- and on-reserve groups. A retrospective cohort study was performed, using data from the Saskatchewan Tuberculosis Control Program database of on and off reserve residents diagnosed with pulmonary tuberculosis between January 1, 1986, and December 31, 2005. Age, sex and residence-specific incidence rates were calculated with the use of Census populations for 1986, 1991, 1996 and 2001. Multivariate analysis using poisson regression was completed.<p>There were 1750 cases during the study period; 710 occurred off reserve and 1040 on reserve. 1337 cases were diagnosed in Registered Aboriginals, with the remaining 413 in the non-registered population. The mean age of Aboriginal cases on reserve was 12.92 and 19.98 for off reserve cases. Females were more likely to have tuberculosis on reserve, while males were more likely off reserve. Overall, TB rates both on and off reserve decreased over the study period. The on reserve population maintains greater rates of tuberculosis compared to their off reserve counterparts, after adjustment for age.<p>Although there is a natural history to infectious disease epidemics such as tuberculosis, it should be a higher priority of government policies and services to further decrease rates. The collection of more accurate population statistics would allow for more in-depth surveillance of TB in Saskatchewan and would contribute to knowledge about how and where to best allocate future resources.

Background: Cancer incidence is increasing among Aboriginal peoples in Canada. The semi-isolated conditions of Northern Saskatchewan provide challenges for both health care workers and patients receiving cancer care. Since limited information exists on the way cancer is perceived and experienced, the purpose of this study was to explore the views of cancer, health and illness among the Woodland Cree in Northern Saskatchewan. </p><p>Methodology: Woodland Cree participants from the Lac La Ronge Band included 6 Elders, 8 cancer survivors, and 12 family members from five northern communities. Being a member of the band and fluent in the traditional language, the principal investigator used a narrative inquiry approach. Perceptions of cancer, health and illness were elicited through 18 personal interviews and two group interviews. Composite story creation and thematic analysis were the two methods used to analyze the data. </p> <p>Findings: Four broad themes were generated from the data. The concepts of health and illness among the Woodland Cree show that there is a complex intertwining of Western and traditional belief systems. Knowledge systems of the Woodland Cree represent the ways of knowing and being, including the seminal role Elders have within the communities as teachers and knowledge keepers. Cancer as experienced by the Woodland Cree reflects the physical, emotional, intellectual and spiritual aspects of having cancer or having a family member with cancer, including the challenges of receiving timely diagnoses and cancer care in isolated northern communities. Straddling both worlds was a theme that meandered throughout the data. The Woodland Cree have the capacity to pick the best from both the Western and traditional worlds, by accessing their inherent survival mechanisms. </p> <p>Discussion: Reluctance to talk about cancer seemed to be a deterrent from participating in the study. Family members need specific support mechanisms apart from the cancer patient and this may not be readily available. Challenges and opportunities for more culturally sensitive ways of providing cancer prevention and care are discussed. Further research is needed to investigate if the findings are reflected among other First Nations.

Tuberculosis is a major public health problem in Aboriginal populations. Studies are lacking to evaluate incidence of tuberculosis across residence status. The incidence of tuberculosis in Saskatchewans Aboriginal population was investigated to determine whether differences existed between off- and on-reserve groups. A retrospective cohort study was performed, using data from the Saskatchewan Tuberculosis Control Program database of on and off reserve residents diagnosed with pulmonary tuberculosis between January 1, 1986, and December 31, 2005. Age, sex and residence-specific incidence rates were calculated with the use of Census populations for 1986, 1991, 1996 and 2001. Multivariate analysis using poisson regression was completed.<p>There were 1750 cases during the study period; 710 occurred off reserve and 1040 on reserve. 1337 cases were diagnosed in Registered Aboriginals, with the remaining 413 in the non-registered population. The mean age of Aboriginal cases on reserve was 12.92 and 19.98 for off reserve cases. Females were more likely to have tuberculosis on reserve, while males were more likely off reserve. Overall, TB rates both on and off reserve decreased over the study period. The on reserve population maintains greater rates of tuberculosis compared to their off reserve counterparts, after adjustment for age.<p>Although there is a natural history to infectious disease epidemics such as tuberculosis, it should be a higher priority of government policies and services to further decrease rates. The collection of more accurate population statistics would allow for more in-depth surveillance of TB in Saskatchewan and would contribute to knowledge about how and where to best allocate future resources.

Compared to other Canadians, Aboriginal people suffer disproportionately from Type 2 diabetes and its complications. In an attempt to fill gaps in services for Aboriginal people to support better management of diabetes and to prevent further complications, the West Side Community Clinic launched a monthly outreach diabetes education program using an informal hands-on approach to learning about meal planning and other forms of diabetes management. The purpose of this qualitative study was to determine the impact that the program has had on the participants' health and well-being through the stories they shared in a group or individual interview. Out of the core group of 30 women, most of them Aboriginal, eleven participated in the group interview and five women participated in individual interviews.<p>Findings reveal that the program's impact on participants' health and well-being is embedded within the context of their lives. Diabetes is managed within multiple life realities in an individual, a familial and a community context. The women report learning management skills and sharing support among participants and staff of Diabetes Morning; and altered health status such as regulated blood glucose levels and weight loss. Opportunities for change include more programming like Diabetes Morning, more often, more information, access to low-cost diabetes-friendly foods, communication with health care practitioners, and integrating knowledge on a day-to-day basis. Domains for outcome indicators and contextual indicators are suggested for the program.

This inquiry answered the questions: What is the most culturally respectful method for a cross-cultural researcher to discover how northern Aboriginal people learn and make decisions about their health? What will be the common patterns of learning among northern Saskatchewan Aboriginal people who have altered their life path? And what strategies will any common patterns suggest for the development of health promotion and community development programs specific to the cultures and people of northern Saskatchewan? Six Aboriginal people, whom I call my teachers, were selected because they had turned their lives around to more closely approximate a Cree idea of health called mithwayawin or the Dene idea of health called hote Zgehenai. A literature search and consultations with my teachers suggested that a respectful form of cross-cultural inquiry was possible in northern Saskatchewan communities. Furthermore, there were common themes suggesting a foundation of wellness and resilience indicating that similar resiliency factors exist in northern cultures as exist in other cultures. As well, common patterns suggested a lateral thinking and learning style or creative problem solving that is different from vertical or linear thinking common to the scientific-industrial cultures. Moreover, other themes suggested that the teachers had a preference for accumulating experience over abstract analysis indicating the desirability of active participation by community members in defining health challenges, arriving at solutions and planning and implementing changes. Furthermore, other themes suggested that the teachers life long learning occurred in a holistic context indicating that health promotion strategies could provide rich social, physical, spiritual and mental contexts within which Northerners can learn. As well, other themes suggested that the teachers used an Aboriginal ecological learning process indicating that health promotion efforts could consider working to revitalize the cultural beliefs, values and practices and could provide a rich environment of spiritual, physical and social activities so that the people would have the opportunity to fully develop their brain, mind, body, memory continuum and thereby achieve balance. The findings further implied that increasing general health knowledge among Northerners and using a community health development process in northern communities are strategies that northern health promotion and community development workers could consider employing in their work. More detailed and specific strategies are suggested.

According to a 2003 Health Canada report, suicide was the leading cause of death among Aboriginal individuals under the age of 45, accounting for 23% of all deaths in this at-risk population. While previous research has explored many potential risk factors for suicide among Aboriginal populations, none have considered the Métis population independent of other Aboriginal groups. Additionally, there have been no studies explicitly examining the relationship between family context and suicidality among either of these populations; this is the primary relationship of interest in this project. Data used for this project was taken from the 2006 Aboriginal Peoples Survey (APS). The APS is a national cross-sectional survey of 61,041 First Nations, Inuit and Métis peoples. Within the APS, family context was constructed using several variables including parental divorce, childhood adoption, number of siblings, etc. Analyses for this project included a multi-stage process consisting of bivariate and multivariable analyses. Multivariable logistic regression analysis was separated by gender and examined those aged 25-54. Results showed that that for women, renting versus owning your home, the death of sibling under age 2, or being removed by a child welfare agency, the church, or government officials was significantly associated with suicidal ideation. For men, unemployment, living in the community of origin, death of a sibling under age 2, and participating in traditional craftwork all significantly associated with suicidal ideation. Not graduating from high school and unemployment were significantly associated with suicide attempts for men or women when controlling for all other demographic, family context, and culture variables within the final model. As has been the case in previous research surrounding culture, several of the results in the bivariate analysis of this project were counterintuitive (Wilson & Rosenberg, 2002). This shows that nuanced and contextual interpretations are critical, and a space is opened with this research to critically consider what exactly is being captured through the survey measures. I argue that the strength of the linkage between a measure and its conceptual basis becomes increasingly tenuous and problematic as the complexity of the circumstance the measure is attempting to capture increases.

The current state of Aboriginal health is of national concern. Aboriginal people as a population do not have the same level of health as other Canadians. There has been a long history of providing health care based on Eurocentric (Western) ideology that has not taken into account Aboriginal peoples perspective. There is limited research to provide insight toward understanding how Aboriginal people understand, define, and address their health concerns. <p> This study used the Kaupapa Maori Philosophy/Methodology to define health from a Plains Cree (Indigenous) perspective. A qualitative descriptive research study was done in Thunderchild First Nation. A combination of purposeful and convenience snowball sampling was utilized to select 14 participants to reach saturation. Semi-structured interviews were conducted with eleven open-ended questions to facilitate elaborations during the interviews. Thematic analysis was used to analyze the data, and then the data was categorized using the Medicine Wheel. <p>Four broad themes were derived from the data. Health was consistently described in relation to physical, emotional, intellectual (mental), and spiritual wellness. Collectively there does appear to be a holistic perception of health, similar to the teachings from the Medicine Wheel. Half of the participants described health from a holistic perspective and half described health using two of the four components of the Medicine Wheel: physical, emotional, intellectual (mental), and spiritual wellness. Pursuing and maintaining health included a combination of information and practices from both the Western and Traditional Indigenous world. Further collaboration and research is necessary to determine if the findings are similar among other Aboriginal Peoples in Saskatchewan.