The thunderstorm encroaches, the smoky raven like clouds float over my spirit. This writing takes place at a time of mourning, a deep and lonesome sadness for family relations who have passed over the last few years, many having died of kidney disease. Yet, I cannot escape this feeling that has filled the silent spaces and the deeper meanings that lie behind spoken words. These are the words of my relations, the words that fill these empty pages, the words of an enduring past and present. As I begin, I wonder, how will I shape these passages into an articulation that may bring an illumination of all that has happened over the last few months since the inception and then ethics approval of this work. So here I shall offer an understanding of the background that brought this study forward. I will recount the progression of thought that precipitated the methodology. Like water that flows and is fluid, this writing has become realized to be ever changing, boundless and repelling conventionality. It is not just a story about living with kidney disease, this is a passage that motions and travels through history making interconnections amidst the broader social, political and contextually traditional and creative ways of being. Through the methodology of the sweetgrass porcupine quill box, living stories came forth within the context of a First Nations community. Sharing circles involving ten participants conveyed the living stories of kidney disease that illumined the significance of Indigenous Knowledge, relationality, cultural safety and equitable access. / Graduate / 2020-04-19

This study explored how public health nurses (PHNs) work to address health inequities. Cultural safety was used as a theoretical lens. Methods for interpretive description were relied on for data collection and analysis. Data sources included interviews with 14 staff from an urban public health unit and document review of three policies. Two themes emerged: building relationships and working within a frame. Building relationships involved: delivering the message, taking the time, being present, the right nurse and learning from communities. The public health frame influenced the capacity of PHNs to address health inequities through: culture and stereotypes, public health standards, setting priorities, inclusion of priority populations, responding to change and (re)action through reorganization. Discursive formations of priority populations, and partnership and collaboration, were revealed. Findings highlighted downstream public health approaches to addressing health inequities. Importantly, embedding cultural safety as a framework for public health practice can guide upstream action.

Cultural Safety is an educational framework and pedagogy developed by Maori nursing scholar, Dr. Irihapeti Ramsden (2002). Through this research, I explored the application of Cultural Safety to the Greater Victoria School District’s Aboriginal Education Enhancement Agreement. My research question is: What are the key elements that would be included in the development of a Cultural Safety Agreement for the Greater Victoria School District? This research is grounded in decolonizing, Indigenous and action research methods. Theoretically, it employs critical and decolonizing perspectives to critique the appropriateness of public education curriculum and teaching practices for Indigenous students. This study utilized a qualitative research method called Action Research and used an existing community council, the Aboriginal Education Council of Greater Victoria (AEC) as a focus group. Data was collected from the focus groups and enhanced through an individual interview with the coordinator of Aboriginal Education in the Greater Victoria School District (GVSD). An outcome of this research is a draft framework for cultural safety in the school district. The framework has now become the property of the Aboriginal Education Council of the Greater Victoria School District. / Graduate

This study explored how public health nurses (PHNs) work to address health inequities. Cultural safety was used as a theoretical lens. Methods for interpretive description were relied on for data collection and analysis. Data sources included interviews with 14 staff from an urban public health unit and document review of three policies. Two themes emerged: building relationships and working within a frame. Building relationships involved: delivering the message, taking the time, being present, the right nurse and learning from communities. The public health frame influenced the capacity of PHNs to address health inequities through: culture and stereotypes, public health standards, setting priorities, inclusion of priority populations, responding to change and (re)action through reorganization. Discursive formations of priority populations, and partnership and collaboration, were revealed. Findings highlighted downstream public health approaches to addressing health inequities. Importantly, embedding cultural safety as a framework for public health practice can guide upstream action.

Asian immigrants are the fastest growing immigrant population in the United States. The literature documents that Asian immigrant parents of children with developmental disabilities (DD) face additional barriers when they access and utilize services in the United States, compared to U.S.-born parents. However, we have a limited understanding of how they respond to these barriers and what they want to achieve while supporting their child with DD, especially when their children transition from high school to adulthood. While there are some studies about Asian immigrant parents of children with DD, these studies singularly attribute barriers to cultural differences between Asian immigrant parents’ cultural backgrounds and the mainstream American culture. Furthermore, previous research has only documented parents’ experiences at one time point, thus limiting the understanding of the potential influence of acculturation when Asian immigrant parents support their child with DD in the United States over time. To achieve the goal of this dissertation, which is to understand how and why Asian immigrant parents are involved in the lives of their child in relation to their acculturation process, I conducted two qualitative studies grounded in role theory and acculturation theory. In study 1, I built on previous qualitative studies related to Asian immigrant parents’ experiences while accessing and utilizing services for their child with DD by conducting a meta-synthesis. I identified 11 qualitative studies for analysis, and examined these studies using a constant comparative approach and thematic analysis. Based on the analysis, I proposed a theoretical framework to describe parents’ role enactment as an evolving process influenced by acculturation that spirals them towards their ultimate parental goal of helping their child with DD thrive and live happily. The framework also describes how system factors are intertwined with parents’ individual factors to facilitate or impede their role enactment. In study 2, to address the lack of understanding of how Asian immigrant parents’ experiences while supporting their child with DD transition to adulthood, I conducted a narrative study with five Chinese-speaking immigrant parents whose children with DD were between 20 and 34 years old. Parents participated in a sequence of three, in-depth narrative interviews to share stories about how they perceived and enacted their parental role while supporting their child’s transition to adulthood. I used the listening guide to systematically analyze the data. Participants’ described their perceived parental role as helping their young adult child with DD live a happy and meaningful life. This role included two role facets: helping their child develop independent living skills and planning for their child’s adult life. Parents’ narratives revealed that their role enactment was not only influenced by their lifeworlds, but that parents could also actively shape their lifeworlds. Parents’ perceptions about their capacities to shape their lifewolds varied. Some parents were more empowered to change their lifeworlds, while other parents tended to adjust to their lifeworld. Parents’ cumulative interactions with American society gradually shaped how they framed their experiences of role enactment and the way they enacted their parental role. Parents felt it was “just harder” for them to enact their parental role as immigrants. Despite this, parents’ perceived the societal attitudes towards disability in American society positively influenced their role enactment and made them feel that the United States could be home for their family. Together, these two studies highlighted that parents’ role enactment is a dynamic temporal process, which is influenced by their cumulative interactions with components in their lifeworlds. Although Asian immigrant parents experience unique challenges related to their status as immigrants while enacting their parental role, they demonstrated resilience in the face of these challenges. The findings of this dissertation can inform researchers’ and practitioners’ understandings of how to develop parent interventions for Asian immigrant parents to help their child thrive and live happily and how to create a culturally safe environment to facilitate realization of their desired role.

ABSTRACT Background. A wealth of data highlights the health disparities and barriers to health care experienced by Aboriginal women and children when compared to non-Aboriginal women and children. The first thousand days time period, from conception to the age of two, is an opportunity for health professionals to positively impact the health of Aboriginal children with effects lasting into adulthood. Cultural safety has been reported to improve access to health care for Aboriginal Canadians, but little is known about the significance of cultural safety from the perspective of Aboriginal women during the first thousand days. Methodology. An interpretive descriptive design and a postcolonial perspective guided this study. In-depth interviews were conducted with six Aboriginal women at a community health centre located in the inner-city of Regina, Saskatchewan, between June and July of 2015. Data was analyzed using principles of interpretive description to determine themes. Findings. Culturally safe and unsafe care was experienced during the first thousand days. Three themes common to participants included: the importance of being able to trust that they are safe when accessing health care, the overwhelming impact of poverty on their ability to achieve or maintain good health, and finally, the experience of worry related to the first thousand days including the worry about being worthy of respectful, culturally safe treatment by all employed in health environments. Discussion. The perception of culturally safe care was significant in affecting access to health care for this group of participants. Findings of this study suggest that more attention needs to be paid to the development of trust in health care encounters, and future research could explore the concept of trust for Aboriginal peoples. Emphasis on awareness of the social determinants of health, including colonialism and racism, should be included in educational programming for health professionals locally.

Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative study methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention, and potentially resources, to pressing health issues in Aboriginal communities. The thesis begins by introducing a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Drawing on a sexual health research initiative with Inuit in Ottawa as a case study, the thesis examines cognitive mapping as a promising culturally safe method to reviewing indigenous knowledge. Juxtaposing this approach with a systematic review of the literature, the standard protocol to reviewing Western scientific knowledge, the thesis demonstrates the potential for cognitive mapping to identify culturally safe spaces in epidemiological research where neither scientific validity nor cultural integrity is compromised. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative study methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention, and potentially resources, to pressing health issues in Aboriginal communities. The thesis begins by introducing a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Drawing on a sexual health research initiative with Inuit in Ottawa as a case study, the thesis examines cognitive mapping as a promising culturally safe method to reviewing indigenous knowledge. Juxtaposing this approach with a systematic review of the literature, the standard protocol to reviewing Western scientific knowledge, the thesis demonstrates the potential for cognitive mapping to identify culturally safe spaces in epidemiological research where neither scientific validity nor cultural integrity is compromised. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative study methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention, and potentially resources, to pressing health issues in Aboriginal communities. The thesis begins by introducing a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Drawing on a sexual health research initiative with Inuit in Ottawa as a case study, the thesis examines cognitive mapping as a promising culturally safe method to reviewing indigenous knowledge. Juxtaposing this approach with a systematic review of the literature, the standard protocol to reviewing Western scientific knowledge, the thesis demonstrates the potential for cognitive mapping to identify culturally safe spaces in epidemiological research where neither scientific validity nor cultural integrity is compromised. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

The Canadian Red Cross (CRC) offers its Swimming and Water Safety Program throughout Canada. The program is delivered by over 35 000 active instructors to over one million participants every year. The research in this thesis is part of a collaborative, interdisciplinary project in partnership with the CRC that examined ways to improve programming for cultural and ethnic minority populations. The thesis is written in the stand alone paper format. The first paper evaluates the program’s content, through a critical whiteness lens, to identify obstacles to offering effective programming to people of diverse cultural and ethnic backgrounds. Based on these findings, I created and piloted a cultural safety training module for program instructors. The second paper then evaluates the effectiveness of this training module to provide recommendations for the CRC to optimize its management of diversity within its organization and aquatics facilities across the country. Collectively, this thesis bridges both understandings of Eurocanadian and whiteness discourses as well as critical whiteness and organizational theories to more holistically understand processes of inclusion, exclusion, accommodation, and the management of diversity in the context of a nation-wide Canadian sport and recreation program.