Urban Indigenous Communities Transforming Health Care: “Where We Feel Safe and Where Our People Are Working”

Abstract

Indigenous knowledge and traditional wellness approaches combined with western health services are increasingly being identified as critical for Indigenous Peoples’ overall health and wellness in Canada. In this article, we share how an Urban Indigenous Collective Governance Circle led to transformational actions responding to community-voiced priorities, and co-development, delivery, evaluation, and sustainability of urban holistic traditional and western Indigenous diabetes and healthy weight programs. This resulted in increased access to, and ownership and leadership of, strengths-based, equitable, culturally safe, and distinctive diabetes and obesity wellness services in urban communities. The use of this holistic approach inclusive of traditional and western knowledge could be used to shape culturally safe, equitable, strength-based, site-specific intervention research, policies, and practice for other communities interested in diabetes, obesity, other chronic disease, and health care provision.

Introduction

Globally, many Indigenous Peoples view wellness as an ongoing balance between physical, spiritual, emotional, and mental aspects of health. Wellness includes relational connections and sense of belonging within family, community, language, and traditional lands and practices (Bonin et al., 2022; Lavoie et al., 2008). Wellness is negatively impacted by ongoing colonization, genocide, and systemic racism, with loss of family and community members, language, traditional ways of living, land, and cultural identity (Greenwood, 2021; Halseth, 2019). Wellness is further affected by lack of access to culturally safe health services (Kolahdooz et al., 2015). Access barriers, systemic racism, structural violence, and lack of culturally safe and relevant health services are significant obstacles to care (Evans, 2009; Hole et al., 2015; Kurtz et al., 2008; Place, 2012; Turpel-Lafond, 2020).

In this article, we share the journey in which urban Indigenous communities, Indigenous and non-Indigenous health researchers, and health providers formed an Urban Indigenous Wellness Collective Governance Circle research partnership. The aim of the study was to improve the health and wellness of urban Indigenous Peoples living in western Canada. Over a six-year period, the collective of six urban communities brought together traditional and western knowledge aimed to increase health equity and access to culturally safe services for holistic wellness. Gaps in health provision and priorities for culturally safe and distinctive locally informed research and program services were identified. Through Indigenous methodologies, Two-eyed seeing, a 4 Rs approach, and integrated sharing of knowledge, the collective collaboratively assessed, co-developed, co-implemented, and co-evaluated urban health and wellness community programs (“interventions”) for the prevention, treatment, and self-management of diabetes and being overweight. The purpose of this article is to provide an overview of relational and research to action processes leading to the development of a successful collective partnership resulting in culturally safe, easily accessible, equitable, strength-based, locally relevant Indigenous-led programs.

Indigenous Peoples, 5% of the total population in Canada (Statistics Canada, 2022), are disproportionately affected by type 2 diabetes, obesity, and have more complications from these chronic diseases than the general population (Adelson, 2005; Cheran et al., 2023). Western health systems have limited success in providing culturally safe health services for Indigenous Peoples and communities. Local community engagement, decision-making, culturally distinctive, and holistic traditional approaches, critical in Indigenous health, are minimal or absent (Redvers & Blondin, 2020). Urban Indigenous Peoples often refuse to access health systems to avoid being ignored, silenced, mistreated (Kurtz, 2011), and denied care from health care providers (Turpel-Lafond, 2020), resulting in health inequities and unnecessary complications that could have been prevented or managed.

Urban Indigenous Peoples are the most rapidly growing group of Indigenous Peoples in Canada, with 63% living away from government-designated reserves (Statistics Canada, 2022) in urban, rural, isolated, and remote communities that provide health and social services (MMIWG National Action Plan Core Working Group, 2021). By living off the reserve, Urban Indigenous Peoples have less access to health services, especially those that are culturally safe, holistic traditional health, and wellness services (Government of British Columbia, 2024). Friendship and Métis Centres in Canada were established to provide culturally safe and relevant programs and services for Urban Indigenous Peoples. In a previous Urban Indigenous community-led research project (2008–2011), Friendship Centre community members shared their negative experiences accessing western diabetes education and care and prioritized actions for change (Kurtz, 2011).

Bear, a middle aged urban Indigenous woman, said,

There is no proper time [to ask questions]. You gotta go over what she [nurse] has to say to you, then you got to understand within that time limit. Finally, it’s [appointment] up, she [nurse] says, I’ll see you in three months’ time. We walk away with questions. By the time our next appointment [comes] we forget the questions. That’s when I will come and see [the nurse at the Primary Health Centre at the urban Aboriginal Centre]. (Kurtz, 2011, p. 48)

Bear’s sister Spirit stated, “. . . it was very negative. I went in there [Diabetes Centre] to explain to her [the nurse] what was happening and then she would be able to help [my sister] better” (Kurtz, 2011, p. 47).

Friendship and Métis Centres offer Indigenous Peoples culturally safe health and social services for improved quality of life, self-determination, and equal access to and participation in society that respects and strengthens cultural distinctiveness (BC Association of Aboriginal Friendship Centres, 2020; Métis Community Services Society of BC, n.d.). However, diabetes and other chronic disease prevention and management health services are not adequately funded or not available at the centres. There continues to be a lack of health care providers and health services that acknowledge, or put into practice, the significance of cultural safety and its benefits in traditional and western approaches to wellness, despite what many Indigenous Peoples continue to request (Allen et al., 2020). In addition, within the local health authority, both Indigenous community members and health providers identified an urgent need for improved access to and understanding of traditional knowledge to include wholistic models of care (Interior Health, 2014). Based on these significant issues faced by Indigenous Peoples and their urgent need for culturally safe, holistic approaches to care, the Urban Indigenous Wellness Collective was established in 2008 (Kurtz et al., 2014).

Formation of the Urban Indigenous Wellness Collective

The Urban Indigenous Wellness Collective was formed by Friendship and Métis Centres, health researchers, and health care providers located in the Interior region of British Columbia, Canada. Growing from one Friendship Centre in 2008 to five Friendship Centres and one Métis Centre in 2018, the collective included Community Advisory Teams, youth, community members and families, Community Research Liaisons, centre staff, community partners and collaborators, university health researchers and trainees, Elder Advisors, health providers, Knowledge Keepers, and Traditional Healers. The collective, as co-researchers, brought together traditional and western knowledge to increase health equity and access to culturally safe services for spiritual, emotional, physical, and mental wellness. Cultural safety for all peoples is a critical part of respectful and ethical relationships across the collective to ensure everyone who joined the collective research project felt safe and their voice heard. These principles are reflected in the Urban Indigenous Wellness Collective Governance Circle, developed by the first Friendship Centre in 2008 to 2011, which was adapted by all centres (Kurtz, 2013; Kurtz et al., 2024) to guide ongoing urban Indigenous-led community research.

Developing the Collective Vision for Indigenous Health

Based on the first Friendship Centre project outcome priorities for change and a 1-year Government of Canada Tri-Council funded Canadian Institutes of Health Research (CIHR) grant, two additional centres joined the Urban Indigenous Wellness Collective. Through Elder-led Talking Circles, traditional and western health wellness surveys, and community and collective gatherings, health and wellness needs, priorities, and transformational change for wellness were recommended by Urban Indigenous community members from the three centres. In response, the collective co-developed a Collective Vision for Indigenous Health (2015–2016) and unanimously agreed to act on what were seen to be priorities. A further three Friendship and Métis Centres in the region recognized the importance of co-developed priorities within their communities and joined the collective of now six-centre communities to support the urgent need for action and change. The Collective Vision developed in the 2018 project identified six priority areas for urban Indigenous Peoples’ wellness—traditional healing, access to care, health education, cultural safety, community belonging and learning together, and food security and nutrition education. The Collective Vision acted as a guide for the transformation to new pathways of culturally safe, respectful, and reciprocal partnerships with health providers and organizations. Continuing in their partnership, the collective co-developed funding applications to put the Collective Vision into action. In 2018, the collective received a 4-year CIHR grant, which supported the expanded six-centre Indigenous Diabetes and Obesity project.

Indigenous Diabetes and Obesity Health Project

The 4-year CIHR-funded Indigenous Diabetes and Obesity Health Project was led by the six-centre Urban Indigenous Wellness Collective and was guided by the Urban Indigenous Governance Circle (Kurtz et al., 2024). The overall goal of the project was to act on the Collective Vision’s six priority areas through (1) collaboratively building teams and respectful, ethical partnerships where gaps in health provision were identified, and recommendations developed for culturally safe, relevant, and locally informed and local-led ways that included both traditional and western approaches for diabetes and healthy weight services; and (2) responding to recommendations for actions from communities by co-developing, co-implementing, and co-evaluating health and wellness community programs and services for the prevention, treatment, and self-management of diabetes and healthy weight for urban Indigenous Peoples and families in western Canada. This required acknowledging and respecting multiple perspectives, and ways of knowing and doing, especially in research partnerships.

Urban Indigenous Wellness Collective: Doing Research in a Meaningful Way

Doing research in a meaningful way is complicated, challenging, and at times requires treading lightly and finding balance and harmony within western and Indigenous worldviews (Kurtz, 2011). This approach supported mutual understanding, collective vision, and transformative action. The project was guided by culturally appropriate and relevant ethical guidelines including local traditional protocols, university–health authority, and federal Tri-Council Agencies funding consistent with ethical community and research requirements including Ethical Conduct for Research Involving Humans (Canadian Institutes of Health Research et al., 2022), research ethical processes, community research agreement protocols, Ownership, Control, Access, Protection (First Nations Information Governance Centre, 2026; Schnarch, 2004), and Métis Research Principles (Métis Centre of the National Aboriginal Health Organization, 2010). Centre Executive Directors informed local bands and traditional landowners about the research. University and health authority research ethical approvals were obtained. Several community members who joined the study provided informed consent and some agreed to be co-researchers. Each centre received research funding to support Elders, Community Research Liaisons, Community Advisory Teams, program teachers including Knowledge Keepers and Healers, and for program supplies, food, and administration expenses.

Doing research in a meaningful way requires using methodologies specific to decolonizing research, self-determination, and honoring the rights of Indigenous Peoples (Kurtz et al., 2024). Members within the Governance Circle guided ongoing community relationships and processes. This facilitated a collective approach with inclusion of diverse and unique perspectives, priorities, and processes of defining the research problem, articulating questions, and developing ideas for current and future projects. This is necessary to respect the distinctiveness of each centre and sharing new and collective knowledge across all centres. Throughout the work together, the collective followed Indigenous Methodologies, Two-Eyed Seeing, 4Rs approach, and integrated knowledge translation, all described in detail elsewhere (Kurtz et al., 2024).

Indigenous methodology is a living methodology of doing research in meaningful and relational ways that honor and respect Indigenous Peoples. Living this methodology proclaims, protects, and preserves traditional and sacred customs and protocols. There are no formulas or step-by-step frameworks (Kurtz, 2013). Rather, this methodology supports sharing and respecting Indigenous knowledges and ensures that all research processes and activities (Kurtz et al., 2024) are led by Indigenous Peoples. For example, community sharing at Talking Circles and Community Gatherings, and Community Advisory Teams co-developed surveys and provided a Two-Eyed Seeing approach for multiple Indigenous and western perspectives to be shared and honored, while helping to find opportunities to learn from each other, with the co-creation of mutually beneficial new knowledge (Bartlett et al., 2012; Kurtz et al., 2024). A 4Rs approach was also used to build, maintain, and guide relationships among the Urban Indigenous Wellness Collective (Kurtz et al., 2024). Shared understanding of respect, relevance, reciprocity, and responsibility (Kirkness & Barnhardt, 1991) were critical to inclusivity, power-sharing, decision-making, self-determination, and mutual learning that benefits all. Integrated knowledge translation, referred to as knowledge sharing during the project, was used to ensure Indigenous community members, those who are most impacted by the research, were engaged as equal partners throughout all stages of the research process. Communities fully contributed to grant writing, developing research questions, determining methods and planning, delivering programs, evaluating research, and determining best approaches for sharing information. Within Indigenous research, the research processes respect and uphold Indigenous values and ways of knowing and doing. Sharing of knowledge and forming new local and collective knowledge helped address the intended goals of the six priority areas of Collective Vision to transform inclusion of traditional and western health and wellness services.

Community Leading the Way

Community Research Liaisons

To honor and respect community leadership, each centre chose and hired a Community Research Liaison who was a local community member known and trusted within their community. Community Research Liaisons, funded by the research grant, were co-researchers who worked alongside community members, centre staff and management, and the university and health authority research team to coordinate and facilitate local research activities. Community Research Liaisons received initial and ongoing mentorship, training, and support from the Community Advisory Team, Elder Research Advisors, and university team to support and uphold cultural safety practices, protect traditional knowledges, and facilitate respectful community engagement. Community Research Liaisons invited community members to join community programs by word of mouth at Community Gatherings, group activities, and events. Centre websites and existing networks shared community posters to broaden the invitation to community members.

Community Advisory Teams

Community Advisory Teams, specific to each centre, consisted of community members across the generations, including Elders, Knowledge Keepers, Traditional Healers, youth, centre staff, and centre-recommended health care providers. The Community Advisory Teams gathered two to three times per year, or more if required to provide knowledge and leadership that honored and respected local protocols and processes to ensure all research activities remained relevant and beneficial to their community. Community Advisory Teams also assisted in the protection and sharing of knowledge and research insights that included recommendations, successes, and outcomes. The Community Advisory Teams offered ongoing wisdom and support for the Community Research Liaisons and other research team members. Community Advisory Team members were recommended and invited to join the team by Community Research Liaisons, Centre Executive Directors, and when requested, university co-researchers. Community Advisory Team members, not attending during paid work time, were provided honoraria through the CIHR grant.

Cultural Safety

Cultural Safety Gatherings, held in person at each centre, were facilitated by a community Elder and often with a university co-researcher who had knowledge and experience in cultural safety education. Teachings included colonial history and health and wellness impacts across generations. Elders and community members shared profound personal stories about racism, inequities, and discrimination within the health system. They described how health care providers and all people can learn how to be culturally safe in practice and everyday life (Kurtz & Nyberg, 2022; Kurtz et al., 2022).

Establishing Community Priorities for the Diabetes and Healthy Weight Programs

Community priorities for holistic diabetes and healthy weight programs and services were identified by community members through Talking Circles, Community Gatherings, and surveys. Local Community Gatherings were organized at each centre to collectively plan centre-specific programs. The Diabetes and Obesity Traditional Healing Survey was provided to community member participants to identify holistic diabetes and healthy weight needs, program topics, and activities. The survey included questions about personal and family experiences with diabetes and obesity and traditional healing interests and needs. Community member research participants were invited to complete the survey before and after each community program. They also completed a demographics survey about age, gender, and residence. Based on the survey and community members’ priorities and recommendations, each centre designed their program content and activities, which were taught and led by known and trusted community members.

Taking Action in Transforming Community Programs

Wisdom shared by urban Indigenous community members identified health and wellness needs, priorities, and recommendations for wellness programs and activities that included traditional and western approaches. In response, each centre with the Community Advisory Team co-developed, implemented, and evaluated culturally safe and relevant centre-specific community programs. These focused on prevention, treatment, and management of diabetes and healthy weight.

Over the 5-year project, 101 community members joined 13 community programs across six centres. Their age ranged from 8 to over 85 years, most being 45 to 74 years, and 67% were female and 33% male. Community program participation included eight to nine community members on average. Community member participation was community-specific and varied depending on age, gender, mobility, and interest. Programs took place in each centre and preferred or sacred locations for ceremony and traditional land-based activities. During COVID-19, Community Research Liaisons consulted with community members who mostly preferred continuing virtually rather than stopping the programs altogether. Several of the centres provided iPad devices to community members. Virtual community programs were offered via the university-secure Zoom. Presenters shared their knowledge during live Zoom sessions or through prerecorded video presentations. While initial interest and participation in the virtual programs was slow, word spread and along with the popularity of the in-person programs, people missed being together and found virtual gatherings were better than being isolated. As a result, virtual sessions became more accepted.

Community programs were unique and specific to each centre to honor local knowledge, experiences, and priorities. Programs were developed collaboratively by the Community Advisory Team and Community Research Liaison, with support from university co-researchers. Centre-recommended Elders, Traditional Healers, Knowledge Keepers, and health and wellness providers decided who they wanted to provide teachings and activities. Community Programs consisted of 3-hr sessions held weekly over 4 to 8 weeks. Sessions started with an opening prayer and introductions followed by traditional teachings, ceremony, and activities, followed by western education teachings and activities. Prior to shifting to virtual community programs, each session included sharing a meal, which is common within centres. Visiting with family and friends, meeting new people, sharing stories, learning together, building, and strengthening relationships help connect the centre community.

Community Program topics and activities addressing the Collective Vision were aimed at balancing mental, emotional, spiritual, physical, and overall wellness with a focus on prevention, treatment, and management of diabetes and healthy weight. Local Elders and knowledge keepers, recommended by the centre, shared knowledge for traditional teachings, and western education and teachings were provided by health care providers, including certified diabetes educators, nurses, dietitians, pharmacists, mental wellness professionals, foot care specialists, and university health researchers. This ensured knowledge shared was locally relevant and helped to build and strengthen relationships between community members and health and wellness providers local to their community (Table 1).

Table 1.

Community Programs Topics and Activities.

Community program topics	Sub-topics	Community program activities
Diabetes, healthy weight, and general health	• Pre-diabetes • Living with diabetes • Diabetes medications • Heart health • Dental, eye, foot health • Immunizations, vitamins	• Education sessions with diabetes nurse, dietitian, physician, pharmacist, endocrinologist, foot care nurse • Indigenous diabetes and healthy weight telehealth clinics with nurse, dietitian, physician
Wholistic approaches to health	• Physical, Spiritual, Emotional, and Mental aspects of health • Connecting mind-body-spirit • Participating in and learning about Ceremony	• Field trips onto the Land, including Sweat Lodge Ceremony • Picking Traditional Medicines • Traditional Talking Circles for community members to share and learn from one another • Traditional dancing, drumming, singing
Traditional medicines and foods	• Hunting, gathering, and harvesting • Fasting and cleansing practices • Traditional crafting	• Making Medicine bags and Tobacco Ties • Learning traditional beading • Picking plants for Labrador Tea • Making pine needle medallions • Learning about traditional fasting and cleansing practices • Education sessions about hunting, gathering, healthy ways of living
Personal goal setting and exploring what does health mean to you	• Pathways to healthy living and opportunities for wellness • Caring for loved ones	• Personal health journaling • Goal setting • Community member storytelling • Medicine Wheel teachings
Healthy eating, cooking, and nutrition basics	• Selecting affordable healthy foods • Reading food nutritional labels	• Cooking healthy meals at centres • Grocery store tour with dietitian • Recipe sharing of traditional and diabetes and weight friendly foods • How to plant, maintain, and share a community garden • Benefits of traditional foods • Low carbohydrate nutrition
Lifestyle changes	• Incorporating more movement into daily life • Mindfulness and meditation	• Gentle guided stretching • Chair yoga • Swimming • Walking programs • Using pedometers • Mindfulness practices • Guided meditations • Relaxation with music

Responding to Recommendations for Action

Following each community program, community members were invited to complete a program feedback survey and join a Talking Circle led by a local Elder to share their experiences, insights, and recommendations for future programs. For virtual community programs, surveys were offered online, and Talking Circles were facilitated by the Elder Research Advisor and held virtually using secure Zoom. Talking Circles held in person included having a meal together. Community member wisdom shared in the Talking Circles and Community Gathering highlighted the importance of continuing to create opportunities and a culturally safe place and space for community members to share knowledge and for ongoing support for diabetes and healthy weight and overall wellness. They agreed everyone in the community must have a voice in programming for wholistic healing to occur. Their comments reflected how this made a difference. Community member feedback and recommendations were integrated into future community programs ensuring community members’ recommendations were heard and the programs remained relevant and responsive to community priorities.

To protect community member research participant confidentiality and identity, the following quotes were not assigned numbers, letters, or fake names, as these terms were considered disrespectful, by participants when referring to human beings.

Traditional Healing

I really enjoyed the traditional healers and speakers that came to share. I particularly liked learning about traditional medicine, smudges, holistic health, the Medicine Wheel, Traditional foods, and hunting and gathering . . . I felt the program helped me learn more about Traditional ways of knowing and how to integrate them to enhance my overall health.

I enjoyed learning new things and going to the Sweat Lodge. I enjoyed the Eagle feather.

To talk about, like, herbs and plants and we could see how people were really . . . kind of, like, really open and hungry for that knowledge. I think that was pretty nice balance and combination of whom we managed to bring into the program.

Access to Care

I find this program brings a lot of people together. You don’t want to put your problems on somebody else because they don’t want to listen. This place is open for us to get together, which is good.

I learned a lot . . . this program is one of the good programs. I like to learn about diabetes, so can just share with my family.

Health Education

What I liked about the program was good information, good education. I also enjoyed the traditional and the western and it helped me be more aware of how we can connect traditional and western perspective, and it also opened my eyes to be more aware of how important our health is.

I’ve absolutely loved the program. I loved the instructor. I’ve been a diabetic for 35 years this was the first time I’ve ever been part of a diabetic program that I’ve actually followed, and I have a normal blood sugar count now . . . I’ve just absolutely loved the program. I’ve loved the new eating, just feeling happier and healthier.

It helped me get out too . . . then when we get into a group like this, we can start to share our stuff and change happens . . . wellness happens . . . and is so important.

What I liked about the program is that we were able to bring different presenters with different . . . aspects, like, more oriented towards medicine and it was nice to see people being more open and asking questions; the pharmacist; to talk about, like, herbs and plants and we could see how people were really . . . kind of, like, really open and hungry for that knowledge. So, I think that was pretty nice balance and combination of whom we managed to bring into the program.

Cultural Safety

I’m learning from all of you. Right? If it wasn’t for you, it wouldn’t be a program, so I am learning from all of you and this feedback is excellent.

I know I am learning a lot and I learn every time we come together as a group, your information is invaluable and for the success of future programs.

Community Belonging and Learning Together

I care about this program. We are not judgmental, no matter what shape size or whatever we are, we take each other of face value. I respect that and I love that.

What I like most of all about this program is feeling not alone with this weight business because, like, this has probably been following my whole life.

I call this my new family, what I enjoy the most is the camaraderie.

Food Security and Nutrition

I found it very educational . . . blood pressure drops and stress related sugar intake; read all instructions on anything you eat . . . I found it a very interesting and rewarding program.

It’s the people in there [the program]. Sharing stories about diet . . . I started to learn that I had to watch what I had to eat.

Everything I’ve been learning with the diabetes and obesity . . . it’s been a great change.

Celebrating Together: Community and Collective Successes

Project updates were provided regularly to the collective through the Community Advisory Team, Executive Director, and Community Research Liaison, either in person or virtually, at meetings, annual collective gatherings, and annual project newsletters and reports.

Centre-specific Community Gatherings were held in all six centres at the beginning of the project and three centres at the end of the project. Collective gatherings were initially to be held in person annually; however, only three occurred due to COVID-19. The project brought together members of the collective to share and learn from one another, plan research activities, celebrate successes, and build and strengthen relationships. Collective gatherings were held in one central location between the centres for easier access and to minimize costs.

Community Resources

Health and wellness resources were developed for community members and centres throughout the project. These resources were created in response to community members’ recommendations, who shared that they wanted resources and more information on diabetes, weight management, and overall wellness. Co-researchers developed community member resource booklets on topics including prevention and management of pre-diabetes, diabetes prevention, healthy nutrition, exercise, healthy weight, and healthy eating on a budget. These booklets were designed to be community-friendly, culturally relevant, and, where possible, specific for Indigenous Peoples. In addition, Community Research Liaisons created centre resource booklets describing the step-by-step process for communities to plan, provide, and seek feedback for their own locally relevant, culturally distinctive, and priority responsive community programs. A collective cookbook was created using recipes shared by community members, university team members, and local health professionals. This cookbook was given to those who contributed a recipe and to each centre. Resources were also created for research team members, including a Community Research Liaison orientation package, research handbook, and program planning and knowledge sharing templates (Table 2).

Table 2.

Co-Developed Resources and Booklets.

Type of resource	Resources developed
Resources for community members project participants	• New to type 2 diabetes • Prevention of diabetes • Pre-diabetes • Healthy weights • Healthy eating on a budget • Nutrition • Exercise
Resources for centres	• Walking program • Métis Earth walkers: How to manual • Gardening guide • From seed to plants: A growing guide • Traditional and healthy eating cookbook
Resources for research team members	• Community Research Liaison orientation package • Community Research Liaison research handbook • Program planning template • Tracking final report template • Community Advisory Team terms of reference • Community Advisory Team orientation presentation • Student and Staff orientation package

Community Programs: Sustainability for Future Generations

To ensure sustainability following the project, the Urban Indigenous Wellness Collective collaborated to share, discuss, explore, and mobilize learnings and pathways for program sustainability. Resources produced in support of sustainability included a policy brief, and the Urban Indigenous Community-Led Wellness Programs Research Guide detailing shared learnings from community members and the collective’s recommendations for ongoing, sustainable, culturally safe urban Indigenous diabetes and obesity programs and services. A Culturally Safe Diabetes and Obesity Services in Urban Indigenous Communities Policy Brief was developed by the collective and presented to multiple levels of leadership within the regional health authority. The policy brief included six community recommendations for sustaining the programs and 11 principles of trusting relationships with Indigenous Peoples (Kurtz et al., 2014). As a result, the health authority has committed to continue funding for certified diabetes educator nurses and dietitians, Elder honoraria, and food during the programs.

Collective Vision Transforming Traditional and Western Health and Wellness Services

In this article, we shared the journey in which urban Indigenous communities and Indigenous and non-Indigenous allied researchers and health professionals formed a partnership within the Urban Indigenous Wellness Collective to co-develop, deliver, evaluate, and sustain holistic traditional and western Indigenous diabetes and obesity programs. Guided by Urban Indigenous Collective Governance, the research partnership led to over 300 people taking part in community-specific programs, cultural safety education sessions, Talking Circles, Community Gatherings, and wellness surveys. Community needs, priorities, and feedback continually shaped future programs and activities.

The Indigenous Diabetes and Obesity Health Project is an example of how Indigenous Peoples, health providers, and researchers working together can result in successful, effective, culturally relevant, and locally accessible health programs. Through community leadership, Indigenous self-determination was upheld and advanced through the Collective Governance Circle and shared decision-making with centres making the final decisions. Centre-selected Community Research Liaisons and Community Advisory Teams provided ongoing guidance to ensure local protocols were respected and upheld, and research remained relevant to the community. This was reflected in community programs which were tailored by each centre to ensure they were locally distinctive with local Elders, knowledge keepers, community members, and trusted health care providers invited to offer teachings, education, and ceremonial and land-based activities. Strong governance of Indigenous leadership and living the methodology in this research was key to ongoing lifelong meaningful research partnerships. Community Advisory Teams are vital for collaborative research with and led by Indigenous communities (Kurtz et al., 2024). For example, Indigenous health programs and research evaluation processes need to be site-specific, within local and collective priorities, informed and led by and for the benefit of the community (Gresku et al., 2022).

Indigenous health research and community engagement must occur before the research starts (Ball & Janyst, 2008; Newhouse et al., 2023). In the collective, community engagement ensured that community programs were community-specific, and reflective of local and distinctive community needs and priorities. Within each community, community members took part in Community Gatherings and surveys to provide feedback and recommendations to plan and adapt community programs and activities. Programs consisted of centre-selected topics, community presenters and activities, and current western diabetes and healthy weight education. Following each community program, community members provided feedback that helped each centre adapt the next program topics and activities that aligned better with community needs and priorities. This ongoing community engagement to adapt community programs provided space for communities to (re)determine their own evolving research needs and priorities (Smith, 2021). Community programs were culturally relevant and embedded local traditional and cultural knowledge with western knowledge. Local cultural and traditional knowledge and practices including an opening prayer, drumming and singing, traditional teachings, education, and activities were shared or led by local and centre-recommended Elders, knowledge keepers, and community members. The community program content and activities aligned with other type 2 diabetes prevention and management programs that incorporate traditional Indigenous practices (Bonin et al., 2022).

The Journey Continues

The collective has taken action and responded to ongoing issues, negative experiences, and gaps for Indigenous Peoples within the health care system. They have identified and demonstrated ways to transform institutional colonial barriers and practices. The new pathway for action developed within the collective is relevant to their local community and across all six centres. As a result, they are providing traditional and western programs and activities for wellness. The collective journey of respect and honoring of one another helped transform ways of connecting and mutual seeking and supporting reciprocal knowledge sharing, learning, and action within relationships across generations. Although it is not always easy to challenge the colonial systems, doing research in a meaningful way has uncovered and begun to address issues and in doing so strengthened commitment to continue the journey long after the research ends. The journey shared by this collective partnership could be used to shape culturally safe, equitable, strength-based, site-specific Indigenous-led research and programs. This can transform policies, practices, and programs for holistic health care services and culturally safe health provision.