Abstract
Using Participatory Research Approaches and Visual Research Methods to Engage Aboriginal Youth in Health Promotion
Symposium Chair: Cindy Jardine, University of Alberta
Participatory research methodologies are becoming increasingly popular as a means of engaging Aboriginal youth as full partners in exploring issues of concern to their communities. Likewise, the use of qualitative visual methods, such as PhotoVoice and participatory video, in a participatory context provides a meaningful ‘voice’ to this population. Through an examination of several participatory projects conducted with Aboriginal youth using visual methods, this symposium will examine various aspects of this type of research, including: (1) partnering with youth as co-researchers; (2) the impact of participatory approaches on youth wellness; and (3) the value of youth generated messages in communicating about health risks and promoting action.
Session One: Engaging First Nation Youth as ‘Co-Researchers’: Building Capacity in Schools and Communities
Shelagh Genuis, University of Alberta
Cindy Jardine, University of Alberta
Noreen Willows, University of Alberta
Jayde Arcand; Alexander First Nation Alexander First Nation
Based on a social constructivist approach and the Positive Youth Development framework this presentation explores the methodological contribution of a community-based, participatory Photovoice study in which we partnered with youth co-researchers to investigate children's knowledge of and experiences with healthy eating and food security. We trained high school students attending a First Nations reserve school as ‘co-researchers.’ These youth contributed to aspects of research design, conducted two sets of interviews with young elementary school Photovoice participants, and provided feedback about research processes. Co-researchers were also involved in data analysis: they identified emerging themes, verified themes following full data analysis, and were partners in the development of a photobook representing research findings. We found that co-researchers demonstrated three primary strategies as they interviewed, elicited responses from and connected with the young PhotoVoice participants: co-researchers assumed a mentoring/teaching role, they engaged in specific rhetorical techniques to encourage participant response, and they built rapport by making personal connections and referencing shared community and/or cultural knowledge. Two important process-related factors promoted capacity building: relationships and ‘dialogic space.’ A critical aspect of this study was the involvement of co-researchers in the development of a photobook representing the participants' lived experiences with food. While we anticipated competency and skill development as a result of participation in photobook development, we found that through their involvement, co-researchers were empowered as agents for advocacy and change in their community.
Session Two: Assessing How the Process of Community-Based Participatory Research Impacts Aboriginal Youth's Health and Wellness
Megan Lukasewich, University of Alberta
Cindy Jardine, University of Alberta
Youth's perspectives of being participants in community-based participatory research (CBPR) projects are rarely assessed. Therefore, we do not know how the process of participating in research impacts youth health as the context of their unique experiences is missed. Through a CBPR project, Aboriginal youth from Edmonton, AB and Ndilo, NWT used video production to promote smoking cessation and prevention in their communities. We assessed from the perspective of the participants, the impact of a CBPR approach on their health and wellness. Focus groups were conducted with the youth participants (ages 13–18 years): five pre-project (n=28), and four post-project (n=18). Individual interviews were conducted pre- and post-project with the eight adult partners. The pre- and post- design, allowed the participants to serve as their own ‘controls’. Through content analysis we developed an inductive code book. Youth described a sense of belonging and support that occurred throughout the project, increasing their self-esteem and self-confidence. This support empowered them to express their voices in meaningful ways. Youth gained leadership skills and described motivation to be healthy role models for their peers and family. Youth bonded with each other by taking the responsibility to lead the project. Coming together as Aboriginal youth resulted in them collectively pursuing Aboriginal teachings. Determining the impact of CBPR to empower youth to be health leaders in their communities has the potential to influence the way research, programs and policies are created with Aboriginal youth. This research contributes new knowledge on the benefits of including youth in CBPR programs.
Session Three: Participatory Health Risk Communication: Using Visual Messages Generated by Aboriginal Youth to Effect Change
Cindy Jardine, University of Alberta
Shelagh Genuis, University of Alberta
Megan Lukasewich, University of Alberta
Keren Tang, University of Alberta
Participatory approaches have demonstrated value in conducting research that reflects community priorities and perspectives, and incorporates the knowledge and expertise of community members. This results in information that is useful and meaningful in addressing health issues because it is responsive to the community and its concerns. However, these approaches can also be an effective means of communicating about the nature and effects of various types of health risks, particularly when coupled with visual methods such as PhotoVoice and participatory video. Although the tenets of effective risk communication include the incorporation of participatory dialogue on health issues, ‘official’ risk messages are nonetheless usually ‘one-way’ communications generated through government or other health agencies. These messages are thus frequently not effective in promoting informed decisions on risks. In contrast, messages conceived and delivered by community members are generally more trusted and effective in conveying information and encouraging healthy lifestyle choices because they are contextualized for the people involved. Based on the results of several participatory projects conducted using visual methods with Aboriginal youth, this presentation examines the effectiveness of these messages as a means of identifying risks of relevance to communities (in a community context), portraying different risk perspectives, and encouraging community discourse and action. It also explores the efficacy of this form of risk communication in promoting individual and community empowerment through giving people a ‘voice’ and the ability to take action.
Dialogue-based Research for Change: Methodological issues and considerations for data analysis
Symposium Chair: Katrina Plamondon, Interior Health/University of British Columbia Okanagan
“The purpose of this symposium is to discuss epistemological, ethical and methodological implications of deliberative dialogue and to invite participants into a mini-deliberative dialogue about these implications. Attendees will experience deliberative dialogue both as a strategy to model facilitative approaches and to spark rich discussion about the epistemological, ethical, and analytical challenges.
Deliberative dialogue is a process of purposeful and transformative discussion among carefully selected stakeholders, often informed by research evidence. We are currently using deliberative dialogue in research to inform priority setting and mobilize policy influence with diverse communities. Through our respective research, we engaged with communities in visioning and consensus-building activities. Participants invited for their connection to the community of interest and unique perspectives create an intentionally constructed group and represent broader communities. Data includes collective narratives, built from processes of consensus that reflect collectively agreed upon exemplars of concepts, challenges, and contexts explored. The process embraces direction from participants, listening for guidance on decisions about emerging themes and calls for action.
As a method for engagement and data collection, extended deliberative dialogue processes are promising, particularly as an enabler of integrated knowledge translation. Weaving deliberative dialogue into action research presents important epistemological and ethical considerations, including issues of positionality, voice, and stewardship of results and outcomes. We argue that research designs involving deliberative dialogue must incorporate synthesis, analysis, interpretation, and priority setting at all stages in the process of dialogue. Further, analytical frameworks must acknowledge (and attend to) data generated from deliberative dialogue as co-constructed, collective voice.”
Session One: Accelerating Nurse Practitioner Integration in Primary Healthcare through Deliberative Dialogue
Nelly Oelke, University of British Columbia Okanagan
Linda Sawchenko, University of British Columbia Okanagan
Donna Mendel, Interior Health
Katrina Plamondon, Interior Health & University of British Columbia Okanagan
“Nurse Practitioners (NPs) were first introduced in Interior Health (IH) in 2005. In some settings, the implementation of the NP role worked well, while in other areas integration presented challenges. Decision makers and NPs desired a collaborative practice model to facilitate better integration in the health system, particularly in primary healthcare settings, and to affect positive outcomes at patient, provider, and system levels. This qualitative study occurred over two phases between 2013-2014: the first involved a literature review and key stakeholder interviews to better understand NP integration in the geographic area; and the second invited stakeholders to develop actions that could accelerate NP integration by engaging in deliberative dialogue.
Interview data were analyzed for common themes and synthesized into a summary report along with results from the literature review. Stakeholders invited into deliberations were provided the summary report with reflective questions in advance of a series of two deliberations. The first deliberation allowed space for interpreting the evidence presented and generating a set of actions that could guide steps toward more effective and rapid integration of NPs in primary healthcare. After six months, stakeholders were invited to participate in a second, half-day deliberation to reflect on progress, revisit the actions, and prioritize dissemination and policy influence strategies.
The final dialogue affirmed and validated substantial progress on actions. Participants were surprised by the influence of the initial dialogue session, commenting on how the presence of facilitated dialogue itself among key stakeholders prompted movement and action on key barriers to NP integration.”
Session Two: Gathering Perspectives from the Global Health Research Community: Visioning a future through deliberative dialogue
Katrina Plamondon, Interior Health & University of British Columbia Okanagan
Jennifer Hatfield, University of Calgary
Jill Murphy, Simon Fraser University
“In 2013, the Canadian Coalition for Global Health Research (CCGHR) led a study to gather diverse perspectives on the role of research in a Canadian vision for global health. Appreciative inquiry and deliberative dialogue were used to invite unconstrained imagining about possible futures while fostering collaborative relationships. The process began with a full-day dialogue that brought together over twenty stakeholders to deliberate on how principles of equity, effectiveness and engagement were reflected in practice and policy; what an ideal future would look like; and what pathways were needed to realize this vision. A series of ten similar dialogues followed, supported at universities across Canada. Online conversation was launched simultaneously, using social media and blogs to prompt dialogue around core issues. Members of the global health research community were invited to further engage in the dialogue by providing their reflections through an online response form. A second dialogue served as a book-end to the six-month process of gathering perspectives, inviting deliberation on policy and practice implications of study results.
Each phase of data informed ongoing, concurrent data analysis. Data were continuously made available to participants through the CCGHR website. An iterative process of coding and emergent thematic analysis was guided directly by the interpretive efforts of participants in the dialogue. Results of the Spring Dialogue guided development of an initial set of themes to guide ongoing analysis. Preliminary analyses were used as a foundation for informing the final deliberation that identified urgent actions to enable an ideal future.”
Session Three: Shaping Collaborative Community-Based Research through Deliberative Dialogue about Mining and Health in Guatemala
Susana Caxaj, University of British Columbia Okanagan
From December 2010 to 2011, a community-based research project was conducted with a rural Indigenous community in the Western highlands of Guatemala. Using an anti-colonial narrative approach that employed participatory action research principles, I worked with local community members to develop a research design that incorporated community priorities and a collective vision towards action and change. The purpose of this investigation was to examine the influence of a large-scale mining operation on the health of the community of San Miguel Ixtahuac'n, and to understand the context, including the role of community resistance, in promoting local health promotion. Data collection included focus group interviews, photo-voice, as well as some informal arts-based approaches. Study findings revealed complex and intersecting systemic factors, meso-level health impacts of a climate of fear and discord and embodied expressions of distress, as well as multiple modes of resistance largely shaped by spiritual, cultural and political strengths. Knowledge translation activities were planned within community meetings, which led to the organization of the Peoples International Health Tribunal. This event brought together academics, economists, legal and environmental experts, health care leaders and communities similarly affected by large-scale mining across the Americas. Diverse relational processes were facilitative of the iterative research design planning, the co-construction of knowledge(s) and representations that ultimately contributed to a more robust, ethical, and participatory methodology.