Aajiiqatigiingniq : An Inuit Consensus Methodology in Qualitative Health Research

Abstract

Indigenous knowledge and approaches to health research have historically been marginalized by Western traditions. Efforts to overcome this marginalization by recognizing Indigenous methodologies as a distinctive form of inquiry are gathering momentum. Health research that seeks to establish levels of agreement about disputed or conceptually unclear subjects frequently relies on consensus methods. Aajiiqatigiingniq is a principle of cultural knowledge and a consensus decision-making approach among Inuit in the Canadian Arctic. We used group meetings and individual interviews involving Inuit elders and other senior community members in Arviat, Nunavut, to explore and describe aajiiqatigiingniq as an appropriate and ethical methodology in qualitative health research. Findings reveal a systematic but apparently informal approach focused on sustained individual and community well-being. Consensus is achieved through the successive addition of group members, respectful communication, mainly narrative discourse, subjective personal engagement, and an unhurried meeting style. While previous research has used Western consensus methods to embed Inuit knowledge in health research, this study provides a first descriptive account of a wholly Inuit consensus methodology.

Introduction

Recognition that Western epistemologies and methodologies are inadequate for research concerning or involving Indigenous people has been growing since the 1990s (Chingwe & Makuwira, 2018). Many researchers now recognize the need to decolonize scientific and knowledge-gathering practices in these contexts (Denzin, Lincoln, & Smith, 2008) and to develop “methodologies and approaches to research that privileged Indigenous voices” (Smith, 2005, p. 87). In Canada, for example, studies of Indigenous health often do not involve Indigenous peoples as researchers and frequently fail “to better understand, integrate and prioritize Indigenous values” (McCalman et al., 2016). The result is that health research, such as studies examining Indigenous mental health, may not capture or interpret relevant data appropriately. While some Indigenous communities are considered affected by mental health issues at higher rates than elsewhere in Canada (Kirmayer, Tait, & Simpson, 2009), Indigenous populations have not historically initiated or been involved in mental health studies involving their communities (Waldram, 2004). Instead, Indigenous mental health research is often directed or influenced by Western worldviews and stereotypes of Indigenous people (Nelson, 2012) that risk misrepresenting types and rates of mental health issues in their communities (Nelson & Wilson, 2017). The result may create barriers to effective mental health-care access for Indigenous people (Nelson & Wilson, 2017).

One approach to overcoming the problem of the marginalization of Indigenous knowledge by Western research is to recognize and incorporate Indigenous methodologies as a distinctive form of inquiry (Smith, Maxwell, Puke, & Temara, 2016). An Indigenous methodology, according to Porsanger (2004, p. 207), is “a body of Indigenous and theoretical approaches and methods, rules and postulates employed by Indigenous research in the study of Indigenous peoples.” In health research, however, the use of Indigenous methodologies appears to be limited. Despite an acknowledgment of the distinctiveness of Indigenous knowledge, well-documented and specific characterizations of Indigenous methodologies in academic texts or peer-reviewed literature are few, particularly in health system research (Chatwood et al., 2015). Characterizing Indigenous methodologies may be part of the problem: Some scholars consider Indigenous research as distinct from conventional qualitative research (Chingwe & Makuwira, 2018) because its methodologies tend to not be theoretically constructed but, rather, based on Indigenous ethical protocols and local cultural imperatives (Porsanger, 2004). Yet, others prefer to situate Indigenous methodologies within qualitative research (Kovach, 2010) among the many other varied methodologies already included in that arena. Indeed, qualitative approaches are often used and considered appropriate for studies examining measures of health and well-being in Indigenous populations (see Rountree & Smith, 2016, for review). Botha (2011), in particular, suggests “combining current qualitative research practices with the specific aspirations of Indigenous communities in a mixed method strategy” to ensure that Indigenous research methodologies “embrace more appropriate epistemological and axiological assumptions” (p. 13). Some researchers find it useful (particularly for readers more familiar with Western methods) to employ the language of qualitative research as a convenient convention to describe Indigenous approaches (e.g., Chatwood et al., 2015).

Qualitative research methods previously considered well aligned with Indigenous health research in Northern Canada include consensus methods (Chatwood et al., 2015; Healey, Noah, & Mearns, 2016). Consensus methods in health research incorporate both available evidence and expert opinion to fill knowledge gaps (Bobrovitz et al., 2013), and as a means to discovery, they represent a legitimate and valuable qualitative research approach. Commonly, consensus methods are described as a suite of tools for finding and/or evaluating areas of agreement among experts while avoiding the pitfalls common to group decision-making, such as the domination of discussion by individuals and/or vested interests (Jones & Hunter, 1995). Two consensus methods with a long history of use in health and medicine are the Delphi and nominal group consensus methods (Fink, Kosekoff, Chassin, & Brook, 1984). While definitions, methodologies, and reporting for consensus techniques vary widely, common features include anonymity of responses, iteration with feedback, measures of group response, and structured group interaction (Humphrey-Murto, Varpio, Gonsalves, & Wood, 2017). The nominal group consensus method, for example, involves face-to-face interactions (as distinct from the Delphi technique which relies on feedback through the use of iterative questionnaires; Jones & Hunter, 1995) with a group of 5–12 experts gathered to develop and, then, to independently and anonymously respond to a nominal question (Humphrey-Murto et al., 2017). This method engages a four-step process that begins with individual generation of ideas on a topic, a collective mapping of these ideas, a discussion, and a vote to gain agreement.

In the territory of Nunavut, one of the four Inuit homeland regions of Canada known collectively as Nunangat, Inuit cultural knowledge (Inuit Qaujimajatuqangit [IQ]) also includes a consensus knowledge-seeking approach (Karetak & Tester, 2017): Aajiiqatigiingniq is one of the eight guiding IQ principles (Nunavut Department of Education, 2007). For Inuit, IQ captures elements of cultural knowledge grounded in a wholly and holistic Inuit worldview. The term has been defined as “the Inuit way of doing things, and includes the past, present and future knowledge of Inuit society” (Tester & Irniq, 2008, p. 49). The application of IQ to health practices and programs in the territory has been described as an effective approach to improving health outcomes for Inuit (Tagalik, 2012). Aajiiqatigiingniq is generally considered an approach to building community scale consensus and is central to Inuit notions of wellness in the context of community harmony (Karetak & Tester, 2017, p. 11). Its purpose has been described as ensuring that inuutsiargniq (wellness) is continually supported by the community and that well-being is restored to individuals to return them to being productive, contributing, and caring members of the community (Karetak & Tester, 2017). Aside from these general characterizations, however, more detailed descriptions of aajiiqatigiingniq as an Indigenous methodology do not exist in a form accessible to non-Inuit or to Inuit unable to readily tap into channels of IQ communication (e.g., counsel by elders).

This descriptive study by Inuit and non-Inuit researchers (one non-Inuit is a long-time Nunavut resident) directly addresses this gap. Here, we explore and describe aajiiqatigiingniq as an Indigenous methodology and an appropriate and ethical health research tool in Inuit communities. The research is a collaboration between the University of Alberta in Edmonton and the Aqqiumavvik Society in Nunavut. The latter is a community-based research and wellness center with expertise in the articulation of IQ in research, programming, and outreach. We brought together Inuit elders and other senior Inuit community members in the hamlet of Arviat (Pop. 2,514; Statistics Canada, 2016) to characterize the elements of aajiiqatigiingniq as a consensus tool for Wellness Court research concerned with issues of mental health. The exercise marks the first time since colonization (involving forced relocation in the late1950s and early 1960s) that Arviat elders gathered with the specific aim of consolidating agreement around a cultural IQ principle to establish its importance and role in a contemporary mental health and legal context. The aim was to create an understanding of this long-practiced Inuit consensus approach as both an Indigenous research methodology and cultural system. While previous research has successfully used Western consensus methods to embed Indigenous knowledge (e.g., Chatwood et al., 2015) and more specifically Inuit knowledge (Healey et al., 2016), this study refers to Western consensus methods where necessary only as a means to illuminate and describe a wholly Inuit research methodology. Its aim is to characterize a research methodology that can ensure the predominance of Inuit epistemology in Wellness Court research. Permission to conduct this study was granted by the Research Ethics Board of the University of Alberta. This research was also licensed by the Nunavut Research Institute pursuant to the Scientist Act (Nunavut Research Institute, 2018), following consultation with the Arviat hamlet office, the regional Inuit organization, and the Government of Nunavut Health Research Committee.

Terms and Language

In this article, the authors use the phrase “cultural knowledge” rather than “traditional knowledge” as the shorthand English-language reference to IQ. While the latter is used frequently in scientific literature, many Inuit elders are not comfortable with this terminology as potentially ignoring the very dynamic and adaptive nature of IQ. The phrase “cultural knowledge” is thought to better capture the need to include contemporary and future knowledge as epistemological conceptions embedded in IQ.

Method

Participants

Recruitment of participants was facilitated by the Arviat-based research team members according to conventional “representative” purposive sampling techniques (Teddlie & Yu, 2007). Twelve community elders participated, representing recognized knowledge holders from two generations of Inuit elders: Three were raised “on the land” and have lived experience of the aajiiqatigiingniq consensus process, and six were from a colonized generation of Inuit with limited direct lived experience with aajiiqatigiingniq but with indirect knowledge of the process. Three other participants were senior community members but younger than the elders and were most familiar with Western formal systems of governance but with exposure to their parents solution-seeking within the domain of family. Participants were or had been employed in the fields of education, counseling, justice, language services, and the church. All were recognized by Inuit and non-Inuit team members as respected and contributing community members. There were an equal number of men and women. Participant ages spanned from 51 to 85 years.

Procedure

The team executing the study comprised three Inuit and two non-Inuit. We conducted three group meetings and individual interviews with participants in Arviat, Nunavut, between October 10, 2018, and October 19, 2018. We started with a group meeting, followed by individual interviews, which were followed by two more group meetings. All team members were present for participant group meetings. Group discussions were facilitated in Inuktitut by an Arviat team member who is also a coauthor. The facilitator is both a member of the Aqqiumavvik Society and a well-respected Nunavut facilitator who has worked with elders for the past 20 years. Individual interviews were conducted by the Inuk facilitator and the University of Alberta team member.

Interviews

Group Meeting 1

The first group meeting of October 10, 2018, involving 2.5 hr of dialogue and comprising elders (n = 6), convened to build a shared understanding of aajiiqatigiingniq and to help develop questions to guide semi-structured interviews.

Individual interviews

Semistructured individual interviews of 30 min to an hour were undertaken with elders from the first group meeting (n = 6) to discuss knowledge and experience with aajiiqatigiingniq. These interviews allowed the anonymous, independent discussion of each elder’s reflective insights and conceptions concerning aajiiqatigiingniq and its expression.

Group Meeting 2

The second group meeting of October 17, 2018, involving 1 hr and 50 min of dialogue and comprising elders from the first meeting and one other (n = 7), provided an opportunity to discuss evolving individual and group understanding of aajiiqatigiingniq. The purpose of this meeting was to distill and confirm the characteristics and expression of aajiiqatigiingniq.

Group Meeting 3

The third group meeting of October 19, 2019, lasted one 1.5 hr and comprised elders from the second group meeting, plus two other elders, and three senior community members younger than the elders (n = 12). The purpose of this meeting was to consolidate aajiiqatigiingniq knowledge and its application in Wellness Court research.

Data

Data for our analysis comprised three group meetings and six individual interviews. Group meetings were conducted in Inuktitut with simultaneous English interpretation. These meetings were video-recorded and audio-recorded in both languages. The English audio recordings were transcribed. Two of the individual interviews were conducted by the facilitator in Inuktitut with simultaneous English interpretation, and four interviews were conducted by the University of Alberta team member in English with consecutive Inuktitut/English interpretation. Individual interviews were audio-recorded, with one exception. The foregoing comprised the mediums used to document the data.

Data Analysis

This study is a descriptive exercise. As much as possible, the explicit characterization of aajiiqatigiingniq by participant group members was used to develop an understanding of the process as a methodology. This typically involved an Inuit comprehension and analysis of what was happening during group meetings that did not lend itself to articulation in a manner readily understood by non-Inuit. This Inuit understanding was discussed in team meetings during and following the execution of the study. In an effort to improve comprehension of the process for those unfamiliar with Inuit epistemology that provides the methodology with meaning, data were also subject to interpretation by conventional qualitative research analytical approaches. In particular, researchers used a two-step process of qualitative thematic analysis followed by discourse analysis as an overlay to the initial findings. The two-step approach was considered by the team to offer a comprehensive and holistic approach to the analysis of Inuit cultural knowledge.

Thematic analysis

Analysis revealed themes (Guest, MacQueen, & Namey, 2012) relevant to describing the aajiiqatigiingniq process as a methodology (the content). Theme development was informed by team discussions following each of the three participant group meetings. More formalized thematic analysis was first undertaken by the Aqqiumavvik Society and then separately by the University of Alberta using inductive coding facilitated by NVivo Version 12 qualitative software (QSR International, 2018). Results were compared and discussed. The protocol for thematic analysis allowed for data to be assigned to more than one theme.

Discourse analysis

We then used a descriptive discourse analysis to examine how agreement around themes was considered, treated, and facilitated by group members (the process). Discourse analysis was undertaken by the University of Alberta team member with the assistance of NVivo Version 12 software and was confirmed by the Aqqiumavvik Society. Descriptive discourse analysis (as distinct from critical discourse analysis) seeks to describe how language works in order to understand it (Gee, 2011). Discourse analysis permitted a deeper understanding of the interactions, relationships, norms, expectations, and implications affecting each group’s consideration of the aajiiqatigiingniq concept and process. The importance of discourse analysis became increasingly clear to team members as participants began to identify their collective effort to find consensus concerning a description of aajiiqatigiingniq as an Inuit exercise in aajiiqatigiingniq itself.

The descriptive discourse analysis in this study followed procedural guidelines set out by Willig (2013) in the context of Foucauldian discourse analysis. A Foucauldian approach to discourse analysis (emerging from the seminal work of Michel Foucault) is considered appropriate for cross-cultural analysis (Xiang et al., 2018) because of its focus on the relationship between communication and the subjective impacts of social/cultural constructions affecting ways of seeing the world and ways of being in the world (Willig, 2013). For Inuit, open communication is considered extremely important (Tagalik, 2012). In an oral society, very detailed and specific terminology was emphasized, and the role of narrative and storytelling was viewed as a preferred way of committing information to memory. We felt that the aajiiqatigiingniq process was well suited to a discourse analysis and that this approach might help illustrate how Inuit negotiate consensus using this process. Our study focused on the second of the following six key elements of Foucauldian discourse analysis. These elements are (1) identifying the “discursive object” (i.e., aajiiqatigiingniq), (2) identifying how the discourse around the discursive object is constructed (e.g., this can include the discourse type used, such as narration, description, persuasion, argument, or exposition), (3) identifying why the discourse is constructed the way it is (e.g., why is a particular discourse type used), (4) identifying “the subject position” of those engaged in the discourse (i.e., how the participants’ place within the discourse context impacts the discourse and its meaning), (5) identifying how discursive constructions and subject positions open up or close down opportunities for action, and (6) identifying how the discourse reflects or facilitates the subjectivity of participants (e.g., how the discourse itself constructs social, psychological, and, possibly, cultural realities). The study’s focus on the second key element meant consideration was given to how discourse around aajiiqatigiingniq was constructed in the three participant group meetings. The protocol for discourse analysis required that data be assigned to the dominant discourse type only.

Rigor was achieved through critical reflective dialogue between research team members about the process, analysis, and findings (Mayan, 2016; Strauss & Corbin, 1998). This critical reflection was undertaken during preparation and debriefings following group meetings and individual interviews as well as by e-mail, text, telephone, and during one meeting in Iqaluit, Nunavut, between two team members poststudy.

Results

Participants in this methodological study generally expressed an understanding that research and inquiry involve a systematic search for knowledge and ways to reflect that knowledge to effect new understanding. The concept of consensus building seeks to find places of agreement or solidarity about that understanding. Aajiiqatigiingniq was described as a consensus process that brings out the truth and seeks solutions that will improve collective well-being.

Themes

Analysis of group discussions revealed themes that characterize aajiiqatigiingniq as a consensus process: (1) applications of aajiiqatigiingniq are varied; (2) the consensus group increases in size and scope as needed; (3) the focus is on wellness; and (4) respectful, open, and trusted communication is essential. Table 1 reflects the number of references (dialogue) from three combined group meetings in support of the themes.

Table 1.

Themes Characterizing Aajiigatigiingniq as a Consensus Process (Three Groups Combined).

	A: Application of Aajiiqatigiingniq Method Is Varied	B: Consensus Group Increases in Size and Scope as Needed	C: Focus Is on Wellness	D: Respectful, Open, and Trusted Communication Is Essential
Number of references (dialogue)	73	13	27	14

Applications of aajiiqatigiingniq are varied

Group participants, especially older knowledge holders with direct experience with aajiiqatigiingniq, described this Inuit consensus process as useful in a variety of contexts and for diverse purposes (Table 1, n = 73). One elder expressed it this way: “To me, aajiiqatigiingniq can be geared at very many areas that we’re trying to go through.” Another elder said, “[W]henever there was something serious to be discussed, then aajiiqatigiingniq was used. Trying to come up with a solution whenever there is something—a disagreement or a problem—within the camp, the family, the community.” Elders described employing aajiiqatigiingniq to plan and prepare for seasonal moves or hunting excursions and as a way to negotiate between different parties. It was also used in preparation for a life change such as marriage or illness, to confront and provide direction to wrongdoers, to identify clear life goals for individuals, and to plan ways to accomplish tasks that required collaborative effort.

Focus is on wellness

While group participants shared an understanding that aajiiqatigiingniq was widely applicable, discussions revealed a very clear understanding that the ultimate role for the aajiiqatigiingniq process was to address wellness and individual and collective healing (Table 1; n = 27). Indeed, the resolution of seemingly very pragmatic concerns or conflicts was often expressed by participants in terms of making individuals or, especially, the community well or “whole” again. One participant described the need this way: “No matter who you are, if this person had something in his heart, if he doesn’t get help or healing, that hurt is going to stay with him all the way to his or her adult life.” In several instances, participants described the focus of aajiiqatigiingniq as facilitating community or collective wellness in the context of historic, colonial disruption. “It’s when their views or beliefs or their respect for themselves has been lost. They have no hope in their own future,” explained one participant. Another described it this way:

[T]his kind of healing and forgiving and discussion with others and continuing their healing journey, it is an ongoing project when it comes to healing. This is a useful tool that we want them to learn to practice, to learn, to know how to do the practice.

The consensus group increases in size and scope as needed

Group participants described the aajiiqatigiingniq process as beginning at the individual/family level and increasing in size, seriousness, and scope as needed (Table 1; n = 13). Elders explained that aajiiqatigiingniq was used by parents in informal, ongoing applications to resolve small conflicts, to correct individual behavior, or to offer life instruction. However, if families could not resolve issues, members of the community were invited to join the effort: “Families were very important to each other whenever something is more serious,” said one participant. “It was the family’s responsibility at first. And then, if the problem could not be corrected, if it was too serious, then it would be necessary for the elders to gather and seek information.”

As issues were recognized as more serious and relevant to the larger community, aajiiqatigiingniq was applied by the camp group, usually comprising extended family members or a few families who were in close relationships either through kinship or hunting associations. These camps could involve 40–50 individuals. Discussions using aajiiqatigiingniq were often about joint planning for the successful functioning of the group, including how to address wrongdoing and discipline in cases where individual behavior affected the whole camp. One elder explained, “When [a behavior] would be damaging to one family, this would lead to a ripple effect [within] the community members. So as soon as they saw a wrongdoing, then this was corrected right away.” Another participant described the escalating intensity of the consensus process this way:

If a person did something wrong or was in trouble, the parents would try to correct him. If that didn’t work, then the other members of the family would be involved. And if that didn’t work, the elders would be seeking outside help so that the person in the middle can be helped.

Said another, “And if that person did not stop doing crime, the people would choose more people so there would be more people talking to that person who did wrong in order to correct him.” If the process was still not successful, explained one elder, a further escalation may have involved a shaman in order to restore harmony. In more dire circumstances, when an individual or group resisted correction, aajiiqatigiingniq was used for censure, including the separation of an offender from the group.

[Elders] would let that person know that, ‘Look, we care about you. We love you. But unless you correct yourself, unless you really stop to think about your life, we’re done with you. It’s up to you to improve your life now.

Respectful, open, and trusted communication is essential

Group participants repeatedly emphasized the importance of respect in the aajiiqatigiingniq process to ensure all participating elders and community members felt welcome to offer opinions on a matter (Table 1; n = 14). “Everybody would have a chance to speak up,” explained one elder. “What he or she thinks is the best way to find a solution. The person who did wrong would be there among these people.” Participants said that during the aajiiqatigiingniq process, each person was given an equal opportunity to speak and each voice was given equal weight, including that of the people central to the concern. According to participants, coercion was not considered an issue: No one was forced to agree with a decision, but everyone was expected to respect a decision. “Whether you are agreeing with each other or not, that’s aajiiqatigiingniq,” said one elder, “to look for something together…thinking about something together.” Another participant explained it this way: “Whenever there is aajiiqatigiingniq, even if a person among the group did not agree with this group…that person would still be respected. This is just a disagreement.”

Similarly, open and trusted communication was critical to ensure the resolution reflected the “truth.” Participants spoke repeatedly of the need to get to “the real truth” and of those involved in an incident speaking openly to confess any wrongdoing or culpability. Explained one participant:

At the time, Inuit were very, very observant about who did what and who was the guilty party. We would try to find out the real facts and we would ask who said what at the time or who did what first and they would be corrected.

Many participants reflected on the contrast of this approach to the contemporary court system: “Today, whenever something is not right in the home or somewhere, we turn to the police officers rather than the elders, rather than someone who can help us to get rid of that bad feeling.” Another said, “Today we are run by the Qallunaat—the Western people…From that time, Inuit no longer arrange aajiiqatigiingniq.”

Key Discourse Elements

Discourse analysis exploring the treatment of themes by discourse type (i.e., narration, description, persuasion, argument, or exposition) provides a useful comparative window into the aajiiqatigiingniq process and helps to situate it in terms of rigor within a fuller research context. Table 2 reflects the number of references (dialogue) from three combined group meetings that support the findings with respect to discourse analysis.

Table 2.

Discourse Type Used in Dialogue (Three Groups Combined).

	A: Argumentative	B: Description	C: Expository	D: Narrative	E: Persuasive
Number of references (dialogue)	10	6	29	59	24

Narrative is by far the dominant discourse type

Analysis of group data revealed that interactions among elders and other senior community members in discussions about aajiiqatigiingniq most frequently took the form of storytelling (Table 2; n = 59). Narration, recounting personal experiences or the experiences of family members, was often used to establish and situate individual perceptions concerning what aajiiqatigiingniq involves. This reflects the Inuit-held view that personal narratives derived from experience are significant as evidence, whereas personal opinions not grounded in real experiences carry less weight. Meanwhile, fact-focused discourse types such as exposition was often used to share foundational information about the concept, process, and practice of aajiiqatigiingniq. Meanwhile, description using words, phrases, and sensory images to evoke a sense of experience about the subject matter was the least frequent fact-focused discourse type. Discourse types that situated individual participants in relation to the collective by either urging group adoption of a position (persuasive discourse) or posing a challenge to the group (argumentative discourse) were present in group interactions but the former was used more often used than the latter. Overall, narrative discourse type was dominant. This was followed by exposition and persuasive discourse types that were used about half as often as the dominant discourse type, and these in turn, were followed by argumentative discourse, which was little used, and descriptive discourse, which was employed even less. This holds with the IQ perspective that direct conflict should be avoided and group harmony sought at all times (Tagalik, 2015).

Personal engagement by the consensus group members is a hallmark

Participants in this study began to identify their collective effort to find consensus concerning a description of aajiiqatigiingniq as an exercise in aajiiqatigiingniq itself. A recurring phenomenon in discussions was the use of first-person accounts by elders. This approach to the discourse ensured the subject position of participants was to be personally engaged in the resolution or healing rather than simply assuming the role of dispassionate arbiters. The process of aajiiqatigiingniq requires that all participants make a commitment to the implementation of the solution. This is also seen as a requirement for the principle of pijitsirniq and the way one serves others and the common good. The result was the suggestion that any consensus resolution would likely involve not simply the person who is the focus of a concern but the elders involved in aajiiqatigiingniq healing process themselves.

The consensus reaching appears less structurally formal, unhurried

While the initial methodological design for this study sought to formalize the group meetings and interview process (e.g., ensuring the structural inclusion of anonymity, iteration, controlled feedback, statistical group response, and structured interaction), the groups (with facilitation by the Inuk research team member) developed in a manner that appeared to obscure these formal structural features, leaving them not readily identifiable through a typical Western epistemological lens. The result was a group consensus process that appeared to be structurally less formal but nevertheless appeared to retain a deep sense of authority and fairness without the strictures of formal consensus demanded by the scientific literature. Sharing by participants was uninterrupted; if there was uncertainty if a participant had finished speaking, the facilitator asked for confirmation. Group participants almost universally spoke reverentially about the process, and none raised concerns about the difficult-to-discern (from a Western perspective) structure of the interaction. One consequence of this was the appearance that the aajiiqatigiingniq process as a consensus approach required significant time and could not be hurried. As an IQ process, it is always to be respectful, reflective, and iteratively seeking improvements. The view is always grounded in the value of seeking solutions that will serve the collective well into the future.

Discussion

The core guiding principles of IQ can each be described as a cultural process that helps to establish positive social systems. These concepts include pilimmaqsarniq—a process for becoming skilled in order to give back to community; piliriqatigiingniq—a process for working collaboratively for shared outcomes; qanuqtuurunnarniq—a process for developing deep and innovative thinking; inuuqatigiitsiarniq—a process for being in respectful relationship with others; pijitsirniq—a process for compassion and meeting the needs of others; tunnganarniq—a process for creating an open, inclusive, and welcoming society; avatimik kamattiarniq—a process for sustainable social/environmental stewardship; and aajiiqatigiingniq—a process for addressing shared issues through consensus to ensure well-being and harmony. These ways of being were instilled through a process called inunnguiniq—making capable human beings. Taken together they are a very holistic and tightly interwoven worldview and system of governance (Tagalik, 2009–2012).

We describe and characterize the IQ principle of aajiiqatigiingniq as an Indigenous methodology. Aajiiqatigiingniq is focused on personal and collective well-being and healing (McGrath, 2005; Tagalik, 2012). Western consensus approaches—especially, the nominal group consensus process—have been used in Arctic health research to successfully incorporate Indigenous knowledge (Chatwood et al., 2015). Some have successfully incorporated Inuit belief and cultural preferences into research (Healey et al., 2016). However, the importance of using wholly Inuit methodologies to address Inuit-relevant health information is increasingly recognized (Tagalik, 2012). This is particularly true in circumstances relevant to mental health and wellness in which cultural bias can result in misinterpretations of health data (Nelson, 2012). Characteristics of the aajiiqatigiingniq process captured in this analysis include the following: (1) an ultimate focus on individual and community well-being; (2) a systematic approach that successively adds members, increasing group size and authority (i.e., parents followed by extended family followed by elders followed, ultimately, by the inclusion of a shaman/respected healer), until consensus is achieved; (3) a requirement of respectful communication; (4) a reliance on narrative discourse; (5) a participant subject position that situates group members as personally engaged within the consensus healing process; and (6) a meeting style that appears structurally informal and unrestricted by time limits.

These characteristics mirror other accounts and understandings of the aajiiqatigiingniq process. Many of its underlying features are best expressed in Inuktitut because the terms are densely defined and resist single word translations into English: “[T]he concepts which are self-evident in the Indigenous language can never be captured by another language” (Smith, 1999). For instance, aajiiqatigiingniq has been previously described by elders as essential to suvuliqsuqtuq or the role of the collective in ensuring a person will have a good future. That is, aajiiqatigiingniq is an approach for restoring harmony to the individual and group when faced with a threat of disruption. The purpose of the aajiiqatigiingniq system is to ensure inuutsiangniq, or wellness, has continual support from the community. Inherent in the process are the concepts of applying a collective wisdom to address a situation and current needs and isumaliuqatijiitsinirningma—or making decisions together in the Inuit way. It also includes aaqiksuiqatigiit (fixing together), uqamanggatigiit (talking together), and aivaqatigiit (arguing together/discussing heavily).

Our findings suggest the discourse used in ajiiqatigiingniq is characterized by a slow, narrative, respectful communication style in keeping with the Inuit tradition of ikajuqtigiinniq or cooperating to help each other. The mode of decision-making in this sense avoids inutuujjingginniq—being individualistic—but rather relies on the collective wisdom, or silatuuniq. The process also assumes that participants rely on naalangniq—respectful listening in the right relationship—and that they participate in a spirit that is inummariktituuqtuq or reflective of Inuit core values and beliefs (McGrath, 2011). Importantly, the process is both methodical and unhurried: Aajiiqatigiingniq is closely related to paningniq tuavijinirlua—the notion of carefully planning without rushing—and to niqiqainnarniq, or securing a change or new way (McGrath, 2011; Tagalik, 2012). As a cultural system, aajiiqatigiingniq is a careful and thoughtful process used to seek solutions at the individual, family, and community level.

In health research, consensus methods are defined as “a systematic means for measuring and developing consensus” (Humphrey-Murto et al., 2017, p. 14). In principle, these methods find legitimacy in the idea that assessing answers to research questions finds improved accuracy and reliability through a group consensus involving a panel of experts (Campbell et al., 2001; Humphrey-Murto et al., 2017). Formal consensus group methods benefit from the range of knowledge and experience provided by experts, while the capacity of multiple experts to challenge and stimulate new ideas lends credibility to the result (Murphy et al., 1998). Typically, however, consensus group methods in health research are thought to be distinguishable from informal group meetings by their systematic inclusion of key features, such as anonymity, iteration, controlled feedback, statistical group response, and structured interaction (Humphrey-Murto et al., 2017). In the case of Inuit consensus using the process of aajiiqatigiingniq, this definition may be culturally restrictive. While aajiiqatigiingniq shares a reliance on experts/elders that lends legitimacy to the process, other features of the approach appear to differ. While participants were clear in their assessment of aajiiqatigiingniq as authoritative, rigorous, and credible, the source of this understanding does not seem to be the same as it is in the case of Western consensus approaches.

Conclusion

This qualitative study provides a descriptive account of a facilitated wholly Inuit consensus methodology for qualitative health research based on group meetings and semi-structured interviews with elders and other senior community members. Aajiiqatigiingniq is described as a cultural process for consensus building and solution seeking. This article situates aajiiqatigiingniq as an appropriate Inuit consensus methodology for Wellness Court research. Developing research approaches that are ethical and respectful of Indigenous communities is critical (Stern & Stevenson, 2006). Efforts are gaining momentum in the development of “collaborative” methodologies and engaging communities using ethical guidelines, respectful of Indigenous concepts of community and networks of relationships. Indigenous researchers are participants in these relationships that “extend beyond the research relationship” (Smith, 1999, p. 15), and Indigenous methodologies are based on cultural practices, beliefs, and ways of being that are integral to research methodology (Smith, 1999). The epistemological foundations of Indigenous research require a deep understanding of language, belief-based methodologies, and conceptual understanding of cultural terminology. This study provides a preliminary description of aajiiqatigiingniq as an Inuit research methodology that suggests similarities but also differences from Western approaches to consensus. Further research is needed to better understand these characteristics and to begin to comprehend the nature of cultural differences in consensus approaches.