Applications of Two-Eyed Seeing in Primary Research Focused on Indigenous Health: A Scoping Review

Abstract

Mi’kmaq Elder Albert Marshall coined “Two-Eyed Seeing” in 2004, an Indigenous concept that emphasizes integrating the strengths of multiple perspectives to address complex challenges in ways that benefit all. In 2011, Two-Eyed Seeing became a policy of the Canadian Institutes of Health Research (CIHR)–Institute of Aboriginal Peoples’ Health, as a part of its 5-year plan, and in 2012, CIHR funding was directed toward supporting efforts that apply the concept of Two-Eyed Seeing to research. However, little is known about how Two-Eyed Seeing has been operationalized in research. To address this ambiguity, a scoping review was conducted to map the key concepts involved when researchers intend to follow Two-Eyed Seeing guiding principles to study Indigenous health topics. Three research questions guided this scoping review: (1) What are the general characteristics (e.g., location of study, health topic studied) of primary research that has attempted to apply Two-Eyed Seeing when studying Indigenous health topics? (2) How did researchers operationalize the concept of Two-Eyed Seeing when they applied it to primary studies regarding Indigenous health topics? and (3) What process-related elements were present in Two-Eyed Seeing studies that accomplished their objectives? The results of this scoping review indicate there is an increasing trend in Two-Eyed Seeing–related peer-reviewed publications since its formal introduction by Mi’kmaq Elder Albert Marshall. The selected Two-Eyed Seeing–related projects were predominately conducted in Canada and published between 2011 and 2019. Projects predominately incorporated a community-based (participatory) research approach and qualitative/Indigenous methods, and six core process–related themes/elements were identified: (i) power was shared, (ii) culturally safe spaces were fostered, (iii) institutional and community ethics were followed, (iv) research projects were transformative, (v) rigor was maintained, and (vi) the structure of Western academia and traditional policy decision-making processes provided challenges for research teams and community partners, respectively.

Keywords

methods in qualitative inquiry narrative research ethical inquiry community-based research PAR—participatory action research action research social justice emancipatory research

Introduction

Positionality

Positionality statements intend to promote transparency throughout the research process via acknowledging the beliefs, political stance, and cultural background (e.g., gender, race, class, socioeconomic status, educational background) of the researcher(s) involved in a study, which impact how each researcher conducts themselves (Bourke, 2014).

I (first author) am a male settler here in North America, where I was predominately immersed in competitive academic and athletic social milieus of Western mainstream culture, and thus, I have Western biases. My motivation for this article stems from when I tried to navigate two new and different worldviews simultaneously (Western science and Indigenous ways of knowing) in my first year of a masters program and realized the challenging, polarizing, and counterintuitive nature, such a task can encompass (often inherently expected of Indigenous students and scholars within Western institutions). While navigating such an experience will be different for everyone, learning how other people have been able to navigate this task when conducting research could have been of immense help to me, and I hope this work can help others who are in the midst of navigating (or preparing to navigate) the complexities that exist when Western ways of knowing and Indigenous ways of knowing engage each other.

The three coauthors include two non-Indigenous scholars with over 25 years of collective experience working in respectful collaboration with Indigenous peoples, and a Haudenosaunee researcher who is a member of the Six Nations of the Grand River and has extensive experience conducting community-based epidemiology and health services research. All three worked with the first author as members of his masters committee and collectively offer their respect and honor to the Anishinaabe communities and territory where they currently live and work with their family. The two non-Indigenous scholars also acknowledge that while being experienced in community-driven research with Indigenous communities, they are situated within a Western scientific position and respect the validity of Indigenous ways of knowing.

This work was conducted on the traditional territory of the Atikameksheng Anishnawbek First Nation in the Robinson Huron Treaty territory of 1850. We hope the insights from this article are helpful to others who are interested in conducting respectful and meaningful cross-cultural health research with Indigenous peoples/communities, especially fellow (Indigenous and non-Indigenous) graduate students. Furthermore, this article informs future researchers about an approach to research that is dedicated to ethically engage in reconciliatory efforts with Indigenous peoples in Canada (and beyond) in ways that support the self-determination of Indigenous peoples and benefit us all.

Background—Two-Eyed Seeing

Two-Eyed Seeing and its guiding principles were introduced by Mi’kmaq Elder Albert Marshall in 2004 and strove to assist an integrative science co-learning journey at Cape Breton University (IISH website, n.d.). Two-Eyed Seeing stemmed from a teaching of the late Mi’kmaq spiritual leader, healer, and chief, Charles Labrador of Acadia First Nation, Nova Scotia, where he said: “Go into a forest, you see the birch, maple, pine. Look underground and all those trees are holding hands. We as people must do the same” (Bartlett et al., 2012). In turn, Albert coined Two-Eyed Seeing (and its guiding principles) to encourage the “it’s us” mentality of the trees in the above teaching and bring the strengths of different worldviews together for a better and healthier world for all (Bartlett et al., 2012). Importantly, Two-Eyed Seeing is not inherently a research methodology but rather a profound guiding principle that encourages self-reflection and emphasizes the transformational capacity of knowledge (Benoit et al., 2019).

Spread and Acceptance of Two-Eyed Seeing in Canada

At the national level, Two-Eyed Seeing became a policy of the Canadian Institutes of Health Research (CIHR) within the Institute of Aboriginal Peoples’ Health (IAPH; now called the Institute of Indigenous People’s Health) in its 5-year plan published in 2011 (Institute of Health Economics, 2011). Two-Eyed Seeing was further supported by IAPH/CIHR in 2012 with the establishment of a research funding opportunity to support research projects applying the concept of Two-Eyed Seeing to studies regarding Indigenous health (IAPH Newsletter, 2012; IISH Website, n.d.). Also in 2012, Debbie Martin introduced the concept of Two-Eyed Seeing and its guiding principles as a promising approach/theoretical framework for research into Indigenous health, capable of enhancing research/er’s ability to understand and address the health concerns of Indigenous peoples (D. H. Martin, 2012). Since 2012, Two-Eyed Seeing has been noted to be cited in journals of health research, qualitative research, outdoor learning programs, environmental justice, and knowledge transfer/exchange in environmental studies (Cook, 2018, p. 36).

Western Research Involving Indigenous Peoples

Two-Eyed Seeing represents a promising approach for research projects involving Indigenous peoples because research involving Indigenous peoples has a history of at times being colonial in nature, intentionally and unintentionally being used to perpetuate control over or disempower Indigenous peoples (Cochran et al., 2008; Denzin & Lincoln, 2008; Dodson, 1994; King et al., 2009; Simonds & Christopher, 2013; Smith, 2013). Traditionally, when research has investigated Indigenous health topics, non-Indigenous understandings of health (i.e., biomedical model; focused on disease and treatment) were often used to make sense of the phenomenon under study, rather than Indigenous notions of health (i.e., promoting wholistic health and well-being; King et al., 2009). The methods used to conduct health research in Indigenous communities have also, at times, resembled a “helicopter” approach, where researchers arrive in a community, collect information with minimal community interaction, return to their university, and publish the information in scientific journals that are not accessible to Indigenous community members (Smylie et al., 2004). Further, when Western research has involved Indigenous peoples, it has historically focused on the negative aspects of their social processes (Ermine et al., 2004) and often resulted in presenting Indigenous health as a problem; contributing to negative stereotypes that reinforce internalized racism (Denzin & Lincoln, 2008; Kovach, 2010; Simonds & Christopher, 2013).

Recent Changes to Western Research Methods

Dating back to about 40 years ago, there has been a shift in Western research involving Indigenous peoples toward participatory and community-based research (Castleden et al., 2012). Such shifts in Western research practices toward participatory and community-based research have striven to challenge unethical mainstream research approaches and promote more respectful and meaningful relationships between Western researchers and Indigenous peoples/communities (Castleden et al., 2012), usually occurring at the level of process or methodology (Cochran et al., 2008). Still, further calls have been made to address the epistemological roots that can permit Western research/ers to oppress other ways of knowing (Cochran et al., 2008). Two-Eyed Seeing offers an approach that can respect Western ways of knowing, while addressing the epistemological roots that can permit Western research/ers to oppress other ways of knowing, through its intentional acknowledgment, validation, and inclusion of Indigenous ways of knowing.

Ethical Space

To avoid “jagged worldviews colliding” (Little Bear, 2000) when interweaving two different worldviews/cultures into a research project, it is important to affirm what Poole (1972) calls an “Ethical Space” and set boundaries that reinforce ethical conduct for the two worldviews to come together in a harmonious way that benefits all (Ermine, 2007). An Ethical Space exists when two or more people - with different perspectives/intentions - engage each other (Poole, 1972). Affirming the existence of an Ethical Space represents an opportunity to cultivate a neutral zone between contrasting worldviews or cultures; and requires each contrasting worldview/culture to acknowledge the existence of human diversity that results from philosophical and cultural differences (Ermine, 2007). Affirming the existence of human diversity and Ethical Space is essential to facilitate an ethical dialogue between Western ways of knowing and Indigenous ways of knowing. Affirming the existence of Ethical Space helps to ensure Two-Eyed Seeing is carried out in a way that is culturally safe, promotes Indigenous health, and works to reduce disparities (Vukic et al., 2012). To date, however, little work has been conducted to provide clarity on how to operationalize Two-Eyed Seeing and the different considerations needed to apply Two-Eyed Seeing in research projects investigating Indigenous health.

Method

Research Objectives

The objective of this scoping review was to explore how Two-Eyed Seeing has been applied to research investigating the health of Indigenous peoples. Three subquestions were used to guide this exploration: (1) What are the general characteristics (e.g., location of study, health topic studied, date of publication, etc.) of primary research that has attempted to apply Two-Eyed Seeing when studying Indigenous health topics? (2) How did researchers operationalize the concept of Two-Eyed Seeing when they applied it to primary studies regarding Indigenous health topics? and (3) What process-related elements were present in Two-Eyed Seeing studies that accomplished their objectives?

Scoping Review Methodology

A scoping review methodology was selected to guide this study because it is considered appropriate for areas of research where evidence is emerging or complex, or the depth of evidence is relatively unknown, such as the area of how researchers operationalize Two-Eyed Seeing guiding principles in primary research focused on Indigenous health topics (Arksey & O’Malley, 2005; Levac et al., 2010; Longboat, 2008; Styres et al., 2010). Arksey and O’Malley’s (2005) five-step scoping review methodology - enhanced by Levac et al. (2010) - and Braun et al.’s (2019) six-step approach to conducting a reflexive thematic analysis were used to accomplish the objectives of this study (Arksey & O’Malley, 2005; Braun et al., 2019; Levac et al., 2010).

Identifying Relevant Studies (Search Strategy)

The search strategy for this scoping review consisted of three parts: (a) a forward and backward citation chaining of three influential Two-Eyed Seeing–related papers; (b) a search in three indexed databases that include a focus on studying human health—MEDLINE (Ovid), CINAHL, and Dissertations & Theses (ProQuest); and (c) a search of CIHR-funded research projects in the CIHR database.

Citation Chaining Introduction of Key Papers and Search Process

The three influential Two-Eyed Seeing–related papers, used as the source for the forward and backward citation chaining, included (1) Two-Eyed Seeing and other lessons learned within a co-learning journey of bringing together Indigenous and mainstream knowledge and ways of knowing (Bartlett et al., 2012), (2) Two-Eyed Seeing: A framework for understanding Indigenous and non-Indigenous approaches to Indigenous health research (D. H. Martin, 2012), and (3) The ethical space of engagement (Ermine, 2007). Google Scholar was used to identify the forward citations of each key paper. Google Scholar was also used to locate the backward citations referenced in each of the three manuscripts.

Database Search Processes

The search strategy applied to the three indexed databases included only one search string that included variations of the “Two-Eyed Seeing” phrase (“two-eyed seeing” or “two eyed seeing” or “two-eyed-seeing” or “2 eyed seeing” or “2-eyed seeing” or “2-eyed-seeing” or “2 eyed-seeing”).

A two-step process was required to identify relevant studies when searching CHIR’s “funding decisions” database: (a) searching CIHR’s funding decisions database to identify relevant CIHR-funded projects and (b) searching for publications that are associated with the identified CIHR-funded projects. For the first step, the phrase “Two Eyed Seeing” was used to search CIHR’s database of CIHR-funded research projects. For each funded project that was identified, a keyword(s) from the project title and at least one of the leading investigators’ name(s) were searched in Google Scholar to see which projects have published results of their work at the time of the search (May 29, 2019). The criteria for identifying publications from the CIHR-funded projects included (a) date of publication must be after the date a project received their CIHR’s funding decision, (b) at least one of the authors of the publication must be an investigator involved in the CIHR-funded project, (c) title of publications must be related to the title of the CIHR-funded project (identified when searching “Two Eyed Seeing” in the CIHR’s funding decisions database), and (d) the author(s) explicitly acknowledged a CIHR grant supported the research effort. Publications had to meet all four requirements of the inclusion criteria to be considered in the “selecting relevant sources” process within this study. Google Scholar was searched using keywords related to the CIHR-funded projects and the projects’ investigators, until a full page of results did not include a publication with any of the project’s lead investigators’ names.

Managing, Cleaning, and Preparing the Identified Source Documents

Zotero (a reference management software, version 5.0.84) was used to manage the source documents that were identified as relevant for this study and remove duplicates.

Selecting Relevant Information Sources

An inclusion and exclusion criteria were used to select relevant information sources identified from the citation-chaining process, the CIHR’s “funding decision database,” and the three indexed databases. The inclusion and exclusion criteria were applied to the unique sources through a three-stage process. The three stages were (a) a title assessment, (b) an abstract assessment, and (c) a full-text assessment.

For the title evaluation, a source’s title had to indicate a focus on Indigenous human health and be predominately written in English to be included. Study protocols or literature reviews were excluded. For the title evaluation, the World Health Organization’s (WHO) definition of health, “a state of complete, physical, mental, and social well-being, and not merely the absence of disease or infirmity” (WHO, 1948), shaped the scope of “Indigenous human health.” In turn, studies regarding the physical, mental, and/or social well-being of Indigenous peoples were included in the abstract evaluation stage.

Abstracts were evaluated using two inclusion criteria: (a) the research conducted a primary study and (b) the research was guided by Indigenous knowledges and Western science. Papers needed to explicitly state both Indigenous and Western ways of knowing informed the study, and be a primary study, to be included in the full-text evaluation stage of the selection process. All studies that met the inclusion criteria for the abstract evaluation stage were included in the full-text evaluation stage.

The inclusion criterion for the full-text evaluation required sources to explicitly state they intend to follow Two-Eyed Seeing guiding principles. Sources that explicitly stated they intend to create an Ethical Space when integrating Western and Indigenous ways of knowing, without explicitly stating they intend to follow Two-Eyed Seeing guiding principles were also included as such intentions follow Ermine’s (2007) principles and resemble Two-Eyed Seeing guiding principles.

Charting the Data

For sources that met the title evaluation’s inclusion/exclusion criteria, the year of the document’s publication was recorded and inputted in the Excel sheet that was being used to organize all the identified sources. Descriptive analysis was applied to the sources’ year of publication to calculate annual publication frequencies and gain insight into the trend of Two-Eyed Seeing–related papers being published by researchers conducting primary studies focused on topics regarding Indigenous peoples’ health.

Ten data items were used to record relevant information from the sources that met all of the inclusion criteria, including (a) year the study was published, (b) geographical location of study, (c) type of document (e.g., thesis manuscript, academic journal article), (d) field of health research, (e) health outcome studied, (f) objective(s) of the study, (g) study design, (h) method(s) used when applying/following Two-Eyed Seeing principles, (i) funding sources, and (j) achievement of study objectives. The information recorded from this data charting form intended to describe general characteristics of the primary studies that intended to follow Two-Eyed Seeing guiding principles when researching topics regarding Indigenous peoples’ health. Quantitative analysis was applied to the results to aid in summarizing the included studies’ general characteristics.

Thematic Analysis

Qualitative thematic analysis helps to make sense of the extracted data from the data charting forms (Levac et al., 2010), and Braun et al.’s (2019) six-step method for conducting a “reflexive” thematic analysis was used in this study. The approach taken for this thematic analysis was inductive in nature, shaped by the research question: “What process-related elements were present in Two-Eyed Seeing studies that accomplish their objectives?” Further, the semantic nature of the included text sources was used to construct the codes [instead of using the text’s underlying (i.e., latent) meaning] to prioritize the experience/perspectives of the researchers who conducted a Two-Eyed Seeing–related primary study.

Reflexivity

To add credibility to this scoping review’s findings, I wrote down my reflective thoughts that pertained to how I (my interpretations and/or subsequent choices) may be influencing the study’s findings and how my positionality may be impacting such interpretations and/or choices (Jootun et al., 2009). This practice was conducted during each step of Braun et al.’s (2019) six step reflexive thematic analysis approach, to actively minimize the risk of bias unintentionally influencing the results.

Results

After applying the search strategy, 658 unique source documents were identified; 111 documents met the inclusion criteria for the title evaluation stage, 41 documents met the inclusion criteria for the abstract evaluation stage, and a total of 38 source documents were retained for quantitative and thematic analysis (see Figure 1).

Figure 1.

Search strategy flow diagram.

There is an increasing trend of Two-Eyed Seeing–related peer-reviewed publications (shown in Figure 2). From the 38 retained source documents, several of the papers described the same research project (Bird-Naytowhow et al., 2017; Castleden et al., 2016, 2017; Hatala et al., 2019; Hovey et al., 2014, 2017; Maar et al., 2013, 2016; Marsh et al., 2015; Marsh, Cote-Meek, et al., 2016; Marsh, Young, et al., 2016; Wakewich et al., 2016; Wood et al., 2014; Wright, 2019; Wright et al., 2019a, 2019b; Zehbe et al., 2011, 2012, 2017; Zehbe, Jackson, et al., 2016; Zehbe, Wakewich, et al., 2016; Zehbe, Wood, et al., 2016). Thus, a total of 22 independent research projects were described by these 38 manuscripts. Of the 22 research projects, all of the projects had either accomplished their stated objectives for the study or appeared on pace to [the conference paper].

Figure 2.

Title evaluation stage—results.

General Characteristics

From the 22 research projects, 1 was conducted with a Yawuru community (in Australia), 3 were conducted with Inuit communities living in NunatuKavut, and the remaining 18 projects were conducted with First Nations communities from across Canada. Geographically and population-wise, 2 research projects were conducted with communities in remote settings, 9 projects were conducted with communities in rural settings, and 10 projects were conducted with communities in urban settings.

Operationalization of Two-Eyed Seeing (and/or Ethical Space)

Five types of study designs were identified as being used in the 22 research projects: (i) descriptive case studies were used in 15 projects, (ii) descriptive case series were used in 4 projects, (iii) a retrospective cohort study was used in 1 project, (iv) a prospective cohort study was used in 1 project, and (v) a cluster/community randomized control trial was in 1 project.

Twenty-one of the 22 independent projects stated they undertook either a participatory and/or a community-based approach. The only project that did not explicitly state or indicate their project was guided by a community-based or participatory approach was led by a researcher who is from the community that was involved in the study, has clinical and personal experience with the study phenomenon, and implemented decolonizing methodologies paired with Two-Eyed Seeing (Cook, 2018).

Of research teams following Two-Eyed Seeing guiding principles, 5 research projects solely intended to create an Ethical Space throughout the research project, 11 research projects solely intended to follow a Two-Eyed Seeing approach, and 6 projects intended to follow a Two-Eyed Seeing approach and create an Ethical Space throughout the study.

Most research teams took steps to adhere to ethical protocols before initiating the study, including obtaining approval for the proposed study from university- and community-level health research ethics authorities, obtaining approval/support from a community partner’s Chief and Council, and/or establishing a local advisory group to guide the research process. Provincial/territorial approval was also required in research projects conducted in Nunavut and Labrador (NunatuKavut). Commonly mentioned ethical guidelines/policies/teachings included, TCPS2 (Chapter 9), CIHR Guidelines for Research involving Aboriginal Peoples, OCAP^TM principles, Kirkness and Barnhardt’s 4 R’s, and teachings that were local to the community partners (e.g., Seven Grandfather Teachings during a project involving an Anishinaabe community and IQ principles during a project involving an Inuit community).

Five types of sampling strategies were identified from the 22 research projects: (a) purposive sampling was solely used in 11 projects, (b) snowball sampling was solely used in 2 projects, (c) convenience sampling was solely used in 1 project, (d) purposive and snowball sampling were used together in 4 projects, and (e) a combination of purposive, snowball, and theoretical sampling was used in 2 projects. Two projects’ sampling techniques were unspecified. A community member, the community partner(s), and/or advisory council members informed, guided, carried an active role, or were fully responsible for recruiting participants in the 22 projects.

To collect data, 16 research projects used solely qualitative methods, 5 projects used both qualitative and quantitative methods, and 1 research project solely used quantitative methods. Of the 5 mixed-methods research projects, 3 projects applied the qualitative and quantitative methods in a “convergent” and/or “transformative” manner throughout the study, and 2 projects applied the mixed methods in a “sequential” manner (i.e., one after the other).

Fifteen of the 22 research project’s source documents did not mention details regarding the research team’s dissemination strategy/activities. Of the 15 projects that did not mention specific dissemination activities, 3 projects indicated that the dissemination strategy was/will be determined collaboratively or through consensus decision-making with the community partners, 1 research project indicated that they will seek the community’s Chief and Council’s permission/approval to disseminate the study’s findings, and 1 project was mobilized to address a community concern. Regarding the seven research projects that outlined a dissemination strategy, five were (or planned to be) collaboratively determined with the community partner(s), and the other two research projects included a local component and an academic component.

Process-Related Elements of Two-Eyed Seeing Studies That Accomplished Their Objectives (Thematic Analysis)

A total of six core themes were identified from the thematic analysis: (A) Power was negotiated/shared between the research team and community partners/participants, (B) culturally safe spaces were fostered, (C) the research teams followed both community and academic ethics, (D) research projects were transformative, (E) rigor of Western research processes was maintained, and (F) the structure of Western academia provided difficulty for research teams, and traditional policy practices provided difficulties for community partners. All six core themes are shown in Figure 3 and expanded upon further in this section. In this thematic analysis section, the references that support each finding are displayed in Table 1.

Figure 3.

Thematic analysis results: core themes.

Table 1.

Citations of Each Finding in the Results Section.

Note	Theme	Subtheme	Finding	Citations
1	Power sharing	Before the research is implemented	Consulting respected community members regarding a proposed study topic’s relevance for the community or the research topic was responding to a community concern	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hatala et al. (2019), Hovey et al. (2014), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
2			(Co-)establishing or recruiting a type of local advisory group, of respected/knowledgeable/relevant community members, to guide/inform the research process	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2017), Hatala et al. (2019), Hovey et al. (2017), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh et al. (2015), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
3			Seeking/obtaining permission/approval/support from local leadership and/or community partners to conduct the study	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hatala et al. (2019), Hovey et al. (2014), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
4			Codeveloping a formal research agreement(s)/set of principles to guide the negotiation/establishment of study objectives, processes, and products	Bird-Naytowhow et al. (2017), Castleden et al. (2016), D. E. Martin et al. (2017), Ryan (2016), Vukic et al. (2016), and Zehbe et al. (2012)
5		During research implementation	(Indigenous) qualitative (narrative or oral/story-based) methods implemented by the research teams worked to mitigate power imbalances between participants and the researchers—promoting more egalitarian, collaborative, and/or empowering dynamics with participants	Benoit et al. (2019), Bird-Naytowhow et al. (2017), Castleden et al. (2017), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), D. E. Martin et al. (2017), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Whitty-Rogers et al. (2016), Wright (2019), and Yap and Yu (2016)
6			Community partner(s) and/or participants taking active roles throughout the research process	Benoit et al. (2017, 2019), Bird-Naytowhow et al. (2017), Carter et al. (2017), Castleden et al. (2017), Hovey et al. (2014), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wood et al. (2014), Wright (2019), and Yap and Yu (2016)
7			Participants, co-community-based researchers, and/or the local advisory group were provided the opportunity to ensure findings were representative of the participants’ experience/the local context	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2017), Hatala et al. (2019), Hovey et al. (2014), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2017)
8		After research implementation	Community members who contributed to the research process/findings were given an opportunity to be/receive credit as coauthors	Benoit et al. (2019), Vukic et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2017)
9			Several projects explicitly mentioned how community partners actively participated in guiding dissemination efforts	Castleden et al. (2016), Knudson et al. (2018), MacDonald et al. (2015), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Ryan (2016), Vukic et al. (2016), Wood et al. (2014), and Wright (2019)
10	Fostering culture safety	Within relationships between the research team and community partners	The research team either had preestablished or developed new relationships with the community partner(s) prior to initiating the study and throughout the study	Benoit et al. (2017, 2019), Bird-Naytowhow et al. (2017), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hovey et al. (2014), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), and Zehbe et al. (2012)
11			Researchers often engaged in reflexivity, and grad students were supported/guided by a culturally competent, safe, and supportive supervisor(s)	Benoit et al. (2019), Bird-Naytowhow et al. (2017), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hovey et al. (2014, 2017), Ley (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), and Wright (2019)
12			Researchers often participated in activities within the community	Bird-Naytowhow et al. (2017), Castleden et al. (2016), Cook (2018), Knudson et al. (2018), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Whitty-Rogers et al. (2016), Wright (2019), and Zehbe et al. (2012)
13			Elders/respected community members were sought for guidance	Benoit et al. (2017, 2019), Bird-Naytowhow et al. (2017), Carter et al. (2017), Castleden et al. (2016), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
14		Within the research process	(Local) cultural protocols/methods (e.g., offering tobacco, smudging, traditional feasts, opening/closing prayers, Haudenosaunee consensus building, carrying out interviews in Anishinaabemowin, visions) were purposefully (not) incorporated into the research process, guided by Indigenous team members/knowledge holders/keepers	Benoit et al. (2017, 2019), Bird-Naytowhow et al. (2017), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hovey et al. (2017), Knudson et al. (2018), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), and Wright (2019)
15			Research teams and community partners predominately indicated that they incorporated a strengths-based approach into the project	Benoit et al. (2019), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hatala et al. (2019), Hovey et al. (2017), Knudson et al. (2018), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), and Yap and Yu (2016)
16			When research teams used Western paradigms/methodologies for the research projects, they were philosophically congruent with Indigenous ways of knowing	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2016), Cook (2018), Hatala et al. (2019), Hovey et al. (2017), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Wakewich et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), and Yap and Yu (2016)
17			Research teams practiced collaborative/consensus decision-making with coresearchers and community partners, and open dialogue was often promoted/sustained throughout the research process	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2016), Hatala et al. (2019), Hovey et al. (2017), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
18			The research teams were (plan to be—regarding the incomplete project) responsive to or led by the community partners’ and/or participants’ priorities, concerns, and/or suggestions	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2016), Hatala et al. (2019), Hovey et al. (2017), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
19	Community and academic ethics	Community ethics	Awareness of treaty territory, inclusion of relevant community/ies, being guided by relevant elders and knowledge holders/keepers, establishing an advisory council with relevant elders/knowledge holders/keepers, obtaining approval/support from Chief and Council (local political leadership), and/or adhering to local teachings (e.g., Anishinaabe Seven Grandfather teachings, and Inuit IQ principles) were ways the research team adhered to community ethics	Bird-Naytowhow et al. (2017), Castleden et al. (2016), Knudson et al. (2018), Ley (2015), Marsh, Cote-Meek, et al. (2016), Marsh, Young, et al. (2016), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Wright (2019), and Zehbe et al. (2012)
20		Academic ethics	Obtaining university-(research institute) level ethics/study approval, adhering to relevant articles within Chapter 9 of TCPS2, obtaining oral and/or written consent forms from participants prior to initiating the study, ensuring participants’ confidentiality/privacy was respected throughout the research project, ensuring participants’ data were stored securely, and discussing how findings related to the existing knowledge present in the academic literature were common ways that the research teams adhered to institutional ethics	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2016), Hatala et al. (2019), Hovey et al. (2014), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh, Cote-Meek, et al. (2016), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Robbins et al. (2017), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2012)
21	Research projects = transformative	Researchers	Hovey et al. (2017) noted that their research teams’ perspectives were transformed through an authentic engagement with Two-Eyed Seeing and explained it as a “fusion of horizons”	Hovey et al. (2017)
22		Community	Research teams provided opportunities for community partners/coresearchers to build capacity throughout the research project	Benoit et al. (2017, 2019), Bird-Naytowhow et al. (2017), Vukic et al. (2016), Wood et al. (2014), and Wright (2019)
23			Several research teams selected an intervention and/or data collection method(s) that were inherently transformative or specifically designed to encourage healing processes such as sharing circles, led by an elder	Benoit et al. (2019), Bird-Naytowhow et al. (2017), Knudson et al. (2018), Marsh et al. (2015), Rand (2016), Ryan (2016), and Vukic et al. (2016)
24a–d		Community and policy/practice/program	Research teams tailored dissemination strategies in several ways to benefit or “give back” to community/ies including multipronged strategies to address policies, program, and practices^24a; hosting traditional feasts and presenting study results^24b; producing oral documentaries of elders’ experiences/histories as potential teaching resources for the community^24c; and maintaining relationships with community partners to develop dissemination strategies that are deemed to be relevant by them^24d	24a: Wood et al. (2014) 24b: Webkamigad (2017) 24c: Castleden et al. (2016) and D. E. Martin et al. (2017) 24d: Knudson et al. (2018) and Wright (2019)
25		Policy/practice/program	Several research teams identified that including political leadership in the research process and dissemination efforts was important for research teams striving to enhance policies, practice, and/or programs	Castleden et al. (2017), Ryan (2016), and Wood et al. (2014)
26	Rigor was maintained	Research methods	Research projects often conducted data collection and data analysis processes iteratively and inductively, where initial analysis findings were either confirmed or enhanced from subsequent data collection processes	Castleden et al. (2016), Hatala et al. (2019), Vukic et al. (2016), Whitty-Rogers et al. (2016), Wood et al. (2014), and Wright (2019), and Yap and Yu (2016)
27		Research process	A research team also provided detailed descriptions of the research context and processes to support the research projects’ dependability and confirmability²⁷	Vukic et al. (2016)
28			Participants and local knowledge holders were involved in the research methods (e.g., co-data analysis, participant/local advisory council validation) to ensure the findings were representative of the community’s/participants’ experiences²⁸	Benoit et al. (2017, 2019), Carter et al. (2017), Castleden et al. (2017), Hatala et al. (2019), Hovey et al. (2017), Knudson et al. (2018), Ley (2015), MacDonald et al. (2015), Marsh et al. (2015), D. E. Martin et al. (2017), D. H. Martin et al. (2018), Rand (2016), Ryan (2016), Vukic et al. (2016), Webkamigad (2017), Whitty-Rogers et al. (2016), Wright (2019), Yap and Yu (2016), and Zehbe et al. (2017)
29a and 29b	Concerns related to Western academia and traditional policy practices	Research funding	The funding system used to finance research projects was specifically identified as insufficient for supporting a research project that entailed multisite pre-research engagement meetings.^29a Additionally, the funding system used to finance research projects was identified as insufficient for supporting a research project that entailed extensive engagement throughout the research; for example, this research project received funding that was restricted to a single year, whereas the process of including the community in the research process extended to 18 months^29b	29a: Zehbe et al. (2012)
29a and 29b		Research funding		29b: Vukic et al. (2016)
30		Reward system	When considering the “reward system” of granting agencies, Zehbe et al. (2012) noted that granting agencies’ emphasis on peer-reviewed publications insidiously penalizes community-based researchers who engage in the time- and resource-intensive activities required to conduct community-based research and thus have less time to generate peer-reviewed publications³⁰	Zehbe et al. (2012)
31		Traditional policy practices	Regarding traditional policy practices, a community partner in one of the research projects questioned the usefulness of Two-Eyed Seeing in research, if Indigenous perspectives will continue to be excluded from influencing policy decisions that impact Indigenous communities³¹	D. E. Martin et al. (2017)

Theme 1: Power was negotiated/shared between the research team and community partners/participants

In all 22 research projects, efforts were made to share/negotiate power between the research team and community partner(s) and/or participants, and the method for determining how power was to be shared often occurred before designing or initiating the study. Methods of power sharing identified from the 22 research projects include: consulting respected community members regarding a proposed study topic's relevance for the community and/or the tailoring a project's research topic so that it responds to a community concern¹; (co-)establishing or recruiting a type of local advisory group, of respected/knowledgable/relevant community members, to guide/inform the research process²; seeking/obtaining permission/approval/support from local leadership and/or community partners to conduct the study³; codeveloping a formal research agreement(s)/set of principles to guide the negotiation/establishment of study objectives, processes, and products⁴; (Indigenous) qualitative (narrative or oral/story-based) methods implemented by the research teams worked to mitigate power imbalances between participants and the researchers—promoting more egalitarian, collaborative, and/or empowering dynamics with participants⁵; community partner(s) and/or participants taking active roles throughout the research process⁶; participants, co-community-based researchers, and/or the local advisory group were provided the opportunity to ensure findings were representative of the participants’ experience/the local context⁷; community members who contributed to the research process/findings were given an opportunity to be/receive credit as coauthors⁸; and several projects explicitly mentioned how community partners actively participated in guiding dissemination efforts.⁹

Theme 2: Culturally safe spaces were fostered

For the 22 research projects, a common practice was to tailor research processes to local contexts, perspectives, and norms. Several factors contributed to these efforts: the research team either had pre-established or developed new relationships with the community partner(s) prior to initiating the study and throughout the study¹⁰; researchers often engaged in reflexivity, and grad students were supported/guided by a culturally competent, safe, and supportive supervisor(s)¹¹; researchers often participated in activities within the community¹²; elders/respected community members were sought for guidance¹³; (local) cultural protocols/methods (e.g., offering tobacco, smudging, traditional feasts, opening/closing prayers, Haudenosaunee consensus building, carrying out interviews in Anishinaabemowin, visions) were purposefully (not) incorporated into the research process, guided by Indigenous team members/knowledge holders/keepers¹⁴; research teams and community partners predominately indicated that they incorporated a strengths-based approach into the project¹⁵; when research teams used Western paradigms/methodologies for the research projects, they were philosophically congruent with Indigenous ways of knowing¹⁶; research teams practiced collaborative/consensus decision-making with coresearchers and community partners, and open dialogue was often promoted/sustained throughout the research process¹⁷; and the research teams were responsive to or led by the community partners’ and/or participants’ priorities, concerns, and/or suggestions.¹⁸

Theme 3: The research teams followed both institutional/academic and community ethics

Awareness of treaty territory, inclusion of relevant community/ies, being guided by relevant elders and knowledge holders/keepers, establishing an advisory council with relevant elders/knowledge holders/keepers, obtaining approval/support from Chief and Council (local political leadership), and/or adhering to local teachings (e.g., Anishinaabe Seven Grandfather teachings and Inuit IQ principles) were ways the research team adhered to community ethics.¹⁹ Obtaining university- (research institute) level ethics/study approval, adhering to relevant articles within Chapter 9 of TCPS2, obtaining oral and/or written consent forms from participants prior to initiating the study, ensuring participants’ confidentiality/privacy was respected throughout the research project, ensuring participants’ data were stored securely, and discussing how findings related to the existing knowledge present in the academic literature were common ways the research teams adhered to institutional ethics.²⁰

Theme 4: Research projects were transformative

A number of the research projects were found to be transformative at different levels, including researchers’ perspectives, community partners’ capacity, and participants’ well-being. Research projects were also identified as being transformative through efforts to enhance policies, programs, and/or practices in a way that benefited community/ies and community members. Hovey et al. (2017) noted that their research teams’ perspectives were transformed through an authentic engagement with Two-Eyed Seeing and explained it as a “fusion of horizons.”²¹ Research teams provided opportunities for community partners/coresearchers to build capacity throughout the research project,²² and several research teams selected an intervention and/or data collection method(s) that were inherently transformative or specifically designed to encourage healing processes such as sharing circles, led by an elder.²³ Research teams tailored dissemination strategies in several ways to benefit or “give back” to community/ies including multipronged strategies to address policies, program, and practices^24a; hosting traditional feasts and presenting study results^24b; producing oral documentaries of elders’ experiences/histories as potential teaching resources for the community^24c; and maintaining relationships with community partners to develop dissemination strategies that are deemed as relevant for them.^24d Notably, several research teams identified that including political leadership in the research process and dissemination efforts was important for research teams striving to enhance policies, practices, and/or programs.²⁵

Theme 5: Rigor of Western research processes was maintained

Research teams maintained rigor throughout the research process in a variety of ways. Triangulation of data collection methods and/or researchers was a common approach used by the 22 research teams. Research projects often conducted data collection and data analysis processes iteratively and inductively, where initial analysis findings were either confirmed or enhanced from subsequent data collection processes.²⁶ A research team also provided detailed descriptions of the research context and processes to support the research projects’ dependability and confirmability.²⁷ Further, participants and local knowledge holders were included to ensure the findings were representative of the community’s/participants’ experiences,²⁸ contributing to the rigor of these cross-cultural research projects.

Theme 6: The structure of Western academia provided difficulties for research teams and traditional policy practices provided difficulties for community partners

Several research teams noted that the funding system used to finance research projects (e.g., single-year funding) and the “reward system” that is used to recognize researchers’ merit was not conducive to community-based (participatory) research. One community also highlighted a concern regarding traditional policy decision-making practices.

The funding system used to finance research projects was specifically identified as insufficient for supporting a research project that entailed multisite pre-research engagement meetings.^29a Additionally, the funding system used to finance research projects was identified as insufficient for supporting a research project that entailed extensive engagement throughout the research; for example, this research project received funding that was restricted to a single year, whereas the process of including the community in the research process extended to 18 months.^29b When considering the reward system of granting agencies, Zehbe et al. (2012) noted that granting agencies’ emphasis on peer-reviewed publications insidiously penalizes community-based researchers who engage in the time- and resource-intensive activities required to conduct community-based research and thus have less time to generate peer-reviewed publications.³⁰ Finally, regarding traditional policy decision-making practices, a community partner in one of the research projects questioned the usefulness of Two-Eyed Seeing in research, if Indigenous perspectives will continue to be excluded from influencing policy decisions that impact Indigenous communities.³¹ In summary, there were a total of 6 core themes and 15 subthemes, shown together in Figure 4.

Figure 4.

Thematic analysis results: core themes and subthemes

Discussion

There is an increasing trend of Two-Eyed Seeing–related peer-reviewed publications. Yet Two-Eyed Seeing’s application in health research has not been assessed or discussed in detail (Wingert & White, 2017). After conducting an integrative review to identify defining characteristics, required attributes, and core components of Two-Eyed Seeing, Wright et al. (2019a, 2019b) highlighted a lack of consistency in how Two-Eyed Seeing is being applied to research. For example, Two-Eyed Seeing, where they highlighted a lack of consistency in how Two-Eyed Seeing is being applied to research as Two-Eyed Seeing has been conceptualized as a framework, a model, a theory, an ethical protocol, and a set of guiding principles, often used interchangeably (Wright, 2019). Results from this scoping review support Wright et al.'s (2019a, 2019b) finding, as Two-Eyed Seeing was conceptualized as a strengths-based approach, an approach to respectfully collaborate with Indigenous worldviews and an approach to integrate perspectives that are different from mainstream to list a few. Wright et al. (2019a, 2019b) also propose a conceptualization of Two-Eyed Seeing in research. However, the inconsistency with how Two-Eyed Seeing has been viewed by researchers to date may be because Two-Eyed Seeing is not inherently a research methodology (Benoit et al., 2019) and was initially developed for science educational curricula (IISH website, n.d.; Wright, 2019). This lack of clarity regarding the concept of Two-Eyed Seeing in research indicates that there is a low value of conducting a systematic review of Two-Eyed Seeing research at the moment as the uncertainty regarding Two-Eyed Seeing in research will limit a systematic review’s ability to critically appraise research approaches that claim to operationalize it.

Nineteen of the 22 research projects operationalized Two-Eyed Seeing and/or Ethical Space through a descriptive case study/series design that incorporated a participatory and/or community-based approach and qualitative/Indigenous methods. The majority of studies being descriptive in nature may be an indicator that a limited amount of research has been conducted with Indigenous communities in each of the fields/research topics studied, and/or each project required an explorative/inductive nature instead of a confirmatory/deductive approach. The descriptive/exploratory/inductive approach may also be more appropriate for developing relationships between academic and community researchers/partners than an experimental/confirmatory/deductive approach as it allows for more flexibility and greater involvement of the community partners when developing the research focus, study design, and methods.

The common types of study designs and research approaches identified in this review are aligned with Ermine et al.’s (2004) characterization of research with Indigenous populations: “primarily qualitative, participatory, collaborative, and community-based” (p.13). Community-based (participatory) approaches to research have the potential to decolonize research through fostering more equitable relationships between Indigenous community members and researchers (Darroch & Giles, 2014) and promote empowerment, inclusivity, and respect of Indigenous epistemology and Indigenous peoples (Ermine et al., 2004). Qualitative approaches, including the use of Indigenous methods (and thus Indigenous epistemologies), were incorporated into the research projects to honor Indigenous oral traditions and have been identified as “an important component of research in Aboriginal communities” (Maar et al., 2011). Numerous research teams noted qualitative/Indigenous methods’ capacity to shift the power balance between the researchers and participants toward a more egalitarian/collaborative/empowering/healing dynamic (Benoit et al., 2019; Bird-Naytowhow et al., 2017; Castleden et al., 2017; Knudson et al., 2018; Ley, 2015; MacDonald et al., 2015; D. E. Martin et al., 2017; Robbins et al., 2017; Ryan, 2016; Vukic et al., 2016; Whitty-Rogers et al., 2016; Wright, 2019; Yap & Yu, 2016).

Each research team collaborated with the community/ies involved to recruit participants in a nonprobability manner, where the community/ies often led the recruitment to connect researchers with potential participants they were confident could provide rich and insightful responses to the research question(s). The involvement of communities (and their leaders) in the recruitment of participants was noted to have strengthened the research projects by several research teams (Ley, 2015; Vukic et al., 2016; Wood et al., 2014). This supports suggestions for communities to lead/play a role in recruiting participants within research projects with Indigenous communities (Maar et al., 2011). One research team learned that their community partner preferred to lead participant recruitment, as it would allow their community to nominate the voices that would represent their community (Carter et al., 2017).

It was noted that 11 research projects intended to follow a Two-Eyed Seeing approach without explicitly affirming the existence of an Ethical Space with the community partners and/or participants throughout their research efforts. While research teams may have affirmed an Ethical Space with community partners intuitively when striving to follow Two-Eyed Seeing guiding principles, the distinction between the concept of Ethical Space and Two-Eyed Seeing is an important one. Academic researchers who do not intentionally affirm an Ethical Space when working with Indigenous community partners/seeking to include Indigenous perspectives into a research project may be at greater risk of causing harm, especially if the researchers are non-Indigenous.

The research projects indicated multiple ethical standards needed to be met during the projects, a Western/institutional ethical standard and the ethical standards of the Indigenous community partners. Bird-Naytowhow et al. (2017) summarized their experiences as Western ethics required the research team to adhere to university ethics and protocols (e.g., signing consent forms and anonymity) and considering the findings within the context of existing knowledge present in the academic literature; whereas, the Indigenous perspective was more concerned with how the research processes were carried out and the why/intentions behind the actions and exchanges with youth (participants/coresearchers) and community partners (Bird-Naytowhow et al., 2017). Several research teams emphasized the importance of research projects involving Indigenous communities/peoples to be guided by an elder or knowledge holder/keeper; someone who can ensure proper cultural protocols are respected throughout the research process (e.g., Knudson et al., 2018). One research team specifically emphasized that elders must be involved if the research is to be based on Aboriginal knowledge (Marsh et al., 2015, p. 5). Altogether, the research teams presented mixed reviews regarding their attempts to incorporate cultural practices into the research project. For example, during a research project in an urban city in Northeastern Ontario, offering tobacco to participants was noted as a practice that enhanced the study’s relevance for the community partners (Webkamigad, 2017); alternatively, during another study in an urban city in Southern Ontario, Indigenous advisors decided against offering tobacco and cloth since not all of the urban-dwelling Indigenous participants have strong ties to Indigenous traditions and may not understand or appreciate its symbolic meaning (Wright, 2019). These nuanced findings indicate the importance of (local) Indigenous knowledge holders leading the incorporation of cultural protocols within a research project. Ermine (2007) defines ethics as “the capacity to know what harms or enhances the well-being of sentient creatures”. Understanding community ethics will enhance a research team’s capacity to know what harms or enhances the well-being of community partners; increasing their chances of successfully cultivating an ethical Ethical Space and following Two-Eyed Seeing guiding principles in a way that is culturally safe, promotes Indigenous health, and works to reduce disparities.

Most research teams worked with the participants themselves, or the advisory council guiding the research process, to validate the preliminary findings from the participants’ responses to the research questions. Several research teams emphasized the importance of including a participant validation/member checking step or process in cross-cultural research projects that are facilitated by researchers who do not have Indigenous lived experience because of its ability to ensure that findings are relevant and meaningful for the participants and community partners (Maar et al., 2013; Vukic et al., 2016; Wright, 2019).

Additionally, there appeared to be a discrepancy between the number of projects that carried out a participatory and/or community-based research approach and the number of research teams who appeared to collaboratively develop their dissemination strategies with the community partners. Twenty-two (100%) of the 22 research projects indicated that a participatory and/or community-based research approach guided the research team, however only 11 (50%) of those projects indicated that a community-based (participatory) approach was used to develop the project’s dissemination strategy (9 research projects indicated a collaborative approach was taken and 2 research projects indicated their dissemination strategy either sought Chief and Council’s permission or was designed to address the community concern that initiated the project). Further, of the 22 projects, only 7 research teams explicitly shared details regarding the dissemination activities they intend to take or have already taken (with exception of evidently publishing the details of their study). Such a discrepancy and void may be due to several factors including: word limits on journal articles, limited time frames, resources for researchers/community partners to complete the project, and/or academic norms that believe a project is over once the collected data has been analyzed, summarized, discussed in relation to existing academic literature, and shared/published.

Limitations

While steps were taken to strengthen the rigor of this scoping review, the generalizability of these results is potentially limited due to several findings: (i) a void of Metis/Métis communities in the assessed research projects, (ii) limited number of projects that included Inuit communities and remote communities, and (iii) a void of projects in five Canadian provinces/territories including Alberta, New Brunswick, Northwest Territories, Yukon Territory, and Prince Edward Island. Still, this study embodies several strengths: (a) it demonstrates an increasing trend in Two-Eyed Seeing–related papers, (b) it provides insights into the ways that research teams have operationalized the concept of Two-Eyed Seeing and/or Ethical Space in their research projects, and (c) it provides insights into the process-related elements present in research projects that accomplished their objectives when striving to operationalize the concept of Two-Eyed Seeing and/or Ethical Space.

Conclusion

Twenty-two projects were identified to have met the inclusion criteria for this scoping review regarding Two-Eyed Seeing primary studies of Indigenous health topics. Most studies operationalized the concept of Two-Eyed Seeing in the form of descriptive case studies that embody community-based (participatory) principles and implemented qualitative methods that were grounded either in Indigenous epistemologies or in Western ontologies/epistemologies/methodologies that are philosophically congruent with Indigenous epistemologies. Six themes were identified from the 22 research projects: (1) Power was negotiated/shared between the research team and community partners/participants, (2) culturally safe spaces were fostered, (3) the research teams followed both institutional/academic and community ethics, (4) research projects were transformative, (5) rigor of Western research processes was maintained, and (6) the structure of Western academia provided difficulties for research teams, and traditional policy practices provided difficulty for community partners. These six themes offer insights that can support researchers who are interested in conceptualizing and/or applying the concept of Two-Eyed Seeing in research. Ultimately, this scoping review aimed to identify process-related elements associated with Two-Eyed Seeing–related research projects and inform future research efforts that intend to follow Two-Eyed Seeing guiding principles.

Supplemental Material

Supplemental_Material - Applications of Two-Eyed Seeing in Primary Research Focused on Indigenous Health: A Scoping Review

Supplemental_Material for Applications of Two-Eyed Seeing in Primary Research Focused on Indigenous Health: A Scoping Review by Andrew Forbes, Stephen Ritchie, Jennifer Walker and Nancy Young in International Journal of Qualitative Methods

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Andrew Forbes

Supplemental Material

The supplemental material for this article is available online.

References

Arksey

O’Malley

(2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32.

Bartlett

Marshall

(2012). Two-Eyed Seeing and other lessons learned within a co-learning journey of bringing together Indigenous and mainstream knowledges and ways of knowing. Journal of Environmental Studies and Sciences, 2(4), 331–340.

Benoit

A. C.

Cotnam

O’Brien-Teengs

Greene

Beaver

Zoccole

Loutfy

(2019). Racism experiences of urban Indigenous women in Ontario, Canada: “We all have that story that will break your heart.” International Indigenous Policy Journal, 10(2), 1–27.

Benoit

A. C.

Younger

Beaver

Jackson

Loutfy

Masching

Nobis

Nowgesic

O’Brien-Teengs

Whitebird

(2017). Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada. Canadian Journal of Public Health, 108(2), e169–e175.

Bird-Naytowhow

Hatala

A. R.

Pearl

Judge

Sjoblom

(2017). Ceremonies of relationship: Engaging urban Indigenous youth in community-based research. International Journal of Qualitative Methods, 16(1), https://doi.org/1609406917707899

Bourke

(2014). Positionality: Reflecting on the research process. The Qualitative Report, 19(33), 1–9.

Braun

Clarke

Hayfield

Terry

(2019). Thematic analysis. In Liamputtong

(Ed.), Handbook of research methods in health social sciences (pp. 843–860). Springer.

Carter

Lapum

Lavallée

Schindel Martin

Restoule

J.-P.

(2017). Urban First Nations men: Narratives of positive identity and implications for culturally safe care. Journal of Transcultural Nursing, 28(5), 445–454.

Castleden

Bennett

Lewis

Martin

(2017). “Put it near the Indians”: Indigenous perspectives on pulp mill contaminants in their traditional territories (Pictou Landing First Nation, Canada). Progress in Community Health Partnerships: Research, Education, and Action, 11(1), 25–33.

10.

Castleden

Lewis

Jamieson

Gibson

Rainham

Russell

Martin

Hart

(2016). “Our ancestors are in our land, water, and air”: A Two-Eyed Seeing approach to researching environmental health concerns with Pictou Landing First Nation. http://www.heclab.com/wp-content/uploads/2018/01/PLFNReport2016.pdf

11.

Castleden

Morgan

V. S.

Lamb

(2012). “I spent the first year drinking tea”: Exploring Canadian university researchers’ perspectives on community-based participatory research involving Indigenous peoples. The Canadian Geographer/Le Géographe Canadien, 56(2), 160–179.

12.

Cochran

P. A.

Marshall

C. A.

Garcia-Downing

Kendall

Cook

McCubbin

Gover

R. M. S.

(2008). Indigenous ways of knowing: Implications for participatory research and community. American Journal of Public Health, 98(1), 22–27.

13.

Cook

(2018). Misipawistik Cree Nation caregivers’ experiences of a family member requiring renal replacement therapy in The Pas, Manitoba: A descriptive qualitative study. https://mspace.lib.umanitoba.ca/bitstream/handle/1993/33399/Cook_Crystal.pdf?sequence=1

14.

Darroch

Giles

(2014). Decolonizing health research: Community-based participatory research and postcolonial feminist theory. The Canadian Journal of Action Research, 15(3), 22–36.

15.

Denzin

N. K.

Lincoln

Y. S.

(2008). The landscape of qualitative research (Vol. 1). Sage.

16.

Dodson

(1994). The wentworth lecture the end in the beginning: Re(de)finding aboriginality. Australian Aboriginal Studies, 1, 2.

17.

Ermine

(2007). The ethical space of engagement. Indigenous Law Journal, 6, 193.

18.

Ermine

Sinclair

Jeffery

(2004). The ethics of research involving Indigenous peoples. Indigenous Peoples’ Health Research Centre.

19.

Hatala

A. R.

Morton

Njeze

Bird-Naytowhow

Pearl

(2019). Re-imagining miyo-wicehtowin: Human-nature relations, land-making, and wellness among Indigenous youth in a Canadian urban context. Social Science & Medicine, 230, 122–130.

20.

Hovey

R. B.

Delorimer

McComber

A. M.

(2014). Social-relational understandings of health and well-being from an Indigenous perspective. International Journal of Indigenous Health, 10(1), 35–54.

21.

Hovey

R. B.

Delorimer

McComber

A. M.

Lévesque

Martin

(2017). Enhancing Indigenous health promotion research through Two-Eyed Seeing: A hermeneutic relational process. Qualitative Health Research, 27(9), 1278–1287.

22.

Institute of Aboriginal Peoples’ Health Newsletter—December 2012.pdf. (n.d.). http://www.integrativescience.ca/uploads/files/IAPH%20Newsletter%20-%20December%202012.pdf

23.

IISH Website. (n.d.). Two-Eyed Seeing. Retrieved June 14, 2019, from http://www.integrativescience.ca/Principles/TwoEyedSeeing/

24.

Institute of Health Economics. (2011). About the Aboriginal peoples’ wellness in Canada: Scaling up the knowledge roundtable. Retrieved June 15, 2019, from https://www.ihe.ca/events/past/conferences/aboriginal/aboriginal-about

25.

Jootun

McGhee

Marland

G. R.

(2009). Reflexivity: Promoting rigour in qualitative research. Nursing Standard (through 2013), 23(23), 42.

26.

King

Smith

Gracey

(2009). Indigenous health part 2: The underlying causes of the health gap. The Lancet, 374(9683), 76–85.

27.

Knudson

Bird-Naytowhow

Pearl

T. B.

(2018). “Well-healthy relationships”: Using Indigenous approaches to support relationship formation for persons with disabilities. 3rd World Conference on Qualitative Research, 1. https://proceedings.wcqr.info/index.php/wcqr2019/article/view/168/168

28.

Kovach

(2010). Indigenous methodologies: Characteristics, conversations, and contexts. University of Toronto Press.

29.

Levac

Colquhoun

O’Brien

K. K.

(2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69.

30.

Ley

(2015). “It’s in the tough times you see who the vulnerable people really are”: The perceived health influences of hydroelectric development along the lower Churchill River among Nunatukavut adults in Labrador, Canada (PhD Thesis). https://dalspace.library.dal.ca/bitstream/handle/10222/60360/LEY-MARISSA-MA-HPRO-JUNE-29-2015.pdf?sequence=3

31.

Little Bear

(2000). Jagged worldviews colliding. In Battiste

(Ed.), Reclaiming indigenous voice and vision (pp. 77–85). UBC Press.

32.

Longboat

(2008). Ethical space in the intellectual terrain: A cultural perspective. Canadian Journal of Native Education, 31(1), 72.

33.

Maar

Burchell

Little

Ogilvie

Severini

Yang

J. M.

Zehbe

(2013). A qualitative study of provider perspectives of structural barriers to cervical cancer screening among First Nations women. Women’s Health Issues, 23(5), e319–e325.

34.

Maar

Lightfoot

N. E.

Sutherland

M. E.

Strasser

R. P.

Wilson

K. J.

Lidstone-Jones

C. M.

Graham

D. G.

Beaudin

Daybutch

G. A.

Dokis

B. R.

(2011). Thinking outside the box: Aboriginal people’s suggestions for conducting health studies with Aboriginal communities. Public Health, 125(11), 747–753.

35.

Maar

Wakewich

Wood

Severini

Little

Burchell

A. N.

Ogilvie

Zehbe

(2016). Strategies for increasing cervical cancer screening amongst First Nations communities in Northwest Ontario, Canada. Health Care for Women International, 37(4), 478–495.

36.

MacDonald

Martin-Misener

Steenbeek

Browne

(2015). Honouring stories: Mi’kmaq women’s experiences with pap screening in Eastern Canada. CJNR (Canadian Journal of Nursing Research), 47(1), 72–96.

37.

Marsh

T. N.

Cote-Meek

Toulouse

Najavits

L. M.

Young

N. L.

(2015). The application of two-eyed seeing decolonizing methodology in qualitative and quantitative research for the treatment of intergenerational trauma and substance use disorders. International Journal of Qualitative Methods, 14(5), https://doi.org/10.1177/1609406915618046.

38.

Marsh

T. N.

Cote-Meek

Young

N. L.

Najavits

L. M.

Toulouse

(2016). Indigenous healing and seeking safety: A blended implementation project for intergenerational trauma and substance use disorders. The International Indigenous Policy Journal, 7(2), 3.

39.

Marsh

T. N.

Young

N. L.

Cote-Meek

Najavits

L. M.

Toulouse

(2016). Impact of indigenous healing and seeking safety on intergenerational trauma and substance use in an Aboriginal sample. Journal of Addiction Research & Therapy, 7(3), 284. https://doi.org/10.4172/2155-6105.1000284

40.

Martin

D. E.

Thompson

Ballard

Linton

(2017). Two-Eyed Seeing in research and its absence in policy: Little Saskatchewan First Nation Elders’ experiences of the 2011 flood and forced displacement. The International Indigenous Policy Journal, 8(4), 6.

41.

Martin

D. H.

(2012). Two-Eyed Seeing: A framework for understanding Indigenous and non-Indigenous approaches to Indigenous health research. CJNR (Canadian Journal of Nursing Research), 44(2), 20–42.

42.

Martin

D. H.

McNally

Castleden

Worden-Driscoll

Clarke

Wall

Ley

(2018). Linking Inuit knowledge and public health for improved child and youth oral health in NunatuKavut. JDR Clinical & Translational Research, 3(3), 256–263.

43.

Poole

(1972). Toward deep subjectivity. Harper & Row.

44.

Rand

J. R.

(2016). Inuit women’s stories of strength: Informing Inuit community-based HIV and STI prevention and sexual health promotion programming. International Journal of Circumpolar Health, 75(1), 32135.

45.

Robbins

Linds

Ironstand

Goodpipe

(2017). Generating and sustaining positive spaces: Reflections on an indigenous youth urban arts program. AlterNative: An International Journal of Indigenous Peoples, 13(3), 161–169.

46.

Ryan

(2016). Positive aging: Indigenous peoples aging with HIV/AIDS (PhD Thesis). https://macsphere.mcmaster.ca/bitstream/11375/20496/2/Ryan_Chaneesa_R_2016August_MasterofArtsHealthandAging.pdf

47.

Simonds

V. W.

Christopher

(2013). Adapting Western research methods to Indigenous ways of knowing. American Journal of Public Health, 103(12), 2185–2192.

48.

Smith

L. T.

(2013). Decolonizing methodologies: Research and Indigenous peoples. Zed Books.

49.

Smylie

Kaplan-Myrth

Tait

Martin

C. M.

Chartrand

Hogg

Tugwell

Valaskakis

Macaulay

A. C.

(2004). Health sciences research and Aboriginal communities: Pathway or pitfall? Journal of Obstetrics and Gynaecology Canada, 26(3), 211–216.

50.

Styres

Zinga

Bennett

Bomberry

(2010). Walking in two worlds: Engaging the space between Indigenous community and academia. Canadian Journal of Education, 33(3), 617–648.

51.

Vukic

Gregory

Martin-Misener

(2012). Indigenous health research: Theoretical and methodological perspectives. CJNR (Canadian Journal of Nursing Research), 44(2), 146–161.

52.

Vukic

Gregory

Martin-Misener

Etowa

(2016). Perspectives for conducting Indigenous qualitative research from a project exploring Mi’kmaw youth mental health. Journal of Ethnographic & Qualitative Research, 10(3), 209–229.

53.

Wakewich

Wood

Davey

Laframboise

Zehbe

Group

(2016). Colonial legacy and the experience of First Nations women in cervical cancer screening: A Canadian multi-community study. Critical Public Health, 26(4), 368–380.

54.

Webkamigad

(2017). Developing dementia health promotion materials for Indigenous people in an urban Northern Ontario community (PhD Thesis). Laurentian University of Sudbury.

55.

Whitty-Rogers

Caine

Cameron

(2016). Aboriginal women’s experiences with gestational diabetes mellitus. Advances in Nursing Science, 39(2), 181–198.

56.

Wingert

White

J. P.

(2017). Introduction to the special issue: Reconciling research: Perspectives on research involving Indigenous peoples. The International Indigenous Policy Journal, 8(2), 10.

57.

Wood

Burchell

A. N.

Escott

Little

Maar

Ogilvie

Severini

Bishop

Morriseau

Zehbe

(2014). Using community engagement to inform and implement a community-randomized controlled trial in the Anishinaabek cervical cancer screening study. Frontiers in Oncology, 4, 27.

58.

World Health Organization. (1948). Constitution of the World Health Organization. Retrieved June 30, 2019, from https://www.who.int/about/who-we-are/constitution

59.

Wright

A. L.

(2019). How urban-dwelling Indigenous mothers experience selecting and using health care to meet the health needs of their infants (PhD Thesis). https://macsphere.mcmaster.ca/bitstream/11375/23844/2/wright_Amy_L_finalsubmission2019Jan_degree.pdf

60.

Wright

A. L.

Jack

S. M.

Ballantyne

Gabel

Bomberry

Wahoush

(2019a). How indigenous mothers experience selecting and using early childhood development services to care for their infants. International Journal of Qualitative Studies on Health and Well-Being, 14, 1601486.

61.

Wright

A. L.

Jack

S. M.

Ballantyne

Gabel

Bomberry

Wahoush

(2019b). Indigenous mothers’ experiences of using primary care in Hamilton, Ontario, for their infants. International Journal of Qualitative Studies on Health and Well-Being, 14(1), 1600940.

62.

Yap

(2016). Operationalising the capability approach: Developing culturally relevant indicators of Indigenous wellbeing—An Australian example. Oxford Development Studies, 44(3), 315–331.

63.

Zehbe

Jackson

Wood

Weaver

Escott

Severini

Krajden

Bishop

Morrisseau

Ogilvie

Burchell

A. N.

(2016). Community-randomised controlled trial embedded in the Anishinaabek Cervical Cancer Screening Study: Human papillomavirus self-sampling versus Papanicolaou cytology. BMJ Open, 6(10), e011754.

64.

Zehbe

Maar

Nahwegahbow

A. J.

Berst

K. S.

Pintar

(2012). Ethical space for a sensitive research topic: Engaging First Nations women in the development of culturally safe human papillomavirus screening. International Journal of Indigenous Health, 8(1), 41–50.

65.

Zehbe

Moeller

Severini

Weaver

Escott

Bell

Crawford

Bannon

Paavola

(2011). Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: A pilot study. BMJ Open, 1(1), e000030.

66.

Zehbe

Wakewich

King

A.-D.

Morrisseau

Tuck

(2017). Self-administered versus provider-directed sampling in the Anishinaabek Cervical Cancer Screening Study (ACCSS): A qualitative investigation with Canadian First Nations women. BMJ Open, 7(8), e017384.

67.

Zehbe

Wakewich

Wood

Sameshima

Banning

Little

, & ACCSS Group. (2016). Engaging Canadian First Nations women in cervical screening through education. International Journal of Health Promotion and Education, 54(5), 255–264.

68.

Zehbe

Wood

Wakewich

Maar

Escott

Jumah

Little

, & ACCSS Group. (2016). Teaching tools to engage Anishinaabek First nations women in cervical cancer screening: Report of an educational workshop. Health Education Journal, 75(3), 331–342.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.48 MB