Background: Aboriginal children experience challenges to their health and well-being, yet also have unique strengths. It has been difficult to accurately assess their health outcomes due to the lack of culturally relevant measures. The Aboriginal Children's Health and Well-Being Measure (ACHWM) was developed to address this gap. This paper describes the validity of the new measure. Methods: We recruited First Nations children from one First Nation reserve in Canada. Participants were asked to complete the ACHWM independently using a computer tablet. Participants also completed the PedsQL. The ACHWM total score and 4 Quadrant scores were expected to have a moderate correlation of between 0.4 and 0.6 with the parallel PedsQL total score, domains (scale scores), and summary scores.
PurposeThe aim of this research was to evaluate the reliability of the Aboriginal Children’s Health and Well-Being Measure© (ACHWM).MethodsTwo cohorts of children from Wiikwemkoong Unceded Territory were recruited for this study. Each child completed the ACHWM independently on a computer tablet running a customized survey app. The data from the first and second cohorts were used to estimate the internal consistencies using Cronbach’s alpha. A subgroup of the second cohort completed the survey twice, within the same day. The data from this subgroup was used to evaluate the test–retest reliability using a random effects Intra-class Correlation Coefficient (ICC).ResultsThere were 124 participants in the first cohort and 132 participants in the second cohort. The repeated measures subgroup was comprised of 29 participants from the second cohort. The internal consistency statistic (Cronbach’s alpha) was 0.93 for the first and second cohorts. The test–retest reliability ICC was 0.94 (95% CI 0.86–0.97) for the ACHWM summary scores based on the repeated measures subgroup.ConclusionsThese results establish the internal consistency and the test–retest validity of the ACHWM. This important finding will enable Aboriginal communities to use this measure with confidence and promote the voices of their children in reporting their health. The ACHWM is an essential data gathering tool that enables evidence-based health care for Aboriginal communities.
OBJECTIVES:The Aboriginal Children's Health and Well-Being Measure© (ACHWM) was developed to assess health from the perspectives of Aboriginal children. The purpose of this paper is to document the screening process, embedded within the ACHWM, and assess its effectiveness. METHODS:The ACHWM was implemented in 2014/2015 with children 8 to 18 years of age living on the Wiikwemkoong Unceded Territory. Survey responses were screened to identify potential risk, using an automated algorithm run on computer tablets. Local mental health workers conducted brief mental health assessments to identify and support children at-risk. Data were analyzed to estimate effectiveness of this screening process.RESULTS: A total of 293 children completed the ACHWM. The screening tool identified 35% with potential risk. Mental health workers confirmed 18% of all participants as being at-risk, and all were referred for support. The sensitivity of the tool was 75% while specificity was 79%. Improvements to the screening algorithm resulted in a specificity of 97% and negative predictive value of 95%, with no loss of sensitivity.CONCLUSION: Responsible population health surveys require a process to recognize and respond to answers indicative of health risks. This paper provides an example of a screening and triage process that enabled our survey team to screen responses in real time, respond to potential risk immediately, and connect participants to local support services. This process proved essential to conducting an ethical survey. The high specificity and negative predictive value make it an effective triage tool that is particularly valuable in Aboriginal communities and with higher-risk populations.KEY WORDS: Mental health; early medical intervention; child; adolescent; Indigenous population; surveys and questionnaires La traduction du résumé se trouve à la fin de l'article.
vidence-based health care is considered a gold standard for clinical practice, policy and planning, 1,2 but it is not yet an option for many Aboriginal communities in Canada. (Note that the term Aboriginal is used in this paper, rather than Indigenous, on the basis of guidance from the community-based Aboriginal Children's Health and Well-being Measure Advisory Committee. Aboriginal peoples include First Nations, Inuit and Métis.) First Nations health directors require local health data that extend beyond the biomedical. From their perspectives, the most meaningful data reflect First Nations models of health and are relevant to Aboriginal cultures and contexts. Decision-makers who are responsible for Aboriginal children's health are challenged when searching for relevant health statistics, because most available statistics are based on illness (e.g., rates of diabetes 3,4) rather than wellness. When health data are presented, the results are typically aggregated at the provincial or national level. 5 As a result, there is a critical absence of health data that are relevant at the local level. 6-8 While national and provincial data are helpful in identifying problems, this information is far less helpful in identifying solutions. Given that each Aboriginal population is distinct (culturally, politically and geographically), the assumption that decisions can be made on the basis of provincial or national estimates is inherently flawed. There have been several calls for solution-focused action to promote health among Aboriginal children in Canada. 9-12
Health solutions for Aboriginal children should be guided by their community and grounded in evidence. This manuscript presents a prospective cohort study protocol, designed by a community-university collaborative research team. The study’s goal is to determine whether community-based screening and triage lead to earlier identification of children’s emotional health needs, and to improved emotional health 1 year later, compared to the standard referral process. We are recruiting a community-based sample and a clinical sample of children (ages 8 to 18 years) within one Canadian First Nation. All participants will complete the Aboriginal Children’s Health and Well-being Measure (ACHWM)© and a brief triage assessment with a local mental health worker. All participants will be followed for 1 year. Children with newly identified health concerns will be immediately connected to local services, generating a new opportunity to improve health. The development of the research design and its execution were impacted by several events (e.g., disparate worldviews, loss of access to schools). This manuscript describes lessons learned that are important to guide future community-based research with First Nations people. The optimal research design in an Aboriginal context is one that responds directly to local decision makers’ needs and respectfully integrates Aboriginal ways of knowing with Western scientific principles. Such an approach is critical because it will generate meaningful results that will be rapidly adopted, thus reducing the knowledge-to-action gap.
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