In the face of negative media attention, community members and Elders from the First Nation community of Maskwacis identified the importance of promoting community strengths and reframing perceptions of their community. Two research questions were addressed: (1) How do youth in Maskwacis view their community strengths? and (2) To what extent can photographs be used as a tool for reframing perceptions of an Indigenous community? A community-based participatory research approach was used for the current photovoice project, through which two Elders and eleven youth were engaged. Indigenous photographers trained youth participants, and Elders mentored youth to capture photographs that represented their community's strengths and resilience. Youth selected forty photos to display at a total of six photo exhibits, where feedback was gathered from 392 attendees using brief questionnaires. The content of their photos was analyzed using thematic analysis. This resulted in four themes that described the strengths of Maskwacis, reflecting the community's strong relationships, commitment to culture, the beautiful natural world that is a part of Maskwacis, and the community's ability to look toward the future. In addition, findings provide foundational support for the use of photographs to reframe perceptions of an Indigenous community. The majority (93%) of survey respondents provided examples of ways that viewing the photos had positively changed their perceptions of Maskwacis. This study prompts consideration of the strengths and resilience of other Indigenous communities facing similar social and health issues. Therefore, findings are highly relevant to paediatric health care providers seeking to provide culturally responsive care.

Background Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. MethodsMen and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. Findings The mean INTERHEART risk score of all communities was 17•2 (SE 0•2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0•0001). Socioeconomic advantage (-1•4 score, 95% CI -2•5 to -0•3; p=0•01), trust between neighbours (-0•7, -1•2 to -0•3; p=0•003), higher education level (-1•9, -2•9 to -0•8, p<0•001), and higher social support (-1•1, -2•0 to -0•2; p=0•02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2•2, 0•3 to 4•1, p=0•02), taking prescription medication (3•5, 2•8 to 4•3; p<0•001), and inability to afford prescription medications (1•5, 0•5 to 2•6; p=0•003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. Interpretation Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing.

Information collected in the indigenous cohort will be used to assist communities to develop local management strategies for chronic disease, and can be used collectively to understand the contextual, environmental, socioeconomic, and biological determinants of differences in health status in harmony with First Nations beliefs and reality.

This qualitative study aimed to explore paediatric residents’ perceptions of the feasibility of incorporating preventive dental care into a general paediatric outreach clinic for a First Nations community. Four focus groups were conducted with paediatric residents and attending paediatricians. Interviews were recorded, transcribed verbatim and analysed using a basic interpretive qualitative approach. Three major themes emerged from the data: advantages of integration, barriers to integration and strategies for integration. Comprehensive care and service delivery were the two identified advantages of integration. Three categories of barriers emerged including patient and caregiver-related, resident-related and setting-related barriers. Training and practice, patient education, support and policy were the suggested strategies for successful integration. Providers were found to be open to integrating preventive dental care into their practice. However, barriers impeded the success of this integration. Multiple strategies including oral health care training for medical providers, office support and policy changes would facilitate successful integration.

To effectively support childhood vaccine programs for First Nations Peoples, Canada’s largest population of Indigenous Peoples, it is essential to understand the context, processes, and structures organizing vaccine access and uptake. Rather than assuming that solutions lie in compliance with current regulations, our aim was to identify opportunities for innovation by exploring the work that nurses and parents must do to have children vaccinated. In partnership with a large First Nations community, we used an institutional ethnography approach that included observing vaccination clinic appointments, interviewing individuals involved in childhood vaccinations, and reviewing documented vaccination processes and regulations (texts). We found that the ‘work’ nurses engage in to deliver childhood vaccines is highly regulated by standardized texts that prioritize discourses of safety and efficiency. Within the setting of nursing practice in a First Nations community, these regulations do not always support the best interests of families. Nurses and parents are caught between the desire to vaccinate multiple children and the requirement to follow institutionally authorized processes. The success of the vaccination program, when measured solely by the number of children who follow the vaccine schedule, does not take into consideration the challenges nurses encounter in the clinic or the work parents do to get their children vaccinated. Exploring new ways of approaching the processes could lead to increased vaccination uptake and satisfaction for parents and nurses.