BackgroundThis paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges.MethodsTwenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi’s (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled ‘hope against hope.’ResultsThe journal entries highlighted: the caregivers’ hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and ‘hope against hope’ describes how hope persists even when there is no hope for a cure.ConclusionsThis research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.

To minimize these adverse experiences, nurses can support parents' ability to keep hope possible and thus to optimize their well-being by understanding, assessing, and supporting parental hope.

The importance of hope in the participants' lives underscores the need to find ways to foster hope in this population. The findings also suggest that the hope experience of men may differ from the experience of women; therefore, strategies to foster hope in this population should be tailored to the male experience.

Widespread silence around cancer reflects both the limited access First Nations people have to formal, supportive programs and services, as well as the creative ways they provide emotional, social, and financial support within their informal networks. Beyond the support of their communities, they also required institutional provision of care that is culturally safe, addressing the colonial impacts on cancer communication and the disproportionate burdens of disease in First Nations communities.

MaTT is a feasible intervention. Future research should evaluate MaTT with larger samples as well as determine the amount of time participants used MaTT.

The incorporation of visual forms of expression has become common in qualitative research over the past two decades, with participant-employed photography being most prevalent. Visual methods such as photovoice have been used in community-based studies and with individuals to explore their lived experiences, particularly because of their participatory nature. Despite widespread support for visual approaches in existing research, there has been insufficient attention paid to how photography can enhance understanding of the phenomenon under study. Additionally, the existing literature is somewhat bereft of discussion of what individuals think about their participation in studies that incorporate participant-employed photography, or researchers' perspectives of carrying out this type of research. In this article, we describe a photovoice study carried out with young adult women affected by serious illness and provide examples of participants' photographs to illustrate how participant-employed photography can enhance the depth of research data. Specifically, the examples highlight how the photographs enriched participants' verbal descriptions of their lived experiences, which generated a better understanding of their personal embodied realities. We also discuss the young adult women's inclusion of previously taken photographs and reflections on their participation in the study. Finally, we examine the need to consider the intended audience of photographs, and specific ethical and methodological considerations for researchers contemplating the incorporation of participant-employed photography. In doing so, we provide insight into the advantages and challenges of photo-

BackgroundThere is an important need to evaluate whether rehabilitation services effectively address the needs of minority culture populations with North America’s increasingly diverse population. The objective of this paper was therefore to review and assess the state of knowledge of barriers and facilitators to cultural competence in rehabilitation services.MethodOur scoping review focused on cultural competence in rehabilitation services. Rehabilitation services included in this review were: audiology, speech-language pathology, physiotherapy, and occupational therapy. A search strategy was developed to identify relevant articles published from inception of databases until April 2015. Titles and abstracts were screened by two independent reviewers according to specific eligibility criteria with the use of a liberal-accelerated approach. Full-text articles meeting inclusion criteria were then screened. Key study characteristics were abstracted by the first reviewer, and findings were verified by the second reviewer.ResultsAfter duplicates were removed, 4303 citations were screened. Included articles suggest that studies on cultural competence occur most frequently in occupational therapy (n = 17), followed by speech language pathology (n = 11), physiotherapy (n = 6), and finally audiology (n = 1). Primary barriers in rehabilitation services include language barriers, limited resources, and cultural barriers. Primary facilitators include cultural awareness amongst practitioners, cultural awareness in services, and explanations of health care systems.ConclusionTo our knowledge, this review is the first to summarize barriers and facilitators to cultural competence in rehabilitation fields. Insufficient studies were found to draw any conclusions with regards to audiological services. Minimal perspectives based on patient/caregiver experiences in all rehabilitation fields underscore a research gap. Future studies should aim to explore both patient/caregiver and practitioner perspectives as such data can help inform culturally competent practices.

Research with indigenous peoples worldwide carries long histories of exploitation, distorted representation, and theft. New “indigenizing” methodologies centre the production of knowledge around the processes and knowledges of indigenous communities. Creative research methods involving artistic practices—such as photovoice, journaling, digital storytelling, dance, and theatre—may have a place within these new approaches, but their applications have yet to be systematically explored. We conducted a scoping review of 36 international research studies literature on arts-based research with indigenous peoples. The majority of studies used photovoice and were conducted in Canada, USA, Australia, or New Zealand. We identify five primary fields in which arts-based methods may offer benefit to an indigenous research agenda: (a) participant engagement, (b) relationship building, (c) indigenous knowledge creation, (d) capacity building, and (e) community action. We propose several opportunities to further explore arts-based methods with indigenous peoples.