Background Indigenous populations have remained strong and resilient in maintaining their unique culture and values, despite centuries of colonial oppression. Unfortunately, a consequential result of facing years of adversity has led Indigenous populations to experience a disproportionate level of poorer health outcomes compared to non-Indigenous populations. Specifically, the rate of Indigenous chronic disease prevalence has significantly increased in the last decade. Many of the unique issues Indigenous populations experience are deeply rooted in their colonial history and the intergenerational traumas that has subsequently impacted their physical, mental, emotional and spiritual well-being. With this, to better improve Indigenous health outcomes, understanding the local context of their challenges is key. Studies have begun to use modes of community engagement to initiate Indigenous partnerships and design chronic disease-based interventions. However, with the lack of a methodological guideline regarding the appropriate level of community engagement to be used, there is concern that many interventions will continue to fall short in meeting community needs. Objective The objective of this study was to investigate the how various community engagement strategies have been used to design and/or implement interventions for Indigenous populations with chronic disease. Methods A scoping review guided by the methods outlined by Arksey and O’Malley was conducted. A comprehensive search was completed by two reviewers in five electronic databases using keywords related to community engagement, Indigenous health and chronic disease. Studies were reviewed using a descriptive-analytical narrative method and data was categorized into thematic groups reflective of the main findings. Results We identified 23 articles that met the criteria for this scoping review. The majority of the studies included the use a participatory research model and the procurement of study approval. However, despite the claimed use of participatory research methods, only 6 studies had involved community members to identify the area of priority and only five had utilized Indigenous interview styles to promote meaningful feedback. Adapting for the local cultural context and the inclusion of community outreach were identified as the key themes from this review. Conclusion Many studies have begun to adopt community engagement strategies to better meet the needs of Indigenous Peoples. With the lack of a clear guideline to approach Indigenous-based participatory research, we recommend that researchers focus on 1) building partnerships, 2) obtaining study approval and 3) adapting interventions to the local context.
Background The COVID-19 pandemic has reduced access to endomyocardial biopsy (EMBx) rejection surveillance in heart transplant (HT) recipients. This is the first Canadian study to assess the role for non-invasive rejection surveillance in personalizing titration of immunosuppression (IS) and patient satisfaction post-HT. Methods In this mixed methods prospective cohort study, adult HT recipients more than six months from HT had their routine EMBx replaced by non-invasive rejection surveillance with gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA). Demographics, outcomes of non-invasive surveillance score, hospital admissions, patient satisfaction, and health status on Medical Outcomes Study 12-item Short Form Health Survey (SF-12) were collected and analyzed using t -tests and chi-squared tests. Thematic qualitative analysis was performed for open-ended responses. Results Among 90 patients, 31 (33%) were enrolled. 36 combined tests were performed; 22 (61%) were -GEP/-dd-cfDNA, 10 (27%) had +GEP/-dd-cfDNA, 4 (11%) had -GEP/+dd-cfDNA and 0 +GEP/+dd-cfDNA. All patients with a positive dd-cfDNA (range 0.19-0.81%) underwent EMBx with no significant cellular or antibody mediated rejection. 15 cases (42%) had IS reduction and this increased to 55% in patients with negative concordant testing. Overall, patients’ reported satisfaction was 90% and on thematic analysis they were more satisfied with less anxiety during the non-invasive testing experience. Conclusions Non-invasive rejection surveillance was associated with the ability to lower immunosuppression, increase satisfaction, and reduce anxiety in heart transplant recipients, minimizing exposure for patients and providers during a global pandemic.
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