What do you mean by engagement? – evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations – scoping review

Abstract

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.

Cultural adaptation of health interventions including a nutrition component in Indigenous peoples: a systematic scoping review

“…However, it was less common for interventions to be owned, delivered and/or directed by the community themselves. Similar findings to this review have also been reported in a recent scoping review evaluating community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations [ 110 ]. In that review, Wali and colleagues reported that despite the agreed need to engage with Indigenous communities to support intervention engagement, few meaningfully consulted the community through all levels of intervention design and delivery [ 110 ].…”

“…Similar findings to this review have also been reported in a recent scoping review evaluating community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations [ 110 ]. In that review, Wali and colleagues reported that despite the agreed need to engage with Indigenous communities to support intervention engagement, few meaningfully consulted the community through all levels of intervention design and delivery [ 110 ]. Several authors have similarly argued that adopting participatory design approaches involving Indigenous communities as co-designers and decision-makers from the outset of intervention development is critical to achieve meaningful and lasting change [ 111 – 113 ].…”

Implementation science should give higher priority to health equity

“…And third, it is useful to consider contextual issues across all levels of a socio-ecological framework (individual, interpersonal, organizational, community, policy) [52]. Table 1 summarizes reviews of equity-relevant studies describing essential implementation contextual elements for interventions among disadvantaged populations and lowresource settings [55][56][57][58][59].…”

Exploring “Intersectoral Collaboration” towards the Integration of Indigenous Knowledge into Adult Education Programs in North Wollo, Ethiopia

“…e engagement of both participants and local institutions to promote IK with initial transformative learning experiences demonstrates the potential for creating a path of critical consciousness [22]. More commonly, community engagement approaches use community members at the centre of the process to empower indigenous voices, strengthen community capacity, and promote meaningful change [23]. Educational communities and their actors, therefore, are encouraged to use their professional judgment and to reprogram educational content in terms of its scope, sequence, progression, continuity, and approach to teaching and evaluating [24].…”

“…Participation of the local community in the provision of the AE is crucial for both the success of the collaboration and the achievement of the overall objective of the program [17]. Two dominant themes related to community engagement such as adapting to a cultural context and inclusion of community outreach [23] can be used within a specific program provision, especially in IK-based on AE delivery. erefore, engaging the local community in the process of their learning is the groundwork for any stakeholders.…”