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Sharing What we Know About Living a Good Life: Indigenous Approaches to Knowledge Translation

Sharing What we Know About Living a Good Life: Indigenous Approaches to Knowledge Translation FEATURE / MANCHETTE Sharing What we Know About Living a Good Life: Indigenous Approaches to Knowledge Translation Janet Smylie, Michelle Olding, and Carolyn Ziegler Abstract: Knowledge Translation (KT), a core priority in Canadian health research, policy, and practice for the past decade, has a long and rich tradition within Indigenous communities. In Indigenous knowledge systems the processes of ‘‘knowing’’ and ‘‘doing’’ are often intertwined and indistinguishable. However, dominant KT models in health science do not typically recognize Indigenous knowledge conceptualizations, sharing systems, or protocols and will likely fall short in Indigenous contexts. There is a need to move towards KT theory and practice that embraces diverse understandings of knowledge and that recognizes, respects, and builds on pre-existing knowledge systems. This will not only result in better processes and outcomes for Indigenous communities, it will also provide rich learning for mainstream KT scholarship and practice. As professionals deeply engaged in KT work, health librarians are uniquely positioned to support the development and implementation of Indigenous KT. This article provides information that will enhance the ability of readers from diverse backgrounds to promote and support Indigenous KT efforts, including an introduction to Indigenous knowledge conceptualizations and knowledge systems; key contextual issues to consider in planning, implementing, or evaluating KT in Indigenous settings; and contemporary examples of Indigenous KT in action. The authors pose critical reflection questions throughout the article that encourage readers to connect the content with their own practices and underlying knowledge assumptions. There is currently no clear consensus in the literature Introduction regarding what KT is and which models and strategies are The emergence of Knowledge Translation (KT) as a the most effective. There is some convergence in the recent health research, policy, and practice priority in Canada is literature about the effectiveness of participatory KT strongly linked to the creation and initial mandate of the processes that attempt to understand and address the Canadian Institutes of Health Research (CIHR) in 2000. context in which KT is taking place and to bridge some This initial aim of the CIHR was to excel not only in the type of ‘‘knowdo gap’’ [4]. Health librarians have high- creation of new knowledge but also to ensure that this lighted the critical role existing human information services knowledge was ‘‘translated’’ from the research setting into (i.e., reference librarians, pharmacists, patient education ‘‘real-world applications to improve the health of Cana- specialists) already play in linking knowledge sources to dians, provide more effective health services and products, knowledge users and the synergies that can be gained by and strengthen the health care system’’ [1, 2]. The CIHR building on and expanding these roles [3]. originally defined KT as ‘‘the exchange, synthesis and Indigenous scholars and communities across Canada ethically sound application of knowledge*within a have been active*if at times reluctant*participants in this burgeoning KT movement, working to ensure that complex system of interactions among researchers and users*to accelerate the capture of the benefits of research Indigenous people, their needs, and their potential con- for Canadians through improved health, more effective tributions were taken into account [5]. The lead author (JS) services and products, and a strengthened health care has had the opportunity to be involved in bridging system’’ [2]. conversations regarding KT and Indigenous community In subsequent years, definitions and models of KT have knowledge systems since the initial CIHR consultations expanded rapidly, extending from research-embedded con- including a CIHR led KT workshop in June 2002 and early ceptualizations to program- and service-based activities [3]. funding initiatives. Ironically, a common initial response Janet Smylie. Well Living House, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute; Dept. of Family and Community Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 and Dalla Lana School of Public Health, University of Toronto, Toronto, ON. Michelle Olding. Dalla Lana School of Public Health, Toronto, ON. Carolyn Ziegler. Health Sciences Library, Li Ka Shing International Healthcare Education Centre at St. Michael’s Hospital, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada. Corresponding author (e-mail: janet.smylie@utoronto.ca) JCHLA / JABSC 35:1623 (2014) doi: 10.5596/c14-009 Smylie et al. 17 when she started talking about KT in diverse Indigenous Understanding the differences and similarities in the communities was that mainstream conceptualizations of root epistemologies of academic health sciences and KT were hard to make sense of and did not appear to be Indigenous community knowledge systems is a key step practically relevant. As the conversations deepened it in supporting the development and implementation of KT became evident that KT was nothing new for Indigenous strategies that are relevant and useful to Indigenous peoples. In contrast to the evolution of European knowl- peoples. An epistemology is a theory of knowledge that edge and knowledge systems that has resulted in a sets out what constitutes knowledge and how we come to separation of knowledge production from knowledge know. Academic health sciences have emerged from use, in Indigenous contexts knowledge is almost always positivist thought traditions in which the goal of knowl- inextricable linked to action both philosophically and edge production is to search for general laws or principles practically. through ‘‘objective’’ observation. Within the positivist There are distinct understandings of knowledge and tradition, knowledge is that which can be quantified and unique, diverse, and contextually specific knowledge counted and is thought to exist independent of the people sharing processes found in Indigenous communities. or places from which it emerges [11]. Health sciences Ideally, efforts to support KT in Indigenous contexts knowledge production is characterized by knowledge would build on local Indigenous languages and existing specialization and academic silos, meaning that KT is knowledge conceptualizations, sharing systems and pro- typically conceptualized as the translation of expert knowl- tocols. Indigenous communities have identified a strong edge from researcher to health care practitioners [10]. preference for approaches to KT that draw on Indigenous Indigenous knowledge systems have underlying epis- ways of knowing and doing [57]. Such approaches have temologies that are distinct from those of academic health also been demonstrated to be practically effective across sciences [12, 13]. Indigenous epistemologies, for example, diverse Indigenous communities [8]. These demonstrations almost always intrinsically connect knowledge with action. build on the much broader literature regarding the For an individual to hold knowledge and not apply it in importance of knowledge, attitudes, and beliefs to health their life or share it for the benefit of the collective could be learning and behaviour change. Clearly, messages, med- seen as foolish and selfish from an Indigenous perspective. iums, and practices that demonstrate socio-cultural con- Knowledge may be considered as pre-existing such that gruency (i.e., draw on local cultural knowledge, attitudes, there are no new ‘‘discoveries’’ but rather a process of and belief systems) will have better uptake. This is gradual awareness and understanding of complex, inter- especially important for Indigenous people and commu- connected, and pluralistic systems of existing knowledge. nities where a big part of colonial policy has been In this way, knowledge development work is actively premised on the marginalization and devaluing of Indi- transformative as it is linked to life-long processes of genous ways of knowing and doing [9]. human development. Stories themselves can be perceived Our aim in this article is to provide relevant information as holding ‘‘medicine’’ and the process of sharing stories as that will enhance the ability of readers from diverse acts of healing. backgrounds to promote and support Indigenous KT Another foundational element of many Indigenous efforts (i.e., KT processes that build on Indigenous under- knowledge systems is that the inter-relationships between standings of knowledge and Indigenous approaches to perceived elements are considered equally or more im- knowledge sharing). Each section features critical reflec- portant than the nature of the perceived elements them- tion questions that we hope will challenge the reader to selves. For example, in considering physical health, it bridge the content of this article to their own underlying would be important to consider not only physical health knowledge assumptions and practices. alone but also physical health in relation to mental, emotional, and spiritual health; family, community, nation; land and the local eco-system; and kin relations past, Indigenous knowledge(s), knowledge present, and future. systems, and KT The importance of inter-relationality extends to the conceptualization of the individual in relation to the Critical reflection questions: What assumptions do I make collective. For many Indigenous people, notions of iden- about what constitutes valid and useful knowledge? How tity, health, rights, and freedoms are rooted in the do these assumptions fit or not fit with the ideas about collective. The health needs of the family or community Indigenous knowledge and knowledge systems described in may take precedence over individual health needs. Likewise this section? land, material goods, or information may be seen as primarily a collective rather than individual resource. As alluded to above, KT scholarship and practice in This contrasts with euro-western concepts of self and Canada has emerged within the context of university- and individual rights and freedoms [14]. hospital-based health sciences research, a knowledge system With these considerations in mind, KT in Indigenous in which the domains of research and actionpractice have contexts could be understood as ‘‘Indigenously led sha- largely been kept separate [10]. It is important to recognize that Indigenous knowledge systems and KT practices ring of culturally relevant and useful health informa- are rooted in a very different linguistic, cultural, social, tion, and practices to improve Indigenous health status, political, and historic context. Not surprisingly given these policy, services, and programs’’ [15] or more simply as differences, mainstream KT theoretical models and proven ‘‘Sharing what we know about living a good life’’ [15]. practices may fall short in Indigenous contexts. Indigenous processes of sharing and applying knowledge 18 JCHLA / JABSC Vol. 35, 2014 have always been an essential and embedded part of scholarship and practice. In the following section we will Indigenous civilizations [16]. Indigenous KT strategies examine some key contextual issues that should inform the development of KT strategies in Indigenous settings. Keep and protocols are commonly dynamic, participatory, in mind that many of these issues may also be relevant integrated into family and community activities, repeated more broadly. or cyclical, and intergenerational [15]. A reliance on the land for sustenance translated into the need for sophisti- cated understandings of and relationships with local eco- Important contextual issues to consider when systems. As such, experiential demonstration and practice planning, implementing, and (or) evaluating in real life situations were common Indigenous KT knowledge sharing activities in Indigenous approaches for this type of knowledge [1517]. Storytelling is another core Indigenous KT strategy, particularly contexts common for the intergenerational transfer of knowledge. Critical reflection questions: What do you know about the It is important to keep in mind that in this section we Indigenous peoples and communities in the geographic introduced only a few overly simplified characteristics of area where you live and work? From what sources is this Indigenous knowledge, knowledge systems, and KT. The knowledge drawn? Can you identify knowledge gaps and actual diversity and complexity of Indigenous knowledge strategies to address these gaps in your personal under- could be paralleled to the diversity and complexity of the standing and knowledge? Which of the contextual issues vast landscapes of the Americas (to which it is heavily listed do you think are relevant for your life and work with tied). There is no one-size-fits-all model for what KT Indigenous individuals and communities? Which issues are should look like, given the diversity of knowledge sharing relevant to your work more generally? practices across communities. Likewise, our portrayal of academic health sciences has not included the modern and Cultural safety post-modern integration of social sciences and the increas- There are many reasons why Indigenous community ingly complex interdisciplinary paradigms currently in use. members may not feel comfortable or safe in non- Our comparisons have highlighted tensions because know- Indigenous institutional contexts, including libraries. ing and understanding difference can be a useful starting These can include historic and current individual and point in contexts where differences have been previously systemic level experiences of abuse, discrimination, and ignored or overlooked. However, although Western and racism. The term ‘‘cultural safety’’ originated in New Indigenous systems of knowledge and knowledge dissemi- Zealand in response to dissatisfaction of Maori people nation have many differences, the two are not entirely with their nursing care. The nursing council of New irreconcilable [18]. Zealand had defined culturally unsafe care as ‘‘any actions Currently though, most health science KT efforts have that diminish, demean or disempower the cultural identity been modelled on the one-way transfer of academic health and wellbeing of an individual’’ [20]. The meaning and knowledge into Indigenous communities, often with little application of the term cultural safety is evolving in consideration of pre-existing Indigenous knowledge sys- Canada; however, it is commonly perceived as an advance- tems. This external imposition of one knowledge system ment beyond ‘‘cultural sensitivity’’ [21]. Cultural safety is onto another, although often done with good intentions, is usually defined by clients themselves, with the onus placed almost always ineffective, especially when there are key on health care professionals to self-reflect and work with theoretical and practical tensions. Indigenous scholar and their institution to address the impact of power imbal- elder Leroy Littlebear described this process as ‘‘jagged ances, attitudinal, and institutional discrimination and worldviews colliding’’ [19]. For Indigenous individuals and colonization on service provision and clientprovider communities, such one-way KT processes may resonate relationships. This work can be particularly challenging with historic and current colonial practices such as the given the pervasive negative representations of Indigenous apprehension of Indigenous children into residential people in the media and education systems. schools, where there was a subsequent one-way transfer of European-based language and schooling or the imposi- Underlying unmet material, social, and health needs tion of European systems of law and land rights into The historic and current unequal distribution of health Indigenous communities through the Indian Act and other and social resources has translated into a disproportionate colonial legislations. The fundamental rights of Indigenous burden of poverty, food insecurity, homelessness and self-determination at the individual and collective levels housing inadequacy, unemployment, and lower formal include not only land rights but also the right to ‘‘construct educational achievement for Indigenous people in Canada. knowledge in accordance with self-determined definitions Linked to these challenges in the social determinants of of what is real and what is valuable’’ [14]. The development health are striking disparities in the health status of and application of Indigenous KT models is therefore not Indigenous peoples compared with the general Canadian only practical but also integral to processes of decoloniza- population [22]. For example, diabetes and mental illness tion and healing. are much more common among First Nations populations Moving towards KT models that embrace diverse compared with non-First Nations populations [23, 24]. It is understandings of knowledge and recognize, respect, and important to understand that these unmet needs and high build on existing knowledge systems will not only result in illness burdens can interfere with participation in learning, better processes and outcomes for Indigenous commu- teaching, and participation in health information sharing nities, it will also provide rich learning for mainstream KT events and programs. Smylie et al. 19 Health literacy Reciprocity in relationships The Canadian Expert Panel on Health defines health Reciprocity is a foundational social and spiritual principle literacy as ‘‘The ability to access, understand, evaluate and for many Indigenous communities that, according to Cree communicate information as a way to promote, maintain philosopher Willie Ermine, ‘‘dictat[es] how all life would co-exist in mutual protection, benefit, and continuity’’ [30]. and improve health in a variety of settings across the life- Within the academic context this may emerge as a two-way course’’ [25]. Although little information regarding the teaching and learning process in which the dichotomy health literacy of Indigenous peoples in Canada is avail- between ‘‘teacher’’ and ‘‘learner’’ is challenged, and the able, we do know that this population faces a dispropor- faculty members make extra efforts to be accessible and tionate burden of low literacy with respect to reading and equally vulnerable in the knowledge relationship [31]. writing in English compared with non-Indigenous com- munities as well as much lower rates of high school Location completion [26]. Indigenous-specific models of literacy A significant proportion of Indigenous people in Canada also exist and are notable for their holistic understandings live in remote and rural areas where geographic location and approaches. The Rainbow/Holistic Approach to can limit access to infrastructure commonly taken for Aboriginal literacy, as one example, uses seven ways of granted, such as high speed internet access, tertiary knowing, each corresponding to a color and recognizes healthcare facilities, and public libraries. The majority of that spirit, heart, mind, and body equally contribute to a Indigenous people now live in urban areas in Canada and life of balance and nurtures them all [27]. this population is rapidly increasing. Urbanization unfor- tunately does not necessarily translate into improved health Protection and custodianship of Indigenous knowledge or living conditions for Indigenous populations [23, 32, 33]. Colonization included the purposeful undermining of In cities, the Indigenous population may be more dispersed Indigenous languages and culture, commercialization of and diverse compared with more rural or remote settings. Indigenous art, and appropriation of Indigenous plant Table 1 summarizes these specific strategies for imple- knowledge in the development of medicine, all without menting KT activities in Indigenous contexts. consent, acknowledgement, or benefit to Indigenous peoples [28]. Current legal regimes are still inadequate to protect Indigenous knowledge [28]. Within the context of Indigenous knowledge translation in Indigenous health and health information there are also contemporary contexts a few examples examples of historic abuses and inequities in Canada, including nutritional experimentation on Indigenous chil- Critical reflection questions: Can you identify how these dren in residential schools and the exclusion of Indigenous examples have incorporated Indigenous understanding of communities from national health surveys. Not surpris- knowledge and Indigenous approaches to KT? Do they ingly given this history, many Indigenous communities are address the contextual issues identified in the previous very concerned about external to community ownership, section? Do you see them as valid examples of KT? Why or control, and access to and use of their health information why not? and therefore have created policies and processes to ensure What follows is by no means meant to be comprehen- Indigenous governance and management of Indigenous sive, we have simply selected a few examples from diverse health information [29]. settings. The lead author is currently in the process of building a more comprehensive listing of Indigenous KT Publication bias initiatives that will be shared on an interactive web page. The large majority of published health information has Please contact her if you have a good example that you been created without taking Indigenous ways of knowing, would like to see included. doing, and sharing information into account. This litera- ture is commonly perceived in Indigenous contexts as not Maria Campbell’s Halfbreed Ball immediately useful or relevant and, at worst, as a continu- On 15 June 2013 as part of the Native American and ing colonial imposition of external ways of knowing upon Indigenous Studies Association Conference, held in Saska- Indigenous people. There is a deficit of Indigenous-led, toon, Saskatchewan, Me ´tis elder, author, and community Indigenous-authored, and community-relevant published activist Maria Campbell organized an evening of food, materials. A large proportion of that which exists is in the dance, art, and entertainment. The Halfbreed Ball was form of ‘‘grey’’ literature (i.e., non-indexed publications). fashioned on historic Me ´tis social events that were held to When Indigenous scholars and communities produce honour the arrival and departure of visitors to Me ´tis materials for non-Indigenous specific scholarly journals communities*times when the word Halfbreed was used there is usually a tension between the defined criteria of with pride. The ten-course meal featured traditional foods what is acceptable in peer-reviewed publications and what served with a contemporary flair (Figure 1). Between might be perceived as relevant and linked to Indigenous courses, guests were treated to a parade of historic Me ´tis ways of knowing and doing. This divergence means that fashion, poetry, fiddle music and jigging, and folk and opera articles that take Indigenous constructions of knowledge singing. This was followed by an old-time dance. In the into account may be less likely to be published. For words of one guest ‘‘this evening...made abundantly clear example, an editor may prioritize generalizability but the continuity of this lively culture and the warm, open- Indigenous communities may want emphasis on the hearted nature of those Me ´tis well-grounded in and proudly uniqueness of their particular context. contributing to the vitality of the culture today’’ (Susan 20 JCHLA / JABSC Vol. 35, 2014 Table 1. Contextual Issues for KT in Indigenous Contexts and Mitigating Strategies Contextual issue Mitigating Strategies Cultural safety Critically reflect on your own knowledge, values, assumptions, and experiences generally with respect to the social hierarchies around class, age, ability, gender, sexual orientation, race and ethnicity, and more specifically with respect to Indigenous peoples. We almost all have bias and prejudicial assumptions; can you identify any of yours? Are there particular populations groups where you are less knowledgeable, less comfortable, or more judgemental? How has the media and your education shaped your views? Fill the gaps and (or) identify populations or groups for which you might need to do some more critical self-reflection to contribute to safe and respectful interactions. Identify allies in your institution and within your communities of practice and work together to identify and address institutional barriers and increase institutional safety. Search for institutional best practices that might be relevant to your place of work. Health literacy Learn more about Indigenous conceptualizations of literacy and health literacy [27]. Think broadly about literacy, (i.e., reading and writing in English is one aspect that is important in most mainstream institutional contexts) but what about the importance of traditional local ecologic literacies in a remote wilderness setting? Strategize with others on how your institution could support diverse knowledge users to obtain an enhanced health literacy. Co-create plain language summaries. Assess and respond to opportunities to build capacity and literacy using health information technologies. Protection and custodianship of Critically examine information sources with an eye towards authenticity of authorship, Indigenous knowledge Indigenous community involvement, and custodianship of Indigenous information and the prevention of appropriation. Support and participate in processes that actively promote Indigenous community production and management of Indigenous health information and health information systems. In situations where it appears a person external to the community is publishing or sharing Indigenous community health information with no apparent community involvement, ask questions. Underlying unmet material, social, Ensure that projects and events involving Aboriginal community members include budgets and health needs for transportation allowance and childcare. Provide healthy food at events and meetings. Ensure schedules fit with the needs of those who are experiencing chronic illnesses. Allow for flexibility in scheduling to account for personal, family, and community illness or crisis. Publication bias Include grey literature and oral histories in your literature searches and indexes. Recognize and value multiple forms of knowledge dissemination. Consider incorporating equity criteria in your critical appraisal methods [34]. Be aware that search terms in use do not always match the terms by which Indigenous people self-refer; this can be problematic, both with the use of search terms that are considered offensive by some people (i.e., Indians, Eskimos) and also the non-specificity of terms now in more current use by Indigenous people (i.e., the term Indigenous). Support Indigenous and community led publication efforts. Reciprocity in relationships Ensure that the KT project or activity will be mutually beneficial to all parties, including Indigenous community partners. For those in a role that may involve structured social privilege (i.e., health professional, librarian, academic faculty) make efforts to bridge relationships and build trust by sharing your own hopes, fears, and vulnerabilities in the learning relationship. Create opportunities for Indigenous community capacity building and recognize that capacity building will be a two-way process (i.e., partners external to Indigenous community will also be gaining capacities and training in working with Indigenous communities). Location When working with Indigenous peoples from a location that is different from where you live and work, ideally try and spend time in this place with a knowledgeable and willing community member who is being compensated for orienting you. Working with Indigenous community partners, actively reflect on what is unique about the context and location where the KT activity is taking place. Consider outreach strategies in urban areas. Smylie et al. 21 Fig. 1. Author Janet Smylie serving traditional food and Rajan their narrative with music, artwork, video clips, and Anderson playing fiddle at the Halfbreed Ball, Native American photographs. KT occurred throughout the workshops as and Indigenous Studies Association conference, June 2013. participants connected with themselves, their history, and the land through storytelling and dialogue. DVDs of the digital stories were made freely available to all participants and the community, and they were disseminated with permission of participants to policy makers and health professionals as well as posted online [36]. Perhaps most importantly, the project’s investment in technology, infra- structure, and community training led to the development of the ‘‘My Word: Storytelling and Digital Media Lab’’, a community-run centre for digital media and research that continues to lead research in the community and the centre has expanded to offer a variety of research, media, and data-gathering services. Indigenous Knowledge Network for Infant, Child, and Family Health The Indigenous Knowledge Network for Infant, Child, and Family Health was a community partnered KT research project designed to support the gathering and application of Indigenous knowledge in 10 diverse First Nations, Me ´tis, and urban Aboriginal communities. Ten frontline Aboriginal prenatal, infant, child, youth, and family health workers including midwives, health promo- Gingell, written communication, 2013). This event exem- tion program staff, health managers, and elders, were plifies experiential, socially embedded Indigenous KT, seconded to this project one day a week for four years. For which in this case showcased historic and contemporary the first two years they gathered oral histories from Me ´tis culture to Indigenous scholars from around the world. Indigenous elders and knowledge keepers in their commu- The Native Youth Sexual Health Network (NYSHN) nities of work. For the second two years they developed, The NYSHN is an organization engaged in KT around implemented, and evaluated community-based knowledge Indigenous youth sexual and reproductive well-being. Led application projects that drew on the Indigenous knowl- by Indigenous youth, NYSHN encompasses a peer-based edge they had collected. The academic research team, network of advocates, families, and communities [35]. The based at the Well Living House Action Research Centre, network collaborates on various initiatives that support supported program activities and facilitated network-wide Indigenous youth in sharing their own knowledge on meetings and interactions. healthy sexuality, as well as mobilizing collective action Evaluation of the network revealed very positive and around youth-identified priorities. Some recent initiatives transformative impacts for network participants, their include a national gathering for Indigenous young women, clients, and the participant Aboriginal communities. a ‘‘sexy health’’ carnival, and a participatory action Many of the knowledge application projects and relation- research project exploring the role of land in the sexual ships across the network and among network participants, community elders, and clients are ongoing. One of the keys health of Metis women and youth [35]. KT, in this example, to this project is that it actively builds on existing means building networks that support Indigenous youth in community resources and infrastructure. You can learn being both experts and knowledge users of sexual health more about this project and the Well Living House Action information. Research Centre at http://www.stmichaelshospital.com/ Changing Climate, Changing Health, Changing Stories crich/well-living-house/. The Changing Climate, Changing Health, Changing Stories project provides a promising example of KT within a community-based research project. With funding from Bridging Indigenous approaches to KT into Health Canada’s First Nations and Inuit Health Branch, health library science and practice the Rigolet Inuit Community Government formed a trans- disciplinary team of Indigenous and non-Indigenous It is our hope that readers will now be full of ideas and researchers to explore implications of climate change on questions regarding the application of Indigenous KT physical, emotional, mental, and spiritual health [36, 37]. approaches in their health information work and practice. The project built from the rich oral tradition of Inuit We would like to remind you that it is very likely that you knowledge systems by using digital storytelling and first- are already actively engaged in KT activities, some of person narratives as methods for exploring and sharing which are synergistic with Indigenous KT ideas and local experiences of climate change. Through a series of protocols. In fact, almost everything that a health librarian week-long workshops, community participants shared and does could be considered KT, especially if one draws on the developed personal stories, while receiving training to Indigenous notions of KT as a sharing of knowledge that is produce these narratives as a digital short that weaved bidirectional, participatory, and social. 22 JCHLA / JABSC Vol. 35, 2014 We have identified some specific strategies for imple- We have done our best in this article to share knowledge menting KT activities in Indigenous contexts in Table 1. and resources to support readers interested in under- More generally, it is our hope that readers will continue to standing and applying Indigenous approaches to KT. We think critically about their underlying assumptions regard- recognize that some of the concepts, critical questions, ing what is valid knowledge and what are valid knowledge- strategies, and examples may be challenging for readers. sharing strategies*and be open to different ideas. In some However, we believe that much of the content is relevant instances health librarians will be able to build on what not only to KT but also to other health and social science they are already doing. For example with respect to research, service, and policy work in Indigenous contexts. reciprocity in relationships, many librarians will recognize ‘‘New’’ ideas and strategies, such as KT, are constantly that in their day-to-day work they are already engaged in emerging in health and health information sciences. For mutually beneficial bi-directional knowledge exchange as example current CIHR strategies include terms such as they are always learning something new and understanding ‘‘implementation science’’ and ‘‘evidence informed health- information needs before proceeding with assisting users. care renewal’’. One commonality that will likely be shared In other cases, implementing some of the suggestions may by many of these future health science research and (or) be more challenging. For example, a health librarian who practice directions is that they will exclude or marginalize has focused on supporting research, policy, and practice Indigenous systems of knowledge and practice. A few, users in acquiring ‘‘best evidence’’ using standardized however, will realize the gains in both process and critical appraisal methods drawn from clinical epidemiol- outcomes that can be made by keeping Indigenous ways ogy may need to expand their knowledge regarding best of knowing and doing in mind*not only for Indigenous evidence for Indigenous contexts and build new skills in communities but for all peoples. identifying, critically appraising, and sharing materials drawn from grey literature and multimedia. References Health librarians may also find themselves in a position where they can facilitate a bridging of the knowledge and 1. Government of Canada. Canadian Institutes of Health knowledge system gaps between researchers working with Research Act. S.C 2000, c. 6. Assented April 13, 2000. [Cited Indigenous communities and Indigenous communities 21 January 2014]. Available from: http://laws-lois.justice.gc.ca/ themselves. 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National Aboriginal Health Organiza- sexualhealth.com/whatwedo.html. tion; 2006 January 31 [Cited 18 January 2014] Available from: http://www.naho.ca/documents/naho/english/Culturalsafety- 36. Cunsolo Willox A, Harper S, Edge V. My Word: Storytelling factsheet.pdf. and Digital Media Lab, Rigolet Inuit Community Govern- ment. Storytelling in a digital age: digital storytelling as an 22. Adelson N. The embodiment of inequity: health disparities in emerging narrative method for preserving and promoting Aboriginal Canada. CanJPub Health. 2005;96(S2):S46S61. indigenous oral wisdom. Qualitative Research. 2013;13(2): 23. Firestone M. Our health counts: Unmasking health and 127147. doi: 10.1177/1468794112446105. social disparities among urban Aboriginal people in Ontario. 37. Harper SL, Edge VL, Cunsolo Willox A, Rigolet Inuit Toronto: University of Toronto; 2013. Community Government. ‘‘Changing climate, changing 24. Reading J. The crisis of chronic disease among Aboriginal health, changing stories’’ profile: using an EcoHealth ap- people: A challenge for public health, population health and proach to explore impacts of climate change on inuit health. social policy. [Internet]. Victoria: University of Victoria Ecohealth. 2012;9(1):89101. doi: 10.1007/s10393-012-0762-x. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du Canada Unpaywall

Sharing What we Know About Living a Good Life: Indigenous Approaches to Knowledge Translation

Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du CanadaApr 2, 2014

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FEATURE / MANCHETTE Sharing What we Know About Living a Good Life: Indigenous Approaches to Knowledge Translation Janet Smylie, Michelle Olding, and Carolyn Ziegler Abstract: Knowledge Translation (KT), a core priority in Canadian health research, policy, and practice for the past decade, has a long and rich tradition within Indigenous communities. In Indigenous knowledge systems the processes of ‘‘knowing’’ and ‘‘doing’’ are often intertwined and indistinguishable. However, dominant KT models in health science do not typically recognize Indigenous knowledge conceptualizations, sharing systems, or protocols and will likely fall short in Indigenous contexts. There is a need to move towards KT theory and practice that embraces diverse understandings of knowledge and that recognizes, respects, and builds on pre-existing knowledge systems. This will not only result in better processes and outcomes for Indigenous communities, it will also provide rich learning for mainstream KT scholarship and practice. As professionals deeply engaged in KT work, health librarians are uniquely positioned to support the development and implementation of Indigenous KT. This article provides information that will enhance the ability of readers from diverse backgrounds to promote and support Indigenous KT efforts, including an introduction to Indigenous knowledge conceptualizations and knowledge systems; key contextual issues to consider in planning, implementing, or evaluating KT in Indigenous settings; and contemporary examples of Indigenous KT in action. The authors pose critical reflection questions throughout the article that encourage readers to connect the content with their own practices and underlying knowledge assumptions. There is currently no clear consensus in the literature Introduction regarding what KT is and which models and strategies are The emergence of Knowledge Translation (KT) as a the most effective. There is some convergence in the recent health research, policy, and practice priority in Canada is literature about the effectiveness of participatory KT strongly linked to the creation and initial mandate of the processes that attempt to understand and address the Canadian Institutes of Health Research (CIHR) in 2000. context in which KT is taking place and to bridge some This initial aim of the CIHR was to excel not only in the type of ‘‘knowdo gap’’ [4]. Health librarians have high- creation of new knowledge but also to ensure that this lighted the critical role existing human information services knowledge was ‘‘translated’’ from the research setting into (i.e., reference librarians, pharmacists, patient education ‘‘real-world applications to improve the health of Cana- specialists) already play in linking knowledge sources to dians, provide more effective health services and products, knowledge users and the synergies that can be gained by and strengthen the health care system’’ [1, 2]. The CIHR building on and expanding these roles [3]. originally defined KT as ‘‘the exchange, synthesis and Indigenous scholars and communities across Canada ethically sound application of knowledge*within a have been active*if at times reluctant*participants in this burgeoning KT movement, working to ensure that complex system of interactions among researchers and users*to accelerate the capture of the benefits of research Indigenous people, their needs, and their potential con- for Canadians through improved health, more effective tributions were taken into account [5]. The lead author (JS) services and products, and a strengthened health care has had the opportunity to be involved in bridging system’’ [2]. conversations regarding KT and Indigenous community In subsequent years, definitions and models of KT have knowledge systems since the initial CIHR consultations expanded rapidly, extending from research-embedded con- including a CIHR led KT workshop in June 2002 and early ceptualizations to program- and service-based activities [3]. funding initiatives. Ironically, a common initial response Janet Smylie. Well Living House, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute; Dept. of Family and Community Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 and Dalla Lana School of Public Health, University of Toronto, Toronto, ON. Michelle Olding. Dalla Lana School of Public Health, Toronto, ON. Carolyn Ziegler. Health Sciences Library, Li Ka Shing International Healthcare Education Centre at St. Michael’s Hospital, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada. Corresponding author (e-mail: janet.smylie@utoronto.ca) JCHLA / JABSC 35:1623 (2014) doi: 10.5596/c14-009 Smylie et al. 17 when she started talking about KT in diverse Indigenous Understanding the differences and similarities in the communities was that mainstream conceptualizations of root epistemologies of academic health sciences and KT were hard to make sense of and did not appear to be Indigenous community knowledge systems is a key step practically relevant. As the conversations deepened it in supporting the development and implementation of KT became evident that KT was nothing new for Indigenous strategies that are relevant and useful to Indigenous peoples. In contrast to the evolution of European knowl- peoples. An epistemology is a theory of knowledge that edge and knowledge systems that has resulted in a sets out what constitutes knowledge and how we come to separation of knowledge production from knowledge know. Academic health sciences have emerged from use, in Indigenous contexts knowledge is almost always positivist thought traditions in which the goal of knowl- inextricable linked to action both philosophically and edge production is to search for general laws or principles practically. through ‘‘objective’’ observation. Within the positivist There are distinct understandings of knowledge and tradition, knowledge is that which can be quantified and unique, diverse, and contextually specific knowledge counted and is thought to exist independent of the people sharing processes found in Indigenous communities. or places from which it emerges [11]. Health sciences Ideally, efforts to support KT in Indigenous contexts knowledge production is characterized by knowledge would build on local Indigenous languages and existing specialization and academic silos, meaning that KT is knowledge conceptualizations, sharing systems and pro- typically conceptualized as the translation of expert knowl- tocols. Indigenous communities have identified a strong edge from researcher to health care practitioners [10]. preference for approaches to KT that draw on Indigenous Indigenous knowledge systems have underlying epis- ways of knowing and doing [57]. Such approaches have temologies that are distinct from those of academic health also been demonstrated to be practically effective across sciences [12, 13]. Indigenous epistemologies, for example, diverse Indigenous communities [8]. These demonstrations almost always intrinsically connect knowledge with action. build on the much broader literature regarding the For an individual to hold knowledge and not apply it in importance of knowledge, attitudes, and beliefs to health their life or share it for the benefit of the collective could be learning and behaviour change. Clearly, messages, med- seen as foolish and selfish from an Indigenous perspective. iums, and practices that demonstrate socio-cultural con- Knowledge may be considered as pre-existing such that gruency (i.e., draw on local cultural knowledge, attitudes, there are no new ‘‘discoveries’’ but rather a process of and belief systems) will have better uptake. This is gradual awareness and understanding of complex, inter- especially important for Indigenous people and commu- connected, and pluralistic systems of existing knowledge. nities where a big part of colonial policy has been In this way, knowledge development work is actively premised on the marginalization and devaluing of Indi- transformative as it is linked to life-long processes of genous ways of knowing and doing [9]. human development. Stories themselves can be perceived Our aim in this article is to provide relevant information as holding ‘‘medicine’’ and the process of sharing stories as that will enhance the ability of readers from diverse acts of healing. backgrounds to promote and support Indigenous KT Another foundational element of many Indigenous efforts (i.e., KT processes that build on Indigenous under- knowledge systems is that the inter-relationships between standings of knowledge and Indigenous approaches to perceived elements are considered equally or more im- knowledge sharing). Each section features critical reflec- portant than the nature of the perceived elements them- tion questions that we hope will challenge the reader to selves. For example, in considering physical health, it bridge the content of this article to their own underlying would be important to consider not only physical health knowledge assumptions and practices. alone but also physical health in relation to mental, emotional, and spiritual health; family, community, nation; land and the local eco-system; and kin relations past, Indigenous knowledge(s), knowledge present, and future. systems, and KT The importance of inter-relationality extends to the conceptualization of the individual in relation to the Critical reflection questions: What assumptions do I make collective. For many Indigenous people, notions of iden- about what constitutes valid and useful knowledge? How tity, health, rights, and freedoms are rooted in the do these assumptions fit or not fit with the ideas about collective. The health needs of the family or community Indigenous knowledge and knowledge systems described in may take precedence over individual health needs. Likewise this section? land, material goods, or information may be seen as primarily a collective rather than individual resource. As alluded to above, KT scholarship and practice in This contrasts with euro-western concepts of self and Canada has emerged within the context of university- and individual rights and freedoms [14]. hospital-based health sciences research, a knowledge system With these considerations in mind, KT in Indigenous in which the domains of research and actionpractice have contexts could be understood as ‘‘Indigenously led sha- largely been kept separate [10]. It is important to recognize that Indigenous knowledge systems and KT practices ring of culturally relevant and useful health informa- are rooted in a very different linguistic, cultural, social, tion, and practices to improve Indigenous health status, political, and historic context. Not surprisingly given these policy, services, and programs’’ [15] or more simply as differences, mainstream KT theoretical models and proven ‘‘Sharing what we know about living a good life’’ [15]. practices may fall short in Indigenous contexts. Indigenous processes of sharing and applying knowledge 18 JCHLA / JABSC Vol. 35, 2014 have always been an essential and embedded part of scholarship and practice. In the following section we will Indigenous civilizations [16]. Indigenous KT strategies examine some key contextual issues that should inform the development of KT strategies in Indigenous settings. Keep and protocols are commonly dynamic, participatory, in mind that many of these issues may also be relevant integrated into family and community activities, repeated more broadly. or cyclical, and intergenerational [15]. A reliance on the land for sustenance translated into the need for sophisti- cated understandings of and relationships with local eco- Important contextual issues to consider when systems. As such, experiential demonstration and practice planning, implementing, and (or) evaluating in real life situations were common Indigenous KT knowledge sharing activities in Indigenous approaches for this type of knowledge [1517]. Storytelling is another core Indigenous KT strategy, particularly contexts common for the intergenerational transfer of knowledge. Critical reflection questions: What do you know about the It is important to keep in mind that in this section we Indigenous peoples and communities in the geographic introduced only a few overly simplified characteristics of area where you live and work? From what sources is this Indigenous knowledge, knowledge systems, and KT. The knowledge drawn? Can you identify knowledge gaps and actual diversity and complexity of Indigenous knowledge strategies to address these gaps in your personal under- could be paralleled to the diversity and complexity of the standing and knowledge? Which of the contextual issues vast landscapes of the Americas (to which it is heavily listed do you think are relevant for your life and work with tied). There is no one-size-fits-all model for what KT Indigenous individuals and communities? Which issues are should look like, given the diversity of knowledge sharing relevant to your work more generally? practices across communities. Likewise, our portrayal of academic health sciences has not included the modern and Cultural safety post-modern integration of social sciences and the increas- There are many reasons why Indigenous community ingly complex interdisciplinary paradigms currently in use. members may not feel comfortable or safe in non- Our comparisons have highlighted tensions because know- Indigenous institutional contexts, including libraries. ing and understanding difference can be a useful starting These can include historic and current individual and point in contexts where differences have been previously systemic level experiences of abuse, discrimination, and ignored or overlooked. However, although Western and racism. The term ‘‘cultural safety’’ originated in New Indigenous systems of knowledge and knowledge dissemi- Zealand in response to dissatisfaction of Maori people nation have many differences, the two are not entirely with their nursing care. The nursing council of New irreconcilable [18]. Zealand had defined culturally unsafe care as ‘‘any actions Currently though, most health science KT efforts have that diminish, demean or disempower the cultural identity been modelled on the one-way transfer of academic health and wellbeing of an individual’’ [20]. The meaning and knowledge into Indigenous communities, often with little application of the term cultural safety is evolving in consideration of pre-existing Indigenous knowledge sys- Canada; however, it is commonly perceived as an advance- tems. This external imposition of one knowledge system ment beyond ‘‘cultural sensitivity’’ [21]. Cultural safety is onto another, although often done with good intentions, is usually defined by clients themselves, with the onus placed almost always ineffective, especially when there are key on health care professionals to self-reflect and work with theoretical and practical tensions. Indigenous scholar and their institution to address the impact of power imbal- elder Leroy Littlebear described this process as ‘‘jagged ances, attitudinal, and institutional discrimination and worldviews colliding’’ [19]. For Indigenous individuals and colonization on service provision and clientprovider communities, such one-way KT processes may resonate relationships. This work can be particularly challenging with historic and current colonial practices such as the given the pervasive negative representations of Indigenous apprehension of Indigenous children into residential people in the media and education systems. schools, where there was a subsequent one-way transfer of European-based language and schooling or the imposi- Underlying unmet material, social, and health needs tion of European systems of law and land rights into The historic and current unequal distribution of health Indigenous communities through the Indian Act and other and social resources has translated into a disproportionate colonial legislations. The fundamental rights of Indigenous burden of poverty, food insecurity, homelessness and self-determination at the individual and collective levels housing inadequacy, unemployment, and lower formal include not only land rights but also the right to ‘‘construct educational achievement for Indigenous people in Canada. knowledge in accordance with self-determined definitions Linked to these challenges in the social determinants of of what is real and what is valuable’’ [14]. The development health are striking disparities in the health status of and application of Indigenous KT models is therefore not Indigenous peoples compared with the general Canadian only practical but also integral to processes of decoloniza- population [22]. For example, diabetes and mental illness tion and healing. are much more common among First Nations populations Moving towards KT models that embrace diverse compared with non-First Nations populations [23, 24]. It is understandings of knowledge and recognize, respect, and important to understand that these unmet needs and high build on existing knowledge systems will not only result in illness burdens can interfere with participation in learning, better processes and outcomes for Indigenous commu- teaching, and participation in health information sharing nities, it will also provide rich learning for mainstream KT events and programs. Smylie et al. 19 Health literacy Reciprocity in relationships The Canadian Expert Panel on Health defines health Reciprocity is a foundational social and spiritual principle literacy as ‘‘The ability to access, understand, evaluate and for many Indigenous communities that, according to Cree communicate information as a way to promote, maintain philosopher Willie Ermine, ‘‘dictat[es] how all life would co-exist in mutual protection, benefit, and continuity’’ [30]. and improve health in a variety of settings across the life- Within the academic context this may emerge as a two-way course’’ [25]. Although little information regarding the teaching and learning process in which the dichotomy health literacy of Indigenous peoples in Canada is avail- between ‘‘teacher’’ and ‘‘learner’’ is challenged, and the able, we do know that this population faces a dispropor- faculty members make extra efforts to be accessible and tionate burden of low literacy with respect to reading and equally vulnerable in the knowledge relationship [31]. writing in English compared with non-Indigenous com- munities as well as much lower rates of high school Location completion [26]. Indigenous-specific models of literacy A significant proportion of Indigenous people in Canada also exist and are notable for their holistic understandings live in remote and rural areas where geographic location and approaches. The Rainbow/Holistic Approach to can limit access to infrastructure commonly taken for Aboriginal literacy, as one example, uses seven ways of granted, such as high speed internet access, tertiary knowing, each corresponding to a color and recognizes healthcare facilities, and public libraries. The majority of that spirit, heart, mind, and body equally contribute to a Indigenous people now live in urban areas in Canada and life of balance and nurtures them all [27]. this population is rapidly increasing. Urbanization unfor- tunately does not necessarily translate into improved health Protection and custodianship of Indigenous knowledge or living conditions for Indigenous populations [23, 32, 33]. Colonization included the purposeful undermining of In cities, the Indigenous population may be more dispersed Indigenous languages and culture, commercialization of and diverse compared with more rural or remote settings. Indigenous art, and appropriation of Indigenous plant Table 1 summarizes these specific strategies for imple- knowledge in the development of medicine, all without menting KT activities in Indigenous contexts. consent, acknowledgement, or benefit to Indigenous peoples [28]. Current legal regimes are still inadequate to protect Indigenous knowledge [28]. Within the context of Indigenous knowledge translation in Indigenous health and health information there are also contemporary contexts a few examples examples of historic abuses and inequities in Canada, including nutritional experimentation on Indigenous chil- Critical reflection questions: Can you identify how these dren in residential schools and the exclusion of Indigenous examples have incorporated Indigenous understanding of communities from national health surveys. Not surpris- knowledge and Indigenous approaches to KT? Do they ingly given this history, many Indigenous communities are address the contextual issues identified in the previous very concerned about external to community ownership, section? Do you see them as valid examples of KT? Why or control, and access to and use of their health information why not? and therefore have created policies and processes to ensure What follows is by no means meant to be comprehen- Indigenous governance and management of Indigenous sive, we have simply selected a few examples from diverse health information [29]. settings. The lead author is currently in the process of building a more comprehensive listing of Indigenous KT Publication bias initiatives that will be shared on an interactive web page. The large majority of published health information has Please contact her if you have a good example that you been created without taking Indigenous ways of knowing, would like to see included. doing, and sharing information into account. This litera- ture is commonly perceived in Indigenous contexts as not Maria Campbell’s Halfbreed Ball immediately useful or relevant and, at worst, as a continu- On 15 June 2013 as part of the Native American and ing colonial imposition of external ways of knowing upon Indigenous Studies Association Conference, held in Saska- Indigenous people. There is a deficit of Indigenous-led, toon, Saskatchewan, Me ´tis elder, author, and community Indigenous-authored, and community-relevant published activist Maria Campbell organized an evening of food, materials. A large proportion of that which exists is in the dance, art, and entertainment. The Halfbreed Ball was form of ‘‘grey’’ literature (i.e., non-indexed publications). fashioned on historic Me ´tis social events that were held to When Indigenous scholars and communities produce honour the arrival and departure of visitors to Me ´tis materials for non-Indigenous specific scholarly journals communities*times when the word Halfbreed was used there is usually a tension between the defined criteria of with pride. The ten-course meal featured traditional foods what is acceptable in peer-reviewed publications and what served with a contemporary flair (Figure 1). Between might be perceived as relevant and linked to Indigenous courses, guests were treated to a parade of historic Me ´tis ways of knowing and doing. This divergence means that fashion, poetry, fiddle music and jigging, and folk and opera articles that take Indigenous constructions of knowledge singing. This was followed by an old-time dance. In the into account may be less likely to be published. For words of one guest ‘‘this evening...made abundantly clear example, an editor may prioritize generalizability but the continuity of this lively culture and the warm, open- Indigenous communities may want emphasis on the hearted nature of those Me ´tis well-grounded in and proudly uniqueness of their particular context. contributing to the vitality of the culture today’’ (Susan 20 JCHLA / JABSC Vol. 35, 2014 Table 1. Contextual Issues for KT in Indigenous Contexts and Mitigating Strategies Contextual issue Mitigating Strategies Cultural safety Critically reflect on your own knowledge, values, assumptions, and experiences generally with respect to the social hierarchies around class, age, ability, gender, sexual orientation, race and ethnicity, and more specifically with respect to Indigenous peoples. We almost all have bias and prejudicial assumptions; can you identify any of yours? Are there particular populations groups where you are less knowledgeable, less comfortable, or more judgemental? How has the media and your education shaped your views? Fill the gaps and (or) identify populations or groups for which you might need to do some more critical self-reflection to contribute to safe and respectful interactions. Identify allies in your institution and within your communities of practice and work together to identify and address institutional barriers and increase institutional safety. Search for institutional best practices that might be relevant to your place of work. Health literacy Learn more about Indigenous conceptualizations of literacy and health literacy [27]. Think broadly about literacy, (i.e., reading and writing in English is one aspect that is important in most mainstream institutional contexts) but what about the importance of traditional local ecologic literacies in a remote wilderness setting? Strategize with others on how your institution could support diverse knowledge users to obtain an enhanced health literacy. Co-create plain language summaries. Assess and respond to opportunities to build capacity and literacy using health information technologies. Protection and custodianship of Critically examine information sources with an eye towards authenticity of authorship, Indigenous knowledge Indigenous community involvement, and custodianship of Indigenous information and the prevention of appropriation. Support and participate in processes that actively promote Indigenous community production and management of Indigenous health information and health information systems. In situations where it appears a person external to the community is publishing or sharing Indigenous community health information with no apparent community involvement, ask questions. Underlying unmet material, social, Ensure that projects and events involving Aboriginal community members include budgets and health needs for transportation allowance and childcare. Provide healthy food at events and meetings. Ensure schedules fit with the needs of those who are experiencing chronic illnesses. Allow for flexibility in scheduling to account for personal, family, and community illness or crisis. Publication bias Include grey literature and oral histories in your literature searches and indexes. Recognize and value multiple forms of knowledge dissemination. Consider incorporating equity criteria in your critical appraisal methods [34]. Be aware that search terms in use do not always match the terms by which Indigenous people self-refer; this can be problematic, both with the use of search terms that are considered offensive by some people (i.e., Indians, Eskimos) and also the non-specificity of terms now in more current use by Indigenous people (i.e., the term Indigenous). Support Indigenous and community led publication efforts. Reciprocity in relationships Ensure that the KT project or activity will be mutually beneficial to all parties, including Indigenous community partners. For those in a role that may involve structured social privilege (i.e., health professional, librarian, academic faculty) make efforts to bridge relationships and build trust by sharing your own hopes, fears, and vulnerabilities in the learning relationship. Create opportunities for Indigenous community capacity building and recognize that capacity building will be a two-way process (i.e., partners external to Indigenous community will also be gaining capacities and training in working with Indigenous communities). Location When working with Indigenous peoples from a location that is different from where you live and work, ideally try and spend time in this place with a knowledgeable and willing community member who is being compensated for orienting you. Working with Indigenous community partners, actively reflect on what is unique about the context and location where the KT activity is taking place. Consider outreach strategies in urban areas. Smylie et al. 21 Fig. 1. Author Janet Smylie serving traditional food and Rajan their narrative with music, artwork, video clips, and Anderson playing fiddle at the Halfbreed Ball, Native American photographs. KT occurred throughout the workshops as and Indigenous Studies Association conference, June 2013. participants connected with themselves, their history, and the land through storytelling and dialogue. DVDs of the digital stories were made freely available to all participants and the community, and they were disseminated with permission of participants to policy makers and health professionals as well as posted online [36]. Perhaps most importantly, the project’s investment in technology, infra- structure, and community training led to the development of the ‘‘My Word: Storytelling and Digital Media Lab’’, a community-run centre for digital media and research that continues to lead research in the community and the centre has expanded to offer a variety of research, media, and data-gathering services. Indigenous Knowledge Network for Infant, Child, and Family Health The Indigenous Knowledge Network for Infant, Child, and Family Health was a community partnered KT research project designed to support the gathering and application of Indigenous knowledge in 10 diverse First Nations, Me ´tis, and urban Aboriginal communities. Ten frontline Aboriginal prenatal, infant, child, youth, and family health workers including midwives, health promo- Gingell, written communication, 2013). This event exem- tion program staff, health managers, and elders, were plifies experiential, socially embedded Indigenous KT, seconded to this project one day a week for four years. For which in this case showcased historic and contemporary the first two years they gathered oral histories from Me ´tis culture to Indigenous scholars from around the world. Indigenous elders and knowledge keepers in their commu- The Native Youth Sexual Health Network (NYSHN) nities of work. For the second two years they developed, The NYSHN is an organization engaged in KT around implemented, and evaluated community-based knowledge Indigenous youth sexual and reproductive well-being. Led application projects that drew on the Indigenous knowl- by Indigenous youth, NYSHN encompasses a peer-based edge they had collected. The academic research team, network of advocates, families, and communities [35]. The based at the Well Living House Action Research Centre, network collaborates on various initiatives that support supported program activities and facilitated network-wide Indigenous youth in sharing their own knowledge on meetings and interactions. healthy sexuality, as well as mobilizing collective action Evaluation of the network revealed very positive and around youth-identified priorities. Some recent initiatives transformative impacts for network participants, their include a national gathering for Indigenous young women, clients, and the participant Aboriginal communities. a ‘‘sexy health’’ carnival, and a participatory action Many of the knowledge application projects and relation- research project exploring the role of land in the sexual ships across the network and among network participants, community elders, and clients are ongoing. One of the keys health of Metis women and youth [35]. KT, in this example, to this project is that it actively builds on existing means building networks that support Indigenous youth in community resources and infrastructure. You can learn being both experts and knowledge users of sexual health more about this project and the Well Living House Action information. Research Centre at http://www.stmichaelshospital.com/ Changing Climate, Changing Health, Changing Stories crich/well-living-house/. The Changing Climate, Changing Health, Changing Stories project provides a promising example of KT within a community-based research project. With funding from Bridging Indigenous approaches to KT into Health Canada’s First Nations and Inuit Health Branch, health library science and practice the Rigolet Inuit Community Government formed a trans- disciplinary team of Indigenous and non-Indigenous It is our hope that readers will now be full of ideas and researchers to explore implications of climate change on questions regarding the application of Indigenous KT physical, emotional, mental, and spiritual health [36, 37]. approaches in their health information work and practice. The project built from the rich oral tradition of Inuit We would like to remind you that it is very likely that you knowledge systems by using digital storytelling and first- are already actively engaged in KT activities, some of person narratives as methods for exploring and sharing which are synergistic with Indigenous KT ideas and local experiences of climate change. Through a series of protocols. In fact, almost everything that a health librarian week-long workshops, community participants shared and does could be considered KT, especially if one draws on the developed personal stories, while receiving training to Indigenous notions of KT as a sharing of knowledge that is produce these narratives as a digital short that weaved bidirectional, participatory, and social. 22 JCHLA / JABSC Vol. 35, 2014 We have identified some specific strategies for imple- We have done our best in this article to share knowledge menting KT activities in Indigenous contexts in Table 1. and resources to support readers interested in under- More generally, it is our hope that readers will continue to standing and applying Indigenous approaches to KT. We think critically about their underlying assumptions regard- recognize that some of the concepts, critical questions, ing what is valid knowledge and what are valid knowledge- strategies, and examples may be challenging for readers. sharing strategies*and be open to different ideas. In some However, we believe that much of the content is relevant instances health librarians will be able to build on what not only to KT but also to other health and social science they are already doing. For example with respect to research, service, and policy work in Indigenous contexts. reciprocity in relationships, many librarians will recognize ‘‘New’’ ideas and strategies, such as KT, are constantly that in their day-to-day work they are already engaged in emerging in health and health information sciences. For mutually beneficial bi-directional knowledge exchange as example current CIHR strategies include terms such as they are always learning something new and understanding ‘‘implementation science’’ and ‘‘evidence informed health- information needs before proceeding with assisting users. care renewal’’. One commonality that will likely be shared In other cases, implementing some of the suggestions may by many of these future health science research and (or) be more challenging. For example, a health librarian who practice directions is that they will exclude or marginalize has focused on supporting research, policy, and practice Indigenous systems of knowledge and practice. A few, users in acquiring ‘‘best evidence’’ using standardized however, will realize the gains in both process and critical appraisal methods drawn from clinical epidemiol- outcomes that can be made by keeping Indigenous ways ogy may need to expand their knowledge regarding best of knowing and doing in mind*not only for Indigenous evidence for Indigenous contexts and build new skills in communities but for all peoples. identifying, critically appraising, and sharing materials drawn from grey literature and multimedia. References Health librarians may also find themselves in a position where they can facilitate a bridging of the knowledge and 1. Government of Canada. Canadian Institutes of Health knowledge system gaps between researchers working with Research Act. S.C 2000, c. 6. Assented April 13, 2000. [Cited Indigenous communities and Indigenous communities 21 January 2014]. Available from: http://laws-lois.justice.gc.ca/ themselves. 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Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du CanadaUnpaywall

Published: Apr 2, 2014

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