Qaujigiartiit Health Research Centre

In Nunavut, data for 2012–2014 shows a high school graduation rate of 34%. Little has been published about the causes of secondary students’ absenteeism and the methods for attracting students back to school. This study explored the barriers and supports to education success from the perspectives of school staff, students, and parents. Interviews and sharing circles were conducted with 141 participants in six communities. The results revealed barriers and supports in relation to the learning environment, staffing issues, and overarching system. Participants identified specific recommendations that can inform future policy and programming to improve attendance and graduation rates in Nunavut schools.

Historically, health research in the Arctic has focused on documenting ill-health using a narrow set of deficit-oriented epidemiologic indicators (i.e., prevalence of disease and mortality rates). While useful, this type of research does not adequately capture the breadth and complexities of community health and well-being, and fails to highlight solutions. A community's context, strengths, and continued expressions of well-being need to guide inquiries, inform processes, and contextualize recommendations. In this paper, we present a conceptual framework developed to address the aforementioned concerns and inform community-led health and social research in the Arctic. The proposed framework is informed by our collective collaborations with circumpolar communities, and syntheses of individual and group research undertaken throughout the Circumpolar North. Our framework encourages investigation into the contextual factors that promote circumpolar communities to thrive. Our framework centers on the visual imagery of an iceberg. There is a need to dive deeper than superficial indicators of health to examine individual, family, social, cultural, historical, linguistic, and environmental contexts that support communities in the Circumpolar North to thrive. A participatory community-based approach in conjunction with ongoing epidemiologic research is necessary in order to effectively support health and wellness. Conclusions: The iceberg framework is a way to conceptualize circumpolar health research and encourage investigators to both monitor epidemiologic indicators and also dive below the surface using participatory methodology to investigate contextual factors that support thriving communities.

One of the greatest challenges of Nunavut's health care system is its reliance on short-term professionals, many of whom are not oriented to the Inuit historical/cultural context and the organization of health care in the territory. Our objective was to develop a free iOS/Android app to address this knowledge gap. We reviewed existing literature and interviewed key stakeholders to develop the content of the app covering the following: Inuit ways of communicating and expectations in the health care setting; Inuit history, settlement, and societal values (including a bibliography and a list of Inuktitut language phrases and resources); health care model (including referral pathways for tertiary care and mental health referrals); maps and community information; and useful information to prepare for your arrival. The app, HealthNU, was launched in September 2017. We targeted new and short-term health care providers in Nunavut, and the app has also been circulated and used by social workers, educators, and health care providers outside of the territory. By September 5, 2019, the app had been downloaded more than 700 times. To evaluate the app, we conducted interviews and a brief survey with key stakeholders (n = 18), who indicated that (1) the app was easy to use; (2) the content was highly relevant and would result in improved cultural competencies; and (3) they would recommend the app to colleagues and were already using it for recruitment/orientation. Challenges and limitations included: ensuring practitioners "completed" all modules while reading/using the app, and low response rate among providers who were solicited for feedback. HealthNU is an example of how technology solutions developed in partnership with community members, health care providers, researchers, and government can improve the quality of care for Nunavummiut. We are currently working with the Nunavut Department of Health to develop similar apps in other contexts.

ABSTRACT The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people’s experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.

In the field of Arctic health, “resilience” is a term and concept used to describe capacity to recover from difficulties. While the term is widely used in Arctic policy contexts, there is debate at the community level on whether “resilience” is an appropriate term to describe the human dimensions of health and wellness in the Arctic. Further, research methods used to investigate resilience have largely been limited to Western science research methodologies, which emphasize empirical quantitative studies and may not mirror the perspective of the Arctic communities under study. To explore conceptions of resilience in Arctic communities, a Sharing Circle was facilitated at the International Congress on Circumpolar Health in 2018. With participants engaging from seven of the eight Arctic countries, participants shared critiques of the term “resilience,” and their perspectives on key components of thriving communities. Upon reflection, this use of a Sharing Circle suggests that it may be a useful tool for deeper investigations into health-related issues affecting Arctic Peoples. The Sharing Circle may serve as a meaningful methodology for engaging communities using resonant research strategies to decolonize concepts of resilience and highlight new dimensions for promoting thriving communities in Arctic populations.

Indigenous peoples in Canada experience disproportionate rates of suicide compared to non-Indigenous populations. Indigenous communities and organizations have designed local and regional approaches to prevention, and the federal government has developed a national suicide prevention framework. However, public health systems continue to face challenges in monitoring the population burden of suicide and suicidal behaviour. National health data systems lack Indigenous identifiers, do not capture data from some regions, and do not routinely engage Indigenous communities in data governance. These challenges hamper efforts to detect changes in population-level outcomes and assess the impact of suicide prevention activities. Consequently, this limits the ability to achieve public health prevention goals and reduce suicide rates and rate inequities.This paper provides a critical analysis of the challenges related to suicide surveillance in Canada and assesses the strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities. To better understand these challenges, we discuss the policy context for suicide surveillance and examine the survey and administrative data sources that are commonly used in public health surveillance. We then review recent data on the epidemiology of suicide and suicidal behaviour among Indigenous populations, and identify challenges related to national surveillance.To enhance capacity for suicide surveillance, we propose strategies to better track progress in Indigenous suicide prevention. Specifically, we recommend establishing an independent community and scientific governing council, integrating Indigenous identifiers into population health datasets, increasing geographic coverage, improving suicide data quality, comprehensiveness, and timeliness, and developing a platform for making suicide data accessible to all stakeholders. Overall, the strategies we propose can build on the strengths of the existing national suicide surveillance system by adopting a collaborative and inclusive governance model that recognizes the stake Indigenous communities have in suicide prevention.