The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.

The Beginning: Initial interviewsIn 2005 the Tlicho people were granted self-government over their lands and four communities. As part of this process, in 2012 the senior directors and managers of the Tljchc Government asked the author to help them develop a program to enhance their skills as leaders and administrators. To determine their priorities for skill development and leadership training, the author conducted confidential interviews with eleven of the senior managers. The interview process included relevant experience and current skills, their professional goals, and suggestions for the development of the Tljchc Government. The goal was to build a management development program that responded to the needs of the managers and directors, and to the priorities of the elected leaders (Chiefs) (McKnight and Kretzmann 1988/2012).These individual interviews were conducted privately, and the data were analysed for priorities and themes. The interviews confirmed that senior staff members are committed to enhancing their personal skills to manage their full range of responsibilities and to strengthening their capacity to be leaders in the Tljchc Government. Examples of the managersu0027 interview comments were included on the agenda of each session as a strategy to remind participants of the responsive nature of their program, and to reinforce their engagement. Participants became increasingly engaged in the management Development Program as they saw that it reflected their own ideas. Although many topics common to other management programs were addressed, this responsive approach strengthened the engagement of the participants (CDC 2011). The core themes from the interviews were:1. Culture and professional management practice2. Communication3. Supervising and delegation4. Day-to-day management skills5. Sustaining the management process in the Tljchc Govern mentEach of these themes framed one of the five 4-day sessions. Topics overlapped, and key issues re-appeared often, permitting deeper ex- ploration of strategies and solutions from various perspectives, both personal, and professional (Gibson et al 2001). These sessions were completed in the 2013-2014 fiscal year.Structuring the Management Development SessionsThis paper includes actual structure of the sessions and a summary of some of the topics in the hope that this approach might be useful to other communities seeking an appropriate strategy for management development. It was considered by the leadership to be very important to distinguish this management program from the more usual training programs offered to more junior staff.Each session began with a review/discussion on the first morning, and concluded with an action planning session, with goals for the participants, as well as recommendations for the government (Chief and Council). Tljchc Government policies and practices benefited from this review based senior management experience. The second and subsequent sessions also included a roundtable discussion reviewing interim progress on the goals from the previous session, because these five sessions were several months apart. Sessions were modified to respond to emerging priorities, with topics shifting from time to time, taking advantage of learning opportunities and making the topics fit into the participantsu0027 cultural context. This dynamic and flexible approach enhances expertise by fitting standard topics into the flow of discussions (Whittaker u0026 Gibson 1986). Slides were used to guide discussions, and ensure that the goals were achieved for each session. Often a slide would simply have key words, or a leading question.Each of the five sessions is summarized below, starting with a comment from the initial management interviews. Topics common to most management development sessions were covered; however, they were always discussed within the Tljchc community context (Minkler u0026 Wallerstein 2008). …

To address high STI rates in their aboriginal communities, the Tlicho of the Northwest Territories adopted a collaborative participatory research approach to sexual health based on four key stages of development. First was community initiation and engagement, where local leaders identified a priority need and began community discussions around sexual health. Secondly, identifying that existing government statistics could not provide them with specific enough information, the Tlicho Community Services Agency partnered with the University of Alberta and CIETcanada to conduct a baseline study in all four Tlicho communities, designed and administered by community-based researchers. Third, a Community Action Research Team (CART) developed evidence-based interventions and partnered with local community health researchers and public health personnel. The fourth phase included a follow-up evaluation of the CART activities and ongoing community-led action planning based on the results from the surveys. Key elements contributing to the success of the community-based participatory research approach include community readiness, community and researcher collaboration, local evidence-based planning, and ongoing capacity building and monitoring. The process has led to an increase in interdepartmental collaboration and the development of culturally relevant knowledge translation resources. Key to continued success is the sustainability and transferability of the CART approach to other priority concerns, and the strengthening of integration within the various programs to ensure continuing collaborative interventions.

For decades, the peopling of the Americas has been explored through the analysis of uniparentally inherited genetic systems in Native American populations and the comparison of these genetic data with current linguistic groupings. In northern North America, two language families predominate: Eskimo-Aleut and Na-Dene. Although the genetic evidence from nuclear and mtDNA loci suggest that speakers of these language families share a distinct biological origin, this model has not been examined using data from paternally inherited Y chromosomes. To test this hypothesis and elucidate the migration histories of Eskimoan- and Athapaskan-speaking populations, we analyzed Y-chromosomal data from Inuvialuit, Gwich’in, and Tłįchǫ populations living in the Northwest Territories of Canada. Over 100 biallelic markers and 19 chromosome short tandem repeats (STRs) were genotyped to produce a high-resolution dataset of Y chromosomes from these groups. Among these markers is an SNP discovered in the Inuvialuit that differentiates them from other Aboriginal and Native American populations. The data suggest that Canadian Eskimoan- and Athapaskan-speaking populations are genetically distinct from one another and that the formation of these groups was the result of two population expansions that occurred after the initial movement of people into the Americas. In addition, the population history of Athapaskan speakers is complex, with the Tłįchǫ being distinct from other Athapaskan groups. The high-resolution biallelic data also make clear that Y-chromosomal diversity among the first Native Americans was greater than previously recognized.

Over the past two decades the various Canadian sources of research funding have moved from an academic, science- based focus to a more inclusive model, encouraging applications that support research partnerships with community organizations. This transition in definitions and expectations is creating challenges for some funders, as well as academic and community applicants. With the advent of community-based participatory research new perspectives on respectful, ethical research partnerships are appearing. The paper reviews some of the challenges and strategies for community partners, academics, and funders in terms of research approach and practice.

The purpose of this study was to investigate the relationship between community-level exposure to changes in economic conditions and the incidence and prevalence of mental disorders and cardiovascular disease in 29 resource-based communities (with a focus on mining communities) in British Columbia (BC) during a period of time marked by an economic downturn (1991–2002) The investigation relied on Labour Force Survey (LFS) and Statistics Canada Census data, and health records from the British Columbia Ministry of Health (MoH). Age and sex adjusted prevalence and incidence rates were calculated for each community from 1991 to 2002 and the development of an economic change indicator defined using Census data and industry/government documents allowed for yearly assessment of community-level exposure to economic conditions. The relationship between exposure to economic change and rates of acute and chronic cardiovascular disease and mental disorders across the 29 study communities was investigated using a generalized linear model (stratified by type of community, and adjusted for the effect of the community). Findings indicate an impact on the prevalence rates for acute cardiovascular disease (CVD) during periods of economic decline (rate increased by 13.1 cases per 1,000 population, p < 0.0001 as compared with stable periods) and bust conditions (rate increased by 30.1 cases per 1,000 population, p < 0.0001 as compared with stable conditions) and mental disorders (rate increased by 13.2 cases per 1,000 population, p = 0.0001) in mining communities during declining economic conditions as compared to steady periods of mining employment. This is not observed in other resource-based communities. The paper concludes by highlighting implications for the mining industry to consider as they begin to recognize and commit to mining community health.

Since 2005, the Tłįchǫ Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tłįchǫ regional rates were nearly four times that of the NT – 91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention.

This book, published as part of Routledge’s Studies in Human Geography, is useful well beyond this discipline, as it provides a welcome review of Participatory Action Research (PAR). In three major sections, beginning and ending with ‘Reflections’ that bracket the ‘Action’ section, this collection provides a timely overview of the current status of this methodology, as well as many useful examples of applying PAR as a research process.

Background: Many sources of valid knowledge may be relevant to a research question. Communities need a mechanism to explore the full range of knowledge that could enrich community-based research. A knowledge profile (KP) is an integrated description of the knowledge and expertise that, once assembled, can help to explore a research issue.Objective: This article describes the establishment of a KP as a purposive process whereby the initial research team identifies the kinds of knowledge that can help to articulate and refine a research question, and assemble the right research team and resources.Method: The KP process is conducted by a core team, which may expand to include additional expertise. The four phases of a KP are (1) creating the research space, (2) articulating and negotiating, (3) identifying the research question, and (4) creating the resource inventory. The process is illustrated by a case study. The outcomes of a successful KP include an inventory of existing and required resources, a strong research team operating in an ethical and safe research space, and clear articulation of the research question. The KP can be revisited regularly throughout a project to evaluate the effectiveness of the research team.Conclusion: KP provides a road map for community-based research teams to navigate through the early phase of research development.

The Tłįchǫ Community Services Agency's (TCSA) Healing Wind Strategy identifies a number of activities and interventions to address the prevention of STI/HIV/AIDS in the Tłįchǫ region of the Northwest Territories of Canada. As a part of this strategy, the TCSA and CIET facilitated research to develop a foundation for interventions targeting sexually transmitted infections. The project recruited and trained community-based researchers who conducted a research survey on sexual health attitudes and behaviours in the four Tłįchǫ communities, covering 65% of the population above 9 years of age. The research process, outcomes, and the strategic plan that arose from the research findings produced a clear framework for interventions that are grounded in the community, but could also influence national and territorial policy. The approach may be relevant in other settings.

Sexuality is an important aspect of a couple’s relationship, but is often neglected in literature which focuses on the dysfunction associated with illness or disability. This study considers the impact of Multiple Sclerosis (MS) on the couple’s sexual relationship. The purpose of the study was to understand the “lived experience” of couples in which the female partner was diagnosed with MS during the relationship. An in-depth semi-structured interview was used with each partner separately. Participants identified the primacy of communication in coping with the effects of MS. The women with MS live with the unpredictable course of their disease and doubts about their worthiness, attractiveness, and identity. The male partners of these women with MS perceived little impact on the women’s sexuality, likely because the women went to great lengths to maintain their customary roles and to buffer their male partners from the full impact of the disease.

This multi-method study used a participatory action research approach to examine the complex net of socio-cultural factors that influenced behaviour related to tuberculosis (TB) prevention and treatment in the 10 highest risk cultural groups consisting of immigrant and Aboriginal populations in the province of Alberta, Canada. Trained community research associates collected qualitative interview data and helped with interpretation and evaluation. A community advisory committee established foundation principles and monitored the ethical and cultural appropriateness of the research process. A key finding is that although patients with active disease learn about TB from health professionals, people in high-risk populations need to learn more about TB transmission and prevention prior to contact. This is particularly important given that lack of knowledge of TB was strongly associated with negative attitudes towards TB and a worse experience of the disease. The study results underline the need for accessible and culturally appropriate health education about TB in the high risk groups. This can be accomplished in collaboration with lay people, particularly those who have recovered from active TB, their family members and health workers from the community.

In recent years, researchers and practitioners have begun to modify existing cognitive assessment instruments and develop new tools in order to increase the accuracy of mental capacity evaluations among seniors in cross-cultural settings. Based on a review of the literature and consultations with members of the Aboriginal capacity assessment committee at the Royal Alexandra Hospital in Edmonton, Canada, during the summer of 1998, the authors argue that both the process by which capacity assessments are conducted and the content of the assessment instruments are problematic. The article summarizes the difficulties that differing degrees of acculturation within and between Aboriginal groups create for cognitive evaluations. It recommends steps that mental health professionals can follow to develop meaningful assessment strategies for Aboriginal seniors that reflect both the content and the interactional processes that characterize their traditional cultural orientations.

OBJECTIVE To describe cultural beliefs of Orthodox Jewish families regarding childbirth in order to help family physicians enhance the quality and sensitivity of their care.QUALITY OF EVIDENCE These findings were based on a review of the literature searched in MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Science Abstracts (1984 to present). Interviews with several members of the Orthodox Jewish community in Edmonton, Alta, and Vancouver, BC, were conducted to determine the accuracy of the information presented and the relevance of the paper to the current state of health care delivery from the recipients' point of view.MAIN MESSAGE Customs and practices surrounding childbirth in the Orthodox Jewish tradition differ in several practical respects from expectations and practices within the Canadian health care system. The information presented was deemed relevant and accurate by those interviewed, and the subject matter was considered to be important for improving communication between patients and physicians. Improved communication and recognition of these differences can improve the quality of health care provided to these patients.CONCLUSIONS Misunderstandings rooted in different cultural views of childbirth and the events surrounding it can adversely affect health care provided to women in the Orthodox Jewish community in Canada. A basic understanding of the cultural foundations of potential misunderstandings will help Canadian physicians provide effective health care to Orthodox Jewish women.

OBJECTIVE:To examine and understand how differences in the cultural backgrounds of Canadian physicians and their Vietnamese patients can affect the quality and efficacy of prenatal and postnatal treatment.QUALITY OF EVIDENCE:The information in this paper is based on a review of the literature, supplemented by interviews with members of the Vietnamese community in Edmonton, Alta. The literature was searched with MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Sciences Abstracts (1984 to present). Emphasis was placed on articles and other texts that dealt with Vietnamese customs surrounding childbirth, but information on health and health care customs was also considered. Interviews focused on the accuracy of information obtained from the research and the correlation of those data with personal experiences of Vietnamese community members.MAIN MESSAGE:Information in the texts used to research this paper suggests that traditional Vietnamese beliefs and practices surrounding birth are very different from the biomedical view of the Canadian medical system. The experiences and beliefs of the members of the Vietnamese community support this finding. Such cultural differences could contribute to misunderstandings between physicians and patients and could affect the quality and efficacy of health care provided.CONCLUSIONS:A sensitive and open approach to the patient's belief system and open and frank communication are necessary to ensure effective prenatal and postnatal treatment for recent Vietnamese immigrants and refugees. Education and awareness of cultural differences are necessary for physicians to provide the best and most effective health care possible.