The high rate of discrepant decisions underscores the importance of effective patient-surrogate communication before medical decision-making incompetence occurs. The potential of increasing patient-surrogate agreement on difficult medical decisions by educational interventions should be explored.

This research draws on the reflections from group discussions with indigenous families and interviews with early childhood educators and community stakeholders from five First Nations reserve communities in Canada whose young children participate in the national aboriginal Head Start On Reserve (AHSOR) programme. The purpose of the study was to examine the contributions of indigenous knowledge to young indigenous children's literacy learning. In the course of this examination what became clear is that there is a greater set of literacy activities in these families than is recognized by early learning settings. Further, there is a literacy orientation within their indigenous knowledge systems that, draws on oral tradition, land-based experiences and ceremonial practices that, when linked to the discourses of schooling and literacy, provide the basis for improving educational outcomes for indigenous children and families, whose relationship with schooling has been historically troubled.

The transition into formal early learning settings, such as preschool and child care, represents a significant milestone for children and families. This paper explores the perspectives of 25 indigenous parents and family members and two caregivers reflecting on the transition of the indigenous children from their home to an early childhood development program in a large urban centre in western Canada. Our findings suggest that the transition experiences begin well before indigenous children and families join a program. There are factors that facilitate their participation, such as costs, transportation and location. How these parents negotiate their transition is impacted by their historical experiences with schooling and the place of culture and language in supporting their children and families. Early learning programs need to understand the social, cultural and historical realities that shape the transition experience for indigenous children and families. 1 ' The indigenous people of Canada are referred to as Aboriginal people. The term Aboriginal is inclusive of First Nations, Inuit and Metis people of Canada. The Aboriginal people of Canada refer to themselves by their tribal affiliations.

Community-based and Indigenous-led health and wellness approaches have been widely advocated for Indigenous peoples. However, remarkably few Indigenous designed and led interventions exist within the field. The purpose of this study was to evaluate an Indigenous-led and community-based health and wellness intervention in a remote and rural Indigenous community. This protocol was designed by and for Indigenous peoples based on the aspirations of the community (established through sharing circles). A total of 15 participants completed a 13-week walking and healthy lifestyle counselling program (incorporating motivational interviewing) to enhance cardiometabolic health. Measures of moderate-to-vigorous physical activity (MVPA; 7-day accelerometry and self-report), predicted maximal aerobic power (VO2max; 6-min walk test), resting heart rate and blood pressure, and other health-related physical fitness measures (musculoskeletal fitness and body composition) were taken before and after the intervention. The intervention led to significant (p < 0.05) improvements in VO2max (7.1 ± 6.3 % change), with the greatest improvements observed among individuals with lower baseline VO2max (p < 0.05, r = -0.76). Resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure decreased significantly (p < 0.05) after the intervention. Self-reported and accelerometry-measured frequency of MVPA increased significantly (p < 0.05), and the total MVPA minutes (~275 min/week) were above international recommendations. Change in VO2max was significantly correlated with change in self-reported (r = 0.42) and accelerometry-measured (r = 0.24) MVPA minutes. No significant changes were observed in weight, body mass index, waist circumference, body fat (via bioelectrical impedance), grip strength, and flexibility. These findings demonstrate that a culturally relevant and safe, community-based, Indigenous-led, health and wellness intervention can lead to significant and clinically relevant improvements in cardiometabolic health and physical activity behaviour, with the greatest changes being observed in the least active/fit individuals.

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