Asthma and allergies are common conditions among Aboriginal children and adolescents. The purpose of this study was to assess the health and health-care inequities experienced by affected children and by their parents. Aboriginal research assistants conducted individual interviews with 46 Aboriginal children and adolescents who had asthma and/or allergies (26 First Nations, 19 Métis, 1 Inuit) and 51 parents or guardians of these children and adolescents. Followup group interviews were conducted with 16 adolescents and 25 parents/ guardians. Participants reported inadequate educational resources, environmental vulnerability, social and cultural pressures, exclusion, isolation, stigma, blame, and major support deficits. They also described barriers to health-service access, inadequate health care, disrespectful treatment and discrimination by health-care providers, and deficient health insurance. These children, adolescents, and parents recommended the establishment of culturally appropriate support and education programs delivered by Aboriginal peers and health professionals.
This paper adds evidence to a growing body of literature seeking to understand the disproportionate occurrence of tuberculosis (TB) in Indigenous populations of Canada and reveals insights that may inform effective interventions. As a disease, TB is recognized as a disorder of the body, for which there are successful treatments. Its persistence in some populations, however, requires an understanding of TB as an illness, whereby disease is shaped into behaviours and experiences. Fifty-five self-identified Indigenous participants with infectious pulmonary TB completed a questionnaire and an interview as part of the Determinants of Tuberculosis Transmission (DTT) project. Questionnaire data report on sociodemographic information and exposure to TB risk factors, while interview data describe participants' experiences of TB within the context of their personal histories and everyday lives. Analysis showed that TB symptoms did not stand out as unusual in the everyday life and health experiences of participants. State of health and decisions about accessing healthcare were associated with socioeconomic deprivation, as well as negative experiences connected with historical and contemporary impacts of colonization. The "tipping point" concept effectively captures the shift in health that pushes participants to seek healthcare. Family, friends, and other caregivers are important influences and need to be part of the effort to avoid advanced TB illness and stop the cycle of transmission. More significantly, there is a need to address the structures and systems that produce and perpetuate life conditions that result in a usual state of compromised health. KeywordsTuberculosis, Indigenous, Canada, social determinants of health, illness experience, tipping point Note on TerminologyWe use the term Indigenous throughout this paper to refer to the first inhabitants of what is now called Canada. In a global context, this term links peoples in similar circumstances of colonization. Where it appears in the text, the term Aboriginal refers to a formal recognition of Indigenous people in Canada in the Constitution Act of 1982, as members of three groups: First Nations ("Indians"), Métis, and Inuit. Terms used throughout this paper reflect those used in source material. Where we report epidemiological information from our research, we use terms consistent with federal government reporting standards for comparability. AcknowledgementsThank you to the 55 people who shared their stories with the project team with the hope that their experiences will change for the better the programs, policies, and services that aim to eliminate TB from Indigenous people and communities.
Asthma is one of the most common chronic conditions affecting Aboriginal children and adolescents in Canada, with associated high rates of hospitalization and emergency room visits. Social support deficits and social isolation pose significant problems for Aboriginal families coping with asthma challenges. However, support interventions that focus on the unique support needs of parents of Aboriginal children affected by asthma have not been investigated. Consequently, our study introduced support interventions to meet parents' perceived support needs and intervention preferences. The study was conducted in urban and rural sites in three Canadian provinces. The interdisciplinary research team encompassed Aboriginal researchers and knowledge users, and the multimethod participatory research design was guided by Aboriginal community advisory committees. Diverse support interventions, designed to address the particular preferences and needs of parents in specific communities, were offered. Seventyseven parents participated. These parents reported expanded support resources, increased support seeking, improved coping skills, and decreased support and education needs following the interventions, which were tailored to their unique needs. These participatory interventions were considered accessible, acceptable, relevant, and useful by parents.
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