Reclaiming Our Spirits: Development and Pilot Testing of a Health Promotion Intervention for Indigenous Women Who Have Experienced Intimate Partner Violence

Abstract

Indigenous women are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), in the context of ongoing colonization and neo-colonization. Health promotion interventions for women who experience violence have not been tailored specifically for Indigenous women. Reclaiming Our Spirits (ROS) is a health promotion intervention designed for Indigenous women living in an urban context in Canada. In this paper, we describe the development of the intervention, results of a pilot study, and the revised subsequent intervention. Building on a theory-based health promotion intervention (iHEAL) showing promising results in feasibility studies, ROS was developed using a series of related approaches including (a) guidance from Indigenous women with research expertise specific to IPV and Indigenous women's experiences; (b) articulation of an Indigenous lens, including using Cree (one of the largest Indigenous language groups in North America) concepts to identify key aspects; and (c) interviews with Elders (n ¼ 10) living in the study setting. Offered over 6-8 months, ROS consists of a Circle, led by an Indigenous Elder, and 1:1 visits with a Registered Nurse, focused on six areas for health promotion derived from previous research. Pilot testing with Indigenous women (n ¼ 21) produced signs of improvement in most measures of health from pre-to post-intervention. Women found the pilot intervention acceptable and helpful but also offered valuable suggestions for improvement. A revised intervention, with greater structure within the Circle and nurses with stronger knowledge of Indigenous women's experience and community health, is currently undergoing testing. ß

“All my relations”: experiences and perceptions of Indigenous patients connecting with Indigenous Elders in an inner city primary care partnership for mental health and well-being

“…40 Access to Elders as part of routine primary care offers one important avenue for meaningful participation in cultural practices that can improve Indigenous patients' care and help reduce inequities. Our findings are consistent with research showing that the inclusion of Elders in health care initiatives led to a reduction in teen suicides, 23 decreased rates of domestic violence, 24 improved quality of life, reduced depressive and trauma symptoms, 41 and improved understanding and trust between Indigenous and non-Indigenous staff and patients. 25 Our research suggests that working with Elders allowed some participants to "open up" and become more receptive to engaging with other health care providers.…”

Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature

“…In health professions education, the primary means of teaching about health inequities has been to frame health and social inequities as stemming from culturally or ethnically based issues. While attention to culturally specific knowledge and practices can be valuable to health and healing in some contexts [13,14], training that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. In nursing for example, the discourse remains grounded in individualism, which precludes collective commitment to injustices and their expression in race-based discrimination [15,16].…”

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“…6 Women simultaneously affected by poverty and violence, for instance, experience multiple chronic illnesses, unstable housing and shorter life expectancy than other women in society. 7 People engaged in illegal drug use and those with mental health issues, homelessness and criminal justice involvement are exponentially more vulnerable to HIV and accidental overdose, situations exacerbated by structural inequities in resources necessary for health. 5 The health inequities experienced by hard-to-reach and hidden populations are further reinforced through structural inequities (ie, poverty, discrimination) and exacerbated by barriers to appropriate, timely healthcare.…”

“… 6 Women simultaneously affected by poverty and violence, for instance, experience multiple chronic illnesses, unstable housing and shorter life expectancy than other women in society. 7 People engaged in illegal drug use and those with mental health issues, homelessness and criminal justice involvement are exponentially more vulnerable to HIV and accidental overdose, situations exacerbated by structural inequities in resources necessary for health. 5…”