Introduction by Croakey: Important cultural practices such as intergenerational feasting, yarning and story-telling are among many ways that Indigenous peoples globally have enacted knowledge translation for millennia.
However, Western journals and institutions ignore or overlook these ancient cultural practices, insisting that knowledges are acquired only through ‘evidence-based’ research and formal academic publications.
Yet these ways of knowing, being and doing are intrinsic to sharing with each other what we know about how to “live a good life” and engage in “wise practice” in Indigenous health globally.
As leading Canadian Metis researcher Dr Janet Smylie says in the article below:
Indigenous peoples don’t tend to separate out knowledge from action and, although there is some deep and careful thinking in my culture before action, the idea of creating knowledge that is disconnected from its practical application is inconceivable.”
This is the second in a series of four articles sponsored by the Lowitja Institute, and edited by Associate Professor Megan Williams, showing the diversity of Indigenous knowledges and excellence in knowledge translation, in Australia and internationally.
Croakey Professional Services writes:
When a First Nations community in Canada wanted to support new mothers and improve breastfeeding rates, they turned to a respected grandmother – known as Auntie – to share with young mothers the benefits of a cultural practice.
What grew into a program sharing “the loving advice of the ever-present mothers, grandmothers, aunts and sisters” saw breastfeeding rates increase significantly over six years, from 19 to 75 percent in the first week of life (see Healthy Bubs breakout below).
Métis health researcher and academic Dr Janet Smylie explains that this approach built on relationships and networks in the Mohawk community of Kanesatake to reframe and support breastfeeding as reflecting Indigeneity.
“There was a whole process of community engagement and investment, so the community actually took on the action,” Dr Smylie said.
Dr Smylie, a Tier One Canada Research Chair and family physician at the University of Toronto and St. Michael’s Hospital, cites the program as a good, documented example of the importance of Indigenous knowledge translation. Intergenerational knowledges and skills were shared to advance Indigenous health and wellbeing.
“I think that First Nations, Inuit and Métis people experience many barriers to living a good life or what we call miyo-pimatisiwin in Cree,” she says.
“Things like being able to access healthcare, having a good place to live, having strong kin relationships, and a sense of self and belonging as an Indigenous person.
“Many of these things are disrupted for Indigenous, Inuit and Métis people and we need to spend a lot of energy trying to repair that in our ways of living.”
A respected international leader in the field of Indigenous health, Dr Smylie’s 25- year-long career has focused on addressing health inequities among Indigenous peoples in Canada by bridging gaps in health knowledge and practice. This has included addressing the failure of euro-western systems of knowledge translation in Indigenous contexts.
Knowledge translation first emerged as a health research, policy and practice priority in Canada following the creation of the Canadian Institutes of Health Research (CIHR) in 2000.
The aim was to ensure new knowledge, such as clinical innovations, was rapidly ‘translated’ from research into better health services and products.
It was needed, Dr Smylie says, due to the siloing of information in academic journals and institutions.
But, after studying the model, many Indigenous health researchers in Canada were concerned these mainstream approaches represented a ‘one-way street’. Information was going to service providers and decision-makers working with Indigenous populations, leaving behind Indigenous communities and knowledge sharing processes, she says.
As Croakey’s first article in this series reported, Aboriginal and Torres Strait Islander peoples know well how their expertise in knowledge translation has often been overlooked or diminished by mainstream researchers and rigid western methodologies, practices and funding processes.
Key elements for knowledge translation should include Indigenous people’s views on:
- what constitutes knowledge
- whose knowledge is shared
- how knowledge is shared, and
- in what contexts particular knowledge is relevant and valued.
It needs to understand that, within Indigenous communities, knowledge translation activities are inseparable from research and other knowledge development activities.
Dr Smylie says:
My understanding as a Métis woman about Indigenous health disparities comes from relatives who have shared their information – often across generations. From my grandmothers, mother, aunties, and from other Elders and knowledge holders who have taken me on as a relative.
If those processes don’t continue, then Indigenous culture and ways of being will be threatened, and we won’t be able to ‘Live a Good Life’.
Indigenous peoples don’t tend to separate out knowledge from action and, although there is some deep and careful thinking in my culture before action, the idea of creating knowledge that is disconnected from its practical application is inconceivable.
Where I come from on the Prairies, if I just sat around and thought stuff all day and came up with ideas but wasn’t practically applying them, it would be laughable. Historically, such a lifestyle would have been in tension with the survival of my family and community.”
Using the current COVID-19 pandemic as an example, Dr Smylie says she recently participated in a vaccine ‘pow-pow’, or traditional gathering, in Toronto – where Indigenous peoples have been hard hit by three waves of infection. The concept was to bring community together socially and in a culturally relevant way to enhance vaccine roll-out.
Dr Smylie has been working with Australian National University health researcher Dr Raglan Maddox, from the Modewa Clan in Papua New Guinea, on a literature review of effective knowledge translation approaches in Indigenous health research.
Their early publication points out that mainstream knowledge translation concepts are based on the premise that knowledges are acquired through ‘evidence-based’ research.
To counter that, they are looking at initiatives to help identify “wise and promising Indigenous knowledge translation practices and language” in Canada, Australia and elsewhere, in a bid to counter systemic inequities, privileges, and power relationships that inhibit Indigenous peoples’ control, input, and benefits over mainstream research.
Dr Maddox says: “How do we make sure that every step along the way is undertaken using wise practices? How do we make sure Aboriginal and Torres Strait Islander voices and other First Nations voices are being heard from pre-conception of research right through to dissemination and improving health outcomes?”
“As a result of our knowledges being sidelined – our ways of knowing, being and doing – Indigenous researchers want to ensure First Nations people are at the decision-making table in health research, policy formulation and program implementation, to minimise poor practice and get the best health outcomes,” says Dr Maddox.
Dr Janet Smylie agrees the literature review will be useful in informing wise practice but adds that “the best Indigenous knowledge translation practitioners I have seen do not use written modalities as their primary mode of sharing”.
Rather they are sharing and modelling through family and community stories, the arts, and day to day practical living. Critical to wise Indigenous knowledge translation practice is knowledge, experience and expertise in the local Indigenous systems, however these are often described only in the grey literature or not written up at all.
The review team is trying to uncover that missing information, and examine the grey literature to identify what has been silenced or hidden because it didn’t fit the way journals accept information or their word limitations.
Dr Maddox says that because knowledge translation literature has generally sidelined Indigenous knowledges, highlighting work being undertaken by Indigenous researchers that is driving tangible benefits in health outcomes is critically important.
“The more we create space for each other, the more we can share and celebrate the successes that people are having, the more we can continue to progress and shift the narrative that Indigenous peoples have been subhuman, or substandard, or second-class citizens,” he says.
Community vote with their feet
Pointing to his own Modewa Clan in Papua New Guinea, Dr Maddox says the way knowledge and information is shared mightn’t be written up in The Lancet or other such medical publications, but there are other ways to pass on knowledges.
“For our clan, ceremony and feasting are an important aspect of knowledge sharing. This might not be considered a knowledge translation exercise, but for us, it upholds our community and kinship lines of accountability and builds relationships, while sharing knowledges.”
Dr Maddox says ceremony and feasting is commonly used by Indigenous peoples, with Aboriginal Community Controlled Health Organisations (ACCHOs) also using ceremony and feasting to improve their programs and services. But this detail might not be shared at a conference, published in a peer-reviewed journal or reported to a government body.
In Australia, where colonisation is ongoing issue and impacts are experienced by Aboriginal and Torres Strait Islander people daily, First Nations people have been doing knowledge translation since time immemorial.
“It just hasn’t been written about, discussed, funded or given the same opportunity to be promoted as euro-western knowledge translation,” says Dr Maddox.
Dr Maddox explains that while euro-western academic research often requires a beginning, a middle and an end, his work in Indigenous knowledge translation has no end – but multiple beginnings.
“Information is constantly shared throughout the process, to make sure that whatever we are implementing, exploring or examining is of tangible benefit to communities in improving health outcomes,” he says.
Community accountability is crucial to the process, because it you don’t get the community to engage, they will “vote with their feet”.
“You learn very quickly that if you don’t have that accountability, you don’t have that type of integrity, then you can’t improve health outcomes.”
Dr Maddox says it’s inherent with Indigenous research that there will be a knowledge translation process occurring.
“There is no time that we would generate knowledge or undertake research … and then not do anything with that information, or continue to build on it,” he says.
Dr Maddox, who spent five years in Canada, thinks Indigenous peoples in Australia, Canada and elsewhere can learn from each other, with ongoing discussions about sovereignty, self-determination and the ongoing impacts of colonisation.
“Sometimes when you are grinding away, the challenges can seem so large, that to share and hear how other people are addressing similar hurdles, pushing each other to thrive, is exciting,” he says.
Twenty or thirty years from now, Dr Smylie wants to see thriving Indigenous communities around the world, where everyone has the opportunity to “Live a Good Life”.
At the root of that we will be sharing with each other what we know about how to live a good life – that’s what knowledge translation means to me.
Knowledge translation doesn’t happen in a vacuum – it’s a global world. Hopefully, if we support continuity of Indigenous knowledges, maybe will be contributing some of those to solve the big world problems.
And our knowledges will be recognised as the amazing global resource that they are – not appropriated and exploited – but another rich resource for the collective good.”
Proof of the importance of community ownership and engagement in health programs has been highlighted in a Canadian review of infant and toddler health outcomes.
Set up against a background of continuing health disparities in Indigenous maternal-child health outcomes in Canada despite increasing health initiatives, the 2016 study looked at why some Indigenous prenatal and infant-toddler promotions were making a positive difference.
The study found the twenty successful programs identified had local Indigenous community investment, community ownership, and high levels of sustained community participation and leadership.
One of the programs included was the Ka’nisténhsera Teiakotihsnie breastfeeding promotion initiative in the Mohawk community of Kanesatake.
Including all three stages of community investment and subsequent community activation, the program began with the community health centre staff identifying low rates of exclusive breastfeeding at birth, then applying for funding, and conducting research which identified a lack of confidence by mothers and their families in their breastfeeding abilities.
Seeking to empower mothers, it built upon Mohawk maternal kin support systems by hiring and training a respected grandmother – known as Auntie – to support breastfeeding by new mothers and promote breastfeeding in the community more generally.
The grandmother became the catalyst for cross-community buy-in and breastfeeding promotion through the vehicle of “the loving advice of the ever-present mothers, grandmothers, aunts and sisters”, and breastfeeding rates increased significantly over six years, from 19 to 75 percent in the first week of life.
Participants told of how they valued the wisdom of peers and extended family over traditional prenatal classes and advice from health care professionals, with the program building on local community systems, in a deliberately decolonising fashion.
All the programs were linked to improved birth outcomes; better access to pre- and postnatal care; less prenatal street drug use; increased breast-feeding; better dental health, infant nutrition and child development; and increased child exposure to Indigenous languages and culture.
In summary, the review outlines local Indigenous community leadership processes for knowledge translation, and actions that increase Indigenous families’ participation in prenatal and infant toddler health promotion programs.
This article was written by Cate Carrigan and edited by Associate Professor Megan Williams, a Wiradjuri researcher and the Research Lead and Assistant Director of the National Centre for Cultural Competence at The University of Sydney, on behalf of Croakey Professional Services.
The series was conceptualised and sponsored by the Lowitja Institute, which had final say over the content. Register here to attend a Lowitja Institute webinar on 12 August on Indigenous Knowledge Translation.
Croakey Professional Services help generate funds to sustain our public interest journalism activities, and also aim to provide a useful service to our readers. To find out more about the range of services on offer, see here.
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