Research Partnership
The project was guided by established community-based participatory research (CBPR) principles and relational approaches to decolonize the research process [36–38]. CBPR is fundamentally driven by relationships and trust [39]. A part of our process included hosting a ceremony at the beginning of the project and as necessary throughout. For example, on the day sacred medicines were picked, an Elder performed ceremony, blessed the workshop, and gave thanks to Mother Earth and the Creator for the traditional medicines. Tobacco was laid in places where medicines were gathered as a sign of gratitude to Mother Earth and the Creator and the traditional teaching that accompanied this process was provided by an Elder to those in attendance (mothers (-to-be), other elders, researcher allies). The first author (KMF) spent time with the Elders to ensure the project’s purpose was clear and accepted by community. The Elders were eager to share their stories and cultural traditions surrounding pregnancy and birth they knew about or had experienced.
CBPR shares characteristics that are compatible with Indigenous methods and often make use of community-based advisory committees that can function as an anchoring site for building trust, reciprocal relationships, collaborative decision-making, co-learning, and co-creation of knowledge [40]. The focus of the first year was on meaningful community engagement and establishing an Elders Advisory Committee (EAC). The establishment of the EAC ensured that Elders were engaged in all phases of the research.
The EAC included two Elders each from the Cree-, Dene-, and Métis populations of Fort Chipewyan. The EAC met once a month to design the program and meaningful ways for the Elders to mentor the mothers (-to-be). This committee guided the research process and made decisions about the program as a group. Due to the COVID-19 pandemic and provincial health guidelines, the EAC meetings were held virtually from July – December 2020. This required the committee to be flexible with their approach, as holding community meetings virtually is not the traditional way of gathering and providing guidance. KMF, who is born and raised in the region, made monthly trips during the planning stages and bi-monthly trips during the implementation phase up until the COVID-19 pandemic. This is crucial to note as relationships and commitment between the researchers and the community is paramount to work in Indigenous communities. Moreover, a community research liaison, mentored and supported by the research team and the Elders in the community, was hired to coordinate program and research activities, support the team of Elders, and to recruit and engage with mothers (-to-be).
Ethics
Ethical approval
was provided by the University of Alberta Research Ethics Board (Pro00070845). This research was performed in accordance with the Declaration of Helsinki and Chap. 9 of the Tri-Council Policy Statement 2 on “Research Involving the First Nations, Inuit and Métis Peoples of Canada” [41]. Approval for this research was also obtained from health leadership, Elders, and community members in Fort Chipewyan. All data related to this project is co-owned by the EAC and researchers. Participants received a participant information sheet and a consent form by email. All participants received an explanation of the project and provided informed consent. In accordance with the ethics protocol approved, a two-staged informed consent process was followed. Mothers provided written informed consent in person for their participation in the workshops and the surveys (described in the Research Design and Approach). This was then followed by oral informed consent prior to a one-on-one debrief conversation by phone post-workshop. Elders provided oral informed consent prior to their participation in a virtual sharing circle. For phone debrief conversations with mothers and virtual sharing circle with Elders, the oral informed consent process was audio/video recorded.
Conceptual Framework
We utilized the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) [42] to identify cultural level protective factors for Indigenous maternal well-being. Recognizing the context of historical oppression in which Indigenous families are situated, the FHORT is a relational framework that conceptualizes resilience by examining the balance of interacting risk, promotive, and protective factors across individual, familial, cultural, community, and societal levels. An Indigenous relational worldview emphasizes the interrelatedness and balance of all things, including mind, body, environmental, and spiritual dimensions. This worldview is congruent with a socio-ecological perspective on resilience [43–45] in that it enables the examination of the interactions and interconnections between risk and protective factors across individual, familial, cultural, community, and societal levels and views resilience as a multidetermined and constantly changing result of peoples’ interactions with their social environment. Families, spiritual coping, enculturation, and reconnection with Indigenous values are proposed promotive and protective factors for Indigenous women and mothers’ social, emotional, and mental well-being.
Research Design and Approach
An explanatory sequential mixed methods research design was applied, with CBPR as the overarching framework. First, quantitative data was collected from a survey administered to Indigenous mothers prior to participating in the project to develop a baseline understanding of the pre- and postnatal health experience of mothers (-to-be) in Fort Chipewyan, determinants of care needs, and factors associated with resilience. Then, qualitative descriptive methods were used post-program to explore in-depth how the program influenced the understanding of the traditional role of Elder mentors, the intergenerational relationships between Elders and young women with respects to cultural transmission of traditional knowledge, cultural values, and identity, and the unique care needs of Indigenous mothers. From a philosophical perspective, qualitative descriptive research represents the view that reality exists within various contexts that are dynamic and perceived differently depending on the subject [46]. Therefore, using qualitative descriptive research allowed us to identify the perspectives and experiences of Elders and mothers participating in the pilot program.
Elders Mentoring Program in Fort Chipewyan
The pilot EMP consisted of 12 Elder-led cultural workshops with mothers residing in Fort Chipewyan. The workshop activities were determined and led by the EAC with the support of the local health director, a First Nation liaison from the health centre, and a public health nurse and community research assistant (Table 1). These workshops involved participation in traditional and cultural activities, including the making of traditional regalia and crafts, alongside cultural teachings related to pregnancy, childbirth, caring for the child, and parenting, and passing on traditional knowledge on cultural identity and values for cultivating social and emotional well-being. Each workshop involved a different Elder mentor from the EAC who imparted their cultural teachings, and at least two other Elder mentors who assisted with the planning of workshop activities and participated in traditional and cultural activities alongside the mothers. Each Elder mentor had specific teachings that were passed on to them from earlier generations specific to their culture. During these workshops, Elders also provided mentorship and support tailored to the mothers’ unique experiences and circumstances, aimed at providing mothers with social support. Workshops were held at Fraser Bay, a sacred location by Lake Athabasca that is home to many traditional medicines. The final two workshops were held virtually due to COVID-19 pandemic restrictions. For the virtual workshops, packages with the necessary materials were dropped off at each of the Elders’ and mothers’ homes.
Table 1
Workshop cultural activities and number of mothers in attendance
Activity | Mothers in Attendance |
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Moss bags and traditional medicine gathering | 4 |
Baby moccasins | 4 |
Baby ribbon blankets | 4 |
Ribbon skirts | 4 |
Baby rattles | 5 |
Baby beaver mitts | 6 |
Class to catch up on unfinished projects | 4 |
Beaded earrings | 3 |
Fleece mittens | 6 |
Beaded medicine pouches (virtual) | 3 |
Beaded sage bags (virtual) | 4 |
Closing workshop gathering catch-up session (virtual) | 4 |
Recruitment and Data Generation
Recruitment of mothers happened through snowball sampling utilizing community relationships and word of mouth. Prior to the start of the workshops, the goal of the project was explained and mothers provided informed consent. Participants were then asked to fill out a brief survey that was developed using questions from a validated questionnaire to assess social and emotional well-being and resilience [47] and specific questions determined by the researchers and the EAC on pre- and postnatal health experience and determinants of care needs in the community. The survey included both closed- and open-ended questions, and a trained community research liaison residing in Fort Chipewyan was present to assist the mothers with completing the survey. The first three questions inquired about services or supports that could be helpful during different times in a mother’s life, i.e., during pregnancy, after childbirth (postpartum), and related to parenting/motherhood. Each question had specific options related to different timepoints or events during motherhood (e.g., use of a birth attendant such as a doula or midwife during pregnancy) as well as a list of social or mental health-related services and supports (Fig. 1). Closed-ended questions on the survey that assessed resilience focused on sense of control, social support, and perceived stress. Questions on sense of control and perceived stress were assessed on a scale from 1–3 (1 = ‘not at all’, 2 = ‘somewhat’ and 3 = ‘a lot’). Some questions included: I can solve many of the problems I have on my own; I do well even when things are tough; and I can change many of the important things in my life. Some questions on social support included: There is a special person who is around when I am in need; I get the emotional help and support I need from my family; and I can talk about my problems with my family. These questions were assessed on a scale from 1–7, with 1 being ‘very strongly disagree’ and 7 being ‘very strongly agree.’ Other questions to assess cultural and community connectedness were assessed on a scale from 1–5, with 1 being ‘strongly disagree’ and 5 ‘being strongly agree’ and included: I have a strong sense of belonging to my community; When I am overwhelmed with my emotions, I look to my community for support; When I am feeling spiritually detached, I look to my culture for help.
Additionally, the EAC and research partners wanted to learn about the experiences of the Elders and mothers who participated in the workshops. Following the last workshop, the research team hosted a virtual sharing circle with the Elders who led the workshops. The sharing circle began and closed with a prayer from an Elder and they provided verbal consent to record their stories prior to the start of the sharing circle. The goal for the sharing circle was to capture the Elders’ perspectives on which aspects of the program could be improved upon for future programming and their experience as ‘Elder mentor’ and passing on traditional knowledge and teachings during the program. In addition, past and ongoing work that the principal investigator (SM) and author (KMF) support within the region considers the several crises (wildfire, flood, COVID-19) that have occurred. To build on the latter work, we were also interested in how the Elders perceived these crises might impact the mothers’ experience of motherhood and all aspects of their well-being. We proposed the following questions:
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Which role do you feel the Elders had in the weekly workshops with mothers?
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Do you feel you were able to provide mentorship to the mothers?
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Do you think this program impacted the mothers’ resilience and coping skills?
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Many crises (the wildfire, the flood, and COVID-19) have happened in the region in the last 5 years that have been very stressful. How have these crises impacted you in your role as an Elder?
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How do you think the crises have impacted the mothers and expecting mothers?
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Which pre- and postnatal services and socio-cultural supports are needed for mothers in your community?
In addition to the Elders sharing circle, debrief conversations with mothers who participated in the program were co-facilitated by KMF and the community research liaison. All mothers who attended the workshops were invited to participate in debrief conversations, however only three participated. The mothers were made aware that they could stop the conversation at any time. Each mother provided oral consent over the phone. The debrief questions included:
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Can you describe or share your experience participating in the program?
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How did the mentorship from the Elders support you as a mother?
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How did the program help you to build a positive sense of self or identity?
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Would you recommend the program to other young mothers in the community?
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We would like to continue this program or something similar. What are some
recommendations for strengthening or improving the program in the future?
The debrief conversations with mothers and sharing circle with Elders were held virtually due to the COVID-19 pandemic. Following the sharing circle and debrief conversations, the recordings were transcribed verbatim by a community research liaison and returned to participants for review and edits.
Data Analysis and Rigour
The survey information was descriptively analyzed with IBM SPSS Statistics, Version 28.0 (IBM Corp, Armonk, NY, USA) and used to inform the development of the workshops and future programming. Thematic analysis was conducted manually by two qualitatively trained researchers (KMF, SM) by following Braun and Clark’s (2006) six-phase methodology to understand and identify the themes [48]. This involved reviewing the data through line-by-line analysis and then iteratively developing descriptive themes (coding text directly from transcripts) and interpretive themes (grouping similar descriptive codes together). Final themes were reviewed with the EAC. The overall findings were presented at individual meetings with EAC and participants for rigour and to ensure participants had an opportunity to validate the findings. Authors BT and LA, who are Elders from the region who participated in the program as Elder mentors, supported analysis and contextualization of results and confirmed interpretation and write up of this manuscript to ensure accurate representation.
Researcher Reflexivity
Part of ensuring the quality and transparency of qualitative research is for investigators to recognize their subjectivity – the values, beliefs, personal qualities and knowledge they bring to their research. The lead author of this paper (KMF) is a Mi’kmaq French Irish scholar who is born and raised in the region (Treaty 8 Territory) where this research was conducted. SM is a white settler and comes from Italian descent. She was born and raised in Toronto, Ontario, the traditional territory of many nations including the Mississaugas of the Credit, the Anishnabeg, the Chippewa, the Haudenosaunee and the Wendat peoples. BT is Dene Elder and member of the Athabasca Chipewyan First Nation. LA is Dene Elder and member of the Mikisew Cree First Nation. BSEV is a recent immigrant to Canada with Belgian-Flemish, English, French, and Dutch ancestry, who now resides in Treaty Six Territory and Métis Region Four, Alberta, Canada. RTO comes from mixed European descent, including Danish, Scottish, German, Austrian and Ukrainian. Since birth, he has called Treaty Six Territory and Métis Region Four, in Alberta, Canada, home.