Publications

Assessing Children’s Interpretations of the Aboriginal Children’s Health and Well-Being Measure (ACHWM)

A total of 18 interviews, with 9 children and 9 caregivers, were required to achieve a stable version of the survey. The children ranged in age from 8 to 18 years. Revisions were required for 19 questions. Most of the serevisions were minor linguistic changes. In addition, 6 questions were deleted due to consistent problems and 4 questions were created to address gaps identified during the process. Community members confirmed the appropriateness of the measure for their community and communicated their pride in their youth’s role in the development of this survey.

The result was a 58-question version of the ACHWM that was consistently interpreted and culturally appropriate, and had face validity confirmed by experts from the community, children and their parents/caregivers.The ACHWM is ready to be assessed for relevance to other Aboriginal communities.

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A Process for Creating the Aboriginal Children’s Health and Well-Being Measure (ACHWM)

The participants ranged in age from 8.2 to 17.7 years (mean age=12.3). Through innovative methods, children and youth identified 206 concepts representing the 4 quadrants of the Medicine Wheel: emotional, spiritual, physical and mental. These concepts were refocused, in collaboration with the community, to create a new 60-item measure of health and well-being that was primarily positive in focus.

This study demonstrates the success of implementing a unique process of photovoice in combination with bicycling and informed by an Aboriginal framework. The results confirm the distinct conceptualization of health and well-being in this population and underscore the necessity for a culturally appropriate measure. This study also produced a first draft of the Aboriginal Children’s Health and Well-being Measure (ACHWM).

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Validity of the Aboriginal Children's Health and Well-being Measure: Aaniish Naa Gegii?

Paired ACHWM and Ped sQL scores were available for 48 participants. They had a mean age of 14.6 (range of 7 to 19) years and 60.4 % were girls. The Pearson ’s correlation between the total ACHWM score and a total PedsQL aggregate score was 0.52 (p = 0.0001). The correlations with the Physical Health Summary Scoresand the Psychosocial Health Summary Scores were slightly lower range ( r = 0.35 p = 0.016; and r = 0.51 p = 0.0002respectively) and approached the expected range. The ACHWM Quadrant scores were moderately correlated withthe parallel PedsQL domains ranging from r = 0.45 tor = 0.64 (p ≤ 0.001). The Spiritual Quadrant of the ACHWMdid not have a parallel domain in the PedsQL.

These results establish the validity of the ACHWM. The children gave this measure an Ojibway name, Aaniish Naa Gegii, meaning “how are you?”. This measure is now ready for implementation, and will contribute to a better understanding of the health of Aboriginal children.

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Reliability of the Aboriginal Children’s Health and Well-Being Measure (ACHWM)

There were 124 participants in the first cohort and 132 participants in the second cohort. The repeated measures subgroup was comprised of 29 participants from the second cohort. The internal consistency statistic (Cronbach’s alpha) was 0.93 for the first and second cohorts. The test–retest reliability ICC was 0.94 (95% CI 0.86–0.97) for the ACHWM summary scores based on the repeated measures subgroup.

These results establish the internal consistency and the test–retest validity of the ACHWM. This important finding will enable Aboriginal communities to use this measure with confidence and promote the voices of their children in reporting their health. The ACHWM is an essential data gathering tool that enables evidence-based health care for Aboriginal communities.

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A screening mechanism to recognize and support at-risk Aboriginal children

A total of 293 children completed the ACHWM. The screening tool identified 35% with potential risk. Mental health workers confirmed 18% of all participants as being at-risk, and all were referred for support. The sensitivity of the tool was 75% while specificity was 79%. Improvements to the screening algorithm resulted in a specificity of 97% and negative predictive value of 95%, with no loss of sensitivity.

Responsible population health surveys require a process to recognize and respond to answers indicative of health risks. This paper provides an example of a screening and triage process that enabled our survey team to screen responses in real time, respond to potential risk immediately, and connect participants to local support services. This process proved essential to conducting an ethical survey. The high specificity and negative predictive value make it an effective triage tool that is particularly valuable in Aboriginal communities and with higher-risk populations.

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Relevance of the Aboriginal Children’s Health and Well-being Measure Beyond Wiikwemkoong

This research was conducted in 2014 and 2015 at four sites. Interviews with 23 children and 21 caregivers were completed. Key lessons were learned in all communities that enabled the team to improve the ACHWM in subtle but important ways. A total of 12 questions were revised, and four new questions were added during the process. This produced a 62-question version of the ACHWM, which was endorsed by all communities.

The ACHWM has been improved through a detailed review process in four additional communities/agencies and resulted in a stable 62-question version of the survey. This process has demonstrated the relevance of the ACHWM to a variety of Aboriginal communities. This survey provides Aboriginal communities with a culturally appropriate tool to assess and track their children’s health outcomes, enabling them to gather new evidence of child health needs and the effectiveness of programs in the future.

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Community-Based screening and triage versus standard referral of Aboriginal children: a prospective cohort study protocol

Health solutions for Aboriginal children should be guided by their community and grounded in evidence. This manuscript presents a prospective cohort study protocol, designed by a community- university collaborative research team. The study’s goal is to determine whether community-based screening and triage lead to earlier identification of children’s emotional health needs, and to improved emotional health 1 year later, compared to the standard referral process. We are recruiting a community- based sample and a clinical sample of children (ages 8 to 18 years) within one Canadian First Nation. All participants will complete the Aboriginal Children’s Health and Well-being Measure (ACHWM)© and a brief triage assessment with a local mental health worker. All participants will be followed for 1 year.

Children with newly identified health concerns will be immediately connected to local services, generating a new opportunity to improve health. The development of the research design and its execution were impacted by several events (e.g., disparate worldviews, loss of access to schools). This manuscript describes lessons learned that are important to guide future community-based research with First Nations people. The optimal research design in an Aboriginal context is one that responds directly to local decision makers’ needs and respectfully integrates Aboriginal ways of knowing with Western scientific principles. Such an approach is critical because it will generate meaningful results that will be rapidly adopted, thus reducing the knowledge-to-action gap.

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Beyond the patient: lessons from community engagement in a rural First Nation

Aboriginal children experience substantial and persistent health disparities compared with their mainstream peers; innovative methods are needed to assess the effectiveness of new interventions. Health leaders in Wiikwemkoong Unceded Territory engaged with a team of scientists at Laurentian University to address these disparities, and developed a strong and respectful engagement. This collaboration began with the Outdoor Adventure Leadership Experience project (https://oalevideo.laurentian.ca) and led to the development of a culturally relevant measure of health for children 8 to 18 years of age: the Aboriginal Children’s Health and Well-being Measure (ACHWM). In this paper, we share the lessons learned through a community-engaged project to evaluate a new intervention for health promotion.

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