Table 2:

Examples of international Indigenous-led partnerships and health outcomes*

Location; year of publication; modelType of siteYear establishedServices offered (beyond the biomedical)Types of evidenceHealth outcomes
New South Wales, Australia; 2017; (34) integratedReproductive and sexual health program2010Strong Family Program includes access to Elders and Indigenous health professionals, yarning circles over 2–3 daysCommunity engagement, focus groups, pre–post surveys. Indigenous youth and adults (n = 76).Knowledge and attitude scores improved 5% points on average. Participants aged 13–20 years had greatest increase in knowledge (p = 0.034); participants aged 20–78 had greatest increase in positive attitudes (p = 0.001).
Unnamed, US; 2015; (35) interdisciplinary and multidisciplinaryResidential treatment centre for substance use and mental health disordersUnknownCultural, spiritual, traditional healing practices (e.g., sweat lodge, talking circle, smudging), access to healers and spiritual counsellorsNative American and Alaskan Native youth (n = 229). Youth Outcome Questionnaire Self Report. Pre–post group matched.96% improved or recovered (using clinically significant change criteria). None deteriorated (compare with the 15%–24% standard in similar settings). Large effect size found with the Cohen criteria.
Rural Oklahoma, US; 2015; (36) multidisciplinarySchool-based youth clinic2010Talking circle intervention, 30-minute sessions 2–3 times per week for 8.5 weeks (10 hr)Native American Indian Plains at-risk youth (n = 44). Pre–post questionnaires (Native Self-Reliance, Global Appraisal of Individual Needs — Quick)One-tailed, paired sample t tests showed significant increase in self-reliance, from 86.227 to 92.204 (t43 = −2.580, p = 0.007) and decrease in substance abuse and use, from 2.265 to 1.265 (t33 = 1.844, p = 0.007).
Perth, Western Australia; 2018; (37) multidisciplinaryYouth clinic for severe mental disorders2014Indigenous mental health practitioners provide clinical care, cultural care, information to non-Indigenous providers and coordinate community support in YouthLinks frameworkMixed methods. Aboriginal youth (n = 40). Outcome Rating Scale and Session Rating Scale over 2 years.65% improved (35% achieved clinical recovery, 30% achieved clinical cut-off by last session), 25% showed no change and 10% deteriorated. Therapeutic bond with practitioner had stronger effect compared with non-Indigenous populations.
Five Mam and 3 K’iche’ communities near Quetzaltenango City, Guatemala; 2019; (38) coordinatedWomen’s centre2018Ten 6-hour sessions co-designed and facilitated by Indigenous health workers using traditional teachings, art, therapies and skill development for women at risk for perinatal mental disordersMixed methods. Randomized parallel groups, women (n = 84) (12 per community in 7 communities) in intervention group, plus 71 in control group. Measured maternal psychosocial distress, well-being (Mental Health Continuum — Short Form), self-efficacy, and engagement in early infant stimulation activities. In-depth interviews to gauge feasibility and acceptance.Postintervention (1 mo), compared with control group, treatment group experienced increased well-being (p = 0.008) and self-care self-efficacy (p = 0.049). Attending more sessions led to improved well-being (p = 0.007), self-care (p = 0.014), infant-care self-efficacy (p = 0.043) and early infant stimulation (p = 0.019) scores.
Two Yup’ik communities in Southwest Alaska; 2018; (39) autonomousSuicide and addictions prevention programUnknownCultural interventions at 2 doses (high and low); modules from Yup’ik Qungasvik Toolbox, Elders’ guidance54 youth participated through analysis stage in community 1 (treatment arm); 74 youth participated in community 2 (comparison arm). Measurement tools: Multicultural Mastery Scale, Brief Family Relationship Scale, Youth Community Protective Factors, American Drug and Alcohol Survey, Reflective Process and Reasons for LifeHigh-dose intervention produced greater impact on Reasons for Life (d = 0.28, p < 0.05), increasing suicide protection in the treatment arm. Analyses found significant growth over time within community 1, but not community 2, on Reasons for Life (d = 0.43, p < 0.05).
  • * This analysis involved literature searches through medical and social science databases, academic journal articles, published theses, and relevant grey literature (e.g., websites, annual reports, organizational statements) from Indigenous organizations, health care facilities, and health research institutions were conducted. These 6 key examples were chosen due to the strength of the partnerships outlined, the clarity of quantitative evidence presented, the recency, and the degree to which Indigenous communities or traditional Indigenous knowledge was central to or leading the research and clinical process to demonstrate the spectrum of models.