Table 5 Characteristics of the included studies [n = 20]

1

Anang et al., 2019 [40].

To describe the processes and findings of a community-based participatory research with Inuit youth on suicide prevention

Naujaat, Nunavut, Canada

Qualitative study engaging 36 Inuit youth over three years under the age of 24 years.

CBPR research design integrated with the two-seeing eye framework. Data were collected using interviews and focus group discussions

Youth were engaged in every aspect of the research process as co-researchers.

1)Youth indicated that the processes of engagement to develop actions that reflected their intergenerational cultural traditions facilitated wellness by producing self-pride and self-identity, which was identified as associated with high community youth suicide occurrences. 2)Youth recommended using strength-based approaches to enhance health and wellness within the community

Engaging Inuit youth as co-researchers revitalized an awareness of their cultural identity and produced leadership qualities in the youth involved.

The authors identified the inability to adjust activities with youth availabilities and responsibilities as a limitation in this study.

2

Crooks et al., 2017 [71].

To evaluate the effects of an Indigenous youth-led relationship-focused mentoring program on positive well-being (assessed by mental health and cultural identity).

First Nation, Métis, and Inuit (FNMI) students from a school district in South-Western Ontario, Canada.

Mixed-methods research. 105 FNMI youth between 11 to 14 years.

Cross-sectional study. Data were collected using structured surveys and interviews

Youth were paired with senior classmates and peers in the Fourth R program. This program sought to develop and evaluate school-based, culturally relevant relationship-focused programming with FNMI students. In this program, youth provided peer-mentorship and built relationships through cultural teaching sessions offered to elementary school graders (grade 7 and 8) transitioning to high schools.

Facilitators mentioned:

1) Creation of a culturally sensitive avenue for relationship building and peer-mentorship

2) Because the mentoring program offered participants a culturally sensitive and affirming space to learn about healthy relationships, students embraced their individuality and explored their cultural identity.

The youth described that the mentoring program helped them develop intrapersonal and interpersonal skills and enhanced their knowledge of cultural and healthy relationships. Also, evaluation results showed positive mental health gains after 1 to 2 years of mentorship (1 year qualitatively and 2 years quantitatively)

Limitations reported were;

1) Small sample size of students receiving mentorship.

2) 93% were First Nations ancestry; hence results may not generalize to Métis and Inuit students.

3

Etter et al. 2019 [74].

To describe a community-specific and culturally coherent approach to youth mental health services in a small and remote northern Indigenous community in Canada’s Northwest Territories, under the framework of ACCESS Open Minds (ACCESS OM), a pan-Canadian youth mental health research and evaluation network.

Inuit community of Ulukhaktok, NWT, Canada

Qualitative case report. Youth 18 to 23 years

Participatory approach engaging and training local health workers and ACCESS OM youth workers as leaders and drivers of the programs. Data were collected using semi-structured surveys.

Youth and adults’ connections were strengthened within the Ulukhaktok community as they engaged in events and activities like fishing trips, cooking workshops, arts and craft projects and land-based wellness programs.

Barriers mentioned included:

1) Lack of mental health knowledge or local skills within the community to provide support to youth.

2) Mistrust of mainstream mental health services provided to the community by outside-sourced professionals.

3) General stigma towards mental health by community members.

Wellness was enhanced by empowering the community through training local health workers in mental health using Indigenous-focused modules, providing avenues for cultural connectedness and increased ownership of resources. Additionally, youth connections and the willingness to use mental health support services improved with engagement activities in ways that outside-sourced professional services couldn’t provide

Study limitations reported included;

1)Older youth were less likely to engage due to other domestic priorities (e.g., work, leaving the community, or family priorities)

2) Trained local health workers and youth coordinators expressed the challenge of managing a dual identity that may have influenced community members’ expectations.

4

Flicker et al., 2019 [75].

To describe a strength-based approach to thinking about Indigenous youth HIV prevention activism.

Native Youth Sexual Health Network, Ontario, Canada.

Qualitative study engaging 18 youth between 16 to 24 years.

Ethnography and community-based participatory action research approach using a health promotion framework grounded in the ideas of Indigeneity and decolonization. Data were collected using digital stories shared by youth participants and interviews.

Youth were engaged as leaders and co-researchers in every sphere of the project over three years: from project design to thematic analysis and interpretation. Youth were also engaged in games, movie nights where relationships were fostered, and trust built.

Seven themes were deduced from the thematic analyses by youth. These themes describe both facilitators and barriers to promoting HIV prevention among Indigenous youth. They were: (1) family and elders support, (2) traditional sacred notions of sexuality, (3) the importance of education, (4) reclaiming history, (5) focusing on strength, (6) Indigenous cosmology and (7) overcoming addictions.

Youth described how engaging in this project enhanced their connections to the universe. One youth explained how sharing stories on the sacredness of participating in sweat lodges bolstered his relationships with the creator and the Indigenous understandings of interconnections between living things, including his physical, cultural, and spiritual wellbeing.

Study limitations reported included;

1) Small sample size. 2) Findings should be generalized only to similar contexts and settings.

5

Gaspar et al., 2019 [57].

To build a sense of empowerment among First Nation girls by exploring supports and roadblocks to empowerment in the Girl Power Program.

Sturgeon Lake First Nations, Saskatchewan, Canada

Qualitative study engaging 22 girls between ages 10 to 15 years.

Employed an integrated framework of participatory action research and transformative action research using a strength-based approach that fostered transformative learning environments. Data were collected using storytelling and reflections.

The Girl Power Program was designed to assist girls with mitigating risk factors related to trauma by empowering them to achieve their full potential by integrating Cree cultural teachings, ceremonies, and the rites of passage. Girls in this program were authentically engaged in all aspects of the research processes.

The following were identified as facilitators to empowerment and, by extension, wellness.

1) empowerment programs

2) culture and ceremonies

3) pets

4) sports

5) relationships

6) reading, and

7) kindness

Barriers or roadblocks included;

1) Hunger

2) being bullied or abused

3) exposure to drugs and alcohol

4) being smart, and

5)lack of support

Working and walking together with the girls on this research facilitated mutual learning and explored ways to identify and implement positive change through sharing stories. The girls indicated that by identifying roadblocks to empowerment, they found healing from wounded spirits, which helped foster positive changes towards wellness through āhkamēyimowin (perseverance).

The authors reported that directions for further research should be grounded in culture and contemporary understanding of empowerment while acknowledging the wounded identities and spirits of Indigenous peoples; and the need for co-creating spaces to learn about their spiritual and cultural transitions.

6

Gaudet & Chilton, 2018 [72].

To describe the creation of a youth-centered project and how its re-centers Indigenous values and conception of health and wellbeing

Moose Cree First Nation community, James Bay region, Ontario, Canada.

Qualitative study engaging 6 Indigenous youth, Knowledge Keepers, Elders, and families.

Community-based participatory research approach ground in the Cree philosophy of milo pimatisiwin, “good and healthy living.”

Youth were engaged as partners in the project, exploring the significance of sharing pimatisiwin teachings over the local youth radio station and within land-based initiatives. Data were collected for evaluation using interviews and focus group discussions

1)The authors and elders described milo pimatisiwin (good and healthy living) as a living concept related to the spirit that ebbs and flows with the seasons of life, experiences, and environment. They, however, recognized the variations and differences in appreciating this concept describing being dogmatic about definitions and traditions of health among communities as a barrier to enhancing wellness.

2) Reliance on Elders’ wisdom, skills and stories were described as facilitators for enhancing wellness.

Youth expressed a revitalized understanding of health and wellness, describing how they better understood that Indigenous health is not intricately connected to their identities through traditional activities and land-based teachings. They described a renewed outlook on wellbeing founded on Cree thought and consciousness.

None mentioned

7

Goodman et al., 2019 [76].

To explore urban Indigenous youth perspectives of health and social support.

Eagle Urban Transition Centre (EUTC), Manitoba, Canada.

Qualitative study. Recruited 18 youth between ages 15 to 24 years.

The study used photovoice within a community-based participatory research framework. Data were collected using photographs taken by youth with narratives describing 1) types and sources of social support; 2) challenges and opportunities for good health; and 3) community strengths and concerns. Follow-up interviews were also carried out.

Youth were engaged in sharing circles where they learned about photovoice and how to use photographs to facilitate dialogue. Youth were also involved in data collection, group analysis of photographs and joint interpretation of study findings.

Youth voiced several barriers and challenges to building health supports, which included.

1) Lack of trust leading to,

a) no sense of belonging

b) impacts in social and emotional learning

c) racism and social exclusion

d)hesitancy to receive support when offered and,

e) low view of self-identity and self-worth (or self-esteem) and,

f) social instability.

2) Systemic racism exacerbated challenges Indigenous youth encountered in building positive support networks. This ultimately resulted in youth engaging in risky behaviors (e.g., substance use, gang activity, etc.) as a way of seeking support from their peers.

Facilitators to health-promoting social support among Indigenous youth included.

1) Access to activities or spaces that provide health supports (e.g., community parks, community centers, drop-in centers)

2) Peer mentorship, and

3) Cultural practices (e.g., powwow and other traditional activities that promote cultural pride and stability).

The youth acknowledged the empowerment and sense of ownership they felt by engaging in this photovoice project. One youth described how this project brought her a feeling of stability and balance. Another youth quoted, “It’s like a sense of pride when you are learning about it, so it contributes to your self-esteem” (page 39), referencing the Seven Grandfather Teachings (i.e., love, respect, courage, honesty, wisdom, humility, and truth) as integrated pillars of youth wellness promotion.

The authors identified the engagement of a unique group of youth experiencing challenges and receiving external community supports to which other youth may not have access as a study limitation.

8

Gray & Cote 2019 [16].

To assess whether cultural connectedness has a specific protective effect on mental health among the descendants of Indian Residential School (IRS) survivors

Anishinaabe (Algonquin) community, Canada.

Quantitative study. Random sampling of 147 community youth between 18 to 25 years

Cross-sectional study design. Data were collected using structured surveys. Key survey questions included age, gender, mental and physical health, cultural connectedness, and residential school attendance by parents and grandparents. Linear regression analysis was used to address study objectives.

Nothing regarding youth engagement was mentioned in this study.

The study showed the following results as facilitators to wellness. They include:

1) A high degree of cultural connectedness may help reverse these negative effects among youth with a family history of IRS.

2) Ways to enhance cultural connectedness included engagement with Indigenous traditions and spirituality, relationships with family/elders and positive social connections.

The findings in this study support the Indigenous notion of ‘culture as a treatment’ as Indigenous culture enhances one’s sense of meaning and self-worth and provides skills for coping with stressful circumstances.

Limitations in this study included.

1) Limitations to study design further to investigate in-depth associations between cultural connectedness and health.

2) Study used a novel single-item self-rated measure of cultural connectedness that left the concept undefined, hence open to other interpretations by respondents.

9

Hatala et al., 2019 [77]

To explore and describe how urban Indigenous youth construct a contemporary sense of themselves in miyo-wicehtowin (having good relations) with culturally grounded land-based approaches to health and wellness

Community Engagement Office, Saskatoon, Saskatchewan, Canada.

Qualitative study engaging 28 Indigenous urban youth between 15 and 24 years.

Integrative participatory research approach combining Indigenous methodologies and modified grounded theory following a two-eyed seeing framework. Data were collected using storytelling interviews that aligned with Indigenous worldviews that honor orality as a means of transmitting knowledge.

Youth were part of the Community Advisory Research Committee (CARC) and Elders, parents, and Indigenous community members. Youth were engaged as co-researchers in all phases of the research, creating an empowering space where youth could choose how and what data were collected, what parts of their stories were shared, and the ways their stories were utilized to support the research objectives.

Barriers to enhancing wellness identified in this study included;

1) Negating Indigenous peoples’ connections to land and nature in urban spaces while naturalizing rural home communities alone as potential health and wellness sources.

2) Notions that youth must maintain connections to rural homelands to maintain authentic Indigenous cultural identities associated with health and wellness advantages

Youth affirmed from this study that miyo-wicehtowin (possessing good relations) with the land and nature promote health, wellness, and resilience among Indigenous youth. This was explained in the following ways:

1)Contesting boundaries and re-locating place: Youth re-imagine land and nature as geographically unbounded, spread out and diffused across different spaces where human activities occur.

2) Hugging trees as a kind of familial love and reciprocity

3) Gift-giving in reciprocity for the gift’s nature gives humans

4) Story-making from land-based teachings for life.

5) Regulating emotions through embodied experiences with soothing places in nature.

The authors argued that the uptake of culturally grounded land-based approaches to health and wellness among Indigenous communities should focus on rural spaces and broaden and strengthen within urban contexts for Indigenous youth in further studies.

10

Halata & Bird-Naytowhow 2020 [82].

To understand Indigenous youth experiences and journeys toward wellness in urban settings.

Gordon Tootoosis Nik̄an̄iw̄in Theatre (GTNT) in Saskatoon, Saskatchewan, Canada

A qualitative study involving 8 Cree and 2 Métis urban youth between 16 to 24 years.

Used performative theory Congruent with Etuaptmumk or “two-eyed seeing,” local Indigenous protocols, relational accountability, and cultural components (e.g., smudging, and traditional prayer offered at the start of interviews to foster an ethical, safe space). Data were collected using in-depth interviews.

Youth were engaged in a theatre program entitled ‘Circle of Voices (COV)’ at GTNT, where they learned, practiced, and performed the comedic play Pimˆatisiwin (to celebrate life). They were also engaged in cultural activities as part of the workshops during this theatre program.

Facilitators described as central to enhancing wellness included:

1) Taking responsibility: The youth reported that through taking responsibility for one’s own personal healing and growth, they could better attain mino-pimˆatisiwin (wellness). On a practical level, the youth exemplified this to actions like rising and retiring with the sun and being in flow with the seasons, being in good relationships with the environment, land, nature, and the spiritual forms that govern and operate within them.

2) Upholding cultural values: This was described as central to mino-pimˆatisiwin. Examples included sharing life experiences, respect for relationships, good moral conduct, connections to the land and nature, role modelling, spiritual practice and participation in the ceremony, and conscious awareness of the medicine wheel and its notions of wholeness, balance, harmony, growth, and healing.

A barrier mentioned was the challenge in describing the performance as a lived and embodied human experience to urban inner-city Cree and Métis youth who may not understand its deep-rooted cultural significance.

1) The youth reported that engaging with culture and ceremonies was a new experience for them and thus, opened them up to other ways of being and living shaped by spiritual worlds and values.

2) the youth indicated that the engagements with Elders and GTNT staff and self-representation in the COV program helped them to reflect on their responsibility to grow and heal as individuals.

3) The authors also indicated that rehearsing in the COV program and later performing Pimˆatisiwin was a powerful way to build capacity at the social performance of being an Indigenous young person in inner-city Saskatoon.

The authors reported that future studies should look at how performing pimˆatisiwin impacts those “off-stage” in the audience and how it plays supportive roles in the lives of Indigenous young people.

11

Hutt-MacLeod et al., 2019 [78].

To describe the implementation of the ACCESS OM (AOM) objectives for youth mental health service transformation within a pre-existing Fish Net Model of transformative youth mental healthcare service.

First Nation community of Eskasoni, Nova Scotia, Canada.

Implementation and evaluation project carried out in the community with a population over 4500. More than 50% of the population was < 25 years.

Employed the two-eye seeing approach where both Indigenous and Western-influenced methods of wellness and treatment were honored and implemented. Data were collected using structured questionnaires

Youth were engaged in the design of the AOM Youth Space. A local youth council was created to guide programming, activities and services provided in this Youth Space. The youth council was also responsible for the continuing evaluation of ongoing services in the space.

Barriers identified in the report included,

1) Sustainability issues,

2) Funding,

3) scale-up and capacity of service providers to meet the demands of the community.

The AOM implementation oversaw the renovation and revitalization of the Youth Space, which served as a central location for youth to engage in activities that facilitated early identification of youth mental health needs, which informed rapid access to care. Youth were also given a choice between Western mental health services or Indigenous methods or a combination of both.

None mentioned

12

Lines et al., 2019 [79].

To explore concepts of health and healthy communities through the eyes of Indigenous youth

Yellowknife Dene First Nation (YKDFN), Northwest Territories, Canada

Mixed methods study involving 15 youth between the ages of 13 to 18 years.

Community-based participatory research (CBPR) methodology through an Indigenous research lens. Authors authentically engaged with 15 YKDFN youth and the YKDFN Wellness Division. Data were collected using sharing circles, observations, fieldnotes, Photovoice, mural art, and two quantitative surveys.

Youth were actively engaged throughout all the processes of this research. They also participated as equal partners in cultural camps, leadership workshops, photovoice, storytelling and research planning preparations.

Youth identified the following facilitators as imperatives to enhancing wellness.

1) relationship/connection to the land

2) practicing cultural skills, 3) Elders passing on traditional knowledge,

4) surviving off the land.

Youth health was enhanced by self-discovery and empowerment as youth appreciated that the symbiotic relationship between the land, environment, and people is fundamental to building a healthy community. The youth also expressed a sense of empowerment as they understood their roles in influencing health research and agency.

The authors framed future health research to include roles for youth and an on-the-land component that builds YKDFN culture, community relations, and traditional knowledge transfer.

13

Loebach et al., 2019 [80].

To explore and describe how visual technology can be used to enhance wellness for and by Indigenous youth.

Mi’kmaq Confederacy of Prince Edward Island (PEI), Canada.

Qualitative study. 11 Indigenous youth between 13 and 19 years of age.

Critical Indigenous research methods integrated with a participatory videography framework. Data were collected using digital storytelling, visual media, interviews, reflections, and field notes.

Youth were engaged in every aspect of the process as co-researchers. Activities included training workshops on video editing, software use, digital media, discussions on health and wellness, storyboarding, visual storytelling, data analyses and interpretation of short films.

Youth described the challenges of technology use to health as follows.

1) addictiveness to games and social networking platforms

2) Cyberbullying

3) Loneliness/separation from the community

Youth described in their reflections how the use of technology had facilitated wellness in the following ways.

1) Building community,

2) Sharing stories

3) creating trust

4) learning about Indigenous traditions and culture.

Three short films were produced by the end of this project. In these films, youth reflect on their wellness journeys describing how this project helped self and cultural identity, empowerment, community, and healing. Engaging youth in an authentic and culturally sensitive participatory approach allowed them to express themselves in ways they didn’t think they had the capacity for. Their videos uploaded on YouTube have opened avenues for other youth to identify with the community’s struggles and change.

None mentioned.

14

Lopresti et al., 2021 [5].

To describe the key characteristics of Indigenous Youth Mentorship Program (IYMP) implementation as perceived by peer youth mentors and young adult health leaders (YAHLs).

IYMP school communities in Alberta, Canada

Qualitative study. 20 Indigenous youth between 13 to 18 years.

Ethnography. Data were collected using onsite observations, focus group discussions and semi-structured individual interviews.

The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program developed for elementary school children in Canada to empower Indigenous youth and reduce risk factors associated with obesity and Type 2 diabetes. Youth already participating in the IYMP program were invited for interviews and focus groups.

Five characteristics were identified as necessary for IYMP delivery. They also identify as facilitators of wellness. They included:

1) a sense of ownership by those delivering the program, 2) inclusion of Indigenous Elders/knowledge keepers, 3) establishing trusting relationships,

4) adequate program supports 5) national gatherings and shared decision making between academic and community partners

Youth participants identified positive health outcomes when the five characteristics identified in the study were upheld in the Indigenous Youth Mentorship Program.

Limitations in this study included

1) Small sample size for interviews (n = 4)

2) Some Indigenous youth were wary of participating in the research due to their experiences of colonial injustice and maltreatment.

3) Youth who did not feel comfortable expressing views in a group setting chose to not participate in the focus group interviews

15

Lys et al., 2018 [73].

To describe and evaluate body mapping as an arts-based activity within Fostering Open eXpression Among Youth (FOXY) among Indigenous young females

Middle to high schools in 6 Indigenous communities in Northwest Territories, Canada.

A qualitative study with 41 female Indigenous youth (aged 13 to 17 years) attended one or more FOXY workshops.

The study used a developmental evaluation methodology to produce context-specific understandings that inform ongoing innovation, support changes in direction based on feedback and emerging data and position the researcher as an integrated member of the collaborative team. Data were triangulated from four sources: body maps, semi-structured interviews, written reflections, and descriptive field notes.

FOXY is a nonprofit organization that utilizes a peer education model and employs adolescent peer leaders to cofacilitate workshops with adult facilitators. Youth were engaged in FOXY workshop activities such as visual word maps and lessons related to sexual health topics, group discussions on health, non-verbal and verbal role-playing exercises, charades, and body mapping.

The youth described body mapping as a valid data collection tool that advanced and promoted trust and youth voices in research while reducing verbal communication barriers and facilitating the collection of rich data on Indigenous youth experiences

Youth affirmed that using the body mapping in FOXY encouraged and supported wellness and healing through self-reflection, introspection leading to self-discovery, and personal/cultural connectedness while enhancing the ability to process difficult emotions.

The authors reported that directions for future research could explore repeat exposure to body mapping interventions and their impact on well-being

16

Merati et al., 2020 [8].

To explore how Cree youth perceived youth health and youth engagement in health and health planning.

Eeyou Istchee territory of northern Quebec, Canada

Qualitative descriptive study recruiting ten Cree youth aged between 10 to < 25 years.

The study adopted a community-based participatory research approach. Data were collected using focus group discussions and key-informant interviews

Youth were engaged in 3 levels on an engagement spectrum. The first level was defined as participation where youth partook in cultural activities and ceremonial events. The second was described as youth council membership, where youth were nominated to represent the youth voice and shared decision-making. The third level of engagement was defined as planners were decision-makers and advocated for planning and action.

Youth identified barriers to youth engagement in leadership capacities in the following,

1) Adults not taking their voices seriously,

2) Micro-managing or terminating youth programs due to low attendance.

Wellness was facilitated through youth engagement in these three levels. Youth described how they needed to be continually engaged to be healthy and healthy to be involved.

Limitations identified in the study included.

1) Small sample size: the study focused on a limited number of Cree youth.

2) Limited tie for meaningful engagement: engagement with youth using the CBPR lasted eight days.

17

Njeze et al., 2020 [83].

To examine and describe intersecting individual and social factors that enhance resilience and wellness among Indigenous urban residing youth.

Community Engagement Office, Saskatoon, Saskatchewan, Canada.

Qualitative study engaging 6 Indigenous urban youth between 15 and 24 years.

Case study design using an integrative framework of intersectionality theory and resilience while drawing on Indigenous methodologies, a “two-eyed seeing” approach, and Stake’s case study methodology involving multiple data sources (i.e., sharing circles, conversational interviews, photovoice and naturalistic interactions).

Youth were engaged as co-researchers in all phases of the research and were actively involved as members of the Community Advisory Research Committee (CARC) guiding the research processes.

The study concluded that several individual and sociocultural processes intersect and contribute to resilience among Indigenous youth. These processes were described as facilitators, which included;

1) Resilience (wellness) is enhanced when grounded at a cultural level and focused on community, spirituality, and cultural relationships.

2) Resilience (wellness) is enhanced with a strong will and determination to acquire and attain lifelong development and lead exemplary lives that positively influence other Indigenous youth.

3) Resilience (wellness) is enhanced by creating safe spaces for Indigenous youth to escape, recharge and return revitalized.

Urban residing Indigenous youth described how they struggled with various forms of acute hardships from intersecting individual, social and cultural lines in 6 case study vignettes. They, however, told how resilience (wellness) was enhanced in their stories summarized in the following ways;

1) By building and strengthening their cultural identity and family connections

2) By engaging in social and cultural groups providing services to themselves and their immediate communities.

3) By keeping a positive outlook on life through arts practices (music, dances, singing, painting, etc.).

Limitations reported included;

1) Intrinsic limitations of using intersectionality theory do not include all possible factors or processes.

2) Failing to engage voices of family members of participating youth to aid triangulation.

Areas for further research should continue to explore and advance the intersectionality of resilience framework to fully understand how different social processes intersect and support youth resilience and wellness in unique ways.

18

Plazas et al., 2019 [81].

To engage Indigenous youth in popular theatre to explore inequities in access to health services for Indigenous people.

Community schools in Alberta Indigenous territory, Canada.

Qualitative study. Age bracket and the number of youth participants not mentioned.

Ethnographic study design integrated with Paulo Freire’s pedagogical work on critical consciousness and reflexivity. Data were collected by observation, interviews, focus groups, story-sharing, real-life vignettes, and field notes.

Popular theatre uses various theatre games and exercises to help build community and communication skills and deepen understanding of oneself and others. Youth were engaged in theatre workshops, rehearsals, games, exercises, story sharing and discussions that evoked critical thinking and consciousness

At the end of the theatre program, the youth produced a 1-hour production of 5 skits with characters, plots, and storylines that described the processes that continued to challenge or facilitate personal transformation and resilience concerning wellness.

Facilitators:

1) dialogues that engage critical thinking and mutual learning

2) community support and leadership

3) self-motivation is driven by cultural self-awareness and self-appraisal.

Barriers

1) misperception of a lack of control for self-governance in Indigenous communities

Youth expressed that they better understood the connections between their community issues and healthcare equity by engaging in this form of interactive theatre. They expressed a feeling of self-awareness and the capacity to thrive in their communities.

Authors identified that the lack of action following the interactive performances was a limitation and direction for further research inquiry

19

Saini et al., 2020 [84].

To share public health information about acute gastrointestinal illness (AGI) by co-developing a whiteboard video with Inuit youth, community members and government partners and evaluating its efficacy.

Rigolet Inuit community, Nunatsiavut, Newfoundland and Labrador, Canada

Qualitative study. Six youth between 11 to 12 years engaged in the co-production. Fifty-four community members were interviewed during the evaluation.

The study used an integrated participatory action research and evaluation framework. A short-term evaluation of the community’s reaction to the whiteboard video was conducted. Data were collected through interviews and focus group discussions.

Whiteboard videos utilize visual, audio, and oral elements to communicate narratives. Rigolet youth were engaged in the co-production processes through workshops and training sessions. The youth selected all the video characters and provided feedback on proposed storyboards and storylines.

Facilitators mentioned: Engaging Rigolet youth in the video co-development process ensured community relevance of the video.

1) Wellness was enhanced by co-producing with youth a 4m46s video discussing locally identified public health messages about ways to reduce the risk of AGI.

2) Evaluation results suggested the video reinforced health knowledge and encouraged behavioral change.

3) Evaluation participants believed the video promoted Inuit health because of locally relevant visuals and narrative, which reflected Inuit art and storytelling traditions.

None mentioned.

20

Sanchez-Pimienta et al., 2021 [44].

To describe insights gained from a youth co-led participatory digital storytelling project focused on Indigenous health promotion strategies.

M’Wikwedong Indigenous Friendship Centre in Owen Sound, Ontario, Canada.

Qualitative type study engaging 4 Indigenous youth aged between 17 to 22 years.

The study used an integrative framework of participatory action research and exploratory case study design. Data were collected using group interviews and discussion circles with youth and the research team.

Digital storytelling is a facilitated technique that guides participants in identifying an idea and transforming it into a compelling story presented in short audio-visual formats. Youth were engaged in mentorship and training sessions on media gathering and video editing

Facilitators identified:

The following were identified as the ‘ethos of connection’ that underpinned Indigenous health promotion, thus, facilitated wellness. They included a) restoring balance in relationships, b) Indigenous youth guided leaderships, and c) egalitarianism and inclusiveness of knowledge from Western ways of knowing (that proposed a notion of control over Indigenous knowledge)

1) Youth researchers created four videos describing their understanding of health and health promotion from an Indigenous perspective. These videos represented themes that described ways the M’Wikwedong Centre reinforced connections to youth, their sense of self, place in the city and Indigenous cultures. Youth documented in these videos how they found healing, self-identity, and balance through the research processes.

None mentioned.