Adeera Levin

Indigenous people in Canada experience rates of chronic kidney disease (CKD) higher than those of non-Indigenous Canadians as a direct result of colonization. Early detection and prevention through screening is a critical public health strategy in optimizing patient outcomes and reducing burden to the health care system. As such, a screen, triage and treat initiative called Kidney Check is currently offering point of care kidney health screening in sixteen First Nations in British Columbia (BC). One of the important aims of the Kidney Check project in its current iteration is to assess the value, acceptance, and sustainability of the project, with the aim of making a case for expansion and continuity. This thesis describes a culturally safe and respectful framework to understand these parameters from the perspective of Kidney Check team members responsible for organization and implementation of the program in community. A two-eyed seeing evaluation approach combining principles from Indigenous evaluation frameworks with qualitative approaches to evaluation was used to ensure a respectful, relational, and academically rigorous evaluation. Specifically, a narrative approach was taken to honor the tradition of oral knowledge sharing and to ensure that the evaluation priorities were set by community members themselves. Ten members of the Kidney Check screening team told their stories through conversational interviews. Interviews were transcribed verbatim and then thematically analyzed in collaboration with an Indigenous Knowledge Holder to maintain an Indigenous perspective throughout. Themes relating to value are described within the framework of the 4R’s; Respect, Relevance, Reciprocity and Responsibility. Themes around sustainability include levers and barriers. Levers to sustainability are intimately connected to the value of Kidney Check. Subthemes around barriers to sustainability include cost, staffing and logistics. The Indigenous metaphor of cedar bark weaving is described as an appropriate visual representation of how the themes illuminated by participants are interconnected and woven together, creating a wholistic evaluation. The results of this evaluation have important implications for both the field of public health as it relates to Indigenous communities and health policy in BC.

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