Annette Browne

The Third Eye Seeing project investigates how Decolonial, Intersectional Pedagogies can inform Canadian Nursing and Medical (NursMed) Education. The intention of the project is to contribute to the development of Canadian NursMed Education and efforts to redress deepening, intersecting health and social inequities. Briefly, Decolonial, Intersectional Pedagogies are philosophies of learning that encourage teachers and students to reflect on health through the lenses of settler-colonialism, health equity, and social justice. Drawing on Decolonial, Intersectional Pedagogies, Canadian NursMed Education could ostensibly prepare learners to address the symptoms of modernity, especially settler-colonialism. Diverse academic perspectives have led me to the following research questions: (A) What are the ways in which Decolonial, Intersectional Pedagogies can inform Canadian NursMed Education? (B) What are the potential struggles and adaptations required to integrate Decolonial, Intersectional Pedagogies within Canadian NursMed Education? Drawing on critical ethnographic research methods, I conducted in-depth interviews with faculty members and engaged in participant observation of classrooms in university-based Canadian NursMed Education. The dissertation as a whole, and the analysis was informed by theoretical perspectives including decolonization, intersectionality, and critical theory. Interpretive description guided the analysis of the themes reflected in the data. The research findings are organized into three chapters, beginning with a presentation of four common ‘institutional features’ influencing the uptake of pedagogical approaches: crowded curriculum, academic freedom, the recent Truth and Reconciliation Commission Calls to Action, and admissions processes. The next set of findings addresses the complex strategies participants applied to integrate Decolonial, Intersectional Pedagogies in their teaching approaches. Lastly, the findings illustrate the emotional and spiritual toll some faculty members face when attempting to deliver Decolonial, Intersectional Pedagogies. Based on an analysis, I discuss the concept of Third Eye Seeing as a heuristic (in solidarity with Two-Eyed Seeing) to apply in creating adaptive pedagogies for Canadian NursMed Education. Through the application of multiple worldsenses teachers and students can support movements towards health equity, social justice, and unlearning/undoing settler-colonialism. With this context in mind, this dissertation project intended to generate new knowledge to stimulate dialogue and action regarding the role of Canadian NursMed Education as an upstream determinant of health.

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Alongside consistent reporting on health inequities affecting Indigenous peoples in Canada, Indigenous people have been routinely excluded from health policy decision-making. This pattern of exclusion perpetuates health policy decisions that are often ineffective at addressing the root causes of persistent health inequities. Despite Indigenous peoples’ repeated calls to be meaningfully involved, and the emergence of health policy initiatives that include Indigenous peoples, the influence of neoliberalism and neocolonialism in the Canadian policy sphere continues to undermine self-determination and limit Indigenous peoples’ involvement in health policy processes. Those advocating for Indigenous health equity are left wrestling with the question: What constitutes, and what can foster, meaningful involvement in the contemporary health policy climate? This exploratory qualitative research aims to provide a window of insight into this urgent social justice question by exploring the perspectives of twenty leaders and decision-makers in First Nations health and other areas of health policy, with a view to understanding what constitutes meaningful involvement of First Nations peoples in health policy decision-making in BC and Canada. A critical analysis of these data reveals that meaningful involvement is often experienced as a paradox where Indigenous people are excluded via processes of inclusion, and that fostering meaningful involvement requires attuning to the underlying power dynamics inherent in policymaking and taking action to decolonize and transform the policy system itself. Based on this analysis, I articulate a new conceptualization of and framework for meaningful involvement, which is rooted in seven key elements: Recognizing and Representing Indigenous Peoples; Interrupting and Re-imagining Relationships; Preparing Agreements; Practicing Protocols; Leveraging Power; Exerting Community Authority; and Shifting Social Structures. This dissertation concludes with a discussion on the significance and implications of these findings and strategic directions and recommendations for meaningfully involving urban First Nations people in health policy decision-making in BC and beyond.

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Improving the health of Indigenous children and fostering health equity requires a radical shift beyond prevailing health care approaches. Early child development (ECD) and intervention programs are increasingly recognized for their potential in promoting children’s health and well-being, and appear to be ideally positioned to play a vital role in fostering child health equity. Currently, there is a lack of research on early intervention (EI) programs in the context of Indigenous families and children in Canada. The purpose of this qualitative study was to generate knowledge on how an urban-based EI home-visiting program for Indigenous families and children in BC, known as the Aboriginal Infant Development Program (AIDP), influences families and children’s health and well-being, and is responsive to health and social inequities affecting families and children experiencing social disadvantages. This inquiry was informed by critical theoretical perspectives and undertaken in collaboration with the AIDP. Ethnographic methods of data collection were used to obtain the perspectives of: Indigenous caregivers (n=10) and Elders involved in AIDPs (n=4), AIDP workers (n=18), and administrative leaders of organizations that hosted AIDPs (n=3). Findings demonstrate: (a) a relational perspective of ECD that emphasizes how family well-being and children’s health equity are inextricably connected, and shaped by intersecting structural inequities; (b) how AIDP workers influence family well-being and foster child health equity by: (i) contextually tailoring their programs for female-led single-parent families in urban contexts, and (ii) reframing the EI process so that it is responsive to women’s agency and self-identified priorities, which are frequently centered on accessing determinants of health and navigating the health care and child welfare systems; (c) how locating AIDPs in multi-service organizational hubs enhances a relational orientation to EI, and (d) how AIDP workers traverse a contested ECD landscape and an increasingly complex relationship with the child welfare system. This knowledge will be used to inform and enhance AIDP practices, policies, and education. These findings are applicable to a broad range of ECD and health care disciplines, including occupational therapists, and EI programs that serve Indigenous and non-Indigenous children who live with social disadvantages that stem from structural inequities.

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This dissertation explored the experiences of health and healthcare reported by members of an urban First Nations community who had arthritis and the ways in which arthritis health services were aligned (or not aligned) with these experiences. Using a community-based, participatory design, grounded in decolonizing methodologies and ethnographic methods, this study had two research fields that related to the research questions. Study activities in one research field included intensive immersion in a First Nations community over a period of three years, and interviews with 24 community members. In the second field, which included three arthritis services settings, study activities involved approximately 100 hours of immersion and interviews with 30 healthcare professionals. The analysis of community-based data revealed that experiences of ongoing arthritis/pain and social suffering were inextricably linked to and underpinned by the social and historical context of life in the community. Most, but not all, community participants were reluctant users of health services, largely related to prior negative experiences utilizing health services. The organization and delivery of arthritis health services, shaped by dominant healthcare discourses, were not well aligned with the experiences of First Nations peoples with arthritis; rationing and biomedical discourses limited the ability of the system to be responsive to social contexts, and culturalist and self-management discourses served to deflect healthcare professionals’ attention away from the role that social and material life conditions played in shaping the experiences of First Nations individuals living with arthritis. Amongst arthritis health services leaders and professionals there was a sincere desire to provide effective, quality care to all people with arthritis. Creating more opportunities for social/critical knowledge to be present in health services settings could go a long way towards improving the alignment of arthritis services with arthritis experiences of First Nations peoples.

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