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Conceptualisation and Operationalisation of a Holistic Indicator of Health for Older Inuit: Results of a Sequential Mixed-Methods Project

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Abstract

Elder Inuit define health as holistic and multifaceted, which contrasts with health-related research where single factor indicators are usually used to measure health in an Inuit context. As the number of Inuit elders is growing, indicators derived from an Inuit definition of health are important if health systems are to be inclusive of the realities of Indigenous Peoples and culture. This study explored and operationalised a model of Inuit health in aging that draws from physical, emotional, spiritual, and interpersonal components identified as salient by participants in this research. Qualitative data gathered through two workshops with 21 participants were analysed to identify key dimensions of health from an Inuit perspective. Quantitative data were retrieved from Statistics Canada Aboriginal Peoples Survey (APS; 2006) with a weighted sample of 4450 Inuit aged ≥ 50 years residing across Inuit Nunangat. Using measures corresponding to the dimensions identified previously, Latent Class Analyses were applied to group survey participants into health profiles to create a holistic indicator of health. Multinomial regressions were conducted with related health and social measures to assess the concurrent validity of the indicator. Health was conceptualised along eight themes: general health balance, mental health, spirituality, not experiencing many activity limitations, being loved and having positive relationships, speaking Inuktitut, and being free of addiction. The holistic indicator grouped participants into three health profiles: (1) good health for most variables; (2) very good perceived and physical health, but poor mental health; and (3) poor health for most variables. Using mixed methods to bridge the concept of health defined in qualitative workshops with quantitative health indicators can contribute to the definition and description of a culturally relevant and sociologically complex understanding of healthy aging in an Inuit context.

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References

  • Bernini, C., Guizzardi, A., & Angelini, G. (2014). Developing a composite indicator of residents’ well-being: The case of the Romagna Area. In F. Crescenzi & S. Mignani (Eds.), Statistical methods and applications from a historical perspective, studies in theoretical and applied statistics (pp. 337–345). Suisse: Springer. https://doi.org/10.1007/978-3-319-05552-7.

    Chapter  Google Scholar 

  • Bjerregaard, P., et al. (2004). Indigenous health in the Arctic: An overview of the circumpolar Inuit population. Scandinavian Journal of Public Health, 32(5), 390–395. https://doi.org/10.1080/14034940410028398.

    Article  Google Scholar 

  • Borré, K. (1994). The healing power of the seal: The meaning of Inuit health practice and belief. Arctic Anthropology, 31(1), 1–15.

    Google Scholar 

  • Bringsen, A., Andersson, H. I., & Ejlertsson, G. (2009). Development and quality analysis of the Salutogenic Health Indicator Scale (SHIS). Scandinavian Journal of Primary Health Care, 37, 13–19. https://doi.org/10.1177/1403494808098919.

    Article  Google Scholar 

  • Chandola, T., & Jenkinson, C. (2000). Validating self-rated health in different ethnic groups. Ethnicity & Health, 5(2), 151–159.

    Article  Google Scholar 

  • Christian, L. M., Glaser, R., Porter, K., Malarkey, W. B., Beversdorf, D., & Kiecolt-Glaser, J. K. (2011). Poorer self-rated health is associated with elevated inflammatory markers among older adults. Psychoneuroendocrinology, 36(10), 1495–1504. https://doi.org/10.1016/j.psyneuen.2011.04.003.

    Article  Google Scholar 

  • Collings, P. (2000). Aging and life course development in an inuit community. Arctic Anthropology, 37(2), 111–125.

    Google Scholar 

  • Collings, P. (2001). “If you got everything, it’s good enough”: Perspectives on successful aging in a Canadian Inuit community. Journal of Cross-Cultural Gerontology, 16, 127–155.

    Article  Google Scholar 

  • Coma, E., et al. (2013). Creation of a synthetic indicator of quality of care as a clinical management standard in primary care. SpringerPlus, 2(1), 51. https://doi.org/10.1186/2193-1801-2-51.

    Article  Google Scholar 

  • Cosco, T. D., et al. (2013). Lay perspectives of successful ageing: A systematic review and meta-ethnography. British Medical Journal Open, 3, 1–9. https://doi.org/10.1136/bmjopen-2013-002710.

    Article  Google Scholar 

  • Creswell, J. W., & Plano Clark, V. L. (2007). Designing and Conducting Mixed Methods Research. Thousand Oaks, London, New Delhi: Sage Publications Inc.

    Google Scholar 

  • Damas, D. (2002). Arctic migrants/Arctic villagers: The transformation of Inuit settlement in the central Arctic. Montreal: McGill-Queen’s University Press.

    Book  Google Scholar 

  • Daniel, M., Cargo, M., Marks, E., Paquet, C., Simmons, D., Williams, M., Rowley, K., O’Dea, K. (2009). Rating health and social indicators for use with indigenous communities: A tool for balancing cultural and scientific utility. Social Indicators Research, 94(2), 241–256. https://doi.org/10.1007/s11205-008-9420-7.

    Article  Google Scholar 

  • Delpierre, C., Lauwers-Cances, V., Datta, G. D., Berkman, L., & Lang, T. (2009). Impact of social position on the effect of cardiovascular risk factors on self-rated health. American Journal of Public Health, 99(7), 1278–1284. https://doi.org/10.2105/AJPH.2008.147934.

    Article  Google Scholar 

  • Fletcher, C. (2017). Measuring Inuit health from Ungava to Nunavik via Nouveau Québec: Episodes in the history of researcher-subject relations. American Review of Canadian Studies, 47(2), 206–224. https://doi.org/10.1080/02722011.2017.1323944.

    Article  Google Scholar 

  • Fortin, M., et al. (2015). Temporal trends of alcohol and drug use among Inuit of Northern Quebec, Canada. International Journal of Circumpolar Health, 74, 1–9. https://doi.org/10.3402/ijch.v74.29146.

    Article  Google Scholar 

  • Fribord, J., et al. (2003). Cancer in Greenlandic Inuit 1973–1997: A cohort study. International Journal of Cancer, 107, 1017–1022. https://doi.org/10.1002/ijc.11502.

    Article  Google Scholar 

  • Golafshani, N. (2003). Understanding reliability and validity in qualitative research. The Qualitative Report, 8(4), 597–607.

    Google Scholar 

  • Goldman, N. (2004). The role of clinical risk factors in understanding self-rated health. Annals of Epidemiology, 14(1), 49–57. https://doi.org/10.1016/S1047-2797(03)00077-2.

    Article  Google Scholar 

  • Gray, A. P., Richer, F., & Harper, S. (2016). Individual-and community-level determinants of Inuit youth mental wellness. Canadian Journal of Public Health, 107(3), 251–257. https://doi.org/10.17269/CJPH.107.5342.

    Article  Google Scholar 

  • Haseli-Mashhadi, N., Pan, A., Ye, X., Wang, J., Qi, Q., Liu, Y., et al. (2009). Self-Rated Health in middle-aged and elderly Chinese: Distribution, determinants and associations with cardio-metabolic risk factors. BMC Public Health, 9, 368. https://doi.org/10.1186/1471-2458-9-368.

    Article  Google Scholar 

  • Hashemnezhad, H. (2015). Qualitative content analysis research: A review article. Journal of ELT and Applied Linguistics (JELTAL), 3(1), 54–62.

    Google Scholar 

  • Health Canada. (2009). A Statistical Profile on the Health of First Nations in Canada: Self-rated Health and Selected Conditions 2002 to 2005. Health Canada. http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/pdf/pubs/aborig-autoch/2009-stats-profil-vol3/2009-stats-profil-vol3-eng.pdf.

  • Hlatky, M. A., et al. (1989). A brief self-administered questionnaire to determine functional capacity (The Duke Activity Status Index). The American Journal of Cardiology. Excerpta Medica, 64(10), 651–654. https://doi.org/10.1016/0002-9149(89)90496-7.

    Article  Google Scholar 

  • Hopkins, S. E., et al. (2007). Keeping busy: A Yup’Ik/Cup’Ik perspective on health and aging. International Journal of Circumpolar Health, 66(1), 42–50.

    Article  Google Scholar 

  • Horsman, J., et al. (2003). The Health Utilities Index (HUI): Concepts, measurement properties and applications’. Health and Quality of Life Outcomes, 1, 1–13.

    Article  Google Scholar 

  • Humble, Á. M. (2009). Technique triangulation for validation in directed content analysis. International Journal of Qualitative Methods, 8(3), 34–52. https://doi.org/10.1177/160940690900800305.

    Article  Google Scholar 

  • Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.

    Article  Google Scholar 

  • Inuit Tapiriit Kanatami. (2008). Inuit Statistical Profile. ITK

  • Inuit Tapiriit Kanatami. (2014). Social Determinants of Inuit Health in Canada. https://doi.org/10.1097/01.aog.0000453605.35883.a0.

  • Inuit Tapiriit Kanatami. (2018). Inuit Statistical Profile.

  • Jylhä, M., Volpato, S., & Guralnik, J. M. (2006). Self-rated health showed a graded association with frequently used biomarkers in a large population sample. Journal of Clinical Epidemiology, 59(5), 465–471. https://doi.org/10.1016/j.jclinepi.2005.12.004.

    Article  Google Scholar 

  • Kirmayer, L. J. (1994). Suicide among Canadian aboriginal peoples. Transcultural Psychiatric Research Review, 31, 3–58.

    Article  Google Scholar 

  • Kirmayer, L. J., Fletcher, C., Corin, E., Boothroyd, L. (1997). Inuit concepts of mental health and illness: An ethnographic study. Culture and Mental Health Unit, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis—Jewish General Hospital. Montréal.

  • Kirmayer, L. J., Fletcher, C., & Watt, R. (2009). 13: Locating the ecocentric self: Inuit concepts of mental health and illness. In L. J. Kirmayer & G. G. Valaskakis (Eds.), Healing traditions: The mental health of Aboriginal Peoples in Canada (pp. 289–314). Vancouver: UBC Press.

    Google Scholar 

  • Kral, M. J., et al. (2011). Unikkaartuit: Meanings of well-being, unhappiness, health, and community change among Inuit in Nunavut, Canada. American Journal of Community Psychology, 48, 426–438. https://doi.org/10.1007/s10464-011-9431-4.

    Article  Google Scholar 

  • Kuh, D., et al. (2013). Life course epidemiology, ageing research, and maturing cohort studies: A dynamic combination for understanding healthy ageing. In D. Kuh, et al. (Eds.), A life course approach to healthy ageing (pp. 3–15). Oxford: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199656516.001.0001.

    Chapter  Google Scholar 

  • Lewis, J. P. (2010). Successful aging through the eyes of Alaska natives: Exploring generational differences among Alaska natives. Journal of Cross-Cultural Gerontology, 25, 385–396. https://doi.org/10.1007/s10823-010-9124-8.

    Article  Google Scholar 

  • Lewis, J. P. (2011). Successful aging through the eyes of Alaska Native elders. What it means to be an elder in Bristol Bay, AK. The Gerontologist, 51(4), 540–549.

    Article  Google Scholar 

  • Loppie Reading, C., & Wien, F. (2009). Health inequalities and social determinants of aboriginal peoples’ health. Vancouver: National Collaborating Center for Aboriginal Health.

    Google Scholar 

  • Lucas, M., et al. (2010). Erythrocyte N-3 is inversely correlated with serious psychological distress among the Inuit: Data from the Nunavik Health Survey. Journal of the American College of Nutrition, 29(3), 211–221. https://doi.org/10.1080/07315724.2010.10719836.

    Article  Google Scholar 

  • Marks, E., Cargo, M. D., & Daniel, M. (2007). Constructing a health and social indicator framework for indigenous community health research. Social Indicators Research, 82, 93–110. https://doi.org/10.1007/s11205-006-9016-z.

    Article  Google Scholar 

  • Martin, G., Keller, C. P., & Foster, L. T. (2012). Constructing a composite adolescent health and wellness index for British Columbia, Canada using a spatial multi-criteria analysis approach. Child Indicators Research, 5(2), 215–234.

    Article  Google Scholar 

  • Maslovskaya, O., Smith, P. W. F., & Padmadas, S. S. (2018). A comparison of simple score and latent class approaches: Application to HIV knowledge data in Chinese and multi-country contexts. International Journal of Social Research Methodology, 21(2), 243–261. https://doi.org/10.1080/13645579.2017.1367555.

    Article  Google Scholar 

  • May, M., Lawlor, D. A., Brindle, P., Patel, R., & Ebrahim, S. (2006). Cardiovascular disease risk assessment in older women: Can we improve on Framingham? British Women’s Heart and Health prospective cohort study. Heart (British Cardiac Society), 92(10), 1396–1401. https://doi.org/10.1136/hrt.2005.085381.

    Article  Google Scholar 

  • McCutcheon, A. L. (1987). Latent class analysis (No. 64). Thousand Oaks, CA: Sage Publications.

    Book  Google Scholar 

  • Morgan, D. L. (1998). Practical strategies for combining qualitative and quantitative methods: Applications to health research. Qualitative Health Research, 8(3), 362–376.

    Article  Google Scholar 

  • Muckle, G., et al. (2007). Alcohol, drug use and gambling amont the Inuit of Nunavil: Epidemiological profile. Retrieved from 11 April 2018, https://www.cpha.ca/sites/default/files/uploads/resources/cannabis/nunakvik_qanuippitaa_2005.pdf.

  • Oster, R. T., et al. (2014). Cultural continuity, traditional Indigenous language, and diabetes in Alberta First Nations: A mixed methods study. International Journal for Equity in Health, 13(92), 1–11.

    Google Scholar 

  • Phelan, E. A., & Larson, E. B. (2002). “Successful aging”—Where next? Journal of the American Geriatrics Society, 50(7), 1306–1308.

    Google Scholar 

  • Phelan, E. A., et al. (2004). Older adults’ views of “successful aging”—How do they compare with researchers’ definitions? Journal of the American Geriatrics Society, 52(2), 211–216.

    Article  Google Scholar 

  • Richmond, C. A. M. (2009). The social determinants of Inuit health: A focus on social support in the Canadian Arctic. International Journal of Circumpolar Health, 68(5), 471–487.

    Article  Google Scholar 

  • Richmond, C. A. M., & Ross, N. A. (2009). The determinants of First Nation and Inuit health: A critical population health approach. Health & Place, 15, 403–411. https://doi.org/10.1016/j.healthplace.2008.07.004.

    Article  Google Scholar 

  • Richmond, C. A. M., Ross, N. A., & Egeland, G. M. (2007). Social support and thriving health: A new approach to understanding the health of indigenous Canadians. American Journal of Public Health, 97(9), 1–7. https://doi.org/10.2105/ajph.2006.096917.

    Article  Google Scholar 

  • Ryff, C. D., & Singer, B. (2008). Understanding healthy aging: Key componentes and their integration. In V. L. Bengston, et al. (Eds.), Handbook of Theories of Aging (2nd ed., pp. 117–144). New York: Springer.

    Google Scholar 

  • Saudny, H., Cao, Z., & Egeland, G. M. (2012). Poor self-reported health and its association with biomarkers among Canadian Inuit. International Journal of Circumpolar Health, 71(21), 1–7. https://doi.org/10.3402/ijch.v71i0.18589.

    Article  Google Scholar 

  • Schreiber, J. B., & Pekarik, A. J. (2014). Technical note: Using latent class analysis versus k-means or hierarchical clustering to understand museum visitors. Curator: The Museum Journal, 57(1), 45–59. https://doi.org/10.1111/cura.12050.

    Article  Google Scholar 

  • Somarriba, N., & Pena, B. (2009). Synthetic indicators of quality of life in Europe. Social Indicators Research, 94(1), 115–133. https://doi.org/10.1007/s11205-008-9356-y.

    Article  Google Scholar 

  • StataCorp. (2017). Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC.

    Google Scholar 

  • Statistics Canada. (2006). 2006 Census Inuit Tables. Ottawa: Statistics Canada.

    Google Scholar 

  • Statistics Canada. (2009). Aboriginal Peoples Survey, 2006: Concepts and methods guide. Ottawa: Statistics Canada.

    Google Scholar 

  • Statistics Canada. (2017). Aboriginal Peoples Highlight Tables, 2016 Census. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/abo-aut/Table.cfm?Lang=Eng&T=101&S=99&O=A.

  • Stewart, A., Hays, R., & Ware, J. (1988). The MOS Short-form General Health Survey. Medical Care, 26, 724–735.

    Article  Google Scholar 

  • Stoller, E. P., Webster, N. J., Blixen, C. E., McCormick, R. A., Hund, A. J., Perzynski, A. T., Kanuch, S. W., Thomas, C. L., Kercher, K., Dawsonet, N. V. (2009). Alcohol consumption decisions among nonabusing drinkers diagnosed with hepatitis C: An exploratory sequential mixed methods study. Journal of Mixed Methods Research, 3(1), 65–86. https://doi.org/10.1177/1558689808326119.

    Article  Google Scholar 

  • Stuart, B., & Hinde, A. (2010). Identifying individuals engaging in risky sexual behaviour for chlamydia infection in the UK: A latent class approach. Journal of Biosocial Science, 42(1), 27–42. https://doi.org/10.1017/S0021932009990289.

    Article  Google Scholar 

  • Svenson, K. A. and Lafontaine, C. (1997) The search for wellness. In First Nations and Inuit regional health survey Committee (pp. 181–216).

  • Tait, H. (2008) Aboriginal Peoples Survey, 2006: Inuit Health and Social Conditions. doi: 89-637-X.

  • Tariq, S., & Woodman, J. (2010). Using mixed methods in health research. Journal of the Royal Society of Medicine Short Reports. https://doi.org/10.1177/2042533313479197.

    Article  Google Scholar 

  • Taylor, J. (2008). Indigenous peoples and indicators of well-being: Australian perspectives on United Nations Global Frameworks. Social Indicators Research, 87(1), 111–126.

    Article  Google Scholar 

  • Thompson, S. J., & Gifford, S. M. (2000). Trying to keep a balance: The meaning of health and diabetes in an urban Aboriginal community. Social Science and Medicine, 51, 1457–1472.

    Article  Google Scholar 

  • Walker, R., Ballard, J., & Taylor, C. (2002) Investigating appropriate evaluation methods and indicators for Indigenous housing programs.

  • Ware, J. E., et al. (1993). SF-30 health survey manual & interpretation guide. Boston: Massachusetts.

    Google Scholar 

  • Waugh, E., & Mackenzie, L. (2011). Ageing well from an urban Indigenous Australian perspective. Australian Occupational Therapy Journal, 58, 25–33. https://doi.org/10.1111/j.1440-1630.2010.00914.x.

    Article  Google Scholar 

  • World Health Organization. (2010). A conceptual framework for action on the social determinants of health, Social Determinants of Health Discussion Paper 2. Geneva. ISBN 978 92 4 150085 2.

  • Young, T. K., & Bjerregaard, P. (2008). Health transitions in Arctic populations. Toronto: University of Toronto Press.

    Google Scholar 

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Acknowledgements

This research was supported by funds to the Canadian Research Data Centre Network (CRDCN) from the Social Sciences and Humanities Research Council (SSHRC), the Canadian Institute for Health Research (CIHR), the Canadian Foundation for Innovation (CFI), and Statistics Canada. Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada. We would like to thank the participants of the workshops in Nunavik for their time and implications in this research. We also thank the participants of the 2006 Census and the 2006 Aboriginal people survey for their participation. At the time this manuscript was prepared, Marie Baron was supported by a doctoral scholarship from the Ministère des études supérieures et de la recherche in Quebec and from ArcticNet. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program. The Qanuilirpitaa 2017 workshops were supported by The Nunavik Regional Board of Health and Social Services and ArcticNet. The data management committee of Q2017 reviewed and approved the manuscript for publication.

Funding

Funding was provided by Canadian Institute of Health Research (Grant No. CIHR 950-231678), and ArcticNet (Phase IV 2015–2018).

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Authors and Affiliations

  1. Vitam – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Québec, Canada

    Marie Baron

  2. Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU du Québec - Université Laval, Hôpital St-Sacrement, bureau JSI-13, 1050, Ch Ste-Foy Québec, QC, G1S4L8, Canada

    Christopher Fletcher & Marie-Claude Lyonnais

  3. Canada Research Chair in Housing, Community, and Health, Institute for Health and Social Policy and Department of Geography, McGill University, Montreal, Canada

    Mylène Riva

  4. Département de Médecine Sociale et Préventive, Laval University, Quebec City, Canada

    Christopher Fletcher

  5. Department of Geography, McGill University, Montreal, Canada

    Melody Lynch

  6. Unité Gestion, analyse et diffusion de l’information – Soutien méthodologique et Infocentre, Institut national de santé publique du Québec, Québec, Canada

    Elhadji A. Laouan Sidi

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Baron, M., Riva, M., Fletcher, C. et al. Conceptualisation and Operationalisation of a Holistic Indicator of Health for Older Inuit: Results of a Sequential Mixed-Methods Project. Soc Indic Res 155, 47–72 (2021). https://doi.org/10.1007/s11205-020-02592-5

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