PART I: METHODS

The targeted literature review aimed to identify sources of information on primary healthcare models that are designed to meet the unique needs, priorities, and distinct circumstances of Indigenous Peoples, support good governance, and advance their vision of self-determination through the progressive and successful devolution of services to Indigenous Peoples. This section describes the methods utilized to identify relevant literature, including the research questions, inclusion criteria, and search strategy, as well as the methods used to extract information.

It is generally acknowledged that Canada, Australia, New Zealand, and the United States share a common language, enjoy a long history of collaboration with each other, and have well-established statistical systems for exploring and reporting on current events. They also share similar histories of Indigenous colonization, face significant problems in the collection of accurate data on Indigenous Peoples, including, specifically, on health, and pursue comparable processes for healthcare reform (Jackson Pulver et al., 2010). Thus, our search for successful models of health governance and funding arrangements with Indigenous communities generally targeted these countries. It is important to acknowledge, however, that while these countries share similar colonial histories, their State government systems, laws, regulations, and practices are very different. Likewise, First Nations, Inuit, and Métis in Canada share similar colonial histories, yet they are distinct, with unique health governance arrangements depending on their scope of delivery, population, and geographical location. In short, what works in one particular context may not necessarily work across all Canadian contexts.

The data collection was guided by the primary research question, “How should governments organize their business to support self-determination for Indigenous Peoples?” Secondary research questions to help inform this policy direction include:

1. Which governance models support self-determination for Indigenous Peoples and

have shown some success in addressing health inequities that may be transferable to the Canadian context? 2. What were the particular supportive and inhibiting factors, including contexts, which influenced the development and implementation of these governance models? 3. How can successful selfdetermination be measured? 4. How are Indigenous ways of knowing, the social determinants of health, the wellness continuum, and engagement/partnership reflected in government governance models and associated accountability frameworks?

The inclusion criteria for the literature review targeted both peer-reviewed and grey sources that were written in English, focused on Indigenous health, and were published between 2000 and 2019. These sources were searched to identify additional relevant sources, which revealed the need to change the date parameters to include years prior to 2000, as several international health governance

models that remain in existence were established earlier than that year. In cases where gaps in information were identified for specific models of health governance, a targeted search was undertaken in an effort to fill those gaps. This involved searching Google and using the particular health governance model as a search term together with a term reflecting the missing information (e.g., funding arrangement, accountability, quality improvement). Only freely accessible sources of information were included in this review. Wherever possible, literature by Indigenous authors and/or community-based participatory literature was emphasized to highlight Indigenous perspectives.

Search Strategy

An online data search was conducted of Google, Google Scholar, PubMed Central, Research Gate, BioMed Central, Science Direct, désLibris Canadian Electronic Library, and Open Access Thesis and Dissertations databases. A combination of key phenomenon and population search terms were used, including Indigenous, Aboriginal, First Nations, Inuit, and Métis in combination with health services, health governance, accountability frameworks, Indigenousgovernment partnerships, devolution, health policy reform, ways of knowing, selfdetermination, community controlled services, collective impact approaches, health funding, complex environments, and sustainable community development. The first webpage of sources (20-50 items) resulting from each database search was scanned for possible information relating to the research questions. The title, authors, abstract, and keywords of each source were screened for compatibility with the inclusion criteria. Open access items selected for further review were downloaded and cited in a reference list of potential sources of evidence.

There are some limitations to this search strategy. For example, the exclusion of terms for specific Indigenous groups, such as Cree or Anishinaabe, and the narrow focus on Indigenous health and health determinants search terms may have resulted in a literature gap, given the holistic perspectives of health and wellbeing among diverse Indigenous groups and the distinctiveness of Indigenous populations. Likewise, First Nations principles of Ownership, Control, Access, and Possession (OCAP®) with regard to principled research, data sovereignty, and information governance may restrict the entry of community research into the public realm. This search strategy also did not utilize systematic review protocols. Nevertheless, it does provide a fairly comprehensive review of the literature in this field.

Information Extraction

Review, selection, and data extraction were undertaken. The abstracts of downloaded sources were read in detail, full texts were reviewed, and data were extracted, based on the primary and secondary research questions related to federal health policy. Additional referenced sources of information that evolved from the selected sources were downloaded and subsequently reviewed as part of the literature review. Approximately 127 sources were downloaded for review. Information sources included academic articles, research journals, governance documents, theses, and dissertations. Recurring themes were identified from the selected sources, and information related to theme topics were compared and assessed in conjunction with the research questions. Material that was deemed relevant, appropriate, and useful to inform new health governance structures and funding models for Indigenous communities was included in the summary of reviewed literature. Additionally, contextual information was derived from the websites of federal and provincial governmental departments and agencies, and from Indigenous health organizations.

Addressing the determinants of Indigenous health means acknowledging that the concept of health extends beyond physical elements to include a range of factors that influence the physical, mental, spiritual, and social well-being of Indigenous Peoples.

(Alberta Health Services, 2018; Wilmot, 2018).