Integrating Traditional Knowledge Into the Care of People With Health Conditions in the Atikamekw Community of Manawan: Qualitative Participatory Case Study Research Protocol

Main Article Content

Sandro Echaquan
https://orcid.org/0009-0002-1401-1715
David Buetti
https://orcid.org/0000-0002-3892-9419
Emmanuelle Bédard
https://orcid.org/0009-0002-6777-1734
Stéphane Grenier
https://orcid.org/0000-0003-4208-0152
Isabelle Toupin
https://orcid.org/0000-0002-5576-5399
Hélène Pourcelot
https://orcid.org/0009-0005-4455-8115
Dave A. Bergeron
https://orcid.org/0000-0002-8404-665X

Abstract

Introduction: The current biomedical vision of health is at odds with Indigenous peoples’ holistic vision of health. The differences between these visions of health create profound fears and mistrust among Indigenous people towards the healthcare system. Yet research shows that integrating traditional knowledge is promising for delivering culturally safe healthcare. Although the integration of traditional knowledge is encouraged by many healthcare stakeholders, there is little empirical research in Quebec (Canada) on how this integration takes place.


Objectives: 1) Describe how traditional knowledge is integrated within the care of Indigenous people living with a health condition, 2) explore the mechanisms and contextual elements that might influence this integration, and 3) identify paths of improvement for better integration of this traditional knowledge within care.


Methods: A qualitative participatory case study guided by the principles of the realist approach will be conducted in the health center of the Atikamekw community of Manawan, using a Two-Eyed Seeing approach. Talking circles, family and individual interviews will be conducted with Indigenous and non-Indigenous health professionals, traditional healers, and Indigenous people. Data will be analyzed thematically and validated by Indigenous co-investigators and collaborators.


Discussion and Research Spin-offs: The results will enable a better understanding of the elements influencing the integration of traditional knowledge into care for Indigenous people. These findings are crucial for a sustainable, holistic approach to health and to improve the quality and safety of care offered to Indigenous peoples.

Article Details

How to Cite
Echaquan, S., Buetti, D., Bédard, E., Grenier, S., Toupin, I., Pourcelot, H., & Bergeron, D. A. (2025). Integrating Traditional Knowledge Into the Care of People With Health Conditions in the Atikamekw Community of Manawan: Qualitative Participatory Case Study Research Protocol. Science of Nursing and Health Practices. https://doi.org/10.62212/snahp.147
Section
Research protocol articles

References

Allen, L., Hatala, A., Ijaz, S., Courchene, E. D. et Bushie, E. B. (2020). Indigenous-led health care partnerships in Canada. CMAJ : Canadian Medical Association journal = journal de l’Association médicale canadienne, 192(9), E208–E216. https://doi.org/10.1503/cmaj.190728

Asamoah, G. D., Khakpour, M., Carr, T. et Groot, G. (2023). Exploring Indigenous Traditional Healing programs in Canada, Australia, and New Zealand: A scoping review. Explore (New York, N.Y.), 19(1), 14–25. https://doi.org/10.1016/j.explore.2022.06.004

Barbo, G. et Alam, S. (2024). Indigenous people’s experiences of primary health care in Canada: a qualitative systematic review. Expériences des Autochtones en matière de soins de santé primaires au Canada : revue systématique qualitative. Health promotion and chronic disease prevention in Canada : research, policy and practice, 44(4), 131–151. https://doi.org/10.24095/hpcdp.44.4.01

Barnabe, C. (2021). Towards attainment of Indigenous health through empowerment : Resetting health systems, services and provider approaches. BMJ Global Health, 6(2), e004052. https://doi.org/10.1136/bmjgh-2020-004052

Bartlett, C., Marshall, M. et Marshall, A. (2012). Two-eyed seeing and other lessons learned within a co-learning journey of bringing together indigenous and mainstream knowledges and ways of knowing. Journal of Environmental Studies and Sciences, 2(4), 331–340. https://doi.org/10.1007/s13412-012-0086-8

Basile, S., Gros-Louis McHugh, N. et Gentelet, K. (2021). Boîte à outils des principes de la recherche en contexte autochtone : éthique, respect, équité, réciprocité, collaboration et culture. Commission de la santé et des services sociaux du Québec et du Labrador, Université du Québec en Abitibi-Témiscamingue, Université du Québec en Outaouais et Réseau DIALOG. https://numerique.banq.qc.ca/patrimoine/details/52327/4339592

Battiste, M. (2005). Indigenous Knowledge: Foundations for First Nations. WINHEC: International Journal of Indigenous Education Scholarship, (1), 1–17. https://journals.uvic.ca/index.php/winhec/article/view/19251

Béland, J. (2020). Les enjeux et stratégies identitaires des Atikamekw Nehirowisiwok de Manawan [mémoire de maîtrise, Université Laval]. CorpusUL. https://corpus.ulaval.ca/server/api/core/bitstreams/2725f2bf-1b68-47a9-8be7-dac5f80d7c42/content

Bergeron, D. A. et Gaboury, I. (2020). Challenges related with the Analytical Process in Realist Evaluation and Latest Development on the Use of NVivo from a Realist Perspective. International Journal of Social Research Methodology, 23(3), 355–365. https://doi.org/10.1080/13645579.2019.1697167

Bergeron, D. A., Tremblay, M.-C., Dogba, M. J., Martin, D. et McGavock, J. (2021). The use of realist approaches for health research in Indigenous communities. AlterNative: An International Journal of Indigenous Peoples, 17(1), 106–110. https://doi.org/10.1177/1177180121996063

Bergeron, D. A., Rey, L., Murillo Salazar, F., Michaud, A. M. et Ccanahuire Laura, F. (2022). An ounce of prevention is worth a pound of cure – The arts as a vehicle for knowledge translation and exchange (KTE) in public health during a pandemic : A research protocol. BMJ Open, 12(9), e058874. https://doi.org/10.1136/bmjopen-2021-058874

Bergström, J. (2021). Whose Knowledge Counts? The Struggle to Revitalise Indigenous Knowledges in Guatemala. Sustainability, 13(21), 11589. https://doi.org/10.3390/su132111589

Browne, A. J., Varcoe, C., Lavoie, J., Smye, V., Wong, S. T., Krause, M., Tu, D., Godwin, O., Khan, K. et Fridkin, A. (2016). Enhancing health care equity with Indigenous populations : Evidence-based strategies from an ethnographic study. BMC Health Services Research, 16(1), 544. https://doi.org/10.1186/s12913-016-1707-9

Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D. et Walker, K. (2020). Purposive sampling : Complex or simple? Research case examples. Journal of Research in Nursing : JRN, 25(8), 652–661.

Capitaine, B. (2018). Expressions ordinaires et politiques du racisme anti-autochtone au Québec. Sociologie et sociétés, 50(2), 77–99. https://doi.org/10.7202/1066814ar

Clark M. J. (2012). Cross-cultural research: challenge and competence. International journal of nursing practice, 18 Suppl 2, 28–37. https://doi.org/10.1111/j.1440-172X.2012.02026.x

Cleland, J., MacLeod, A. et Ellaway, R. H. (2021). The curious case of case study research. Medical education, 55(10), 1131–1141. https://doi.org/10.1111/medu.14544

Coldwell, M. (2019). Reconsidering context: Six underlying features of context to improve learning from evaluation. Evaluation, 25(1), 99–117. https://doi.org/10.1177/1356389018803234

Collin-Vézina, D., De La Sablonnière-Griffin, M. et Dutrisac, C. (2011). Development of a Mental Health Service Organization Model Among the First Nations of Quebec. Commission de la santé et des services sociaux des Premières Nations du Québec et du Labrador. https://files.cssspnql.com/index.php/s/Z5xXiBJQVOuOyp9?_gl=1*purlwd*_ga*OTA0NDUzNTU2LjE3NDcyMzU1MDg.*_ga_906VEPXQGV*czE3NDcyNDA4MzAkbzIkZzAkdDE3NDcyNDA4MzAkajAkbDAkaDA.

Commission d’enquête sur les relations entre les Autochtones et certains services publics. (2019). Commission d’enquête sur les relations entre les Autochtones et certains services publics : Écoute, réconciliation et progrès - Rapport final. Gouvernement du Québec. https://www.bibliotheque.assnat.qc.ca/DepotNumerique_v2/AffichageNotice.aspx?idn=97224

Conseil des Atikamekw de Manawan et Conseil de la Nation atikamekw. (2020). Principe de Joyce. https://principedejoyce.com/sn_uploads/principe/Principe_de_Joyce__FR.pdf

Daigle, M., Bergeron, D. et Ledoux, I. (2025). La démarche d’analyse inductive : principes, défis et pistes de solutions. L’infirmière clinicienne, 22(1), 1–11.

Dalkin, S., Forster, N., Hodgson, P., Lhussier, M. et Carr, S. M. (2020). Using computer assisted qualitative data analysis software (CAQDAS; NVivo) to assist in the complex process of realist theory generation, refinement and testing. International Journal of Social Research Methodology, 24(1), 123–134. https://doi.org/10.1080/13645579.2020.1803528

de Leeuw S. (2017). Passer de l’appel à l’action: Traiter les patients autochtones en collaboration avec les guérisseurs et les aînés indigènes. Canadian family physician Medecin de famille canadien, 63(1), e70–e73.

de Souza, D. E. (2013). Elaborating the Context-Mechanism-Outcome configuration (CMOc) in realist evaluation: A critical realist perspective. Evaluation, 19(2), 141–154. https://doi.org/10.1177/1356389013485194

Donalek, J. G. (2009). The family research interview. Nurse Researcher, 16(3), 21–28. https://doi.org/10.7748/nr2009.04.16.3.21.c6943

Duhamel, F. (2015). La santé et la famille. Une approche systémique en soins infirmiers (3e éd.). Chenelière Education.

Dylan, A. (2003). Talking circles: A traditional form of group work. Dans N. Sullivan, L. Mitchell, D. Goodman, N. Lang et E. Mesbur (dir.), Social Work with Groups—Social Justice Through Personal, Community, and Societal Change (p. 119–133). Routledge.

Fawcett, J. (2021). The Conceptual Model of Nursology for Enhancing Equity and Quality: Population Health and Health Policy. Dans M. P. Moss et J. Phillips (dir.), Health Equity and Nursing: Achieving Equity Through Policy, Population Health, and Interprofessional Collaboration (p. 101–117). Springer. https://doi.org/10.1891/9780826195074.0007

Forbes, A., Ritchie, S., Walker, J. et Young, N. (2020). Applications of Two-Eyed seeing in primary research focused on Indigenous health: A scoping review. International Journal of Qualitative Methods, 19. https://doi.org/10.1177/1609406920929110

Fraser, S. L., Gaulin, D. et Fraser, W. D. (2021). Dissecting systemic racism: policies, practices and epistemologies creating racialized systems of care for Indigenous peoples. International journal for equity in health, 20(1), 164. https://doi.org/10.1186/s12939-021-01500-8

Gall, A., Anderson, K., Howard, K., Diaz, A., King, A., Willing, E., Connolly, M., Lindsay, D. et Garvey, G. (2021). Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review. International journal of environmental research and public health, 18(11), 5832. https://doi.org/10.3390/ijerph18115832

Gogovor, A., Mollayeva, T., Etherington, N., Colantonio, A. et Légaré, F. (2020). Sex and gender analysis in knowledge translation interventions: Challenges and solutions. Health Research Policy and Systems, 18(1), 1–10. https://doi.org/10.1186/s12961-020-00625-6

Guest, G., Namey, E. et McKenna, K. (2017). How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes. Field methods, 29(1), 3–22. https://doi.org/10.1177/1525822X16639015

Hovey, R. B., Delormier, T., McComber, A. M., Lévesque, L. et Martin, D. (2017). Enhancing Indigenous Health Promotion Research Through Two-Eyed Seeing: A Hermeneutic Relational Process. Qualitative health research, 27(9), 1278–1287. https://doi.org/10.1177/1049732317697948

Hudon, C., Chouinard, M. C., Bisson, M., Danish, A., Karam, M., Girard, A., Bossé, P. L. et Lambert, M. (2021). Case Study With a Participatory Approach: Rethinking Pragmatics of Stakeholder Engagement for Implementation Research. Annals of family medicine, 19(6), 540–546. https://doi.org/10.1370/afm.2717

Institute of Health Economics. (2011). About the Aboriginal peoples’ wellness in Canada : Scaling up the knowledge roundtable—Cultural Context and Community Aspirations. https://ihe.ca/files/aboriginal_roundtable_report.pdf

Iwama, M., Marshall, M., Marshall, A. et Bartlett, C. (2009). Two-Eyed Seeing and the Language of Healing in Community-Based Research. Canadian Journal of Native Education, 32(2), 3–23. https://doi.org/10.14288/cjne.v32i2.196493

Jeffery, T., Kurtz, D. L. et Jones, C. A. (2021). Two-eyed seeing: Current approaches, and discussion of medical applications. British Columbia Medical Journal, 63(8), 321–325.

Jérôme, L., Chalifoux, É. et Bousquet, M.-P. (2019). Mot de la direction : le racisme, une histoire qui se répète. Recherches amérindiennes au Québec, 49(3), 3–4.

Kitching, G. T., Firestone, M., Schei, B., Wolfe, S., Bourgeois, C., O’Campo, P., Rotondi, M., Nisenbaum, R., Maddox, R. et Smylie, J. (2020). Unmet health needs and discrimination by healthcare providers among an Indigenous population in Toronto, Canada. Canadian journal of public health = Revue canadienne de sante publique, 111(1), 40–49. https://doi.org/10.17269/s41997-019-00242-z

Kyoon Achan, G., Eni, R., Kinew, K. A., Phillips-Beck, W., Lavoie, J. G. et Katz, A. (2021). The Two Great Healing Traditions: Issues, Opportunities, and Recommendations for an Integrated First Nations Healthcare System in Canada. Health systems and reform, 7(1), e1943814. https://doi.org/10.1080/23288604.2021.1943814

Lavallée, L. F. (2009). Practical application of an Indigenous research framework and two qualitative Indigenous research methods: Sharing circles and Anishnaabe symbol-based reflection. International Journal of Qualitative Methods, 8(1), 21–40. https://doi.org/10.1177/160940690900800103

Leclerc, A.-M., Vézeau-Beaulieu, K., Rivard, M.-C et Miquelon, P. (2018). Sécurisation culturelle en santé : Un concept émergent. Perspective infirmière, 15(3), 50–53. https://www.oiiq.org/securisation-culturelle-en-sante-un-concept-emergent

Martin, D. H. (2012). Two-Eyed Seeing: A Framework for Understanding Indigenous and Non-Indigenous Approaches to Indigenous Health Research. Canadian Journal of Nursing Research, 44(2), 20–42.

Maxwell, J. A. (2012). A Realist Approach for Qualitative Research. Sage Publications, Inc.

Merriam, S. B. (1998). Qualitative Research and Case Study Applications in Education (2e éd.). Jossey-Bass.

Merriam, S. B. et Tisdell, E. J. (2016). Qualitative Research: A Guide to Design and Implementation (4e éd.). Jossey-Bass.

Miles, M. B., Huberman, A. M. et Saldaña, J. (2019). Qualitative Data Analysis: A Methods Sourcebook (4e éd.). Sage Publications, Inc.

Ministère de la Santé et des Services sociaux. (2021, mars). La sécurisation culturelle en santé et en services sociaux : vers des soins et des services culturellement sécurisants pour les Premières Nations et les Inuit (publication no 20-613-02W). https://publications.msss.gouv.qc.ca/msss/fichiers/2020/20-613-02W.pdf

Mtisi, S. (2022). The Qualitative Case Study Research Strategy as Applied on a Rural Enterprise Development Doctoral Research Project. International Journal of Qualitative Methods, 21. https://doi.org/10.1177/16094069221145849

Native Women’s Association of Canada. (2020, June). A Culturally Relevant Gender-Based Analysis (CRGBA) Starter Kit: Introduction, Incorporation, and Illustrations of Use. https://www.nwac.ca/assets-knowledge-centre/A-Culturally-Relevant-Gender-Based-Analysis.pdf

Paillé, P. et Mucchielli, A. (2021). L’analyse qualitative en sciences humaines et sociales (5e éd.). Armand Colin.

Parter, C., Gwynn, J., Wilson, S., Skinner, J. C., Rix, E. et Hartz, D. (2023). Putting Indigenous Cultures and Indigenous Knowledges Front and Centre to Clinical Practice: Katherine Hospital Case Example. International journal of environmental research and public health, 21(1), 3. https://doi.org/10.3390/ijerph21010003

Peltier, C. (2018). An Application of Two-Eyed Seeing: Indigenous Research Methods With Participatory Action Research. International Journal of Qualitative Methods, 17(1), https://doi.org/10.1177/1609406918812346

Périllat-Amédée, S., Delormier, T., Flamand, S., Ottawa, G., Flamand, D., McBeath, B., McComber, A. M., Macaulay, A. et Lévesque, L. (2021). Atikamekw Nehirowisiw Mirowatisiwin: Identifying the Strengths of the Manawan Community to Promote Wellness and Healthy Lifestyles. Turtle Island Journal of Indigenous Health, 1(2). https://doi.org/10.33137/tijih.v1i2.36135

Phillips-Beck, W., Eni, R., Lavoie, J. G., Avery Kinew, K., Kyoon Achan, G. et Katz, A. (2020). Confronting Racism within the Canadian Healthcare System: Systemic Exclusion of First Nations from Quality and Consistent Care. International journal of environmental research and public health, 17(22), 8343. https://doi.org/10.3390/ijerph17228343

Posca, J. (2018). Portrait des inégalités socioéconomiques touchant les Autochtones au Québec. Institut de recherche et d’informations socioéconomiques. https://iris-recherche.qc.ca/wp-content/uploads/2021/03/Note_Ine_galite_s_4_WEB_02.pdf

Ragoonaden, K., Fraser, T., Hoffman, R. et Hebert, B. (2021). Mindfulness and Indigenous Knowledge: Shared Narratives About Reconciliation and Decolonization in Teacher Education. Journal of Contemplative Inquiry, 8(1), 12.

Reading, C. et Wien, F. (2009). Health inequalities and social determinants of Aboriginal Peoples’ Health. National Collaborating Centre for Aboriginal Health. https://www.ccnsa-nccah.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf

Redvers, N. et Blondin, B. (2020). Traditional Indigenous medicine in North America: A scoping review. PloS one, 15(8), e0237531. https://doi.org/10.1371/journal.pone.0237531

Redvers, N., Marianayagam, J. et Blondin, B. (2019). Improving access to Indigenous medicine for patients in hospital-based settings: a challenge for health systems in northern Canada. International Journal of Circumpolar Health, 78(2). https://doi.org/10.1080/22423982.2019.1589208

Réseau GRAINE Guyane. (2017). AGIR ENSEMBLE pour notre environnement—Guide pratique d’accompagnement pour mettre en œuvre la participation et animer un projet participatif en Guyane. https://graineguyane.org/wp-content/uploads/2017/01/GUIDE-DP-COMPLET.compressed.pdf

Sanchez-Pimienta, C. E., Masuda, J. R., Doucette, M. B., Lewis, D., Rotz, S., On Behalf Of The Native Women's Association Of Canada, Neufeld, H. T. et Castleden, H. (2021). Implementing Indigenous Gender-Based Analysis in Research: Principles, Practices and Lessons Learned. International journal of environmental research and public health, 18(21), 11572. https://doi.org/10.3390/ijerph182111572

Thomas, D. R. (2006). A General Inductive Approach for Analyzing Qualitative Evaluation Data. American Journal of Evaluation, 27(2), 237–246. https://doi.org/10.1177/1098214005283748

Van Belle, S., Rifkin, S. et Marchal, B. (2017). The challenge of complexity in evaluating health policies and programs: the case of women’s participatory groups to improve antenatal outcomes. BMC health services research, 17(1), 687. https://doi.org/10.1186/s12913-017-2627-z

Westhorp, G. (2018). Understanding mechanisms in realist evaluation and research. Dans N. Emmel, J. Greenhalgh, A. Manzano, M. Monaghan et S. Dalkin (dir.), Doing Realist Research (p. 41–58). Sage Publications, Inc.

Wright, A. L., Wahoush, O., Ballantyne, M., Gabel, C. et Jack, S. M. (2016). Qualitative Health Research Involving Indigenous Peoples: Culturally Appropriate Data Collection Methods. The Qualitative Report, 21(12), 2230–2245. https://doi.org/10.46743/2160-3715/2016.2384

Wright, A., VanEvery, R., Burnside, H., Lopez, K. B., Kewageshig-Fyfe, K., Jacobs, B., Floyd, A. E. M. et Ferron, E. M. (2023). The Unexpected Benefits of a Decolonized Knowledge Translation Initiative for Indigenous Mother Participants. Qualitative health research, 33(7), 638–646. https://doi.org/10.1177/10497323231167308