A Community of Practice Approach for Aboriginal Girls Sexual Health Education

A Community of Practice Approach for Aboriginal Girls’ Sexual
Health Education
Elizabeth M. Banister, RN, PhD1; Deborah L. Begoray, PhD2
Abstract
Introduction: There is a paucity of inter vention programs for Aboriginal girls and many of those that exist are delivered in cul-
turally inappropriate ways. Methods: In this paper, we provide an over view of recent research that focused on delivering a
sexual health mentorship program that enhanced the voices of Aboriginal youth and was culturally relevant and appropriate
to indigenous youth. Results: Our program ser ved to enhance social connection and reinforced a sense of belonging and
relational mutuality among group members. Conclusion: The purpose of this ar ticle is to illustrate how a mentorship program
that used a community of practice approach empowered Aboriginal youth to become successful border crossers and helped
to align them with the wider community.
Key words: Aboriginal, girls’ sexual health, education
Résumé
Introduction: Les programmes d’inter vention pour les adolescentes autochtones sont rares et ceux qui existent ne
respectent pas les aspects culturels de cette communauté. Méthodologie: Nous donnons une vue d’ensemble des plus
récents travaux de recherche axés sur la mise en place d’un programme de mentorat en matière de santé sexuelle qui donne
la parole aux adolescentes autochtones et est adapté à leur culture. Résultats: Notre programme a permis de renforcer la
cohésion sociale, le sentiment d’appar tenance et les liens entre les membres du groupe. Conclusion: L’objectif du présent
ar ticle est de montrer en quoi un programme communautaire de mentorat axé sur la pratique aide les jeunes autochtones
à sor tir de leur communauté et à s’aligner sur la communauté en général.
Mots clés: aborigène, adolescentes, santé sexuelle, éducation
1School of Nursing, University of Victoria, Victoria, British Columbia
2Faculty of Education, University of Victoria, Victoria, British Columbia
Corresponding email: ebaniste@uvic.ca
Submitted June 1, 2006; Accepted November 18, 2006
Introduction
feminist research approach because it is voice-
There is a paucity of inter vention programs
centered and based on listening to women’s
for Aboriginal girls and many of those that exist
stories and experiences (Way, 2001). A com-
are delivered in culturally inappropriate ways.
munity of practice (Smith, 2005) is a social unit
The lack of success of mental health programs,
that has a common purpose. “Members inter-
for example, has been attributed to the “lack of
act regularly, share common beliefs and vocab-
Aboriginal par ticipation, which could make pro-
ular y and learn from one another as they
grams culturally meaningful and locally more
engage in mutual activities” (Richards, 2006.
relevant” (Kirmayer, Simpson, & Cargo, 2003,
p. 3), including exper t and novice members.
p. S21). As described by First Nations people,
Exper ts then foster novices’ growth in under-
healing results from interdependence and not
standing. Communities of practice models
from independence (McCormick, 1997b). In
“offer rich contexts for learning and develop-
this paper, we provide an over view of recent
ment” (Richards, 2006, p. 3). Features of com-
research that focused on delivering a sexual
munities of practice include mutuality and reci-
health mentorship program that enhanced the
procity between members, a shared sense of
voices of Aboriginal youth and was culturally rel-
belonging, and the production of common
evant and appropriate to indigenous youth. In
reper toires such as ar tifacts or routines
par ticular, our investigation demonstrates
(Wenger, 1998). The purpose of this ar ticle is
health education approaches that enhanced
to illustrate how a mentorship program that
social connection between Aboriginal girls and
used a community of practice approach
their community and were repor ted by them as
empowered Aboriginal youth to become suc-
being successful in terms of improving
cessful border crossers and helped to align
Aboriginal adolescent sexual health.
them with the wider community. Border cross-
This community-based study used a
ing includes productive dialogue in which space
respectful and par ticipator y approach based
is created for challenging dominant social rela-
on principles of feminist ways of knowing and
tions and practices that obliterate the voice of
a community of practice model. We used a
“other” (Friere, 1985).
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A COMMUNITY OF PRACTICE APPROACH FOR ABORIGINAL GIRLS’ SEXUAL HEALTH EDUCATION
Adolescent girls’ sexual health issues
inequities remain in relation to the general
Adolescent girls face a number of serious
population (Health Canada, 1999). One reason
health issues related to sexuality and relation-
for the higher incidence of sexual health issues
ships. Unplanned pregnancy, HIV/AIDS and
among such women is the incongruency
sexually transmitted diseases (STD’s) are a
between Western medical approaches (based
major public health concern (Health Canada,
on a biomedical framework of disease, treat-
2002). In the US, The Centers for Disease
ment and prevention), and approaches that are
Control and Prevention (CDC) (2004) identified
more holistic and culturally sensitive (Van
risky sexual behaviour as one of six health
Uchelen, Davidson, Quressette, Brasfield, &
behaviours most associated with mor tality,
Demerais, 1997). Western values and individu-
morbidity, and social problems among youth.
alistic views ser ve to isolate the adolescent at
Conflicting social pressures continue to affect
a time when connections take on greater
adolescents’ abilities to make decisions about
meaning (Banister & Begoray, 2006).
contraceptive use and safe sex and contribute
Fur thermore, cultural discontinuity and oppres-
to risk-taking behaviours in heterosexual inti-
sion, and marginalization have been linked to
mate relationships. For example, Hutchinson
high rates of depression, alcoholism, suicide,
(1998) found that for 59% of adolescent girls,
and violence in many communities, with the
sexual risk histor y was not discussed with their
greatest impact on youth (Kirmayer, Brass &
par tners prior to having sexual relations for the
Tait, 2000). Chandler and Lalonde (1998)
first time.
argue, for example, that cultural discontinuity is
strongly associated with suicide risk for
Aboriginal adolescent girls’ sexual health
Aboriginal youth.
issues
While the general adolescent population is
Intervention programs for Aboriginal youth
already at risk for poor health, the health prob-
There is a lack of research on sexual health
lems are even more pronounced in Aboriginal
education specifically targeted to Aboriginal
communities. This disparity is par ticularly
populations and par ticularly per taining to
obvious in areas concerning adolescent
Aboriginal youth (Majumdar, Chambers, &
sexual/dating health issues including risky
Rober ts, 2004). Although HIV prevention pro-
alcohol use/sexual activity and risk for Fetal
grams have reached a number of Aboriginal
Alcohol Spectrum Disorders (FASD); unplanned
communities, few models tailored to the needs
pregnancy; and contacting sexually transmitted
of Aboriginal youth exist (Majumdar, Chambers,
diseases (STD’s), namely AIDS, gonorrhea and
& Rober ts, 2004). Aboriginal youth tend to
chlamydia (Health Canada, 2001). Aboriginal
be excluded from community decision making
people are being infected with HIV at a younger
and are instead passive recipients of decision
age compared to non-Aboriginal persons (Public
makers at the centralized state levels
Health Agency of Canada, 2004). Fur thermore,
(Kirmayer, Simpson & Cargo, 2003). Health
higher levels of psychological distress among
promotion programs and practices are more
Aboriginal youth are repor ted as being associ-
effective when created from knowledge pro-
ated with younger age, female sex, early loss of
vided by Aboriginal youth themselves (Banister
parents or a relative, and a smaller social
& Begoray, 2006; Moffitt & Vollman, 2004). It
network – or fewer than five close friends or
has been suggested that to effectively change
relatives (Kirmayer, Simpson & Cargo, 2003).
behaviours of high-risk youth, program designs
Joining communities effectively will expand indi-
should include messages delivered by those
viduals’ social networks. In Canada, Aboriginal
who have similar life experiences (Villarruel,
peoples (First Nations, Inuit, and Metis) make
Sweet-Jemmott, Howard, Taylor, & Bush,
up 2.8% of the total population with approxi-
1998). Group discussion and increasing social
mately 60% of the population younger than age
connection is essential to achieving health
30 (Health Canada, 2002).
goals with Aboriginal youth (McCormick,
Even though in Canada advancements are
1997a). McCormick (1997a) argues that
being made in health ser vices deliver y specific
“establishing a social connection and obtaining
for Aboriginal adolescent women, significant
help/suppor t from others” (p. 79) is a central
J Can Acad Child Adolesc Psychiatry 15:4 November 2006
169

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BANISTER ET AL
theme of First Nations healing. The traditional
secondar y school. Of the for ty par ticipants
First Nations person is more likely to receive
accessed for the study, ten were Aboriginal.
help from family, friends, and traditional
The study had two phases. During phase
healers than from mainstream mental health
one, four consecutive focus groups were con-
ser vice providers (McCormick, 1997a).
ducted with each of five groups of girls at their
respective sites for obtaining ethnographic
Mentoring
data on their sexual health concerns (Banister,
Adolescence is a time in the life course
Jakubec & Stein, 2004). Themes detected the
when “possibilities for relationships present
complex interaction of power dynamics and
themselves and an adult can step in and make
socialization processes in the girls’ relation-
a significant dif ference” (Spencer, 2006,
ships with men. Findings from the focus groups
p. 313). Mentors have been shown to promote
provided the foundation for the development of
positive development through role modeling
the mentoring program used in phase two.
and emotional suppor t (Grossman & Rhodes,
During phase two of the study, with the same
2002), facilitate improvements in adolescents’
girls who par ticipated in the focus groups, we
attitudes, self-perceptions and behaviours
delivered the mentoring program weekly for 16
(Walker & Freedman, 1996), and reduce risky
weeks, in 1.5 hour sessions. Each group had
sexual behaviour among adolescent women
approximately eight girls, an adult woman
(Taylor-Seehfer & Rew, 2000). “By obser ving
mentor, and a research assistant. The four
adults and comparing their own per formance to
school sites incorporated the program into their
that of adults, adolescents can begin to adopt
regular school hours which facilitated a low
new behaviors” (Rhodes & Roffman, 2002,
attrition rate.
p. 232). In Aboriginal communities, role model-
ing within an individual or group context is an
Mentoring Curriculum
effective means for teaching others about
The mentoring curriculum included strate-
traditional values and for the transmission of
gies designed to facilitate egalitarian relation-
traditional knowledge (McCormick, 1994).
ships in the groups, for example, circling where
Elders, healers, traditional teachers or commu-
each person takes a turn to speak while others
nity members can role model positive behav-
in the group listen in situations involving deci-
iours (Poonwassie & Char ter, 2001).
sion making or conflict (Banister & Begoray,
2004). Aspects of Wolfe, Wekerle and Scott’s
Overview of the Study
(1997) youth relationship project that used
Our community-based mentorship research
information, skill building, and social action to
project focused on understanding adolescent
empower youth to end relationship violence
girls’ sexual health concerns and best prac-
were also included to increase learning about
tices for addressing them (Banister & Begoray,
unhealthy power imbalances, and visits were
2006; Banister & Leadbeater, in press). We
made to local community resources to gain
used an ethnographic research approach
information (such as counseling ser vices avail-
(Denzin, 1997; Tedlock, 2000) to obtain par tic-
able for teens) and repor t back to the group
ipants’ perspective of their sexual health
(e.g., sexual assault centre). We incorporated a
issues. Par ticipants’ “thick descriptions”
pedagogical approach known as “multilitera-
(Geer tz, 1973), which convey central meanings
cies” (New London Group, 1996) to enhance
of experiences (Denzin, 2000), provided the
par ticipants’ learning (see Banister & Begoray,
empirical data used by this inductive research
2004). Activities such as free writing and role
method (Fetterman, 1989).
playing and were used to encourage par tici-
Well established community-university par t-
pants’ use of a variety of sign systems (e.g.,
nerships from our previous research facilitated
kinestics and visual design systems) for explor-
our access to par ticipants (Banister &
ing multiple aspects of self and for expression
Schreiber, 2001). For ty adolescent par tici-
(Begoray & Banister, 2005). Talking and writing
pants, ages 15-16, were recruited through five
are both literacy skills commonly used in edu-
sites including three local secondar y schools,
cational settings to help learners to reflect on
a youth health clinic; and a rural Aboriginal
knowledge and understand it more deeply. One
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A COMMUNITY OF PRACTICE APPROACH FOR ABORIGINAL GIRLS’ SEXUAL HEALTH EDUCATION
girl said: “Yeah, it’s helped like seeing other, I
of their authentic voice (Banister & Begoray,
guess hearing other people’s point of views
2006). Native traditions such as stor ytelling
and then kind of reflecting back on what I
(per taining to the research topic) in addition to
thought and then just like, thinking about what
understanding the impor tance of body, mind,
they do about it.” Different communities call for
and spirit were woven into the program (Napoli,
a variety of literacy skills, not only reading and
2002). For example, the girls’ shor t and long
writing but also listening and speaking, viewing
term goals for par ticipation in the program
and visually representing. Moving between
were linked to the medicine wheel.
communities necessitates the ability for ado-
The elder’s presence helped to remind the
lescents to deal with the challenges “perceived
mentors and girls of their interconnectedness
when negotiating personal, home/community,
to the larger community and prepared the par-
and school multiliteracies” (Hagood, 2000,
ticipants for their mentoring responsibilities
p. 317).
within their Aboriginal community (Banister &
Leadbeater, in press). The elder asser ted:
Creating an Aboriginal Version of the
Some of them don’t want to be in bad
Mentoring Curriculum
relationships and they’ll find their way
Because of the repor ted benefit of the men-
out of them and I think that some of
toring program by the ten Aboriginal par tici-
them will, if I can keep telling them to
pants in the initial focus groups and program
keep sharing, that’s how it’s going to
and because of the greater sexual health risks
benefit the whole community.
among Aboriginal women, we sought to create
a second version of the curriculum that was
The elder stressed the impor tance for older
tailored to the needs of Aboriginal youth and
members of the community to transfer tradi-
focused more specifically on sexual health edu-
tional knowledge about relationships to the
cation (see Banister & Begoray, 2006). A new
girls: “It’s an oppor tunity for me to be able to
group of adolescent Aboriginal women (N = 9,
speak to the girls, to share more. They’re just
aged 15 to 17) was accessed from the same
young kids and they need to keep hearing from
rural Aboriginal secondar y school as before.
the older people.”
The curriculum offered Aboriginal youth the
The mentoring program helped build com-
oppor tunity to share their stories and to obtain
munity both within and outside of the group. For
information about sexual health including
example, the group crossed divisions repre-
HIV/AIDS information and prevention. Our use
senting various family units in the Aboriginal
of a “teaching and sharing circle” for delivering
community that were entrenched among groups
the curriculum helped to reinforce the tradi-
of girls attending the school (Banister &
tional belief that all knowledge is valued
Leadbeater, in press). As one girl said: “When
(Poonwassie & Char ter, 2001, p. 67). In addi-
all us girls, get together we connect … we
tion to the inclusion of Aboriginal girls’ voices,
share our problems … and things we like.” The
we incorporated suggestions from the
girls were practicing school and community
Aboriginal mentors and elder who helped facili-
par ticipation norms. A mentor obser ved how
tate the group. Two female Aboriginal school
the girls were reaching out to others beyond the
suppor t staf f members were chosen as
group:
mentors. In Aboriginal communities, elders are
From the beginning some of the girls
viewed and respected for knowing, living, and
would not talk, not even say good
passing on traditional knowledge (Hunter,
morning but now they are so open and
Logan, Goulet & Bar ton, 2006). The elder was
they are socializing more. One girl was
not only a health care worker with the local
definitely that way, she would not talk.
band but knew all the girls and many of their
Now she is chatting up a storm for her
health issues within their family and community
teachers.
context. She offered suggestions for group
activities that were culturally appropriate; for
The elder and mentors’ exper tise helped
example, par ticipants created a wild woman
foster par ticipants’ greater understanding of
necklace as a concrete symbol to remind them
issues of sexual health (Richards, 2006). At
J Can Acad Child Adolesc Psychiatry 15:4 November 2006
171

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BANISTER ET AL
the same time, the girls were learning to utilize
environment helped the girls learn from others
their own knowledge and resources related to
while at the same time learn to trust their
sexual health decision making (Wenger, 1998).
resources from within (Bradley, 2004). In the
A par ticipant said: “I learned how to say ‘no.’
words of one par ticipant: “I learned that I have
To say ‘no’ when it’s not right. Listen to your
a choice in a relationship … and not to put up
hear t or guts.” Bradley (2004) suggests that
with any guy that abuses me.” Our inclusive
through encouraging a balance between learn-
and egalitarian approach to sexual health edu-
ing from community resources and learning
cation drew upon Aboriginal connectedness
from one’s own resources, individuals “may
and offered the girls a source of resilience
come to identify themselves as members of
(Kirmayer, Simpson & Cargo, 2003).
communities of practice” (p. 363).
Acknowledgements
Recommendations for Practice
The study was made possible by the generous funding of
the Social Sciences and Humanities Council (SSHRC) and
Our research suggests that health practi-
Canadian Institutes of Health Research (CIHR).
tioners’ consider developing and implementing
adolescent sexual health promotion programs
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