A scoping review of evaluated Indigenous community-based mental wellness initiatives

Many Indigenous peoples around the world are disproportionately affected by mental health challenges, due to intergenerational and collective trauma stemming from historical losses and ongoing colonialism. A growing body of literature suggests that mental wellness initiatives are more culturally safe and result in more successful and sustainable outcomes when they are developed by, for and with Indigenous communities using community-driven approaches that prioritize and privilege Indigenous leadership, knowledge systems, beliefs and practices. However, knowledge has not been synthesized on mental wellness initiatives and the extent of community engagement during the development, implementation, and evaluation stages of these initiatives. The authors conducted a scoping review of studies on Indigenous community-based mental wellness initiatives to identify the (1) characteristics of these initiatives, (2) types of evaluation approaches (specific measures and assessment tools), (3) level of community engagement from inception to the evaluation stage of the initiative, and (4) lessons learned as identified by the authors. Published and grey literature were searched across several electronic databases. Inclusion criteria required that each study was published between January 2008 and June 2018, focused on Indigenous peoples and their communities in Canada, USA, Australia, and/or New Zealand, focused on a community-based mental wellness initiative, was meaningfully co-led or co-designed by the community, described the initiative and how it was evaluated, and was printed in English. The search yielded 1491 unique articles, and 22 of these articles met all of the inclusion criteria. All included studies took place in Canada, the USA, or Australia. Most mental wellness initiatives addressed general mental wellness, substance use, suicide prevention, and/or co-occurring conditions, and many were tailored for Indigenous youth. Culture-based initiatives were emphasized in most studies, with cultural adaptation and relevance prioritized in all initiatives. Approaches to evaluation ranged from process evaluations to outcome evaluations. Most studies used a mixed methods approach and a wide range of assessment tools, including questionnaires and indicators of community capacity building. Many evaluations used a shared leadership model between community leaders and researchers and had combinations of community members, families, Elders, Knowledge Keepers, and leaders inv