In a recent study published in Nature Medicine, researchers reviewed the evolution of health research co-production with Indigenous peoples, where a collaborative effort explores shared control and reciprocity in health research while examining the divergent aspects of Indigenous and Western knowledge systems, political and strategic differences, and ethical standards.
Study: Coproducing health research with Indigenous peoples. Image Credit: Renan Martelli da Rosa/Shutterstock.com
The concept of co-production has recently gained much attention in health research in a push to enhance health research outcomes through a process that is responsive to the participants and stakeholders.
It fosters collaborations between health researchers and a wide range of stakeholders such as Indigenous peoples, patients and their families, service providers, communities, and the general public, and the design, analyses, dissemination, and evaluation of results is conducted through shared control.
The primary goal is to improve the meaningfulness and tangibility of the results from the outset for all the parties involved in the process. Co-production is also thought to enlarge the scope of the study and improve the possibility of uptake.
The long history of colonization of Indigenous communities has naturally resulted in a level of mistrust and suspicion among Indigenous researchers towards Western research methodologies.
Furthermore, the structural nature of research design can also perpetuate discrimination and prejudice if conducted in an unethical and non-inclusive manner.
About the study
In the present study, the researchers discussed co-production as a distinct form of collaborative research, examined the evolution of co-production involving Indigenous peoples, reviewed some illustrative examples involving Indigenous peoples, such as the Indigenous Maori of New Zealand, and presented recommendations for effective and responsive methods of co-production with Indigenous peoples.
The study found that while there have been significant efforts to establish and diversify coproduced research, there have also been numerous studies that have claimed to be coproduced or codesigned but have not involved any of the non-academic stakeholders such as patients, citizens, or service users.
There also seems to be a shortage of evidence on the effectiveness of coproduced research. Furthermore, the number of coproduced studies involving non-academic stakeholders or ethnic or minority groups was very few.
The co-production of health research generally involves various parties — one is invariably an academic functioning within an intellectual, public service, or commercial institution.
The other parties often include non-academic groups to ensure ethical and responsive research, real-world implementation of the results, and representatives of the stakeholders or communities.
However, given that research that is generally collaborative or consultative ultimately has an unequal hierarchy in who makes the final decisions, neither of these research designs is suitable for co-production.
Co-production in itself also presents various challenges and is subject to numerous criticisms. A co-production research design often focuses on local partners or communities, making the results difficult to generalize to larger populations due to the non-representative sampling of participants.
This limits the broader applications of the research and reduces its potential impact. Furthermore, such studies are resource-intensive, and the scalability and sustainability of co-production research are challenging, making such analysis localized and not feasible for expansion.
Co-production research involves substantial collaborative research, often resulting in disagreements and conflicting interests that can jeopardize the study.
Co-production and indigenous peoples
The involvement of Indigenous peoples in objective research has undergone a significant shift over the years. Early participation of Indigenous peoples in research was as subjects, sometimes without their permission.
Their roles have slowly shifted to those of respondents who participate in surveys and respond to questionnaires by choice. However, this role continues to relegate them to providing information for analysis.
Co-production brings about a fundamental change in the role of Indigenous peoples in research and the interactions between them and academic researchers.
As participants, Indigenous peoples play a wider role by being involved in the study design and analysis and as peer interviewers or community liaisons. Co-production also allows indigenous knowledge systems to be incorporated into research in parallel analyses.
However, indigenous definitions of well-being and health are often based on a holistic, multidimensional approach, encompassing not only the mental and physical aspects of health but also centered on spirituality and family.
Co-production in health research involving indigenous communities will require collaborative efforts to design studies and conduct research that includes and respects Indigenous peoples' cultural practices, values, and knowledge.
The review discussed some challenges and criticisms of the co-production of health research. It examined the evolution of co-production involving Indigenous peoples, from their roles as subjects to their progression to being participants and stakeholders in objective research.
Using illustrative examples of the Māori communities in New Zealand, the review presented the idea of shared control and reciprocity while bringing together two different knowledge systems ethically and responsively, with respect for the indigenous ways.