Evidence review of Indigenous culture for health and wellbeing

Abstract

There is growing evidence that the cultures of Indigenous peoples influence their health and wellbeing. We reviewed articles published between 1997 and 2017 that studied the relationship between culture, and health and wellbeing outcomes, and used an adapted version of the Agency of Healthcare Research Quality Framework to determine their strength of evidence. We examined the literature grouped by six cultural domains: country and caring for country, knowledge and beliefs, language, self-determination, family and kinship, and cultural expression. Seventy-two publications were included in the review, focusing on populations from Australia, Canada, the United States, and New Zealand. Across the literature there were conceptual variations in defining and measuring culture, and in the comparison of differing social constructs across Indigenous groups. The literature largely report that culture is significantly and positively associated with physical health, social and emotional wellbeing, and reduces risk-taking behaviours. The majority of publications presented evidence on the impact that culture, or culturally-based interventions, have on social and emotional wellbeing outcomes. The strength of evidence from most publications was assessed as moderate or low quality, and was limited by a lack of reliable and valid measures, population level studies, and longitudinal studies. Cultural domains including language, cultural expression and connection to country were more likely to be reported in quantitative studies, whereas cultural domains of knowledge, beliefs, kinship, and family were more likely to be reported using qualitative methods. Those studies that used mixed-methods approaches were more likely to be assessed as high or moderate quality. This review encourages future research to consider adopting mixed-methods approaches to investigate the complex, causal pathways through which culture influences health and wellbeing for Indigenous populations.