Phyllis Novak (aka Nowakowski) is an artist-researcher and educator, and the founding artistic di... more Phyllis Novak (aka Nowakowski) is an artist-researcher and educator, and the founding artistic director of SKETCH Working Arts. Her work centres culture-making as a primary way to build equitable and vibrant communities, and social change, which is the focus of her current doctoral studies. Sarah Flicker is the York Research Chair in Community-Based Participatory Research. She is a widely recognized expert in participatory and community-engaged research, working collaboratively with communities on equity-oriented agendas. Her research has informed policy at the municipal, provincial, and federal levels. Her teams have won a number of awards for youth engagement in research. Making With Place is a collective of diverse artists engaged in public art and placemaking experiments with SKETCH Working Arts. This article discusses works by T. J. Banate, Jess DeVitt (aka DeVittoris),
It is widely accepted that researchers have an obligation to inform survey participants of resear... more It is widely accepted that researchers have an obligation to inform survey participants of research results. However, there is little evidence on the effectiveness of various dissemination strategies. The emerging field of knowledge transfer and exchange (KTE) may offer insight given its focus on techniques to enhance the effectiveness of communicating evidence-based information. To date, KTE has focused primarily on information exchange between researchers and policy-makers as opposed to study participants; however, there are principles that may be relevant in this new context. This gap in the literature becomes even more salient in the context of public health research where research results can reveal particular misunderstandings or shortcomings in knowledge that threaten to severely compromise participants' health. The objective of this article is to describe how KTE principles were used to inform dissemination of results of a self-administered sexual health survey to adolescent study participants in a resource-deprived, peri-urban area of South Africa. Strategies for enhancing two-way information exchange included constructing interactive dissemination sessions led by young, isiZulu fieldworkers. We also employed techniques to create a safe space for dialogue, encouraged the shared ownership of results and crafted targeted messages. Particularly noteworthy was the benefit accrued by the research team through this process of exchange, including novel explanations for study findings and new ideas for future research.
showed that criminalisation and repressive policing disrupted sex workers' safety and risk reduct... more showed that criminalisation and repressive policing disrupted sex workers' safety and risk reduction strategies and access to health services and justice, including where clients are criminalised. Criminalisation and regulatory frameworks exacerbated stigma, racial, economic and other inequalities. In decriminalised contexts, sex workers' relationships with police have improved and they report being better able to refuse clients and insist on condom use. Conclusions The evidence shows the increased harms associated with sex work criminalisation-including laws and enforcement targeting the sale and purchase of sex, and sex work organisation. These demonstrably harmful sex work policies and laws must be reformed urgently if sex workers' right to health is to be realised.
Given the growth of interdisciplinary and community-engaged health promotion research, it has bec... more Given the growth of interdisciplinary and community-engaged health promotion research, it has become increasingly common to conduct studies in diverse teams. While there is literature to guide collaborative research proposal development, data collection and analysis, little has been written about writing peerreviewed publications collaboratively in teams. This gap is particularly important for junior researchers who lead articles involving diverse and community-engaged co-authors. The purpose of this article is to present a series of considerations to guide novice researchers in writing for peer-reviewed publication with diverse teams. The following considerations are addressed: justifying the value of peer-reviewed publication with non-academic partners; establishing co-author roles that respect expertise and interest; clarifying the message and audience; using the article outline as a form of engagement; knowledge translation within and beyond the academy; and multiple strategies for generating and reviewing drafts. Community-engaged research often involves collaboration with communities that have long suffered a history of colonial and extractive research practices. Authentic engagement of these partners can be supported through research practices, including manuscript development, that are transparent and that honour the voices of all team members. Ensuring meaningful participation and diverse perspectives is key to transforming research relationships and sharing new insights into seemingly intractable health problems.
Background: For graduate students addressing health issues pertinent to marginalized communities,... more Background: For graduate students addressing health issues pertinent to marginalized communities, community-based participatory research (CBPR) methods may be an appropriate mode of inquiry. Although there are a number of useful guides on conducting traditional doctoral dissertations (TDD), there is a paucity of similar resources for students engaged in CBPR. Objectives: Drawing on our own experiences, we aimed to describe the key lessons learned from doing participatory doctoral research. Furthermore, this paper outlines 6 suggestions for those who may be considering or already conducting a CBPR dissertation. Suggestions are derived from elements of the CBPR process that were employed in our own projects. Lessons learned: Upon reflection on our experiences conducting CBPR dissertations, we identified 4 lessons learned: (1) to understand the differences between TDDs and the CBPR approach; (2) to be aware of and able to clearly articulate the advantages of CBPR doctoral dissertations; (3) to acknowledge and plan for the possible challenges of CBPR doctoral research; and (4) to recognize aspects of the CBPR process that contribute to the successful completion of doctoral projects. Conclusion: This paper provides an additional resource for doctoral students, based on our own experiences working on CBPR projects. Despite many of the obstacles and challenges, we found the process of engaging in CBPR dissertations deeply rewarding, and hope that our experiences are useful to others.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 3, 2013
ABSTRACT BACKGROUND: One explanation for the elevated prevalence of HIV/AIDS within Aboriginal co... more ABSTRACT BACKGROUND: One explanation for the elevated prevalence of HIV/AIDS within Aboriginal communities is that systemic colonial oppression faced by Indigenous populations propagates conditions of risk. Many conventional HIV prevention strategies that fail to take these legacies into account, have proven ineffective. METHODS: Taking Action: Using Arts-Based Approaches to Develop Aboriginal Youth Leadership in HIV Prevention is a community-based research project examining how Aboriginal youth understand the links between individual risk and structural inequalities. A participatory research design using arts-based approaches (e.g. photography, theatre, painting, hip hop) was adopted in six Aboriginal communities. Data were collected through the creation of cultural productions during weekend workshops and in-depth follow-up interviews. Over 100 youth participated. RESULTS. Youth involved identified that both the process and product of arts-based methods were important. They identified the process: as fun, participatory, empowering, instilling pride, helpful in learning about culture, healing, enhancing recall, and assisting in opening up dialogue. In addition, products were: a source of pride, accessibly transmitted complex information, useful in raising awareness, conveyed emotion, tangible and long lasting and helped to both bridge and challenge traditional culture. CONCLUSION: Our findings support the notion that arts-based approaches to HIV prevention with Aboriginal youth can work. As an innovative tool that involves youth where they are at, it also embeds cultural understandings of health in by-youth, for-youth prevention and policy efforts. Arts-based approaches represent one way to assist with decolonizing the research process, moving forward the agenda of self-determination.
In 2016 the Women's Environmental Alliance and The Native Youth Sexual Health Network released th... more In 2016 the Women's Environmental Alliance and The Native Youth Sexual Health Network released their toolkit "Violence on the Land, Violence on our Bodies: An Indigenous Response to Violence." It maps the ways that settler colonialism and extractive industries create conditions of social and biological violence on Indigenous women's bodies in North America. As a white, cis-gender, female identified, settler professor, I assigned the toolkit to students enrolled in my Health and the Environment Masters class in the fall of 2018. Students were asked to create a cellphilm (short video made on a cellphone) to respond to the themes in the toolkit and write a short reflection. In this paper, we (my students and I) reflect on the toolkit, the assignment and what we learned about the relationships between land, violence and women's bodies. This paper summarises our teaching and learning journey together, with an emphasis on the possibilities of participatory visual methods as pedagogy for exploring these complicated issues.
Canadian Journal of Public Health-revue Canadienne De Sante Publique, Aug 9, 2022
Objective Studies have highlighted the inequities between the Indigenous and non-Indigenous popul... more Objective Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population. Methods The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (selfreported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada. Results The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample. Conclusion Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
Canadian Journal of Public Health-revue Canadienne De Sante Publique, Mar 1, 2013
OBJECTIVES: Sexual pleasure and satisfaction are integral components of the human sexual experien... more OBJECTIVES: Sexual pleasure and satisfaction are integral components of the human sexual experience, yet these crucial aspects of sexuality are rarely placed on sexual education agendas. The objective of this paper is to explore the ways in which various groups of Service Providers (SPs) participating in the Toronto Teen Survey (TTS) understand the role of pleasure in sexual education for youth, highlighting the challenges and benefits of teaching pleasure in diverse settings. METHODS: The TTS employed a community-based research (CBR) methodology. Between December 2006 and August 2007, 1,216 surveys were collected from youth in over 90 different community-based settings across Toronto by youth peer researchers. In 2008, 13 follow-up focus groups were conducted with 80 service providers from 55 different agencies around the Greater Toronto Area. All transcripts were input into qualitative data management software, NVIVO. Coding and analysis of data employed the constant comparative method. RESULTS: SPs had a number of competing opinions about the inclusion of pleasure in sexual health education and programming. These concerns can be divided into three major areas: placing pleasure on the agenda; the role of gender in pleasure education; and the appropriate spaces and professionals to execute a pleasure-informed curriculum. CONCLUSION: Access to resources, training and personal background determine SPs' willingness and ability to engage in the pedagogy of sexual pleasure. Medically trained clinicians were less likely to see themselves as candidates for instructing youth on issues of pleasure, believing that public health and health promotion professionals were more adequately trained and organizationally situated to deliver those services.
Phyllis Novak (aka Nowakowski) is an artist-researcher and educator, and the founding artistic di... more Phyllis Novak (aka Nowakowski) is an artist-researcher and educator, and the founding artistic director of SKETCH Working Arts. Her work centres culture-making as a primary way to build equitable and vibrant communities, and social change, which is the focus of her current doctoral studies. Sarah Flicker is the York Research Chair in Community-Based Participatory Research. She is a widely recognized expert in participatory and community-engaged research, working collaboratively with communities on equity-oriented agendas. Her research has informed policy at the municipal, provincial, and federal levels. Her teams have won a number of awards for youth engagement in research. Making With Place is a collective of diverse artists engaged in public art and placemaking experiments with SKETCH Working Arts. This article discusses works by T. J. Banate, Jess DeVitt (aka DeVittoris),
It is widely accepted that researchers have an obligation to inform survey participants of resear... more It is widely accepted that researchers have an obligation to inform survey participants of research results. However, there is little evidence on the effectiveness of various dissemination strategies. The emerging field of knowledge transfer and exchange (KTE) may offer insight given its focus on techniques to enhance the effectiveness of communicating evidence-based information. To date, KTE has focused primarily on information exchange between researchers and policy-makers as opposed to study participants; however, there are principles that may be relevant in this new context. This gap in the literature becomes even more salient in the context of public health research where research results can reveal particular misunderstandings or shortcomings in knowledge that threaten to severely compromise participants' health. The objective of this article is to describe how KTE principles were used to inform dissemination of results of a self-administered sexual health survey to adolescent study participants in a resource-deprived, peri-urban area of South Africa. Strategies for enhancing two-way information exchange included constructing interactive dissemination sessions led by young, isiZulu fieldworkers. We also employed techniques to create a safe space for dialogue, encouraged the shared ownership of results and crafted targeted messages. Particularly noteworthy was the benefit accrued by the research team through this process of exchange, including novel explanations for study findings and new ideas for future research.
showed that criminalisation and repressive policing disrupted sex workers' safety and risk reduct... more showed that criminalisation and repressive policing disrupted sex workers' safety and risk reduction strategies and access to health services and justice, including where clients are criminalised. Criminalisation and regulatory frameworks exacerbated stigma, racial, economic and other inequalities. In decriminalised contexts, sex workers' relationships with police have improved and they report being better able to refuse clients and insist on condom use. Conclusions The evidence shows the increased harms associated with sex work criminalisation-including laws and enforcement targeting the sale and purchase of sex, and sex work organisation. These demonstrably harmful sex work policies and laws must be reformed urgently if sex workers' right to health is to be realised.
Given the growth of interdisciplinary and community-engaged health promotion research, it has bec... more Given the growth of interdisciplinary and community-engaged health promotion research, it has become increasingly common to conduct studies in diverse teams. While there is literature to guide collaborative research proposal development, data collection and analysis, little has been written about writing peerreviewed publications collaboratively in teams. This gap is particularly important for junior researchers who lead articles involving diverse and community-engaged co-authors. The purpose of this article is to present a series of considerations to guide novice researchers in writing for peer-reviewed publication with diverse teams. The following considerations are addressed: justifying the value of peer-reviewed publication with non-academic partners; establishing co-author roles that respect expertise and interest; clarifying the message and audience; using the article outline as a form of engagement; knowledge translation within and beyond the academy; and multiple strategies for generating and reviewing drafts. Community-engaged research often involves collaboration with communities that have long suffered a history of colonial and extractive research practices. Authentic engagement of these partners can be supported through research practices, including manuscript development, that are transparent and that honour the voices of all team members. Ensuring meaningful participation and diverse perspectives is key to transforming research relationships and sharing new insights into seemingly intractable health problems.
Background: For graduate students addressing health issues pertinent to marginalized communities,... more Background: For graduate students addressing health issues pertinent to marginalized communities, community-based participatory research (CBPR) methods may be an appropriate mode of inquiry. Although there are a number of useful guides on conducting traditional doctoral dissertations (TDD), there is a paucity of similar resources for students engaged in CBPR. Objectives: Drawing on our own experiences, we aimed to describe the key lessons learned from doing participatory doctoral research. Furthermore, this paper outlines 6 suggestions for those who may be considering or already conducting a CBPR dissertation. Suggestions are derived from elements of the CBPR process that were employed in our own projects. Lessons learned: Upon reflection on our experiences conducting CBPR dissertations, we identified 4 lessons learned: (1) to understand the differences between TDDs and the CBPR approach; (2) to be aware of and able to clearly articulate the advantages of CBPR doctoral dissertations; (3) to acknowledge and plan for the possible challenges of CBPR doctoral research; and (4) to recognize aspects of the CBPR process that contribute to the successful completion of doctoral projects. Conclusion: This paper provides an additional resource for doctoral students, based on our own experiences working on CBPR projects. Despite many of the obstacles and challenges, we found the process of engaging in CBPR dissertations deeply rewarding, and hope that our experiences are useful to others.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 3, 2013
ABSTRACT BACKGROUND: One explanation for the elevated prevalence of HIV/AIDS within Aboriginal co... more ABSTRACT BACKGROUND: One explanation for the elevated prevalence of HIV/AIDS within Aboriginal communities is that systemic colonial oppression faced by Indigenous populations propagates conditions of risk. Many conventional HIV prevention strategies that fail to take these legacies into account, have proven ineffective. METHODS: Taking Action: Using Arts-Based Approaches to Develop Aboriginal Youth Leadership in HIV Prevention is a community-based research project examining how Aboriginal youth understand the links between individual risk and structural inequalities. A participatory research design using arts-based approaches (e.g. photography, theatre, painting, hip hop) was adopted in six Aboriginal communities. Data were collected through the creation of cultural productions during weekend workshops and in-depth follow-up interviews. Over 100 youth participated. RESULTS. Youth involved identified that both the process and product of arts-based methods were important. They identified the process: as fun, participatory, empowering, instilling pride, helpful in learning about culture, healing, enhancing recall, and assisting in opening up dialogue. In addition, products were: a source of pride, accessibly transmitted complex information, useful in raising awareness, conveyed emotion, tangible and long lasting and helped to both bridge and challenge traditional culture. CONCLUSION: Our findings support the notion that arts-based approaches to HIV prevention with Aboriginal youth can work. As an innovative tool that involves youth where they are at, it also embeds cultural understandings of health in by-youth, for-youth prevention and policy efforts. Arts-based approaches represent one way to assist with decolonizing the research process, moving forward the agenda of self-determination.
In 2016 the Women's Environmental Alliance and The Native Youth Sexual Health Network released th... more In 2016 the Women's Environmental Alliance and The Native Youth Sexual Health Network released their toolkit "Violence on the Land, Violence on our Bodies: An Indigenous Response to Violence." It maps the ways that settler colonialism and extractive industries create conditions of social and biological violence on Indigenous women's bodies in North America. As a white, cis-gender, female identified, settler professor, I assigned the toolkit to students enrolled in my Health and the Environment Masters class in the fall of 2018. Students were asked to create a cellphilm (short video made on a cellphone) to respond to the themes in the toolkit and write a short reflection. In this paper, we (my students and I) reflect on the toolkit, the assignment and what we learned about the relationships between land, violence and women's bodies. This paper summarises our teaching and learning journey together, with an emphasis on the possibilities of participatory visual methods as pedagogy for exploring these complicated issues.
Canadian Journal of Public Health-revue Canadienne De Sante Publique, Aug 9, 2022
Objective Studies have highlighted the inequities between the Indigenous and non-Indigenous popul... more Objective Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population. Methods The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (selfreported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada. Results The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample. Conclusion Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
Canadian Journal of Public Health-revue Canadienne De Sante Publique, Mar 1, 2013
OBJECTIVES: Sexual pleasure and satisfaction are integral components of the human sexual experien... more OBJECTIVES: Sexual pleasure and satisfaction are integral components of the human sexual experience, yet these crucial aspects of sexuality are rarely placed on sexual education agendas. The objective of this paper is to explore the ways in which various groups of Service Providers (SPs) participating in the Toronto Teen Survey (TTS) understand the role of pleasure in sexual education for youth, highlighting the challenges and benefits of teaching pleasure in diverse settings. METHODS: The TTS employed a community-based research (CBR) methodology. Between December 2006 and August 2007, 1,216 surveys were collected from youth in over 90 different community-based settings across Toronto by youth peer researchers. In 2008, 13 follow-up focus groups were conducted with 80 service providers from 55 different agencies around the Greater Toronto Area. All transcripts were input into qualitative data management software, NVIVO. Coding and analysis of data employed the constant comparative method. RESULTS: SPs had a number of competing opinions about the inclusion of pleasure in sexual health education and programming. These concerns can be divided into three major areas: placing pleasure on the agenda; the role of gender in pleasure education; and the appropriate spaces and professionals to execute a pleasure-informed curriculum. CONCLUSION: Access to resources, training and personal background determine SPs' willingness and ability to engage in the pedagogy of sexual pleasure. Medically trained clinicians were less likely to see themselves as candidates for instructing youth on issues of pleasure, believing that public health and health promotion professionals were more adequately trained and organizationally situated to deliver those services.
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Papers by Sarah Flicker