Taking on colonial institutions: making room for an Indigenous Research Paradigm in prospective biomedical research in tertiary hospitals

BackgroundA paradigmatic clash exists between biomedical and Indigenous research frameworks. Problematically, when ill-fit biomedical research frameworks are applied Indigenous peoples can experience exclusion from biomedical studies and consequent potential health benefits. To overcome these issues, community based participatory research methodologies are often recommended. However, these can prove difficult to apply in tertiary healthcare research where prospective Indigenous peoples and families participating in research will come from unforeseen and numerous Indigenous communities. Adding further complexity, there appears a dearth of information for achieving incorporation of decolonising and Indigenous research frameworks into this type of prospective research. MethodsWe sought to reflect on and describe inclusion of an Indigenous Research Paradigm into the establishment of a prospective multi-site tertiary healthcare study on improving diagnosis and treatment of acute rheumatic fever. To generate reflection, the First Nations Yarning method was employed allowing qualitative findings to be generated via Indigenous epistemology and ontology. FindingsFour main areas were identified as requiring significant change to align with an Indigenous Research Paradigm: stakeholder engagement, project design, consent processes, and multi-site approach. Multi-layered Indigenous leadership was recognised as a crucial component of the transformation and of the projects success more broadly. InterpretationWith extensive local First Nations involvement and a First Nations-led research team, a multi-site institution-based biomedical research project can be successfully adapted to be more in keeping with an Indigenous Research Paradigm.