Introduction
Community care is one of the most critical areas of the public health and it is the indigenous communities and communities of low socioeconomic background, oppressed in different and many other ways are the major areas of concern that should be given emphasis and importance by the health care systems and the social support framework of the nations (Popova et al., 2017). (Leos-Toro et al., 2019). Hence the chosen population or rather the chosen community for this study is the aboriginal people of Community who are both socially deprived and also very deprived in a very adverse manner with respect to the health parameters and also with respect to the quality of living.
Approach used to assess chosen issue in chosen community
According to the reports pertaining to the health and social system, it is highly important to note that the aboriginal community living in Canada, suffer from a lot of health issues and social issues as well which is chiefly due to the disruption in the factors that pertains to the social determinants of health (Goodman et al., 2017). It is also very vital to note that the factors such as low income, low educational background, lack of level of awareness about the diseases and the management and the preventive strategies to be used in a disease, low or rather a poor quality of living with unhygienic environmental factors along with the events of social; disruption and conflicting events, lack of access to the quality health care services and the lack of the access to the primary health services as well, lack of affordability of the health care services that is being delivered at the expensive care settings in the urban regions, lack of employability, low economy and also poor nutritional factors leads to increased rates of diseases such as hypertension or the high blood pressure, diabetes mellitus, Cerebro vascular accidents, cardiovascular diseases and the coronary artery diseases, dyslipidemia, hypercholesteremia, renal diseases (Lee et al., 2019). It is highly crucial to be noted that the development of the cerebrovascular accidents is due to both physical, nutritional as well as psychological factors of stress and anxiety. In addition, another huge problem associated with the aboriginal community of the Canada, is the increased incidences or rather the increased prevalence of the psychosocial disorders amongst the various age groups and genders of the population and there are various forms of sociocultural as well as biosocial factors or psychosocial factors or rather underpinnings to the problem (Shahram et al., 2017). It is highly important to note that the main issue that is chosen for this study is the psychosocial addiction disorders in the aboriginal community living in the country of Canada and this includes the smoking, alcohol and addiction to other substances and drugs as well. All the above diseases that are mentioned to an important area of concern with respect to the community health of the aboriginal community of Canada and all the above-mentioned diseases have more or less a negative implication that is with the psychosocial addiction to the alcohol, substance abuse and smoking that causes both clinical deterioration of physical and mental health and wellbeing as well it reduces the social functioning of the individual, leading to the development other behavioral issues such as anti-social behavior within and outside the community thus affecting the community health, both socially and culturally as well (McPherson et al., 2017). Using the ‘determinants model’ the chief issues and the main problems of the aboriginal community living in the country of Canada have been discussed in details and it is vital to consider that the social determinants of health include the social, cultural, political, economic, nutritional, quality of living, educational factors that has resulted in the final problem of psychosocial addiction to smoking, alcohol and other substances such as drug abuse among the different aged members of the aboriginal community which is indeed a very serious problem. The cultural underpinning lies strong in this analysis of the psychosocial issue of alcohol and other drugs abuse by the members of Canadian aboriginal community and factors such as spiritual drinking, religious drinking, lifestyle and cultural social values and traditions surrounding spiritual practices with the use of the alcohol and the psychoactive drugs for ecstasy pose the major issue and risk to the health of the community. Lack of income and education to support one’s own wellbeing and the wellbeing of the family is a major reason that lead to the development of psychosocial disorders of addiction and other problems and it is the ongoing lack of knowledge, lack of psychological safety, cultural pressure to commit to the cultural group norms of spiritual and religious drinking, the cases of the chosen problem that is the psychosocial addiction to alcohol, smoking and the use of the other drugs and substance abuse- has been increasing in very high rates and also in numbers, in these parts of the Canadian nation where the aboriginal people are living and it is chiefly due to lack of proper and apt political and administrative funding of the health and the social care services, the rates and the numbers of the members in the aboriginal community of Canada has be3en found to be affected with the chosen problem which is not eventually being professionally managed, thus causing further disruption to the aboriginal community, in terms of health and also social support (Maremmani et al., 2018)). According to the social determinants of health, as because the cultural and the social factors are highly involved in the development and the maintenance of the psychosocial drinking and substance abuse disorders amongst the members of the aboriginal community, the external interference from the non-governmental organizations, the government houses and the infrastructural frameworks are seen by the leaders of the community to be intrusive and the help is not well welcomed or rather, in other words, received by the Canadian aboriginal community, thus leading to political and social tensions and conflicts amongst the groups and this in no possible manner, help the deteriorating health and the psychosocial disorders in the public health scenario with respect to the aboriginal community of Canada. Hence, analyzing the problem further, it is important to see that the major problem of cultural competence deficiency in the services being delivered to the community posed for a cultural risk to the problem and also a health care challenge to the issue.
Identifying the social factors
Using the Freire’s problem-posing method, the root causes that lies and exists towards the above-mentioned psychosocial problem that is of addiction habits and addiction disorders in the members of the indigenous community of Aboriginal community was found out. According to the problem posing method provided by the educator, it is the culture of silence that is promoted by thew paternal dominance in the society, that leads to the majority of the social issues and cultural issues, chiefly out of the reason that is also known as oppression. This is important to understand as because the psychosocial addiction to alcohol, drugs and smoking issue that we have chosen as an issue with respect to the community health of the indigenous aboriginal community living in the parts of Canada, is highly underpinned the actual issues that are assessed and measured by the Freire’s problem-posing method. According to the educator who gave the problem-solving method believe in the factors such as the economic, social and the political factors are highly involved in the development of the paternal dominance or ‘oppression’ and using the assessment method and applying it to our chosen problem that the similar critical factors were found to be associated with the chosen issue in the chosen community (Russell et al., 2016). At first, the aboriginal people are socially isolated from the main urban race of the Canadian population and lack of human rights or rather the problems associated with the human rights of the aboriginal people lead to the first form of social dominance or oppression. The feelings of discrimination with the aboriginal people with respect to the Freedom of Thought, Freedom of Expression, worker’s right and rights concerning social security, right to education, right involving social justice that is fair and free world and food and shelter for all – lead to the adverse social factors that cause the disruption of the social determinants of health and psychological safety, thus leading way to psychosocial issues of addiction. Lack of social participation in a boarder urban society of multiple cultures is another social factor that cause social isolation and decreasing feelings of acceptance, openness and connectedness as they were not nurtured in a more flexible environment and this cause rigidity in Aboriginal thoughts, causing issues with psychosocial drug and alcohol addiction issues. The sociopolitical factors include lack of education being given to the aboriginal community, creates the actual problem or barrier with the ‘critical thinking or consciousness’, that the problem-solving method emphasizes upon for transformational experiences and well-being. The socioeconomic factors such as low income, low rates of employability are involved with more inclination towards psychosocial addiction. Overall, the crucial social factor of societal dominance to group conformation, group and peer pressure to conform to group norms of spiritual drinking and substance abuse can be considered equivalent with the ‘paternalism’ problem which was assessed and revealed.
Prioritizing the problem
The major or the issue that are above mentioned and revealed, were found out with respect to the chosen community and population but on the basis of certain criteria which should be considered as critical. The inclusion criteria were that the participants will belong from the aboriginal community, who are residents of the country of Canada, the age of the participants were between 18 to 45 and this was to make sure the young adults and middle aged adults who are in the mid-life crisis who are more prone to the psychosocial addiction to alcohol, substance abuse and smoking are chosen. The inclusion criteria were also that the participants did not suffered from any major neurological, lifestyle or terminal diseases which hinder both the ethical considerations and the validity of the results with the chosen issue. As per the scientific researches, the chosen age group was most prone to these addiction issues due to a variety of social, political and economic factors and that is why, they were chosen for assessment, regarding the chosen issue of addiction disorders in the aboriginal community of Canada.
Data collection
The method that was chosen to collect the community level data were critical and also very difficult to implement at first as there was a cultural competence issue. Hence a translator was included in the process. The mixed method of data collection in a two-way process was undertaken and this ensured the quality of the data and its interpretation. Firstly, a survey was conducted with contained a structured set of closed ended questions and this survey was manually run through the whole Canadian community Aboriginal settlement. The age of the participants along with any severe illnesses, the level of alcohol and other drugs dependency, the level of social impairment and behavioral, emotional, cognitive and personality issues was captured in this survey that was run through the aboriginal community, with the help of the translator who helped the participants with the questions and their meanings (Wilk, Maltby & Cooke, 2017). This method was chiefly helpful to sort out those aboriginal community members who were at the greatest risk of psychosocial disorder and the triage or rather the prioritization was then made and out of all people actually filled the questionnaire in the survey, only forty percent was included in a second round of data collection, given the severity of their issues to the psychosocial addition to alcohol, smoking and other drugs. The second round of data collection used the semi structured interviewing method so that the experience, feelings, perceptions, ideas, existential issues are understood, known more properly in a subjective manner, so in order to develop the bigger picture about the chosen issue. Again, a translator was present in the interviewing room to ensure effective culturally safe communication which is also therapeutic.
Level of community participation
The level of community participation developed in this study and program was astonishing and the first level of engagement was bought through ‘manipulation and therapy’ where the participants were educated about the self-care strategies and was given with behavioral therapies such as cognitive behavioral therapy and dialectical behavioral therapy. The latter was chiefly administered to help those with self-harm along with addiction problem, develop resilience. Motivational interviewing was another important strategy delivered in these stages to counter the issue. In the next stages of information and consultation, the participants were given information about the diseases and this was done through a seminar. In the process of consultation, the community leaders were partnered with, in order to develop more engagement. The educational and the social support tools were given to them to address the chosen issue. In the placation stage of the ladder of participation, the advices were taken from the community leader, so that a better purposeful and insightful service system can be created and then in the partnership phase, the community leaders were partnered with well and the right negotiation skills and shred decision making protocols were used to develop an informed and self-sustainable community mental health and social care framework.
The results
According to the assessment results, the major issues with the social stigma, lack of informed policy making and sociocultural factors were found to be the major and crucial problems. It is to be very closely noted and analyzed as well very imperatively though that the health campaigns and the health seminars and other health and social education services are being delivered to the people of the Aboriginal community living in the nation of Canada, the barriers such as inappropriate policy making by the government and the health frameworks policy makers are the chief issues that are associated with the lack of proper service delivery to the aboriginal community people living in the nation of Canada (Lavalley et al., 2020). There are various other factors that are related to family violence, social stigma about the mental health diseases, lack of public knowledge about stress, anxiety and depression as well as personality disorders such as bipolar and borderline personality disorders also lead to negative coping, when left untreated over a period of time and due to this negative coping, the individuals also commit to drinking and drug abuse as well increased levels of smoking that is again very disastrous for their health and also for the wellbeing of their family. Social drinking and spiritual drinking were cardinal issues as well (Sikorski, Leatherdale & Cooke, 2019).
The change
First to address the community problem of psychosocial addiction to alcohol, smoking and other drugs, there education system needs to change to bring about the transformation in with respect to this social determinant of health that is education. Secondly, the school teachers, the community educators, the primary health workers, the community workers as well as the mental health workers and counsellors needs to come up to inform and educate the aboriginal people about the problem associated with aboriginal people (Jetty, 2017). This is important for the critical transformation.
The challenges
The challenges to using a participatory approach to assessing a community and identifying community problems, are many and firstly it is the very lack of cultural competence and cultural awareness. The lack of cultural sensitiveness is a huge area of concern that prevents the program or service providers to connect with the participants and bring about the change (Conigrave et al., 2020). The power shift from the service providers to the community leaders to community members, to take action is often not that smooth and erratic transition leads to community disruption and more psychosocial and socially adverse problems. The other challenge to participatory approach is cultural integrity and value system that incorporates spiritual and religious drinking and substance abuse.
Conclusion
Hence it can be concluded saying that in Canada, the indigenous section of the aboriginal community is one of the most important areas of social interest and also health interest that is due to the fact, that the indigenous aboriginal community is one of the first generations of the Canada and because of a cultural heritage, the health and social concern is increasingly emphasized upon the deprived modern day aboriginal community, living in the parts of the nation and it is important to be noted very closely, that the social determinants of health is critically adjoined with the barriers that are posed to the health care and the social care service delivery to the Aboriginal people living in Canada. The holistic well-being and mental health programs are critical to psychosocial problem and addiction issue solving.
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