Academic Journal
Inuit experiences of and expertise on the 21st-century tuberculosis epidemic in Nunavik, Quebec: a qualitative community-based participatory study.
| Τίτλος: | Inuit experiences of and expertise on the 21st-century tuberculosis epidemic in Nunavik, Quebec: a qualitative community-based participatory study. |
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| Συγγραφείς: | Geboe B; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Sandy G; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Tooktoo D; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Tukalak S; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Law S; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., White-Dupuis S; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Nappaaluk Q; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Aliqu N; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Quananack E; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Emudluk M Sr; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Watt L; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Mangiok P; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Dunn-Suen A; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Yaaka M; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., MacDonald NI; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que., Khan FA; Respiratory Epidemiology and Clinical Research Unit (Geboe, Tooktoo, Tukalak, Law, Mangiok, Dunn-Suen, Yaaka, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre and Montreal Chest Institute, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Sandy, White-Dupuis), Kuujjuaq, Que.; Puvaqatsianirmut (Committee for Healthy Lungs) (White-Dupuis, Aliqu, Quananack, Emudluk, Watt); Northern Village of Kangiqsujuaq (Nappaaluk); Northern Village of Kangiqsualujjuaq (Emudluk), Nunavik, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Medicine (Yaaka, Ahmad Khan), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Silattusarniq Community Solutions Consulting (MacDonald), Nunavik, Que. faiz.ahmadkhan@mcgill.ca. |
| Πηγή: | CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [CMAJ] 2026 Apr 05; Vol. 198 (13), pp. E474-E485. Date of Electronic Publication: 2026 Apr 05. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 9711805 Publication Model: Electronic Cited Medium: Internet ISSN: 1488-2329 (Electronic) Linking ISSN: 08203946 NLM ISO Abbreviation: CMAJ Subsets: MEDLINE |
| Imprint Name(s): | Publication: Ottawa : Canadian Medical Association Original Publication: [Ottawa] : The Association = L'Association, [1985]- |
| Ιατρικοί όροι (MeSH): | Inuit*/psychology , Tuberculosis*/epidemiology , Tuberculosis*/ethnology , Tuberculosis*/therapy, Quebec/epidemiology ; Humans ; Female ; Community-Based Participatory Research ; Adult ; Male ; Qualitative Research ; Focus Groups ; Epidemics ; Health Services, Indigenous |
| Περίληψη: | Background: In Nunavik, the Inuit lands in Quebec, the incidence of tuberculosis has been rising and is currently 1000 times that seen among non-foreign-born Quebec residents. To inform tuberculosis policies aligned with Inuit self-determination, we sought to explore Nunavimmiut (Inuit of Nunavik) experiences with tuberculosis care. Methods: We undertook a community-based participatory action research project in an Indigenous research methodology (IRM) framework. From 2022 to 2023, Indigenous researchers (First Nations and Inuit) conducted interviews and focus groups with Nunavimmiut about tuberculosis and health care experiences. We also interviewed health care workers. In our data analyses, we used constructivist grounded theory integrated with IRM to identify constructs. Findings derived from Nunavimmiut-reported perspectives and experiences informed calls for policy and service changes. Results: We interviewed 156 Inuit (37% aged ≤ 35 yr, 61% women), in 5 Nunavik communities and in Montréal, and 21 health care workers. Nunavimmiut shared a strong desire to protect individual and community health, which they reported was undermined by under-resourced health services. Contemporary tuberculosis care itself was identified as a source of hardship, with contributing factors including displacement outside of community, isolation, directly observed therapy, fear of coercive measures, and threat of culturally unsafe experiences in health care settings. Information gaps undermined agency and caused heightened anxiety and stigma related to tuberculosis. The rarity of the Inuktitut language in health services contrasted with its predominance in community life. Health care workers echoed these concerns. Recommendations by Nunavimmiut for improving tuberculosis care were grouped into 7 calls to action: increasing Inuit control over services and data; providing person-centred care; increasing local services to minimize displacement; using community-wide screening, adapted locally; training and hiring more Inuit health care workers; reducing stigma; and implementing Inuit-led cultural safety training for health care workers. Interpretation: Nunavimmiut reported experiencing program-centred tuberculosis care, requiring Inuit to adapt to services that are shaped by resource scarcity. By contrast, Inuit recommended person-centred tuberculosis care that is supportive and responsive to community needs. Changes will necessitate reconciliation- and decolonization-aligned policy changes and increased resources. (© 2026 CMA Impact Inc. or its licensors.) |
| Competing Interests: | Competing interests:: Ben Geboe and Glenda Sandy declare support for the present manuscript from the Research Institute of the McGill University Health Centre and the Canadian Institutes of Health Research (CIHR). Glenda Sandy declares reimbursement for conference registration and travel to conference to present findings, from the Research Institute of the McGill University Health Centre. Ms. Sandy is also co-chair of the TB Regional Committee Nunavik. Stephanie Law reports a postdoctoral award from CIHR. Shirley White-Dupuis, Nellie Aliqu, Maggie Emudluk Sr., and Larry Watt report honoraria from Puvaqatsianirmut. Shirley White-Dupuis also reports board membership with the Nunavik Regional Board of Health and Social Services (NRBHSS), and the Ungava Tulattavik Health Center. Maggie Emudluk Sr. reports support for attending the World Conference on Lung Health to present on tuberculosis from the Research Institute of the McGill University Health Centre and CIHR. Ms. Emudluk also reports a leadership role with Kangiqsualuujjuaq and Kativik Regional Government. Larry Watt reports a leadership role with Ungava Tulattavik Health Center. Faiz Ahmad Khan reports support for the present manuscript from CIHR, the McGill Interdisciplinary Initiative in Infection and Immunity, Fonds de Recherche Quebec–Santé, Institut nordique du Québec, McGill University Health Centre Foundation, and Margaret Becklake Award (payments made to the Research Institute of the McGill University Health Centre). Dr. Ahmad Khan also reports support for travel and registration for a conference to share findings from CIHR and Institut nordique du Québec, and a leadership role with the Montreal Chest Institute and McGill University Health Centre as medical director of a tuberculosis clinic. No other competing interests were declared. |
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| Entry Date(s): | Date Created: 20260406 Date Completed: 20260714 Latest Revision: 20260921 |
| Update Code: | 20260921 |
| PubMed Central ID: | PMC13053088 |
| DOI: | 10.1503/cmaj.251824 |
| PMID: | 41942149 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1488-2329 |
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| DOI: | 10.1503/cmaj.251824 |