title: Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review.
abstract: OBJECTIVE
  Striking disparities in Indigenous maternal-child health outcomes persist in relatively affluent nations such as Canada, despite significant health promotion investments. The aims of this review were two-fold: 1. To identify Indigenous prenatal and infant-toddler health promotion programs in Canada that demonstrate positive impacts on prenatal or child health outcomes. 2. To understand how, why, for which outcomes, and in what contexts Indigenous prenatal and infant-toddler health promotion programs in Canada positively impact Indigenous health and wellbeing.
  
  
  METHODS
  We systematically searched computerized databases and identified non-indexed reports using key informants. Included literature evaluated a prenatal or child health promoting program intervention in an Indigenous population in Canada. We used realist methods to investigate how, for whom, and in what circumstances programs worked. We developed and appraised the evidence for a middle range theory of Indigenous community investment-ownership-activation as an explanation for program success.
  
  
  RESULTS
  Seventeen articles and six reports describing twenty programs met final inclusion criteria. Program evidence of local Indigenous community investment, community perception of the program as intrinsic (mechanism of community ownership) and high levels of sustained community participation and leadership (community activation) was linked to positive program change across a diverse range of outcomes including: birth outcomes; access to pre- and postnatal care; prenatal street drug use; breast-feeding; dental health; infant nutrition; child development; and child exposure to Indigenous languages and culture.
  
  
  CONCLUSIONS
  These findings demonstrate Indigenous community investment-ownership-activation as an important pathway for success in Indigenous prenatal and infant-toddler health programs.
authors.affiliation: Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing, Centre for Research on Inner City Health, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; CIHR Applied Public Health Research Chair in Indigenous Health Knowledge and Information, Canada. Electronic address: janet.smylie@utoronto.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
authors.forename: Maritt
authors.initials: M
authors.lastname: Kirst
authors.affiliation: Department of Pscyhology, Ryerson University, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: McShane
authors.affiliation: Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing, Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Firestone
authors.affiliation: Seventh Generation Midwives Toronto, Canada; Well Living House Action Research Centre for Indigneous Infant, Child and Family Health and Wellbeing, St. Michael's Hospital, Toronto, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Wolfe
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
mesh_terms: D002170:Canada; D002675:Child, Preschool; D003256:Community Participation; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D044382:Population Groups / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*
keywords: Child health promotion; Indigenous; Prenatal health promotion; Program evaluation; Realist review