Indigenous communities in Latin America and elsewhere have complex bodies of knowledge, but Western health services generally approach them as vulnerable people in need of external solutions. Intercultural dialogue recognises the validity and value of Indigenous standpoints, and participatory research promotes reciprocal respect for stakeholder input in knowledge creation.
As part of their decades-long community-based work in Mexico’s Guerrero State, researchers at the Centro de Investigación de Enfermedades Tropicales responded to the request from Indigenous communities to help them address poor maternal health. We present the experience from this participatory research in which both parties contributed to finding solutions for a shared concern. The aim was to open an intercultural dialogue by respecting Indigenous skills and customs, recognising the needs of health service stakeholders for scientific evidence.
Three steps summarise the opening of intercultural dialogue. Trust building and partnership based on mutual respect and principles of cultural safety. This focused on understanding traditional midwifery and the cultural conflicts in healthcare for Indigenous women. A pilot randomised controlled trial was an opportunity to listen and to adjust the lexicon identifying and testing culturally coherent responses for maternal health led by traditional midwives. Codesign, evaluation and discussion happened during a full cluster randomised trial to identify benefits of supporting traditional midwifery on maternal outcomes. A narrative mid-term evaluation and cognitive mapping of traditional knowledge offered additional evidence to discuss with other stakeholders the benefits of intercultural dialogue. These steps are not mechanistic or invariable. Other contexts might require additional steps. In Guerrero, intercultural dialogue included recovering traditional midwifery and producing high-level epidemiological evidence of the value of traditional midwives, allowing service providers to draw on the strengths of different cultures.
- health systems
- maternal health
- public health
- cluster randomised trial
- other study design
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Handling editor Seye Abimbola
Collaborators Alba Meneses-Rentería; Abraham De Jesús García; Nadia Maciel Paulino. Centro de Investigación de Enfermedades Tropicales (CIET) at the Universidad Autónoma de Guerrero.
Contributors IS drafted the document and synthesised the steps for intercultural dialogue. NA, SP-S and GZ participated in the codesign of the interventions and established the basis of the intercultural dialogue approach. AC, AMC and DL contributed with their critical appraisal of the approach and its theoretical considerations. All authors participated in the review and construction of this manuscript.
Funding The pilot received support from UBS Optimus Foundation. CONACyT, the National Council of Science and Technology of Mexico funded the BMx2 randomised controlled trial (PDCPN-2013-214858). The Quebec Population Health Research Network and the Faculty of Medicine of McGill University provided support for fieldwork. Ceiba Foundation and the Center of Intercultural Medical Studies in Colombia, and the Fonds de recherche du Québec Santé (255253) supported the analysis of the randomised controlled trial.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data from the surveys are available upon reasonable request and after authorization from the participating communities.
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