The power of collective learning and co-creation for transforming health research

The Lunch & Learn series launched by CIEDAR and EDI&I as an example

Models of collaboration and interdisciplinary partnerships are key CoVaRR-Net legacies. A great strength of the Network has been the way CIEDAR (CoVaRR-Net’s Indigenous Engagement, Development and Research Pillar 7) and EDI&I (Equity, Diversity, Inclusion and Indigeneity) have worked together, modelling how researchers should work with Indigenous and other underserved groups.

“We co-create initiatives from scratch, engage with different ways of knowing and learning, practice deep listening, and work collectively to amplify marginalized voices,” says Dr. Kimberly Huyser, CIEDAR Pillar 7 Lead and Associate Professor, University of British Columbia. “In deep listening, it’s important not only to hear what other people are saying but to truly try to understand their perspectives.”

This transformative approach is reflected in the recent Lunch & Learn series, co-developed by CIEDAR and EDI&I to promote equity in research activities within CoVaRR-Net. “Our goal with the Lunch & Learn webinars has been to foster collective learning and create a legacy of shared knowledge that outlives our time in the Network,” says Dr. Huyser.

The Lunch & Learn series is an example of a transformative method that commits to models of co-development work aiming to break top-down approaches and foster non-hierarchical relationships to encourage diverse voices, which are both represented and amplified. The series does not merely promote principles of co-creation, but actively demonstrates them. For instance, CIEDAR and EDI&I actively integrated Indigenous research methods and diverse ways of knowing with Western research methodologies in their planning sessions to cultivate transformative engagement.

Dr. Claire Betker, Associate Director of EDI&I and Scientific Director of the National Collaborating Centre for Determinants of Health, explains: “We’re not just talking about inclusion, we’re living it. From deep listening to amplifying marginalized voices, every step we take is intentional.” She advises researchers: “Learn more and don’t be defensive. Ask questions and hang out with the people you are partnering with – and be open to questioning and adapting your own ways of doing research to the needs of each community.”

“CoVaRR-Net health researchers, basic or applied, should understand underserved communities and how they’ve been excluded in the past. We have to undertake research that includes underserved communities to obtain truly representative and meaningful results, and we must do that through a collaborative approach, where all voices are heard and valued,” says Dr. Ninan Abraham, CoVaRR-Net’s Director of EDI&I, Professor in Microbiology and Immunology and Zoology at the University of British Columbia, and former Associate Dean, Equity, Diversity and Inclusion in the UBC Faculty of Science.

“The Lunch & Learn series we created with CIEDAR is an example from within CoVaRR-Net of what co-creation with Indigenous Peoples entails. There are lessons and guiding principles here for our Network, other Canadian health researchers and governments, all of which can be applied when doing research in partnership with Indigenous Peoples and other underserved communities,” Dr. Abraham adds.

Co-creation in action

Co-creation refers to a collaborative approach of creative problem-solving between diverse participants at all stages of a research initiative. It begins when identifying the problem and continues when a solution is generated and implemented and through to the evaluation of the impact of outcomes. Co-creation is widely believed to increase research impact on complex health problems, especially with participants from marginalized and underserved communities who must be meaningfully involved.

The Decolonial Model, for example, emphasizes a collaborative, non-hierarchical approach that creates a safe environment for interaction, where all voices are heard and valued, in which decisions are made by consensus. “Drawing strength from each person’s positionality, expertise, and skill sets helps to ensure the best possible outcome,” Dr. Abraham explains.

When CIEDAR & EDI&I co-developed the Lunch & Learn webinar series in November 2023, a key objective was to model what co-creation in research with Indigenous Peoples looks like in practice.

It builds on the success of earlier co-created initiatives, such as the workshop organized by CIEDAR and EDI&I at the CoVaRR-Net Spring 2023 Conference, held in Ottawa in May 2023. That workshop included an educational skit that simulated health researchers presenting a collaborative research application to a hypothetical Indigenous nation with a formal community health review board. The skit illustrated a typical interaction between researchers and Indigenous leaders, with researchers voicing common intentions and the Indigenous community health review board members voicing common questions. In such presentations, there are typically moments in which researchers respond well to community expectations and moments in which researcher assumptions do not align with community needs. It was clear from the skit that the researchers had not thought deeply about what was meaningful to the Indigenous nation, and their actions and words showed how too many researchers do not give enough consideration to underserved communities and their perspectives. To establish successful research collaborations with Indigenous communities, researchers must examine their assumptions and center their proposals on Indigenous community wants and needs.

The origins of the Lunch & Learn series lie in findings from EDI&I Listening Tours, led by EDI&I Manager Michelle Zinck, and knowledge gaps in EDI&I identified in a pillar-by-pillar assessment conducted by Areeba Asif, EDI&I Project Coordinator. In November 2023, teams from both CIEDAR and EDI&I began meeting weekly to develop webinar ideas and concepts, gauge interest, and define the desired impact. The planning phase from January to May 2024 involved transforming ideas into actionable plans, with team members taking on responsibilities equitably.

The Lunch & Learn sessions integrate decolonial knowledge systems with Western methodologies, moving beyond traditional webinar formats and aiming to foster impromptu, natural conversations that foster learning and unlearning in real time. The goal of the webinar sessions is to create a respectful and safe space for all CoVaRR-Net members to engage and learn. Participants are meant to feel safe to speak frankly and advocate, without external influences or judgment, which is achieved by keeping the webinar space internal to the network.

Another key goal is to actively advocate for Black, Indigenous, and People of Color (BIPOC) and historically marginalized voices by bringing BIPOC voices to the forefront through specially designed sessions, ensuring diverse perspectives are heard. “It’s important to demonstrate the interconnectedness of health equity, such as the link between Indigenous health and Black health equity,” says Dr. Abraham.

Engaging with communities in future research

To promote health equity and co-create with participants from underserved communities, health researchers need to take the time to build relationships and trust and engage with diverse perspectives.

In response to the high interest within CoVaRR-Net in learning more about successful community engagement and co-development, CIEDAR and EDI&I are dedicating the next two Lunch & Learn sessions in October 2024 to exploring how to engage communities in research to promote health equity, with co-creation as a key pathway.

“We see co-creation as a possible model for health researchers to adapt in collaborating with underserved communities and PIs to interact with their own trainees,” says Dr. Huyser who is hopeful that CoVaRR-Net researchers and trainees will, in turn, share these innovative practices with their colleagues in the Canadian health research community.