Culturally tailored substance use interventions for Indigenous people of North America: a systematic review

Probably not a substantial claim: may not pass S3 (load-bearing).

Health systems that service Indigenous groups can be poorly resourced.

“health systems that service Indigenous groups can be poorly resourced (Kruse et al., 2022)”

• cites Kruse et al., 2022 sourceCould not verify

  The indexed copy contains an abstract mentioning inadequate funding and limited human resources, but no usable full-text passage; the page states that the full text is not currently available. Because the abstract is not admissible evidence under this audit’s rules, the claim cannot be verified from our copy. (LLM, conf=0.72)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

In total, seven studies (38.89%) were rated a bias rating of 5.

“In total, seven studies (38.89%) were rated a bias rating of 5 (Burduli et al., 2018; Dickerson et al., 2012; Edwards, 2003; Pearson et al., 2019; Ray et al., 2020; Running Bear et al., 2017; Tonigan et al., 2020)”

• cites Burduli et al., 2018 sourceSupported
• cites Dickerson et al., 2012 sourceSupported
• cites Edwards, 2003 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In total, six studies (33.33%) were rated a bias rating of 4.

“six studies (33.33%) were rated a bias rating of 4 (Gone and Calf Looking, 2015; Kelley et al., 2017, 2018; Venner et al., 2021; Wright et al., 2011)”

• cites Gone and Calf Looking, 2015 sourceNot checked — no full text of the source
• cites Kelley et al., 2017, 2018Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Venner et al., 2021 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One article was a feasibility study (Hanson and Pourier, 2015) and one is a program evaluation (Wright et al., 2011).

“It may be important to note that one article was a feasibility study (Hanson and Pourier, 2015) and one is a program evaluation (Wright et al., 2011), as these types of study designs are less appropriate for this particular quality assessment.”

• cites Hanson and Pourier, 2015 sourceSupported
• cites Wright et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The systematic review was guided by PRISMA and included creating a protocol that defined rationale, objectives, inclusion/exclusion criteria, search methods, study selection, and data collection and extraction guidelines.

“This systematic review was guided by core tenets of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Page et al., 2021), which included creating a protocol that defined the rationale and objectives, inclusion and exclusion criteria, search methods and study selection and data collection and extraction guidelines.”

• cites Page et al., 2021 sourcePartly supported

  The Abstract describes PRISMA as guidance for transparently reporting why a review was done and how studies were identified and selected, so it supports using PRISMA to guide reporting. But the Scope of the guideline section says PRISMA 2020 is not intended to guide review conduct or protocol reporting; it points to the separate PRISMA-P statement for protocols. It therefore does not support attributing creation of the described protocol to PRISMA 2020. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the three qualitative studies, two (66.67%) were rated a bias rating of 5.

“Of the three qualitative studies, two (66.67%) were rated a bias rating of 5 (Dickerson et al., 2012; Edwards, 2003)”

• cites Dickerson et al., 2012 sourceSupported
• cites Edwards, 2003 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the four RCT studies, one (25%) was given a bias rating of 4.

“one (25%) was given a bias rating of 4 (Venner et al., 2021)”

• cites Venner et al., 2021 sourcePartly supported

  The Design section (page unavailable) confirms that Venner et al. conducted a randomized controlled trial, so the citation identifies an RCT. The paper does not report a bias rating of 4 or establish the citing document’s four-study denominator; searches for a bias rating and quality-assessment score found no such passage. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

Both authors independently reviewed and assigned quality scores using the Mixed Methods Appraisal Tool (MMAT).

“Both authors independently reviewed and assigned quality scores to each of the articles using the Mixed Methods Appraisal Tool (MMAT) (Hong et al., 2018).”

• cites Hong et al., 2018 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Past research has called for tribal sovereignty in the development of effective substance abuse treatment to effectively imbue cultural perspectives and themes to best serve their own communities.

“Past research has called for tribal sovereignty in the development of effective substance abuse treatment to effectively imbue cultural perspectives and themes to best serve their own communities (Richer and Roddy, 2022).”

• cites Richer and Roddy, 2022 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

RCTs were the next most common study type (n = 4; 22.22%).

“RCTs were the next most common type (n = 4; 22.22%) of study design”

May combine two claims.

The sample size of the studies ranged from 4 to 742, with an average of approximately 213 participants.

“The sample size of the studies ranged from 4 to 742, with the average number of participants being approximately 213 individuals.”

May combine two claims.

No intervention was gender-specific or serviced two-spirit or nonbinary populations.

“There was no indication that any intervention was gender-specific or serviced two-spirit or nonbinary populations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Three (16.67%) articles used strictly qualitative methods.

“Finally, three (16.67%) articles used strictly qualitative methods”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two studies (11.11%) were conducted in intensive outpatient settings.

“Two studies (11.11%) were conducted in intensive outpatient settings”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two (11.11%) articles used mixed methods designs combining quantitative outcome measurement with focus groups and ethnography.

“The two (11.11%) articles that used mixed methods study designs combined quantitative outcome measurement with focus groups (Naquin et al., 2006) and ethnography (Saylors, 2003).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the two Canadian interventions, one was located in British Columbia and one in Ontario.

“Of the two interventions, one was located in the province of British Columbia (van der Woerd et al., 2010) and one was located in Ontario (Kanate et al., 2015).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Three of five contacted researchers responded, yielding two additional studies.

“Three of the five researchers responded, which yielded two additional studies.”

May combine two claims.

The studies primarily measured outcomes related to substance use but rarely reported effects on spiritual dimensions of health despite the nature of the interventions.

“The studies presented primarily measured outcomes related to substance use, but rarely reported effects on spiritual dimensions of health despite the nature of the interventions.”

May combine two claims.

Experimental studies without randomized treatment were the most common mode of intervention dissemination, followed by RCTs.

“In sum, experimental studies without randomized treatment were the most common mode of intervention dissemination, followed by RCTs.”

May combine two claims.

All studies identified were in North America, involved individuals above the age of 18 and were culturally tailored.

“All studies identified were in North America, involved individuals above the age of 18 and were culturally tailored.”

May combine two claims.

The results illustrate that the majority of these programs were located in the American Southwest, with only two located across all of Canada.

“Further, the results illustrate that the majority of these programs were located in the American Southwest, with only two located across all of Canada.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

During abstract review, 534 papers were excluded, leaving 106 full-text articles for review.

“During the abstract review, we excluded 534 papers that lacked clear relevance to the inclusion and exclusion criteria, leaving 106 full-text articles for review.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the three qualitative studies, one (33.33%) received a bias rating of 4.

“one (33.33%) received a bias rating of 4 (Gone and Calf Looking, 2015).”

• cites Gone and Calf Looking, 2015 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Two articles were added from hand search and expert review, bringing the total full-text review articles to 108.

“We added two articles from the hand search and expert review, which brought the total full-text review articles to 108.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One study (Saylors, 2003) could not be assessed for quality because it lacked a clear research question.

“One study (Saylors, 2003) could not be assessed for quality because it lacked a clear research question.”

• cites Saylors, 2003 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the two mixed methods articles, one received a bias rating of 4.

“Of the two mixed methods articles, one received a bias rating of 4 (Naquin et al., 2006).”

• cites Naquin et al., 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

One mixed methods study (Saylors, 2003) could not be assessed because a research question was not clearly defined.

“We could not assess one mixed methods study because a research question was not clearly defined (Saylors, 2003).”

• cites Saylors, 2003 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A total of 1,040 records were yielded from the PsycINFO, CINAHL, MEDLINE and PubMed databases.

“A total of 1,040 records were yielded from the PsycINFO, CINAHL, MEDLINE and PubMed databases.”

May combine two claims.

A large proportion of interventions followed CBPR considerations, and many consulted with tribal elders, Indigenous community boards or relevant authorities.

“A large proportion of these interventions followed the considerations of CBPR, and many consulted with tribal elders, Indigenous community boards or relevant authorities to inform best practices in implementation.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

These studies not only reported quantitative findings, but contextualized findings qualitatively.

“These studies not only reported quantitative findings, but contextualized findings qualitatively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Reviewing references of relevant articles did not yield any additional studies.

“Coauthors also reviewed references of relevant articles, but this did not yield any additional studies.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In total, two studies (11.11%) were rated a bias rating of 3 (moderate bias).

“two studies (11.11%) were rated a bias rating of 3 (moderate bias) (Gray et al., 2010; Kanate et al., 2015)”

• cites Gray et al., 2010 sourceNot checked — no full text of the source
• cites Kanate et al., 2015Not checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the four RCT studies, one (25%) received a bias rating of 3.

“one (25%) was received a bias rating of 3 (Gray et al., 2010).”

• cites Gray et al., 2010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

After removing 393 duplicates, 640 records were screened for relevance using titles and abstracts.

“Once we removed 393 duplicates, we screened the remaining 640 records for relevance using their titles and abstracts.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Exclusion reasons were: 55 had no intervention, 25 focused only on youth, four had wrong outcomes, three were not culturally tailored, two did not include an Indigenous population, and one was outside the USA or Canada.

“Article exclusion reasons are as follows: 55 had no intervention, 25 focused only a youth population, four had wrong outcomes, three were not culturally tailored, two did not include an Indigenous population and one study was outside of the USA or Canada which was out of the scope of this study.”

May combine two claims.

Nonrandomized studies displayed the most variability in terms of bias, with quality ratings ranging from 2 (serious) to 5 (low).

“Nonrandomized studies displayed the most variability in terms of bias, with quality ratings ranging from 2 (serious) to 5 (low).”

Probably not a substantial claim: may not pass S3 (load-bearing).

There were 1,033 merged studies when accounting for multiple data sets coming from the same study.

“There were 1,033 merged studies when accounting for multiple data sets coming from the same study.”

May combine two claims.

Most interventions serviced both drug and alcohol use disorders, with a few specific to either alcohol or opioid use.

“In sum, most interventions serviced both drug and alcohol use disorders, with a few specific to either alcohol or opioid use.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Upon full-text review of 108 articles, 90 studies were excluded that did not meet inclusion and exclusion criteria.

“Upon close full-text review of 108 articles, we excluded 90 studies that did not meet the inclusion and exclusion criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The locations of the two Canadian interventions are in areas of Canada with the highest overdose fatalities.

“The locations of these interventions take place in areas of Canada with the highest overdose fatalities (Government of Canada, 2021).”

• cites Government of Canada, 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The majority of the studies contained in this review were quantitative in nature, and few used qualitative data or mixed methods.

“Further, the majority of the studies contained in this review were quantitative in nature, and few used qualitative data or mixed methods.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The explicit focus on North American Indigenous populations rather than Indigenous communities globally is a limitation.

“A second limitation is the explicit focus on North American Indigenous populations rather than Indigenous communities globally.”

May combine two claims.

Historical trauma has been identified as a prominent source of health disparity and used as a lens to contextualize rates of drug and alcohol use disorder in Indigenous populations.

“Historical trauma has been identified as a prominent source of health disparity (Gone et al., 2019 for a review), and has been used as a lens to contextualize rates of drug and alcohol use disorder in Indigenous populations (Brave Heart, 2003).”

• cites Gone et al., 2019 sourceNot checked — no full text of the source
• cites Brave Heart, 2003 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Indigenous individuals in North America have the highest rates of abstinence from drugs and alcohol.

“Though Indigenous individuals in North America have the highest rates of abstinence from drugs and alcohol (Cunningham et al., 2016)”

• cites Cunningham et al., 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Health systems that service Indigenous groups are sometimes located in areas geographically removed from the Indigenous populations they intend to serve.

“are sometimes located in areas that are geographically removed from the Indigenous populations they intend to serve (Indian Health Service, 2018).”

• cites Indian Health Service, 2018Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

There exists a profound lack of access to culturally relevant treatment resources for Indigenous communities outside of the Southwestern USA, and in urban settings.

“First, there exists a profound lack of access to culturally relevant treatment resources for Indigenous communities outside of the Southwestern USA, and in urban settings.”

Probably not a substantial claim: may not pass S2 (checkable).

The finding that spiritual outcomes are rarely reported reinforces the need for researchers to acknowledge culturally tailored treatment contributions outside Western conceptions of wellness.

“This result reinforces the need for researchers to acknowledge the contributions of culturally tailored treatment that fall outside of the bounds of Western conceptions of wellness.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Both authors discussed conflicts and came to consensus based on the inclusion and exclusion criteria.

“Both authors discussed conflicts and came to a consensus based on the inclusion and exclusion criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No articles that appeared to meet inclusion criteria were later excluded.

“No articles appeared to meet inclusion criteria that were later excluded.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Both coauthors independently reviewed all relevant articles and selected include or exclude in Covidence.

“Both coauthors independently reviewed all relevant articles and selected “include” or “exclude” in Covidence.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Both authors screened all articles independently using the inclusion/exclusion criteria.

“Both authors screened all articles independently using the inclusion/exclusion criteria”

Probably not a substantial claim: may not pass S3 (load-bearing).

A standardized template for data extraction was developed and completed in Covidence for each article.

“A standardized template for data extraction of key information was developed and completed in Covidence for each article.”

Classified as probably not a substantial claim.

Multiple papers reporting data from the same dataset or project were merged and counted as the same study.

“Multiple papers that reported data from the same data set or project were merged and counted as the same study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Both authors reviewed the spreadsheet together to ensure information was presented clearly and consistently.

“Together, both authors reviewed the spreadsheet ensuring that information was presented clearly and consistently across each data extraction variable.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Per the guidance of the MMAT, quality should not be assessed for articles without clearly defined research questions.

“Per the guidance of the MMAT, quality should not be assessed for articles without clearly defined research questions.”

• cites MMATNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

The 18 programs contained in this review serve as meaningful examples in culturally tailored treatment as they effectively center culture in treatment, highlight the importance of community and improve accessibility for Indigenous groups.

“The 18 programs contained in this review serve as meaningful examples in culturally tailored treatment as they effectively center culture in treatment, highlight the importance of community and improve accessibility for Indigenous groups.”

Probably not a substantial claim: may not pass S2 (checkable).

The expansion of access to culturally tailored treatment should aid Indigenous communities outside of the USA and Canada.

“the expansion of access to culturally tailored treatment should aid Indigenous communities outside of the USA and Canada.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Both authors independently reviewed the data extraction spreadsheet.

“Both authors independently reviewed the spreadsheet and made notes about information that needed further clarity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Feasibility study and program evaluation designs are less appropriate for this particular quality assessment.

“as these types of study designs are less appropriate for this particular quality assessment.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

This review highlights the scope of this need across Indigenous groups in the USA and Canada, though this need is ubiquitous for Indigenous populations globally.

“This review highlights the scope of this need across Indigenous groups in the USA and Canada, though this need is ubiquitous for Indigenous populations globally.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Discrepancies in quality appraisal were settled by review and consensus between both authors.

“Discrepancies were settled by review and consensus between both authors.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Despite the lack of a clearly defined research question, the article (Saylors, 2003) is included in this systematic review because it meets the goal of more clearly understanding what culturally tailored interventions are available.

“Despite the lack of a clearly defined research question, the article is included in this systematic review because it meets the goal of more clearly understanding what culturally tailored interventions are available.”

• cites Saylors, 2003 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

We still included the three qualitative studies because of their rich description of the setting, intervention and the use of participants' voices.

“We still included the three qualitative studies because of their rich description of the setting, intervention and the use of participants’ voices.”

• AssumptionRests on an assumption: Rich description of the setting, intervention and participants' voices is important when discussing, developing and replicating culturally tailored and community-based interventions.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Dividing our sample based on political nation states rather than Indigenous identity represents a larger issue related to the geopolitics of Indigeneity and colonialism.

“We are aware of the ways in which dividing our sample based on political nation states rather than Indigenous identity represents a larger issue related to the geopolitics of Indigeneity and colonialism.”

Classified as probably not a substantial claim.

We continued with the study protocol as designed, as it allowed us to assess and compare the study quality and bias across peer-reviewed works explicitly.

“Despite this limitation, we continued with the study protocol as designed, as it allowed us to assess and compare the study quality and bias across peer-reviewed works explicitly.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The methodological examples from this review may inform work and research agendas for Indigenous populations located in other geographic areas.

“The methodological examples from this review may inform work and research agendas for Indigenous populations located in other geographic areas.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This method inherently reinforces the belief and hierarchy of Western (academic) versus Indigenous (community) systems of knowledge.

“We recognize that this method inherently reinforces the belief and hierarchy of Western (academic) versus Indigenous (community) systems of knowledge.”