In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities and opportunities to revitalize local food systems as a pathway to food security and food sovereignty. The objectives of our project were: (1) to build a shared understanding of food security and sustainability; and (2) to document community priorities, challenges and opportunities to enhance local food access. Utilizing an Indigenous methodology, the conversational method, within the framework of community-based participatory research, formative work undertaken helped to conceptualize food security and sustainability from a community perspective and solidify interests within the four participating communities to inform community-led action planning. Knowledge generated from our project will inform development of initiatives, programs or projects that promote sustainable food systems. The community-based actions identified support a path towards holistic wellbeing and, ultimately, Indigenous peoples’ right to food security and food sovereignty.

Background: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research, program development, and implementation with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015–2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning and action from key learnings and successes on scaling-up of the Learning Circles (LC) model vertically in Haida Nation, British Columbia (BC), and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. The application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. Methods: A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson’s (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from interviews (n = 55) and meeting reports (n = 37) was thematically analyzed to inform the development of guiding principles. Community sense-making of findings informed applicability in a new community context embarking on food systems work. Results: Emergent guiding principles for participatory food system planning and action are described within four main areas: (1) create safe and ethical spaces for dialog by establishing trust and commitment from the ground up, (2) understand the context for change through community engagement, (3) foster relationships to strengthen and sustain impact, and (4) reflect and embrace program flexibility to integrate learnings. Conclusions: Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community protocols and perspectives in support of Indigenous self-determined priorities.

The increased frequency and severity of extreme weather events (EWEs) have underscored the need to strengthen climate-resilient health systems and capacity. Community health workers (CHWs) are integral health systems actors with the potential to protect and improve population health in a changing climate. The aim of this review was to synthesize the literature on the roles of CHWs amid EWEs in low- and middle-income countries, the barriers and facilitators to implement these roles, and program supports to strengthen CHW capacity and health system functions. Scoping review. Four academic databases and gray literature published between January 2000 and June 2023 were searched. Data were thematically analyzed using a deductive-inductive approach guided by the World Health Organization's (WHO's) Operational framework for building climate-resilient health systems. Thirty sources were included. Amid EWEs, CHW roles included: 1) delivery of diagnostic, treatment, and other clinical services; 2) support with access, utilization, or navigation of health services and/or referrals; 3) community education and health promotion; 4) data collection and health surveillance; 5) psychosocial supports; and 6) weather-related health emergency response. Facilitators and barriers to the provision of CHW supports amid EWEs were categorized within WHO's building blocks of health systems. Considerations for strengthening CHW programs to enhance climate-resilient health systems are also discussed. CHWs are uniquely positioned to provide health-related supports amid EWEs that extend to emergency preparedness and response to climate-health challenges. These efforts can contribute to the community and health systems resilience to climate change.

Background: Addressing Indigenous food security and food sovereignty calls for community-driven strategies to improve access to and availability of traditional and local food. Participatory approaches that integrate Indigenous leadership have supported successful program implementation. Learning Circles: Local Healthy Food to School is a participatory program that convenes a range of stakeholders including food producers, educators and Knowledge Keepers to plan, implement and monitor local food system action. Pilot work (2014–2015) in Haida Gwaii, British Columbia (BC), showed promising results of the Learning Circles (LC) approach in enhancing local and traditional food access, knowledge and skills among youth and adolescents. The objective of the current evaluation was therefore to examine the process of scaling-up the LC vertically within the Haida Nation; and horizontally across three diverse First Nations contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake Cree Nation, Saskatchewan; and Black River First Nation, Manitoba between 2016 and 2019. Methods: An implementation science framework, Foster-Fishman and Watson’s (2012) ABLe Change Framework, was used to understand the LC as a participatory approach to facilitate community capacity building to strengthen local food systems. Interviews (n = 52), meeting summaries (n = 44) and tracking sheets (n = 39) were thematically analyzed. Results: The LC facilitated a collaborative process to: (1) build on strengths and explore ways to increase readiness and capacity to reclaim traditional and local food systems; (2) strengthen connections to land, traditional knowledge and ways of life; (3) foster community-level action and multi-sector partnerships; (4) drive actions towards decolonization through revitalization of traditional foods; (5) improve availability of and appreciation for local healthy and traditional foods in school communities; and (6) promote holistic wellness through steps towards food sovereignty and food security. Scale-up within Haida Gwaii supported a growing, robust local and traditional food system and enhanced Haida leadership. The approach worked well in other First Nations contexts, though baseline capacity and the presence of champions were enabling factors. Conclusions: Findings highlight LC as a participatory approach to build capacity and support iterative planning-to-action in community food systems. Identified strengths and challenges support opportunities to expand, adopt and modify the LC approach in other Indigenous communities with diverse food systems.

Background: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research and program development with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning from key learnings and successes on scaling-up the Learning Circle (LC) vertically in Haida Nation, British Columbia (BC) and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. Application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. Methods: A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson’s (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from community interviews (n=52), meeting summaries (n=44) and tracking sheets (n=39) was thematically analyzed to inform development of guiding principles. Community sense making of findings informed applicability in a new community context embarking on food systems work. Results: Emergent guiding principles for participatory food system planning and action included: (1) Create safe and ethical spaces for dialogue by establishing trust and commitment from the ground up; (2) Understand context for change through community engagement; (3) Foster relationships to strengthen and sustain impact; and (4) Reflect and embrace program flexibility to integrate learnings. Conclusions: Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community-protocols and perspectives in support of Indigenous self-determined priorities.

Produce prescription programs (PRx) are gaining traction in Canada and globally as an approach to promote food security and healthy diets. Unison Health and Community Services (Unison), a community health centre in Toronto, Canada, piloted a PRx program to promote food access and healthy eating for adults with experiences of food insecurity and chronic disease risk factors. In this study, we explored the barriers and facilitators to implementing a pilot PRx program in a community health setting to inform program improvements, including opportunities to better meet participant health needs and preferences. Participant follow-up calls, focus group discussions, and semi-structured key informant interviews were conducted in person and online. Detailed call logs and interview transcripts were analyzed thematically using a hybrid inductive-deductive approach guided by the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to program implementation. Key themes were identified across the five domains of the CFIR: (i) Innovation, (ii) Outer Setting, (iii) Inner Setting, (iv) Individuals, and (v) Implementation Process. In total, 19 themes were selected across 14 CFIR constructs, including six inductive sub-themes. The main barriers included the outdoor and public designs of the market, reduced staffing on the clinical team, and a lack of communication infrastructure between primary care providers, program providers, and program participants. Key facilitators included the integration of the PRx pilot into existing Unison programs, the inclusion of nutrition education workshops, and the person-centered and adaptable approach adopted by program providers. These facilitators supported participant referrals and program satisfaction, contributing to participants’ desire to continue engaging in the program. This study, guided by the CFIR, revealed valuable insights into the barriers and facilitators that may influence the implementation of a PRx program in community health settings. Study findings emphasize the importance of team-based care to ensure program adaptability and support a person-centered approach. Identifying key champions within primary care teams is needed to strengthen referral pathways and communication with program providers. Future PRx programs may consider incorporating opportunities for knowledge sharing with participants and community-building activities to address important needs related to social connection, community belonging, and mental health.