Perinatal wellbeing through restoring healthy family systems in a nêhiyaw (Plains Cree) community: a mixed methods study.

Introduction: A collaborative research partnership in Alberta (Canada) was formed with the goal of supporting optimal health during the perinatal period for diverse Indigenous populations. Our approach utilized community-led strategies that promote the best possible healthy life for families and children. This partnership was guided by a Restoring and Supporting Healthy Family Systems (RSHFS) conceptual model based primarily on Indigenous ways of knowing. We sought to explore components of the RSHFS model with members of a nêhiyaw (Plains Cree) community of childbearing age, focused on refining codesigned perinatal strategies and supports for women and families. Methods: We utilized a convergent parallel mixed methods design. In collaboration with nêhiyaw community members, we developed and implemented a survey for women of childbearing age and their partners. Follow-up semistructured interviews were carried out. Data generation approaches were guided by the RSHFS model that incorporates seven interrelated elements: identity, supportive environments, culture, language, grandfathers and grandmothers, fathers and mothers, and extended family. Results: Fifty-two participants completed the survey and seven completed the interviews. All seven domains of the RSHFS model were found to be salient and interconnected influences on perinatal wellbeing. Participants emphasized the importance of supportive family relationships and connections to culture, language, identity, and land, while also describing the ongoing impacts of intergenerational trauma, gaps in perinatal supports, and culturally unsafe health care interactions. Discussion: Perinatal wellbeing in this nêhiyaw community is influenced by interconnected family, cultural, and structural systems. The RSHFS model reflected participants' lived experiences and identified pathways to restoring family relationships, strengthening cultural identity, supporting healing, providing additional perinatal supports and system navigation, and addressing cultural safety.