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Article History

Received: 1 March 2025

Accepted: 18 August 2025

First Online: 21 September 2025

Declarations

:

: The HE-TAG data that supports this study are available from the Collaborative Applied Research for Equity in Health Policy and Systems (CARE) Lab, but restrictions apply to the availability of these data. The data are, however, available from the authors upon reasonable request and with the permission of the CARE Lab.

: The authors declare no conflicts of interest.

: Ethics approval for Health Economics Technical Advisory Group under the I-HeLTI project is covered under Alberta Research Information Services (ARISE) ethics protocol number 97455, led by Principal Investigator Dr Stephanie Montesanti. The study is titled Restoring Healthy Family Systems in Indigenous Communities . This research was conducted in accordance with the Declaration of Helsinki [ ] and Chapter 9 of the Tri-Council [ ].

: Not applicable.

: Not applicable.

: Not applicable.

: This study was grounded in a community-based participatory research (CBPR) approach, co-developed with the Cree Nations of Maskwacîs (CNM) and the five Cree and Dene Nations of the Regional Municipality of Wood Buffalo (CDNWB). Co-Principal Investigators Dr Stephanie Montesanti and Dr Richard Oster engaged regularly with these partner communities to guide the research process, ensuring that the work is informed by local priorities, Indigenous knowledge systems, and lived experience. The work was co-produced through iterative collaboration with members of the Canadian Institutes of Health Research (CIHR)-funded Indigenous Healthy Life Trajectories Initiative (I-HeLTI) Health Economics Technical Advisory Group (HE-TAG), established by Dr Montesanti, to support the development of culturally grounded economic evaluation methods for the CIHR-funded team cohort grant. Lea Bill, as a Co-Principal Investigator, guided the HE-TAG session discussions around topics of Indigenous knowledge based on her expertise as a Knowledge Keeper and speaker of the Cree language. Lea’s perspective as recorded in session transcripts provided a rich source of cultural meaning. Dr Montesanti provided extensive conceptual framing, mentorship, critical review, and refinement of the manuscript. Dr Rhonda Bell, Dr Richard Oster, and Dr Barbara Verstraeten played active roles in HE-TAG sessions and the review of the manuscript. Dr Mike Paulden provided expertise as a senior health economist during all HE-TAG discussions. In his capacity as a senior health economist, Dr Arto Ohinmaa provided extensive editing of the manuscript and guidance, as a PhD supervisor to Dr Aidan Neill, who was a student at the time of this research. Dr Neill contributed knowledge of health economics during HE-TAG sessions. He also provided the overall vision for the data synthesis by conducting the conceptual and thematic analysis on the HE-TAG session transcripts. Dr Neill designed the framework, which is based upon the data.

: The strength of this work is grounded in the diverse and complementary expertise of the eight co-authors, whose leadership spans Indigenous health systems, health economics, community-based research, and policy development. Stephanie Montesanti is a nationally recognized expert in Indigenous health systems research, with specialized expertise in Indigenous research methodologies, systems thinking, health system integration, and intersectoral policy analysis. She is a Professor and Canada Research Chair in Health Systems Integration, leading the Collaborative Applied Research for Equity in Health Policy and Systems (CARE) Lab at the University of Alberta. As a Principal Investigator of the I-HeLTI Alberta team, Dr Montesanti provides strategic vision for advancing equity-centered and values-based approaches to health system transformation. Lea Bill is an Indigenous knowledge holder from the Cree Pelican Lake First Nation in Saskatchewan with thirty years of experience in community as a registered nurse. Lea is also Executive Director of the Alberta First Nations Information Governance Centre (AFNIGC) where she is also a project lead and research manager. Barbara S.E. Verstraeten holds a medical degree and a PhD in health sciences, with a focus on pregnancy, maternal, and child health, as well as the developmental origins of health and wellness. Barbara is a research associate in the CARE lab, supporting qualitative and quantitative data analysis for the I-HeLTI and other projects. Rhonda Bell is a professor of human nutrition in the Faculty of Agricultural, Life & Environmental Sciences at the University of Alberta. Rhonda is an expert in maternal and infant nutrition and health outcomes with a focus on the developmental origins of health and disease. Richard Oster is Scientific Director, Indigenous Wellness Core with the government of Alberta, and he has worked with and learned from Indigenous communities, particularly relating to engagement, collaboration, community-based participatory research, epidemiology, qualitative inquiry, intervention design, project management, knowledge translation, Indigenous ways of knowing, and Indigenous research ethics. Arto Ohinmaa is a professor of health economics at the University of Alberta with expertise in economic evaluation, health-related quality of life, health outcomes, cost-effectiveness analysis, and health services research. Mike Paulden has expertise in cost-effectiveness analysis and developing appropriate methods for the economic evaluation of health technologies. Mike is also interested in how social values can be integrated within the methods used for health economic evaluations. Aidan Neill is a recent PhD graduate in health services and policy research. Aidan is a resource professional and chartered professional accountant (CPA) who has worked in the Canadian federal policy space for over twenty years.