"Every day I grew stronger and stronger being there".: empowerment through land-and art-based Peer Leader retreats with Indigenous and Northern young people.

Indigenous adolescents in Canada are among those shouldering the impacts of colonialism and racism. Peer approaches and art-and-land-based programming have demonstrated promise to support empowerment and well-being, yet little is known about their efficacy with Northern and Indigenous adolescents in Canada or of how this group conceptualises empowerment. Fostering Open eXpression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) conduct land-and-arts-based Peer Leader Retreats with adolescents from the Northwest Territories, Nunavut and the Yukon Territories. Retreats (2017-2019) included 286 participants (n=196 women [trans-inclusive], n=84 men [trans-inclusive], n=5 non-binary), aged 12-19, the majority of whom (n=235) were Indigenous. Participants completed surveys immediately before and following retreats and 6 months after. Focus group discussions (FGDs) (n=24) were conducted with participants (peer leaders and apprentices) (n=232) following the retreat, and youth staff members (peer facilitators) (aged 14-21, n=7 FGDs). Applying thematic analysis, we explored retreat experiences (FGDs), and Wilcoxon signed-rank tests to examine pre/post retreat changes in leadership, empowerment, and self-confidence (surveys). Quantitatively, there were statistically significant increases in leadership and empowerment in post-retreat scores compared to pre-retreat. Qualitatively, findings demonstrate how Peer Leader Retreats premised on land-and-art-based approaches can support empowerment, confidence, leadership, and social-connectedness.

Introduction

The effects of colonisation, racism, residential schools, and disconnection from land and culture are evident in the mental, emotional, spiritual and physical well-being of Indigenous peoples in Canada and throughout the world [1-4]. In Canada, these deep-reaching harms include intergenerational trauma; loss of language and culture; disconnection from family structure; and physical and emotional harms [2,5-7], including the poorer physical and emotional well-being of children and young people [2,8,9]. Despite these historic and ongoing harms, Indigenous ways of knowing and being continue to be a source of well-being, strength, resilience and possibility [9].

Adolescence is an important life stage and represents a sociobiological window of opportunity, comprised of social, physical, and brain development transitions [10]. Emergent evidence points to the role of peer programming and arts- and land-based approaches with Northern and Indigenous adolescents in Canada to explore coping strategies [11] and support resilience, personal connectedness, and self-efficacy [12]. Land-based approaches can share teachings of relationality, reciprocity, and holism [13-15] to support resilience, address adversity, and improve health and well-being. Land-based activities have been documented as having the potential to improve mental health and wellness, as assessed through an Indigenous, culturally-relevant lens [16]. Art-based approaches with youth have the transformative potential to catalyse social change [17]. For example, arts-based research with Arctic youth in Canada facilitated self-connectedness and acceptance, healthy decision making, identity building, meaning-making, and emotional processing [11]. Participatory art-based processes with youth can also reduce stigma [18] and promote social inclusion [17].

Social age-based hierarchies often cast young people as risky and deficient in skills to care for their health and well-being [19]. Similarly, colonisation continues to be perpetuated in knowledge production through “deficit-discourses” in Indigenous health [20], and side-lining the voices of Indigenous people [11,21-24]. For these reasons, empowered and positive youth development framings may be especially important for disrupting such deficiency approaches in Indigenous and Northern contexts. Further, dynamic, generative, and relational understandings of power and empowerment are important to counter individualistic and deficit-based approaches to understanding youth development and well-being [19].

Positive youth development is a strengths-based perspective on adolescence that has been applied to diverse youth and communities [25]. It conceptualises mutually influential relationships between individual, biological, and contextual factors as important to youth development, resilience, and well-being [25]. Positive youth development programmes can strengthen relationships and skills and promote the development of a positive view of the future and are characterised by bonding, social, cognitive, emotional, behavioural, moral competence, self-efficacy, clear and positive identity, prosocial norms, spirituality, and self-determination [26]. The original proposed “Five Cs” of positive youth development include: connection, caring and compassion, character, confidence and competence [25]. Positive youth development programmes have been documented as promoting health and well-being [26]. A recent positive youth development programme for Indigenous youth in the USA called for Indigenous-focused models of positive youth development and empowerment and documented efficacy of programming through an Indigenous lens to support well-being and healthy decision making [27].

Positive youth development approaches can be empowering, supporting the holistic well-being of youth, and transferring power by supporting their voices, decision making, and actions [28]. Empowerment has been described as a complex process, encompassing multiple levels of psychological, social, organisational, and structural change [29]. Empowerment can allow groups and individuals to achieve positive growth, addressing the psychological and social impacts of disadvantage, marginalisation, and historical oppression [29]. Empowerment is conceptualised as a bottom-up process on a continuum from “individual empowerment” through increases in self-esteem and self-efficacy [30] to community empowerment through critical action and collective consciousness-raising [30], including through engaging art-based, culturally relevant approaches [31]. A recent empowerment-focused positive youth development model with African American youth presents a vision for healthy youth development that includes strengths-based, culturally relevant and action-oriented approaches to positive youth development that emphasise developmental assets and relationships between youth, the environment and their communities [32]. Art-based approaches are also participant- and process-focused and can be empowering through supporting individual self-esteem and awareness [11] towards a collective consciousness and social action [17].

Relationships between youth empowerment and improved health and well-being have been widely documented [33] yet key knowledge gaps remain. Little is known about the factors associated with the empowerment and well-being of Indigenous and Northern young people in Canada, a group that is among those shouldering the lasting impacts of colonialism. There is a dearth of evidence on how Indigenous and Northern young people in Canada conceptualise empowerment themselves, the aspects of land-and-art-based programming that are important to them, and the impacts of land-based, art-based, and peer-led programming on empowerment-related measures.

This manuscript responds to these critical knowledge gaps by exploring empowerment-related experiences among adolescent participants of a peer-led art- and land-based youth programme. The study aims were (1) to identify, using quantitative analysis, pre-to-post Peer Leader Retreat changes in leadership and empowerment outcomes among youth participants; and (2) identify, using qualitative analysis from focus groups, perspectives on empowerment, and experiences among youth participating in a land-and art-based Peer Leader Retreat in the Northwest Territories, Canada.

Method

Fostering Open eXpression among Youth (FOXY) [12] and Strength, Masculinities, and Sexual Health (SMASH) [34] conduct Peer Leader Retreats as part of an action research programme to promote healthy relationships, sexual health, and resilience among Northern and Indigenous adolescents in the Northwest Territories using a peer model [12]. Retreats were held annually between 2017 and 2019 with adolescents aged 13–17 and included Indigenous teachings, arts-based methods, leadership skill development, and land-based activities. Participants in the Yukon, Northwest Territories, and Nunavut were recruited through social media, school and community partners, and peer networks. Each Peer Leader Retreat was conducted over 9-days at Blachford Lake Lodge, NT and in Yellowknife, NT. FOXY and SMASH Peer Leader Retreats included Elder teachings, ceremonies, sharing circles, grief circles, digital storytelling, photography, rattle-making, beading, traditional hand drumming, sexual and mental health education, visual arts, Northern games, journaling, community-leadership projects, and personality mapping. Art-based methods are imbibed in all aspects of FOXY and SMASH Activities. Art-based approaches that were consistent over the three years reported on in this manuscript included: digital storytelling; photography; journaling; theatre-based activities; “Northern Games” focused on traditional storytelling and teaching; and dance parties. Beading and other visual arts approaches were also offered at many retreats. Land-based activities included education, ceremony, learning from Elders and recreation, in the acknowledgement that identity and well-being are deeply interwoven and connected with land [16].

FOXY and SMASH Peer Leader Retreats were designed by two lifelong Northerners with a group of rotating facilitators, most of whom are from Northern Canada and/or Indigenous. The facilitators at the SMASH Peer Leader Retreat are men, women, and non-binary people, while the facilitators at the FOXY Peer Leader Retreats are women and non-binary individuals. Retreat leadership also includes volunteer apprentices and staff peer facilitators (aged 14–21) who previously attended Peer Leader Retreats as participants and returned in more in-depth leadership capacities.

The author team hold various roles and identities. Authors include the Principal Investigators of FOXY and SMASH, as well as research and programme staff in the Northwest Territories and Toronto. We are people of diverse identities, including Indigenous and non-Indigenous researchers and programme staff. We hold diverse racial, cultural and gender identities. We are also gender and sexually-diverse people of different ages, abilities, and career stages. The FOXY and SMASH programmes, as well as our data collection tools and analysis methods are informed by over a decade of feedback from Indigenous and Northern Youth and their communities.

Data collection

Retreat data was collected using a single-group, pre-post test design [35,36]. Following retreats, gender-segregated focus group discussions were conducted with 232 participants, including peer leaders and apprentices (n = 24, ages: 13–17; 68 boys, 164 girls) and peer facilitators (n = 7 focus groups), which were recorded with participant consent and transcribed verbatim. Each retreat participant was invited to participate in a focus group at the end of the retreat. Focus groups were separated into peer leaders, apprentices who are returning peer leaders, and facilitators, which included peer facilitators and adult facilitators. Focus group questions focused on retreat experiences, relationships skills, leadership, observations of changes in self, and sexual health knowledge.

Participants also completed a paper-based pre- and post-retreat survey collecting information on socio-demographic characteristics (e.g. age, gender, and ethnicity). Outcome measures assessed before and after the retreat were leadership (engaging the Leadership Skills Inventory [37]) and empowerment (Growth and Empowerment Measure [29]). An evaluation consultant administered surveys to participants before and after they attended the retreat to assess outcome changes following retreat participation.

Measures

Quantitative measures associated with empowerment-related outcomes included: leadership, social connection, empowerment, and self-confidence. The leadership skills inventory (Cronbach’s alpha: 0.89) [37] was used to determine participants’ self-reported leadership skills before and after the retreat. The leadership skills inventory is a 25-item questionnaire that employs a 5-point Likert scale for each leadership-related question, where: 1 represents “strongly disagree”, 2 represents “disagree”, 3 represents “unclear”, 4 represents “agree”, and 5 represents “strongly agree”. The tally from responses to the 25 questions formed any given participant’s final score. The higher a participant’s score, the stronger their self-identified leadership skills. The minimum and maximum scores possible for the leadership skills inventory were 25 and 125, respectively.

The growth and empowerment measure (Cronbach’s alpha: 0.86) [29] was used to determine participants’ sense of emotional empowerment before and after the retreat. The growth and empowerment measure is a 12-item questionnaire that employs a 5-point Likert scale for each empowerment-related question, where: 1 represents “not at all”, 2 represents “a little”, 3 represents “somewhat”, 4 represents “quite a bit”, and 5 represents “a lot”. The tally from responses to the 12 questions formed any given participant’s final score. The higher a participant’s score, the more they identified as feeling empowered. The minimum and maximum scores possible for the growth and empowerment measure were 5 and 60, respectively.

The number of workshops/retreats attended was our independent variable of interest. The FOXY/SMASH intervention initially conducted a series of arts-based, sexual health workshops between September 2015 and May 2016 for secondary school students in 17 NWT regions. A subset of school-based workshop attendees then participated in Peer Leader retreats along with people newly recruited into the FOXY/SMASH retreat. This study includes a mixture of youth who either: 1) attended school-based workshops; 2) attended a previous Peer Leader retreat; 3) attended school-based workshops and a previous Peer Leader retreat; or 4) never attended any FOXY/SMASH school-based workshop or prior Peer Leader retreat. The quantitative questionnaire for this study asked if participants had previously participated in any FOXY/SMASH programme, and if so, how many. The questionnaire did not distinguish between previously attended school-based workshops or Peer Leader Retreats; instead, it grouped them together as both being representative of prior engagement with FOXY/SMASH programmes.

Our independent variable of interest aimed to determine if participants in FOXY/SMASH Peer Leader Retreats had prior exposure to FOXY/SMASH either through school-based workshops or having previously attended a Peer Leader Retreat. In this analysis, the number of workshops/retreats attended was a categorical variable based on participants’ responses to being asked how many previous workshops/retreats they had attended, to which participants either indicated: 1) it was their first workshop/retreat; 2) they had attended one workshop/retreat; 3) they had attended two workshops/retreats; 4) they had attended three or more workshops/retreats.

Statistical analysis

The quantitative analysis aimed to answer two research questions:

Do participants in a FOXY/SMASH Peer Leader retreat report higher leadership and empowerment levels at the end of the retreat compared to the beginning of the retreat?

Are participants who attended previously held FOXY/SMASH workshops or retreats more likely to report higher levels of leadership and empowerment than participants attending their first ever FOXY/SMASH retreat?

We conducted descriptive analyses using frequencies and percentages to summarise categorical variables and means with standard deviations to summarise continuous variables. Non-parametric tests were used to compare pre- and post-retreat scores because these data were not normally distributed. We used Wilcoxon signed rank tests to assess the median difference in pre- and post-retreat scores for all participants to measure the impact of attending the retreat. Mann-Whitney U tests were employed to compare gender-stratified pre- and post-retreat scores. We constructed four multivariable linear regression models to determine whether the number of workshops/retreats attended was associated with improved scores in leadership and empowerment. The multivariable analyses adjusted for age, gender and pre-test scores. All statistical analyses were performed using Stata 16 (StataCorp, Texas, USA).

Qualitative analysis

We took an inductive [35], data-driven approach, integrating quantitative and qualitative findings, by triangulating focus group and survey data [38]. We applied thematic analysis [39] to focus group data informed by positive youth development frameworks [40] to explore Peer Leader Retreat experiences. After data familiarisation through reviewing transcripts, we generated an initial list of codes and then reviewed, defined and named themes. We first conducted data familiarisation and generated an initial coding framework for the complete dataset, which was then shared, discussed and modified with the author team. Following this, we selected codes related to empowerment-related outcomes, based loosely on a multi-level conceptualisation of empowerment that considers psychological, social, organisational and structural aspects [32,41].

Where applicable, codes were mapped onto the Lerner’s model of Positive Youth Development [40] model. Codes were named and adapted using an inductive approach to reflect the content and language used by participants. Analysis was also informed by a strengths-based approach that embraces individual and cultural strengths [32].

Ethics

Ethical approval for this study was obtained from the University of Toronto Research Ethics Board (Protocol #00038346) and the Aurora Research Institute. All participants provided voluntary, informed consent to take part in the surveys and focus groups.

Results

Participant characteristics

Table 1 displays the sociodemographic characteristics of participants enrolled in the Peer Leader Retreats. Overall, we enrolled 286 participants of whom over two-thirds identified as women (n = 196), close to a third identified as men (n = 84) and the remainder (n = 5) identified as neither men nor women (Table 1). Participants were 14 years old (SD: 1.13) on average, with the vast majority (87%, n = 235) being Indigenous and from the NWT (84%, n = 234). Close to two-thirds of participants had attended one or more prior workshops or retreats (62%, n = 176).

Table 1.

Sociodemographic characteristics of participants (N = 286).

Variable	n (%)
Mean age in years (standard deviation) n=286	14.4 (1.3)
Gender n=285
men	84 (29)
women	196 (69)
neither man nor woman	5 (2)
Indigenous n=270
Yes	235 (87)
No	35 (13)
Territories n=282
Northwest Territories	236 (84)
Nunavut	40 (2)
Yukon	6 (14)
Number of workshops/retreats previously attended n=285
None	109 (38)
One	102 (36)
Two	44 (15)
Three or more	30 (10)

Quantitative results

Impact of retreat on leadership and empowerment

Leadership post-retreat scores for participants were 3.5 points higher than pre-retreat scores (P < 0.001) and empowerment post-retreat scores for participants were 4 points higher than pre-retreat scores (P < 0.001) (Table 2).

Table 2.

Pre- and post-retreat scores for leadership and empowerment among participants.

	Pre-Camp Median Score	Post-Camp Median Score	Median Difference	P-value
Leadership scale	80	83.5	3.5	<0.001
Empowerment scale	42	46	4	<0.001

P-values were generated using Wilcoxon signed-rank tests comparing pre- and post-test scores

Table 3 displays a gendered analysis of median score gains after participating in the retreat. Male participants gained four points fewer than females on the empowerment scale at the end of the retreat (p < 0.001). Although we observed a higher score gain for females than males on the leadership scale, this difference was not statistically significant (p > 0.05).

Table 3.

Pre- and post-retreat score gains for leadership and empowerment stratified by gendered retreat (N = 286).

	FOXY Pre to Post Median Score Gain	SMASH Pre to Post Median Score Gain	P-value
Leadership scale	5	4	0.466
Empowerment scale	5	1	0.001

P-values were generated using Mann-Whitney U tests comparing pre- and post-test scores

Impact of peer model on leadership and empowerment

Compared to participants who had not previously attended a workshop or retreat, those who attended two workshops or retreats were likely to score close to six more points on the leadership scale (β: 5.74, 95% CI: 1.50–9.98) (Table 4). There was no statistically significant association between number of retreats attended and empowerment scores.

Table 4.

Simple linear regression multivariable models for leadership and empowerment in relation to number of workshops/retreats attended.

	Coefficient	95% CI	P-value
Leadership scale
Number of workshops/retreats previously attended
None	1	–	–
One	1.53	−1.78–4.84	0.363
Two	5.74	1.50–9.98	0.008
Three or more	0.43	4.65–5.50	0.869
Empowerment scale
Number of workshops/retreats previously attended
None	1	–	–
One	0.18	−2.01–2.38	0.869
Two	2.13	−0.69–4.94	0.138
Three or more	−2.85	−6.19–0.49	0.094

All models controlled for pre-test scores, age and gender

Qualitative results

Three empowerment-related themes were present across the qualitative data. These included: (1) improved leadership abilities and role-modelling; (2) social connections; and (3) increased feelings of empowerment and confidence. Each of these is described below, alongside exemplary participant quotes from focus group discussions. In this qualitative analysis, focus group discussion participants consisted of Peer Leaders, Peer Apprentices and Peer Facilitators, as described in the methods section. In the presentation of findings and discussion, these categories are noted where applicable, and all participant quotes denote the group type.

Leadership and role modelling: “I can actually lead the group!”

Qualitatively, participants expressed an increased desire and capacity to act as leaders and role models for other young people as a result of attending the retreat. Role-modelling was conceptualised as “leadership by doing”, a form of reciprocity in action where participants viewed their own behaviours, including how they treated others, their own health-affirming practices, and supporting the well-being of other youth as interconnected.

“ … something I do ferociously in my life is sit at the end of the day and think about how I interacted with everyone, how I made other people feel … it made me stronger. Every day I grew stronger and stronger being there.”

(Facilitator Focus Group, SMASH, 2019)

“When I first heard that I’d been accepted back into SMASH, I’m like … I’ve got to be on my best behaviour, I’ve got to be a leader … . I’m like, I’ve got to do this.”

(Apprentice Focus Group, SMASH, 2019)

Similarly, facilitators remarked on the value of peer leadership to peer leaders and apprentices. In the excerpts below, facilitators remarked on how peer leaders were motivated to grow in order to support others, and how their leadership roles encouraged them to navigate difficult situations with integrity:

“It meant a lot to [one of the peer facilitators] to be your helper, and he was doing a lot of growing, and he talked about how supported he felt by you … because of that he said that he wants to be able to help people more and stuff.”

(Facilitator Focus Group, SMASH, 2018)

“He [participant] displayed a lot of integrity in the cabin when he was like ‘you know what, [participant name] is my friend, but he’s putting other people at risk … he is putting other people in bad situations and we need to deal with this.’”

(Facilitator Focus Group, SMASH, 2018)

Participants shared that learning how to open up and express themselves in healthy ways and feeling connected socially enabled them to step into leadership roles.

“ … I talk more. I’m not so shy and everything, and I can actually lead the group and lots of things … ”

(Apprentice Focus Group, FOXY, 2018)

“I’m really grateful that I had that mentoring chance last time … It benefited my confidence for this time.”

(Facilitator Focus Group, FOXY, 2018)

“I think for me, just coming in here as a new person I was finding my legs and my role within it … I feel more confident going into the next one and thereafter because this was a huge learning experience for me.”

(Apprentice Focus Group, SMASH, 2019)

Importantly, returning participants also spoke about how their leadership roles supported them to navigate difficult situations. For example, one Apprentice participant (quoted below) described escalating issues of his school leadership to the school board, while another discussed that the retreats led to him to respond to disrespect in a respectful and positive way:

“ … all the stress, all those people who are not respecting you, and you respect them but they don’t respect you back. So, I just try to stay positive about that.”

(Peer Leader Focus Group, SMASH, 2017)

“I took confidence … because I don’t like really talking to people, and so I took this subject to my principal, and my principal … I’m not going to say the word, but he’s just very not a principal. So, I went to the school board with this subject, and they said that they would do something, and the teachers were there. I tried.”

(Apprentice Focus Group, FOXY, 2019)

As described above, improving leadership abilities and becoming role models for peers was enjoyable and a source of pride for participants. Participants understood role modelling and leadership as practices that benefited both themselves, as well as other young people.

Social connection: “It was meaningful because I could relate to everyone … ”

Participants from both the FOXY and SMASH Peer Leader Retreats consistently discussed connecting in healthy ways with other young people as one of the most impactful parts of the retreat. They conceptualised these social connections as being part of a “community” and a “family” and spoke effusively about how this was meaningful to them. An important part of such connections included feeling understood by other young people who had similar experiences and emotions.

“It was meaningful because I could relate to everyone and everyone knew how I felt …, and they were saying, like, ‘no one else is inside your body and knows what it’s like to be you’, but in everything we were doing there’s always at least one person that knew what I was talking about and knew how I felt. When I came here, I was scared … after the sleepover it was easy to talk to people … ”

(Peer Leader Focus Group, FOXY, 2018)

“The best parts for me were meeting new people, having a new family, having lots of fun, and having great activities to do and realizing that I need to start loving myself.”

(Peer Leader Focus Group, FOXY, 2018)

Similarly, FOXY and SMASH Peer Leader Retreat facilitators highlighted the importance of social connection for retreat participants. They suggested that these connections were important on their own, and that such connections also encouraged participants to take on leadership roles and to feel more confident and empowered:

“I always ask them on the way to the airport what their favourite parts at the retreat were, and there was a lot more like ‘we love everything’ … I was like ‘what, everything? You even love the community clean up?’ and some of them were like ‘well yeah, we don’t mind – we were all doing it together, so it was okay.”

(Facilitator Focus Group, FOXY, 2018)

“The new friends, like the new friends not just with the other participants but also with the staff uhmm because everyone would listen … people were listening and not judging and trying to help everyone. Alright yeah.”

(Peer Leader Focus Group, SMASH, 2017)

As demonstrated above, connecting with other young people, including feeling understood and seen without judgement, was a central feature of participant retreat experiences. Participants described retreat groups as tight-knit, often referring to them as “family” and “community”.

Empowerment and self-confidence: “It’s like you could finally feel good about yourself”

Feeling more empowered and confident was a strong theme that emerged qualitatively. Participants spoke about “confidence” directly, as well as through related sub-themes of: (1) feeling “less shy”, which resulted in speaking and participating more; (2) feeling more connected with and accepting of themselves; and (3) being able to better identify and express feelings. These sub-themes are described in further detail below with illustrative quotes.

Participants consistently spoke about feeling confident, describing their confidence as growing from their involvement in the Peer Leader Retreat:

“I think I grew as a more confident person, and I think I learned to do stuff more on my own and like not ask for help as much as I did at the beginning and learn to express myself more … ”

(Peer Leader Focus Group, FOXY, 2018)

“I am like a hundred times more confident in myself … ”

(Peer Leader Focus Group, FOXY, 2018)

“ … Past me, probably before coming to this camp, I really am not that positive about myself, and going to this camp has given me a lot more confidence in myself.”

(Peer Leader Focus Group, FOXY, 2019)

Participants also described feeling less shy, speaking more, and expressing themselves more easily and freely. Participants credited facilitators and peers for modelling confidence. They described the retreat as an open, non-judgemental environment that encouraged growth and expression rooted in connectedness with each other, facilitators, staff, Elders and land. After experiencing this retreat environment, participants felt better able to be expressive when they returned home. They also described how feeling less shy allowed them to connect more with others.

“Like everyone being so open with everything was really nice, cause then you like got to be open and express yourself, so now I feel more confident being open, so I feel like when I get back it will be easier to just be like more confident … Like just be your true self, cause everyone was really open with who they are here, so then it’s easier to do that when you get home. It was just really good.”

(Apprentice Focus Group, FOXY, 2019)

“ … uhmm, well before SMASH I was very shy, very, very shy … I would have a hard time talking in front of my friends, but SMASH has taught me like not be as shy and mostly because here no one judges, so it makes me comfortable talking in front of the group.”

(Peer Leader Focus Group, SMASH, 2017)

“Interviewer: Ok have you noticed any changes in yourself? … .

Participant: I have noticed some changes. I’m actually talking.

Interviewer: Yes, you are. Now you’re a talking ninja.

Participant: Yes. I’m talking … . Before I came here … I’m really quiet and no one really notices me when I’m in the room … ”

(Peer Leader Focus Group, FOXY, 2018)

Apprentices (returning peer leaders providing retreat support) also remarked that they saw participants become more open over the course of the Peer Leader Retreat:

“You just see people come out of their shells and start communicating with everyone, and participating … that’s really cool how FOXY does that … they did that to me last year, too, because I was really shy when I first got here.” (Apprentice Focus Group, FOXY, 2019)

“A couple of people, they were really, really shy, and in their own little box when they first came, and by the end of it, they were just new selves, and they really opened up. I think that was pretty cool to see.”

(Apprentice Focus Group, FOXY, 2019)

Participants also spoke about being more connected to and feeling better about themselves. They suggested that this made it easier to be comfortable around others and to express themselves freely:

“ … it’s like you could finally feel good about yourself”

(Peer Leader Focus Group, FOXY, 2017)

“It’s okay to talk to people, and you’re beautiful inside and out … ”

(Peer Leader Focus Group, FOXY, 2019)

“Participant 1: The changes in myself, I guess would be like I feel more like open to trying things and like I don’t know just kind of like more open.

Participant 2: That’s what I was about to say, but like it made me feel more like you don’t have to be ashamed of yourself, yeah and it like made patience too. That helped me”.

(Peer Leader Focus Group, FOXY, 2018)

“I have more confidence in myself cause so many people ditched me in my hometown, and it just brings me down. It like bottles all up inside and like I have mental breakdowns and so that changed for me as a person and just the way I speak about myself. I’m starting to speak more, good about myself than bad, and it’s meaningful to me, because I never thought I would be able to change myself for the better.”

(Peer Leader Focus Group, FOXY, 2018)

This corroborated with accounts of facilitators, who shared anecdotes about the growth demonstrated by specific participants. Facilitators spoke about seeing changes in participants, such as wearing bright colours, becoming louder, or changing their hairstyles as forms of self-expression which they related to improved confidence.

“ … she was even loud on the last day … I thought that was like … huge. That’s up there with like, “what did you do to my kid? She’s wearing colour now.” … I’ve known (participant) now for I think four years, she started coming to workshops when she was quite young and in that entire time, she has never spoken as much as I’ve heard her talk in one day at this retreat and it was awesome.”

(Facilitator Focus Group, FOXY, 2018)

Participants spoke about being better able to identify and express their feelings because of FOXY/SMASH Peer Leader Retreats. They appreciated being encouraged to connect with themselves and their feelings, and having the opportunity to express emotions in a space that felt safe and non-judgemental. This was especially important as many participants shared about experiencing trauma and loss prior to the retreat. Some participants spoke about the ability to be vulnerable as something that felt good and that they had not felt able to do at home. Importantly, they related these skills to relationship skills and identifying and expressing what they like and do not like in healthy, non-violent ways. Participants discussed talking circles and drum circles at the retreats as spaces that were conducive to opening up and being supported to identify and express feelings. Traditional drumming and singing were activities that supported Peer Leaders to develop embodied connections to themselves, their stories and their emotions. These activities included learning and singing traditional songs, connecting with peers during campfires, and an “island day” on an island close to the retreat location, which included a grief circle, ceremony, smudging, traditional drumming and a sharing circle.

“When it was time for drum circle and then time for the activities and all that stuff, it was easier to go inside yourself and recognize your feelings, and not like just if you get mad at someone then your first reaction is to hit someone because you can notice what you’re feeling like instead of just wanting to hit.”

(Peer Leader Focus Group, FOXY, 2018)

“In my family I was treated not … to cry so I never cry ever since my sister passed away … I only cried about three or two times for her, because my family and my father were treating me that the way for me to cry is to let me cry in my heart, so I just did that … It felt pretty good to cry again … ”

(Peer Leader Focus Group, FOXY, 2018)

“It was good to let everything out … Good that we all know each other’s stories and no one can talk about it and we all can trust each other and we just – and that all our feelings are welcomed here.”

(Peer Leader Focus Group, FOXY, 2018)

“Ah the changes in myself, that I got to my feelings in front of the whole group which I never ever done in my life … It feel … good to let it out. And try to get the anger out too.”

(Peer Leader Focus Group, SMASH 2017)

Feeling more empowered and confident – including feeling less shy; more accepting and connected with themselves; and being about to better identify and share feelings – was a strong theme and an aspect of participant retreat experiences that they described as important and meaningful.

Discussion

Findings demonstrate how peer programming, imbibed with land- and- art-based approaches supported the empowerment of Indigenous and Northern youth who attended FOXY and SMASH Peer Leader Retreats through improving confidence, leadership, and positive social connections. Our results build on previous findings from this same programme, which demonstrated improved sexual health knowledge, safer sex self-efficacy, and increased resilience [12].

The perspectives and experiences of FOXY and SMASH Peer Leader Retreat participants – gathered from focus groups and triangulated with surveys – build upon the positive youth development literature and point to important areas for empowerment-related programming with Indigenous and northern young people. First, they bolster growing evidence on the value of positive youth development programming grounded in Indigenous land- and art-based teachings, – which included cultural teachings through storytelling, ceremony, and connecting with Elders –

alongside traditional arts such as beading, songs and drumming. They affirm the value of strengths-based approaches that uphold and draw upon the knowledge and skills of Indigenous and Northern young people. In focus groups, participants consistently described feeling more confident and less shy, more capable of responding to challenges, and more prepared to act as leaders. Qualitative data triangulated with quantitative findings, which suggest that participating in FOXY/SMASH Peer Leader Retreats improved leadership and empowerment scores.

These findings dovetail with growing evidence on how land- and- art-based approaches, grounded in social justice with Indigenous youth can be empowering [17,42]. For example, a positive youth development programme for Indigenous youth in the USA demonstrated efficacy in health and empowerment and documented the value of Indigenous-focused youth empowerment models through an Indigenous lens [27]. Programming that focuses on youth development strengths, including through skill-building, opportunities for participation in leadership, and sustained positive adult-relationships can support confidence, connection, health, and well-being of young people [25]. Prioritising the strengths and knowledge of young people and focusing on health and well-being principles (such as respect and trust) rather than negative, deficit, and risk-focused discourses may be a more fruitful way to promote adolescent health and well-being [19].

Second, findings align with multi-layered approaches to empowerment that address individual, relational, and communal aspects of positive youth development. Youth empowerment has been described as a continuum, encompassing individual empowerment through increased self-esteem and self-efficacy to community empowerment through raising collective consciousness and critical action [30]. Findings from this study suggest that the Peer Leader Retreat was effective across domains of individual, relational, and communal aspects of empowerment. Qualitatively, participants noted that the young people who attended grew in confidence, felt more connected with others and – for those who returned as Peer Apprentices to later retreats – felt more empowered outside of the retreat. Although empowerment was a strong theme qualitatively, and improved quantitatively post-retreat, empowerment was not associated with the number of workshops or retreats attended. This suggests that attendance of one workshop or Peer Leader Retreat may be effective on its own.

Participants also highlighted that the open environment of the retreat encouraged awareness of themselves and their feelings and supported healthy communication skills. This finding was particularly prominent with boys, who spoke about social norms that deter them from identifying and expressing emotions, and forming meaningful connections with other boys and men. Similarly, in her work with Indigenous young people in Alaska, Wexler [43] found that engaging methods for sharing lived experiences can augment identity-based factors, contribute to positive development and support youth to move into healthy adulthood. An Australian adolescent sexual health intervention found that building skills, awareness, skills, improving communication, safe and open environments, peer engagement and confidence-building were central to empowerment and health and well-being related practices [44].

Third, findings demonstrate the possibilities of peer-models to support confidence, connection, and empowerment. Our findings build upon a small but crucial body of evidence on Indigenous youth peer leadership. In our study, prior retreat or workshop attendance was associated with increased leadership scores, and participants suggested that retreat or workshop attendance increased their capacity and desire to act as role models and leaders to other young people. Importantly, they described role modelling healthy behaviours and relationships as a form of leadership through action. Similarly, a Canadian peer-led Indigenous youth HIV prevention initiative found that Indigenous youth leaders reported confidence, trustworthiness, resilience, and health [45]. A systematic review [46] of Indigenous youth peer-led health promotion in Canada, Australia, and the USA found that being a peer leader conferred benefits of improved self-perception, improved self-confidence and self-esteem. A school-based culturally-relevant mentorship programme for Indigenous youth in Ontario found positive mental health outcomes and improved cultural identities for programme participants [47]. The same study found evidence of improved intrapersonal impacts with peer facilitators, including new and strengthened relationships, increased communication and connectedness with peers [47].

Connectedness – that is, a sense of caring, support, and belonging [48] with peers at school and with family – has been reported as protective across a number of adolescent health and well-being related outcomes including mental health, sexual behaviour, violence, and substance misuse [49-51]. FOXY and SMASH Peer Apprentices reported feelings of social connectedness with peers, Elders and their broader communities. This may be because returnees felt more connected due to returning to the same place and seeing some of the same people year after year, or that acting as a Peer Apprentice contributed to feelings of connectedness. It is also possible that being trusted with increasing responsibility improved feelings of social connectedness. Future research could explore how long-term involvement in such a programme may support identity-related factors, increased social connectedness and a sense of belonging. Last, nascent findings point to the importance of gender-transformative mentorship and programming. Gender emerged from both the qualitative and quantitative evidence as an important aspect of programming. Qualitative findings suggested that being encouraged to open up, express feelings, and meaningfully connect with male participants and leaders was especially important for attendees of the SMASH Peer Leader Retreat.

Within Indigenous and Northern Canadian contexts, western patriarchal colonial masculine norms have been documented as having far-reaching and damaging impacts, disrupting more egalitarian gender norms [52]. Given current hegemonic masculine norms [53], which place pressure on men to act tough and limit expressions of emotion, the possibilities and mechanisms for the efficacy of masculinity-related programming are rich for future exploration.

Given the increasing acknowledgement that men and boys must be better engaged in HIV, SRH [54,55] and GBV programming [56], such exploration would be timely. Despite growing research and programmatic focus on work with men and boys, limited research explores the processes, politics, limitations, and challenges of such work [55], and this is true within Indigenous and Northern Canadian contexts. Similarly, approaches that seek to improve the mental, sexual, and reproductive health of boys and men increasingly highlight the need for gender transformative programming to address and transform harmful hegemonic masculine norms [57]. Some participants in this study suggested that including male Elders could be a valuable addition to the masculinity programming, and spoke about the value of male peers and facilitators that can act as role models. This aligns with the suggestion that it is important to consider the intersubjective identities of programmers and participants and to consider gender-concordant facilitators [58].

The role of art- and land-based approaches in shaping reported empowerment-related outcomes is important to note. While primary data reported on in this manuscript focuses on empowerment-related outcomes, these cannot be separated from the art- and land-based activities which form the backbone of retreat programming. Art- and land-based retreat activities were specifically designed to engage the knowledge, lived experiences and agency of participants and to bring Peer Leaders, Apprentices, Facilitators and Elders into connection and dialogue. This approach aimed to foster community, trust and agency – all relevant to the themes presented below of empowerment, leadership, confidence and social connectedness. Land-based activities and traditional learning were engaged with explicit aims of connecting young people to each other, nature, Elders and traditional teachings. Further, cellular phones and other personal electronic devices were not allowed at the retreat, with the aim to encourage participants to connect with themselves, the land and with one another, staff and elders. As can be seen by the qualitative quotes, aspects of drumming in particular were often cited as supporting participants to feel more connected to themselves and each other. Although outside of the scope of this paper, further research could identify specific land- and art-based activities that were particularly meaningful and supportive to participant empowerment and well-being related outcomes.

There are several study limitations. Dominant frames of empowerment have been critiqued for over-emphasising individual-level aspects of empowerment in light of social and structural oppression [19]. Further, there are diverse – and sometimes conflicting – ways that empowerment outcomes can create both possibilities for, and limit action based on youth priorities and context [19]. For these reasons, it has been suggested that empowerment should be understood to be dynamic, generative, and acknowledge complex relationships between empowerment and the health of young people. Outcome measures were self-reported and therefore subject to social desirability bias, which we limited by pilot-testing and reviewing the surveys. Our independent variable of interest (number of workshops/retreats attended) did not differentiate previously attended school-based workshops from Peer Leader Retreats. We were, therefore, unable to attribute any association between our independent variable and leadership/empowerment scales to a specific FOXY/SMASH programme. The sample is non-random, and thus results cannot be generalised to all Northern youth. Also, there could be selection bias, whereby youth who felt more empowered and were already leaders might be more likely to participate in the retreat. Lastly, our convenience sample was not gender balanced and potentially overrepresented the FOXY Peer Leader Retreats.

Conclusion

Adolescence is a crucial time in the life course, and empowerment-related programming can be especially supportive of adolescents who have been marginalised. Indigenous and Northern young people in Canada are one such group that has been marginalised due to the historical and ongoing effects of colonialism and racism. Findings from this mixed-methods study document how peer leader art- and land-based, culturally grounded programming with this group can be empowering, improve confidence, social connectedness, and leadership abilities.

This research responds to the call for evidence on peer-led interventions with Indigenous young people that explore contexts and mechanisms under which peer health promotion is effective [46]. Findings demonstrate the possibilities of peer models to support confidence and connection and provide details about the empowerment-related pathways through which such programming may improve sexual and reproductive health and mental health outcomes.

Findings contribute to the emergent evidence base on the value of strengths-based positive youth development programming grounded in Indigenous teachings, and align closely with the suggestion that empowerment programming should target multiple individual, relational, and communal levels. Findings suggest that gender shapes empowerment-related programme outcomes, and that further gender-transformative research and programming is warranted.

Further research should explore the longitudinal effects of such programming, and the mechanisms through which such changes occur.

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