Introduction

Indigenous girls and women in Canada are at the highest risk of violence victimization of all population groups in the country [1]. Intimate partner violence (IPV)–defined as ‘violence committed by a current or former legally married or common-law spouse, or dating partner’ [2]–is among the most pervasive forms of violence against women [3], and is a major element of violence experienced by Indigenous women. Indigenous women are significantly more likely that non-Indigenous women in Canada to experience all forms of IPV, with 59% of First Nations, 64% of Mátis and 44% of Inuit women reporting experiencing psychological, physical or sexual violence by an intimate partner in their lifetime [4]. This epidemic of IPV is among the deep reaching intergenerational harms caused by colonialism, residential schools, the Indian Act and state enforced erasure of traditions and culture [2,5–8]. It is particularly important to understand IPV in Arctic contexts such as the Northwest Territories (NWT), Canada where girls and women are disproportionately affected.

Prevalence of IPV in NWT are among the highest in Canada, up to ten times higher than the rest of the country [9]. In 2019, the NWT saw 4,083 reports of IPV per 100,000, although such reports are largely a gross underestimate of IPV occurrences [3]. Indigenous peoples comprise a majority of the NWT population and are significantly overrepresented in experiences of IPV of all forms [4,10]. IPV is gendered, and women and girls report IPV in NWT at a rate 2.2 times higher than men and boys [3]. It is urgent to address IPV among young people in the NWT, as adolescence is also a time of heightened risk of IPV—in Canada, young people aged 15–24 are more than twice as likely as the general adult population to have experienced recent IPV [10].

While less data is available on prevalence of IPV among Indigenous and Northern young people in Canada, a recent study among 240 youth in NWT found high prevalence of experiencing (62%) and perpetrating (55%) IPV [11]. Adolescence is an important time in the life course, comprised of major social and developmental transitions with lifelong implications. While risk for IPV victimization and perpetration increases throughout adolescence into emerging adulthood, and then decreases, risk can remain high for those who have survived IPV [12]. Experiencing IPV in adolescence is associated with adult experiences of IPV [13] and depression [13]. IPV has significant and long-lasting impacts on survivors, families and communities [2]. Long-term health impacts of IPV victimization include adverse psychological consequences including depression, suicidality and post-traumatic stress disorder [14], as well as a range of other health issues such as hypertension and chronic pain [15]. The long term impacts of IPV among adolescence underscores the critical need for contextually, gender, culturally appropriate prevention strategies.

Emergent evidence points to the benefit of strengths-based, culturally relevant approaches in health programming with Northern and Indigenous youth. This is needed as a counterpoint to deficits-based research with young people that can frame youth as risk takers, and lacking the skills to care for their health and well-being [16]. Similarly, deficits-based approaches are common in Indigenous health research and practice [17] which marginalise the voices of Indigenous people [18–22]. Despite this, Indigenous youth continue to demonstrate tremendous creativity and resilience. Approaches such as peer-led, art- and land-based youth programming can be empowering [23], and can support coping,[22] resilience, connectedness and self-efficacy for Indigenous and Northern Youth [24]. Such approaches have been documented as transformative, with the potential to catalyze social change and promote social inclusion in diverse global contexts [25]. The importance of culturally-, socially- and historically-responsive violence prevention and healing strategies for youth are being increasingly recognised in research and policy [4]. While strengths-based approaches to healthy relationships hold the potential to advance the health and wellbeing of Northern and Indigenous adolescents, less is known about youth experiences of such programming and their promise in advancing IPV prevention in the NWT.

In response to this critical knowledge gap, this study examines the role of Peer Leader Retreats in addressing attitudes towards IPV and in instilling the knowledge and skills to promote healthy relationships with youth in NWT. The study aims were two-fold. First, we use qualitative analysis from focus groups to explore and document the knowledge, experiences, and perspectives of youth participants in Peer Leader Retreats. Second, we use quantitative analysis to determine pre -post Peer Leader Retreat changes in IPV attitudes by gender. We apply findings to Michau and colleagues’ prevention of violence against women and girls framework [26] to conceptualise the inter-related individual, interpersonal and communal aspects of healthy relationship promotion and IPV prevention among youth participants of Peer Leader Retreats in the NWT.

Materials and methods

Fostering Open eXpression among Youth (FOXY) [24] and Strength, Masculinities, and Sexual Health (SMASH) [27] deliver Peer Leader Retreats in the NWT [24]. As an action research program, they aim to promote healthy relationships, sexual health, and resilience among Northern and Indigenous adolescents using a peer model [24]. FOXY and SMASH nine-day retreats were held annually with adolescents aged 12–19 between 2017 and 2021 in NWT. Retreat participants were recruited using purposive and peer-driven recruitment strategies, including through school, community partners, peer networks, community agencies and over social media in NWT, Yukon and Nunavut between 2017 and 2021. Inclusion criteria were: aged 13–17, living in NWT, Yukon or Nunavut and providing parental consent and youth assent.

FOXY and SMASH Peer Leader Retreats were designed by two lifelong Northerners, one of whom is Indigenous. They were delivered by a group of rotating facilitators, most of whom are from Northern Canada and/or Indigenous. The facilitators at the FOXY Peer Leader Retreats were women and non-binary individuals, while SMASH Peer Leader Retreat facilitators were men, women, and gender diverse people. Retreat leadership also included peer apprentices (volunteer) and peer facilitators (staff), aged 14–21 who had previously attended the retreats as Peer Leaders. Peer Leader Retreat programs included ceremonies, Elder teachings, sharing circles, grief circles, digital storytelling, rattle-making, beading, traditional hand drumming, photography, visual arts, Northern games, sexual and mental health education, journaling, personality mapping and community leadership projects. Design and findings from these programs have been documented elsewhere [23,24,28,29]. FOXY and SMASH are funded by a government and non-governmental research and programmatic funders [30,31].

Data collection

Quantitative retreat data were collected using a single-group, pre-post test design. A paper-based questionnaire was administered to Peer Leader Retreat participants by an evaluation consultant immediately before, and directly after attending the retreat to assess outcome changes following retreat participation and socio-demographic characteristics (e.g., age, gender, and ethnicity).

Each participant was invited to participate in a focus group discussion (FGD) at the end of the retreat. Focus group discussions (FGDs) were conducted in 2017–2021 with 311 participants, including peer leaders and apprentices (n = 69 groups; ages:12–19) and peer and adult facilitators (n = 14 focus groups; n = 165 facilitator participants). FGD participants were peer leaders, apprentices (returning peer leaders), and facilitators (including youth and adult staff facilitators). FGD questions focused on retreat experiences, relationships skills, leadership, observations of changes in self, healthy relationships and sexual health knowledge. FGDs were recorded with participant consent and transcribed verbatim. Further details of retreat participants demographics can be found in Table 1.

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Table 1. Focus groups by group type and year (2017–2021).

https://doi.org/10.1371/journal.pone.0298166.t001

Qualitative results

Qualitative findings suggest three, interconnected levels of healthy relationship promotion and violence prevention among FOXY and SMASH participants that align with social ecological approaches to IPV [26]. First, they spoke about the content and value of individual-level learning of healthy relationship knowledge and skills. Second, they spoke about specific aspects of the Peer Leader retreat as an enabling environment to learn about, and practice healthy relationship skills. Third, they spoke about the relevance of their learning for their families, communities, and across generations. In doing so, they demonstrated how they understood learning about, and enacting healthy relationships as relational, communal and intergenerational. Each of these three, interconnected layers are described below with attention to sub-themes. We adapted Michau and colleagues’ [26] socio-ecological framework for the prevention of violence against women and girls, focusing on youth empowerment at the individual, interpersonal, and community levels (see Fig 1).

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Fig 1. IPV prevention and healthy relationship empowerment across the ecological model amongst Indigenous and Northern youth peer leaders (adapted from Michau et al prevention of violence against women and girls model).

https://doi.org/10.1371/journal.pone.0298166.g001

Quantitative results: Participant characteristics

Table 2 displays the sociodemographic characteristics of participants enrolled in the Peer Leader Retreats. Our analysis included 240 participants who had ever been in an intimate relationship (87 young men and 144 young women) about their attitudes towards IPV. The mean age of the respondents was 14.5 years (SD = 1.3), and most participants (64.2%) were from the FOXY retreat. Nearly seventy percent of participants were Indigenous. Most participants identified as heterosexual (66.4%), while sexually diverse participants accounted for 33.6% of the study sample.

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Table 2. Sociodemographic characteristics of quantitative participants (n = 240).

https://doi.org/10.1371/journal.pone.0298166.t002

Quantitative results: IPV attitudes

Cronbach’s alpha was computed separately by gender, and the scale had an acceptable internal consistency with Cronbach alpha of 0.73 (male: 0.69; female: 0.74) for the 10 items’ scale, and 0.90 (male: 0.90; female: 0.86) on the 11-item scale.

As shown in Table 3, respondents from 2018 to 2020 indicated low attitudes accepting of IPV. The mean level of attitudes accepting of IPV for the entire sample was 1.41, and most study participants (88%) stated higher acceptance of violence as either “completely wrong,” or “mostly wrong”. IPV attitude scores among young men were not significantly different between pre-retreat (mean = 1.39, SD = 0.65) and post- retreat (mean = 1.49, SD = 0.76). However, among FOXY participants, approval of attitudes toward accepting IPV reduced significantly after the retreat (mean pre-retreat = 1.41, SD = 0.62; mean post-retreat = 1.28, SD = 0.46; p = 0.0019).

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Table 3. Mean levels of endorsement of attitudes toward IPV before and after training by gender, 2018–2020 (N = 173) Pvalues were generated using paired T-tests comparing pre- and post-test scores.

https://doi.org/10.1371/journal.pone.0298166.t003

For study participants enrolled from 2018 to 2020, pre- and post-training changes in boys’ and girls’ on approval levels for each item in the scale were similar, except for three items among girls (Table 3). After the retreat, FOXY participants showed significantly lower acceptance attitudes for the following three scale items: “A person sometimes deserves to be hit by the person they date” (1.41 vs 1.19, P< 0.001), “Sometimes a person has to hit their boyfriend/girlfriend/partner to get them back under control” (1.64 vs 1.47, P< 0.05), and “It is OK for a boy to force a girl to have sex if he paid for all the costs of a date (1.25 vs 1.05, P< 0.05).

Likewise, for the 2021 participants, FOXY participants scored significantly lower for their overall attitude toward acceptance of IPV after retreat, pre- (mean = 13.21, SD = 3.64) and post-retreat (mean = 12.29, SD = 2.63) (p = 0.0256). As shown in Table 4, SMASH participants’ attitudes toward accepting IPV also reduced, though was not significantly different between pre- (mean = 16.38, SD = 6.18) and post-retreat (mean = 14.67, SD = 4.49) (p = 0.1592).

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Table 4. Mean levels of endorsement of attitudes toward IPV before and after training by gender, 2021 (N = 63).

https://doi.org/10.1371/journal.pone.0298166.t004

Discussion

We explored the role of Peer Leader Retreats in supporting healthy relationship knowledge, skills and efficacy amongst Indigenous and Northern young people in the NWT. Findings demonstrate the potential role of Peer Leader retreats in improving IPV and healthy relationships knowledge and skills, alongside effective aspects of programming. Findings also point to the communal, relational and intergenerational meaning of such knowledge for young men and women. Results build on previous findings from this same program, which demonstrated empowerment-related outcomes [23], improved sexual health knowledge, safer sex self-efficacy, and increased resilience [24] to show that peer and land-based approaches hold promise in IPV prevention.

The perspectives and experiences of FOXY and SMASH participants–gathered from focus groups and triangulated with surveys–point to important areas for strengths-based, healthy relationships programming with Indigenous and Northern young people. First, findings affirm the value of strengths-based peer leader approaches that focus on teaching about healthy relationships, providing skills and creating opportunities to see, enact and share about healthy relationships. Such an approach stands in contrast to negative, deficit, and risk-focused youth violence discourses [16]. Further, findings affirm the value of a trauma-informed approach, which acknowledges intergenerational trauma, including from violence of colonisation and residential schools. In doing so, findings respond to the paucity of literature on strengths-based and culturally-informed approaches to intimate violence prevention among Indigenous and Northern young people, which may have relevance for both primary, and secondary IPV prevention. They contribute to a growing call for the importance of culturally, socially and historically responsive violence prevention and healing strategies for youth in Canada [4]. They also bolster a growing evidence on work with Indigenous and northern young people in the Northwest Territories on sexual health, relationships, health and wellbeing [36–38].

While qualitative findings demonstrate the value of violence prevention and healthy relationship programming with Indigenous and Northern young people, results were gendered and suggest that programmatic aspects may affect young men and women differently. While this study was not designed to test effectiveness of the Peer Leader Retreats in impacting outcomes, we did note among young women significant reductions in accepting attitudes toward IPV following retreat attendance. Qualitatively, young women were strongly committed to sharing what they had learnt with other women, demonstrated uptake of leadership roles and a communal commitment to violence prevention. Young men discussed the importance of being able to identify and express emotions as an important aspect in preventing violence perpetration, and resonated strongly with learning about values of respect. The gendered nature of these findings point to a need to further explore gender-tailored healthy relationship and IPV prevention programming, including the possibilities and processes through which strengths-based and trauma-informed Peer Leader Programming may interrupt and re-signify hegemonic masculine norms [39]. This is especially pertinent given a relatively limited research and programmatic focus on boys and men [40,41]. Such an exploration would be well-placed and timely, given the damaging and far-reaching impacts of western patriarchal colonial masculine norms which have disrupted more egalitarian gender norms within Indigenous and Northern contexts [42].

Findings also demonstrate the value of peer-models in healthy relationship programming. In a previous study, we found that role modelling healthy behaviours and relationships was considered to be a form of leadership through action [23]. Similarly, a school-based, culturally-relevant peer programme for Indigenous youth in Ontario documented improved communication, strengthened relationships, and connectedness with peers [43]. Connectedness–including belonging, caring and support [44]–with peers, family and community is protective against violence [45]. Findings from this paper contribute to this evidence in the North, and provide insight into how young Indigenous and Northern women take on leadership roles in IPV prevention and the promotion of healthy relationships. In particular, FOXY participants discussed improving healthy relationship knowledge as something highly relevant to their communities, and described feeling excited and empowered to share what they learnt with others through community projects. This finding suggests that a motivator for enacting and promoting healthy relationships is feeling empowered through knowledge and a leadership role to enact positive change. Peer leaders interpreted violence prevention and healthy relationship promotion as a relational responsibility, extending beyond their own intimate relationships to the health of their communities. In this way, they demonstrated that they viewed their commitment to healthy relationships as communal, relational and intergenerational.

Findings demonstrate the broad applicability of Michau and colleagues’ [26] socio-ecological framework for the prevention of violence against women and girls, mapping aspects across inter-related ecological systems in creating relationships free of violence. Findings from this study suggest that Peer Leader Retreats supported violence prevention at individual, interpersonal and communal levels. At the individual level are empowerment and opportunities for women, and support and accountability for men, developed through awareness and knowledge (consciousness-raising) as well as skills for healthy relationships and IPV prevention. The interpersonal level includes the Peer Leader Retreat environment, inclusive of learning from role-models, skill-building through embodied and relational activities, traditional teachings and learning through practice. At the community level, we note enabling environments inclusive of leadership skills and opportunities, relational and communal violence prevention approaches, community-level outreach including social media (e.g., TikTok, Instagram) and popular education. We also include strengths-based and trauma-informed approaches as part of an enabling environment. Given the nature of data collected, we did not engage enabling aspects of the broader societal level of the model. While this framework was broadly applicable, there were notable distinctions in study findings which are reflected in the adapted model.

First, participants engaged these levels relationally, and as a continuum from individual consciousness-raising and skill building outwards towards the creation of enabling environments and collective empowerment for social change. Second, they demonstrated that they understood promoting healthy relationships and preventing IPV as a communal, relational and intergenerational commitment, encompassing care and respect for Elders and future generations. For this reason, we have added an arrow across spheres to demonstrate the intergenerational and temporal nature of empowering heathy relationship learning and skills-development. We note the presence of relationality, holism and reciprocity as core enablers across domains. Last, findings demonstrate the value of strengths-based, culturally-grounded and trauma-informed programming. Participants engaged respect–within the ‘interpersonal’ category of the Michau model–as well as holistic, relational and communal notions of well-being as motivators towards healthy relationships. We amend the model to include approaches that value reciprocity and holism as enablers across individual, interpersonal and community levels. This finding builds upon literature that documents how building culturally relevant approaches of holism, reciprocity and relationality into research and practice with Indigenous and Northern young people is supportive of health and well-being [46–48].

There are several study limitations. There was no control group, so it is not possible to determine causality and attribute changes in outcomes to intervention participation. As the sample size per retreat was small, we pooled data across several retreats, and this could obscure differences that may have happened between retreats. We did not power the study to evaluate changes in outcome variables; the study design reflected a community-based approach to building skills among youth and the ideal number of youth were determined by the FOXY and SMASH programmes. IPV attitudes were self-reported and therefore subject to social desirability bias, which we limited by pilot-testing and reviewing the surveys. Further, IPV attitudes were measured using two different scales, which impacted comparability across retreats. Selection bias may be present in our sample, whereby youth who were more attuned to issues of violence prevention and already identified as leaders might be more likely to participate in retreats. Last, our convenience sample potentially overrepresented female participants.

Despite these limitations, this study provides a unique contribution to the small but crucial literature on strengths-based, empowering IPV prevention and healthy relationship programming with Indigenous and Northern young people, shining valuable light on an existing, strengths-based and culturally-informed model for Indigenous and Northern youth in Canada’s Arctic. Findings thus have relevance for policy and programming, amplifying the call for culturally-grounded, locally- informed and community-oriented IPV prevention within an important, yet underserved group.

Conclusions

This multi-methods study documented how Peer Leader programming can empower Indigenous and Northern young people, their families and communities with healthy relationship knowledge and skills. Findings suggest that the effects of such programming are gendered, and that components of effective violence prevention programming with adolescent boys and young men merit further exploration.

Findings demonstrate the possibilities of peer models to encourage healthy relationships, suggesting that embodied learning and leadership opportunities are particularly effective in equipping youth with violence prevention and healthy relationship skills. Young women in particular demonstrated a commitment to sharing knowledge and skills about healthy relationships in their communities, including through novel approaches such as social media. For young men, teachings of respect, alongside support to feel and express feelings was described as empowering and transformative. Participants regardless of gender, demonstrated their belief that healthy intimate partner relationships also have communal and relational functions, and are an investment for future generations.

Findings contribute to the emergent evidence base on the value of strengths-based, culturally-responsive violence prevention programming, and suggest that such programming is well-placed within peer-led, community initiatives.

Supporting information

Acknowledgments

Foremost thanks to FOXY and SMASH participants, including those who attended Peer Leader Retreats for generously sharing their time and expertise.