A new study in Canada’s Indigenous communities, using sharing circles as the primary method of qualitative data collection, shows that heart health is shaped by emotional, spiritual, social and systemic factors, and that trauma has a strong impact on how care is accessed and trusted. The research results are CJC Openpublished by Elsevier as the journal’s first arts-based report. This innovative format provides an authentic visual narrative that reflects the depth of our community’s experiences and perspectives.
This study highlights the need for interventions beyond clinical management, including culturally-based nutrition programs, relationship-centered care pathways, and models that combine Indigenous and Western knowledge systems.
Indigenous people in Canada are approximately 2.5 times more likely to develop cardiovascular disease than non-Indigenous people. The remote location of communities in the James Bay and Hudson Bay regions poses significant challenges for people living with heart disease. Local medical services are limited, with many patients having to travel three to nine hours south for treatment.
Despite these barriers, communities continue to draw strength from cultural bonds, relationships, and collective resilience toward a promising future. A collaborative partnership was formed between the University Health Network (UHN) and the Weeneebayko Area Health Authority (WAHA) to gain critical insights into regional heart health and the opportunity to improve access to culturally safe care.
This study is based on community-based participatory research (CBPR), which emphasizes equity, reciprocity, and shared decision-making across all stages of research. To integrate the relational principles of CBPR into practice, sharing circles, a communication practice rooted in Indigenous storytelling traditions, were used as the primary method of qualitative data collection.
Four themes emerged from the sharing circle in Moosonee, Ontario:
- Heart health is more than an indicator
- honor our trauma
- Eliminating the stigma of care through relationship building
- Innovative solutions start with the community
“Academic research is often accompanied by predetermined, deficit-based assumptions about Indigenous communities and their health outcomes without considering the colonial influences that created the situation,” said Dr. Searle Wali, principal investigator and team leader of the Transform Heart Failure Strategy Initiative at the Ted Rogers Heart Research Center at the University of Toronto.
This study celebrates the stories of communities inspired by traditional teachings that challenge Western definitions of heart health. We wanted to emphasize overall health rather than just focusing on physical symptoms. ”
Sahar Wali, University of Toronto
One of the most surprising and meaningful findings was the central role of humor as a culturally rooted and intentional mode of communication. “Community partners emphasized that humor is deeply embedded in everyday life and is an important way to address topics that are emotionally heavy, historically painful, or difficult to discuss.Rather than diminishing the severity of the heart disease experience, humor served as a source of strength, resilience, and connection,” explains WAHA co-author Justice Seidel, a medical student at the Northern Ontario College of Medicine and a member of the Moose Cree First Nation.
Insights from the research were translated into an art-based graphic report based on the principle of “seeing with both eyes” (a metaphor for negotiation between two cultures) to bridge Indigenous and Western knowledge and foster engagement across communities and caregivers.
This is the first time that research has been published in this form. CJC Open. “Tracking a path less traveled, this art-based graphic report upholds the authenticity of Indigenous stories, embraces a holistic worldview of health and healing, and strengthens the voices of Indigenous communities,” said accompanying editorial author Laura Banks, Ph.D., M.A., Ontario Institute of Technology in Oshawa, and University of Toronto Health Network.
She added: “Storytelling remains a valuable form of knowledge for Indigenous peoples, used to share traditions such as cultural beliefs, history, values, relationships, and customs. This approach can perhaps increase the potential for both healing and well-being for the complex grief and history that continues to be lived out by too many Indigenous peoples in today’s world.”
Graphic medicine was intentionally chosen for its ability to convey complex health concepts and lived experiences in an approachable and emotionally resonant manner.
Q. “Cartoons are one way to make research fair for everyone,” said Jane Zhao, lead author, senior graphic artist and PhD candidate at the Institute for Health Policy, Management and Evaluation at the University of Toronto. “By translating the research into an accessible comic report, we’ve made sure that the public, the community members who participate in the sharing circle, understand what they contributed – that their stories really matter.”
Although the methodology of this study was developed in the context of indigenous communities, it offers valuable transferability to other minority groups. These minority populations often face disproportionate cardiovascular risks, systemic barriers to care, and the need to navigate complex social and cultural determinants of health.
Dr. Wali concludes, “Storytelling empowers community members to speak and share their stories in their own voices, reclaiming space and power from systems that have long silenced or distorted the truth.”
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Reference magazines:
Chao, J. others. (2026) Heart Health Starts with Community: An Arts-Based Report on Heart Health Experiences in the Moosonee Community. CJC Open. DOI: 10.1016/j.cjco.2025.12.013. https://www.cjcopen.ca/article/S2589-790X(25)00771-1/fulltext.
