SAMINOR 3

       

SAMINOR 1 and 2 have contributed significantly to our understanding of public health among the Sami and northern Norwegian populations. However, they have also raised new research questions, which are being addressed in this third round. Additionally, there is a need to monitor the public health profile over time.

It is essential that the research conducted benefits the population and is carried out in close collaboration with them. Therefore, local communities and municipalities have been included in all phases of the research project, from planning to publication—this approach is unique. This collaboration establishes a close partnership between the research institution and the multi-ethnic population.

Photo: Jonatan Ottesen, Inger Dagsvold, Fotodama AS

Purpose

The main objective of SAMINOR 3 is to enhance knowledge about health and living conditions among the Sami, Kven, and Norwegian populations in selected areas of northern and central Norway. Key topics in SAMINOR 3 include major lifestyle diseases such as diabetes and cardiovascular diseases, as well as various issues related to mental health and quality of life.

User involvement in SAMINOR 3

The Centre for Sami Health Research emphasizes the principle of community-based participatory research, which involves close and equal collaboration and partnership between researchers and the target population. To ensure that SAMINOR 3 is relevant and beneficial to society, input from the population has been used to shape the study. This has been achieved through:

Interviews with individuals and groups to identify important topics for inclusion in the questionnaire. User groups from different geographical areas, participating in the planning, implementation, and publication phases.

This approach aligns with the Sami Parliament’s ethical guidelines for Sami health research, which emphasize respect, reciprocity, equality, cultural safety, and Sami self-determination in the relationship between researchers and Sami communities/informants.

User involvement is particularly important to safeguard the rights of indigenous and minority groups to influence the production of knowledge about themselves—“nothing about us without us.” The population is involved in identifying key topics that should be included in research on their health and living conditions. This increases the likelihood of producing useful knowledge that can contribute to better health and healthcare services for the population. 

Earlier research on the Sami population was characterized by a view of indigenous peoples as an inferior race. Researchers conducted skull measurements on living Sami and removed skeletal material from Sami graves in an attempt to find evidence that the Sami were a primitive and less intelligent race.

In SAMINOR 3, we aim to involve the population in the relevant municipalities throughout the entire research process—from the idea stage, design, and methodology, through data collection and interpretation of results, to final reporting and dissemination of findings.

In SAMINOR 3, we collaborate with the population in three main ways:

1. Qualitative Interviews: The qualitative interview study is an integral part of SAMINOR 3, allowing participants to share their perspectives on health and living conditions.
2. Reference Groups for Questionnaire Topics: Reference groups are established to provide input on various topics included in the questionnaire, ensuring that the questions are relevant and meaningful to the population.
3. Dialogue Meetings: Before the health and living conditions survey, we held dialogue meetings with municipalities, counties, and the Sami Parliament to discuss the content and practical implementation of the study. In the municipalities, meetings were conducted with administrative staff, political representatives, healthcare administrators, and professionals, as well as with voluntary organizations and patient organizations.

The interview study

The first part of SAMINOR 3 was a qualitative interview study. We invited individuals from different geographical areas and ethnic backgrounds to participate in either individual interviews or focus group interviews with 5–6 participants. A total of 55 people participated in the interviews, which were conducted in Sami, Kven/Finnish, or Norwegian, depending on the participants' preferences.

The interview study explored what the population itself considers relevant regarding health and living conditions and what they believe a health survey in their area should focus on. Participants decided how much they wanted to share about the various topics. Due to the sensitive nature of some topics, an agreement was made with the Sámi Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS) to provide free, low-threshold counseling to all participants who wanted it after the interviews, regardless of their ethnicity.

The interview study is important because:

• The results were used to create better and more relevant questions for the SAMINOR 3 questionnaire.
• The interviews contribute to qualitative research, providing insights into the multi-ethnic population's perspectives on health and living conditions.  

Questionnaires and Clinical Examinations

To uncover differences in health and living conditions between ethnic groups in different areas, it is essential to collect data from a diverse range of people across multiple geographical regions. The survey includes questionnaires, clinical measurements, and biological samples. A total of approximately 73,000 individuals aged 40–79 years were invited to participate. SAMINOR 3 was conducted in 49 municipalities in northern and central Norway. This includes all the 25 municipalities included in SAMINOR 1 or 2, as well as additional municipalities:

Information on health and living conditions is collected through questionnaires, clinical measurements (such as height, weight, and blood pressure), and biological samples. Together, this forms a large database. A wide range of topics is covered, partly based on previous research, findings, results from the interview study, and input from various sources and collaborators.

SAMINOR 3 has the following main themes:

Themes 

Data on health and living conditions will be collected from questionnaires, clinical measurements (e.g. height, weight and blood pressure) and blood samples. Altogether, this will constitute a large database for researchers to use. Many different topics will be covered, and these will partly depend on previous research and findings, results from the interview study and input from various actors and partners.

SAMINOR 3 has the following main themes:

1. Physical health and the factors affecting it
   Here the main focus is on two major lifestyle diseases: diabetes and cardiovascular disease. Important influencing factors are smoking, diet and physical activity. Obesity, blood pressure and lipids (blood fats) are examples of health indicators that can indicate the risk of disease.
2. Mental health and the factors affecting it
   Relevant topics are symptoms of anxiety/depression and post-traumatic stress, eating problems and suicidal behaviour. Here, factors with a negative influence are violence, unemployment, bullying and discrimination, while good relations with family and friends can have a positive effect.
3. Public healthcare services
   Respondents will be asked how often they go to the doctor, whether they have been to hospital for treatment and how satisfied they are with the healthcare services and the treatment they receive. Further topics will be language problems in dealing with healthcare services and interpreting for Sami-speaking patients.
4. The impact on public health of historical trauma and long-term Norwegianization policies
   Prolonged Norwegianization policies and traumas after World War II have left a clear mark on the population of northern Norway. It is therefore of great interest to include the impact of these historical processes on people’s mental and physical health across generations. 

Communication and dissemination

It is important to involve collaborators even before data collection begins and to maintain this throughout the entire research process until the dissemination of results. Communication and dissemination efforts thus become an integral part of the methodology and are crucial for ensuring that the research has legitimacy in the communities where it is conducted.

Good communication before and during data collection is also essential to ensure high participation in the SAMINOR 3 health and living conditions survey.

The Centre for Sami Health Research is committed to ensuring that the results are shared with the communities where the research was conducted. Therefore, municipal reports with key findings will be published. These reports will be presented to municipalities and the population in collaboration with municipal leadership, county councils, and user representatives. 

An overview of SAMINOR 3