Adapting and enhancing PAX Good Behavior Game for First Nations communities: a mixed-methods study protocol developed with Swampy Cree Tribal Council communities in Manitoba

Abstract
Introduction High rates of mental health problems,
such as suicidal behaviours, among First Nations youth
in Canada are a major public health concern. The Good
Behavior Game (GBG) is a school-based intervention
that provides a nurturing environment for children
and has been shown to promote positive outcomes.
PAX Good Behavior Game (PAX GBG) is an adaptation
and enhancement of the GBG. While PAX GBG has
been implemented in Indigenous communities, little
research exists examining the cultural and contextual
appropriateness and effectiveness of the intervention in
First Nations communities.
Methods and analysis The present paper describes
a protocol of the mixed-methods approach guided by
an Indigenous ethical engagement model adopted to
implement, adapt and evaluate PAX GBG in First Nations
communities in Manitoba, Canada. First, implementation
outcomes (eg, acceptability, adoption) of PAX GBG will
be evaluated using qualitative interviews with teachers,
principals and community members from Swampy Cree
Tribal Council (SCTC) communities. Second, by linking
administrative databases to programme data from schools
in 38 First Nations communities, we will compare PAX
GBG and control groups to evaluate whether PAX GBG is
associated with improved mental health and academic
outcomes. Third, the qualitative results will help inform a
cultural and contextual adaptation of PAX GBG called First
Nations PAX (FN PAX). Fourth, FN PAX will be implemented
in a few SCTC communities and evaluated using surveys
and qualitative interviews followed by the remaining
communities the subsequent year.
Ethics and dissemination Ethical approval was obtained
from the University of Manitoba Health Research Ethics
Board and will be obtained from the Health Information
Privacy Committee and respective data providers for
the administrative database linkages. Dissemination
and knowledge translation will include community and
stakeholder engagement throughout the research process,
reports and presentations for policymakers and community
members, presentations at scientific conferences and
journal publications.

Citation: Fortier J, Chartier M, Turner S, Murdock N, Turner F, Sareen J, Afifi TO, Katz LY, Brownell M, Bolton J et al: Adapting and enhancing PAX Good Behavior Game for First Nations communities: a mixed-methods study protocol developed with Swampy Cree Tribal Council communities in Manitoba. BMJ open 2018, 8(2):e018454