Learning Together to Think Critically About Health Information: How Two Relational Approaches Shaped Our Research Project

We are increasingly flooded with health information, advice, and opinions from social media, friends, news, and experts. Some of it is confusing, contradictory, incorrect, or potentially harmful. What if we could learn together by sharing experiences, asking questions, and listening to different perspectives? Can we create spaces where we learn with and from each other, where we’re not just expected to absorb information, but to build understanding? These are the questions Vera brought to a Peer Café group at the Atwater Library and Computer Centre, where Marlene was a long-standing member.

We are writing this blog post to complement a QUESCREN podcast featuring our research, as an intergenerational pair who collaborated on a participatory project[i] to build critical health literacy through community engagement and collaborative learning (hereinafter co-learning). After providing project background, we will focus on two key elements that transformed our partnership: relational accountability, a core concept in Indigenous methodologies, and a co-writing process called Essays in Two Voices. We hope our insights could inspire other lifelong learning initiatives in the English-speaking communities in Quebec and inform collaborations led by QUESCREN researcher-members.

Critical health literacy is about making sense of health information and being able to act on it. It means knowing how to find trustworthy information, ask the right questions, and make decisions that fit our lives and realities. But it is not just about individual skills. It is something we can build together, as groups and communities, to support each other in navigating health choices and reducing health inequalities. Most of the time, health care does not happen within “clinical walls.” Most of it happens at home, in our families, and in our communities. Friends, family, and neighbours become caregivers and our go-to sources for health information. That’s why critical health literacy as a lifelong learning process matters.

Co-learning can help build critical health literacy by making learning a shared, social activity. Instead of learning alone, people learn together, by exchanging perspectives, asking questions, and making sense of information as a group. This kind of community-based, experiential, lifelong learning was already happening in the Peer Café, where a group of English-speaking community members met weekly online to co-develop their digital literacy skills.

In proposing the health literacy project to the Peer Café group, Vera also proposed a participatory research approach—an approach that brings together research and practice to promote community engagement and empowerment.[ii] It is about building relationships, co-creating knowledge, and critical reflection. In practice, this meant shaping the research project together.

In the beginning, the sub-group interested to learn about health, discussed how to work together, what we wanted to learn about health literacy, and what data collection methods would match existing group dynamics and culture. Once the details were settled, we were ready to submit the protocol to the ethics review board. It was then that we discovered relational accountability, a key concept in Indigenous methodologies, which helped us develop a meaningful ethical framework, alongside the institutional consent form.

The two of us continued reflecting on this concept. We learned that an Indigenous kincentric worldview acknowledges that accountability extends to all relationships, human and non-human, emphasizing interconnectedness, interdependence and our relationship with nature. In Research Is Ceremony: Indigenous Research Methods (2022), Shawn Wilson discusses maintaining relational accountability through ceremonies, such as research, that engage individuals and communities with respect, responsibility, and reciprocity. He emphasizes lifelong learning across generations—relationships are built over lifetimes. As he explains, rather than view themselves as being in relationship with other beings or things, “we are the relationships that we hold and are part of.”[iii] With the health literacy group, we took time and care to build a trusting relationship, spending the “first year to drink tea”[iv] as described in our podcast episode because, to quote the poet Mary Oliver, “things take the time they take.”[v]

As we were learning about relational accountability, the Office of Community Engagement at Concordia University was launching Toolkit: Dewemaagannag: My Relations Indigenous Engagement Guide co-authored by Amanda Shawayahamish and Geneviève Sioui.[vi] This guide for self-reflection and action outlines seven core principles: listening, respecting Indigenous expertise, relating in reciprocity, being accountable, compensation, obtaining consent, and positionality. We found that all of these apply to relationships of all kinds and certainly to the critical health literacy project.

To further deepen our understanding of relational accountability, we embarked on a co-writing project. We used the method proposed by Madelyn Blair – Essays in Two Voices.[vii] Blair explains that this process “to move past agreement to shared understanding” accommodates an endless diversity of exchanges and ways of thinking with. Throughout the process, it became apparent that the method itself served as a tool, or in the words of the 2024 CBC Massey Lecturer, Ian Williams, an invitation “to find language within your own vocabulary and according to your relationship with your [writing] partner.”[viii]

The co-writing process unfolds as each writer responds to the co-writer’s text, starting with 500 words and progressively shortening to 250, 160, 60, 30 words, and finally 140 characters. The collaboration respects the integrity of each voice and evolves organically as the texts “braid” together, becoming a co-creation. The game-like writing process constantly energized and surprised us as we visibly worked towards a distillation or conclusion of sorts in answer to the question: How did you come across relational accountability and what resonated?

Co-writing to reflect on relational accountability helped us listen to each other and build a shared understanding—insights that are crucial in collaborations, co-learning, and fostering critical health literacy. Without a doubt, language barriers make it even harder to understand health information, ask questions, or navigate the health system. Because health literacy is fundamentally about communication and mutual understanding, it is especially important to create lifelong learning initiatives with English-speaking communities in Quebec, so that everyone can access the care and support they need.

When these initiatives are built with communities, grounded in concepts like relational accountability and supported by tools like Essays in Two Voices, they have the potential to build partnerships that are meaningful and impactful, rooted in reciprocity, knowledge sharing, and dialogue.

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Notes and References

[i] Research conducted as part of the Building critical health literacy capacity through collaborative learning: implementation and evaluation of a community-based intervention project, supported by a postdoctoral fellowship from the Fonds de recherche du Québec – Société et culture (FRQSC).

[ii] Wallerstein, N., & Duran, B. (2008). The theoretical, historical, and practice roots of CBPR. In M. Minkler & N. Wallerstein (Eds.), Community-Based Participatory Research for Health: From Process to Outcomes (pp. 25–46). Jossey-Bass.

[iii] Wilson, S. (2008). Research Is Ceremony: Indigenous Research Methods. Fernwood Publishing.

[iv] Castleden, H., Morgan, V. S., & Lamb, C. (2012). “I Spent the First Year Drinking Tea”: Exploring Canadian University Researchers’ Perspectives on Community-Based Participatory Research Involving Indigenous Peoples. The Canadian Geographer / Le Géographe canadien, 56(2), 160–179.

[v] Oliver, M. (2017). Felicity: Poems. Penguin Random House.

[vi] Sioui, G., & Shawayahamish, A. (2023). Dewemaagannag: My relations Indigenous Engagement Guide [PDF]. Office of Community Engagement, Concordia University.

[vii] Blair, M. (2011). Essays in Two Voices. Pelerei.

[viii] Williams, I. (2024). What I Mean to Say: Remaking Conversations in Our Time (CBC Massey Lectures). House of Anansi Press.