Exploring Sense of Purpose and Conscientiousness as Correlates to Health and Well-Being With Indigenous and Low Socioeconomic Communities on Coast Salish Territories, Vancouver, Canada

Abstract

Research is needed to better understand factors promoting health and well-being with Indigenous Peoples and people with socioeconomic barriers in Canada, given they face multiple social determinants that are barriers to health. Individual dispositions, sense of purpose and conscientiousness, are known to predict health and well-being in broader samples. In a community-based approach, guided by Indigenous Elders with traditional ways of knowing, we aimed to determine whether these measures correlate with self-rated health and well-being among Indigenous (n = 149) and non-Indigenous (n = 151) Peoples in Vancouver, Canada. The majority of participants (mean age 49 years, and 58% male) had relatively low income (≤$15,000/year) and educational attainment (<high school). Factors were valid and reliable in all groups. Mean scores were similar between Indigenous and non-Indigenous groups, and lower among participants with lower than with higher income. Correlations were similar between Indigenous and non-Indigenous groups: purpose significantly correlated with health (SF-6; 0.34 and 0.28, p < .001) and life satisfaction (0.55 and 0.58, p < .001), and conscientiousness with health (0.19 and 0.18, p < .05). Correlations were similar between income groups. When exploring and promoting the health, equity, and well-being of Indigenous and low socioeconomic status communities, purpose and personal disposition are factors to consider alongside social determinants of health.

In Canada, Indigenous communities experience disproportionately lower socioeconomic status (SES) and health outcomes than the general population, an inequity due to the lasting, harmful impacts of colonization (Adelson, 2005; Berger et al., 2019; Braveman et al., 2011; Vliegenthart et al., 2016). Acts of assimilation including the Residential School System, Child Welfare System, 60’s Scoop, Indian Hospitals, and land dispossession, sought to strip Indigenous Peoples of their cultures, lands, and beliefs, and instilled racism and discrimination towards Indigenous communities (Allan & Smylie, 2015; Bombay et al., 2014; Waldram et al., 2006). This resulted in intergenerational trauma, which is an underlying cause of the high prevalence of substance use, low SES, and chronic health illnesses, such as diabetes, HIV, and depression, among Indigenous populations (Adelson, 2005; Brave Heart, 2003; Fournier & Crey, 1997; Kirmayer et al., 2000; Marsh et al., 2015). Social determinants of health, such as low educational attainment and income, act as barriers to accessing care and are often associated with poorer health behaviours and outcomes (Berger et al., 2019; Braveman et al., 2011; Vliegenthart et al., 2016). Low SES is linked with exposure to poorer work and living conditions, more chronic stress, and increased engagement in risky health-related behaviours such as smoking, substance use, violence, and high-risk sexual behaviour (Braveman et al., 2011; Vliegenthart et al., 2016). Furthermore, low SES limits access to health care due to inability to overcome cost, travel, and/or time barriers (Butkus et al., 2020; Syed et al., 2013). Thus, communities with low SES face extra challenges in improving their health, further widening the inequity between high and low SES groups (Ingram et al., 2014). Our responsibility is to better understand the health and well-being of Indigenous communities and people with low SES in Canada to improve healing processes, access to care, and ultimately health outcomes.

Research suggests that understanding personal dispositions can help predict which individuals will experience better or worse health (Hampson, 2012; Smith, 2006). However, this research has rarely focused on lower SES and/or Indigenous communities, showing us a responsibility for additional work. This is particularly true with respect to understanding the health and well-being of Indigenous communities in Canada, where the unique impact of intergenerational trauma is ongoing. The present study addressed this gap by investigating the associations between personal dispositions and health and comparing the associations by SES and Indigenous identity.

Individual Differences and Health

For this present study, we focused on sense of purpose, conscientiousness, and agreeableness, as three dispositions that may influence health in Indigenous and low SES communities. Sense of purpose involves perceiving life goals that guide daily activities and promote a sense of personal meaning in life (Ryff, 1989; Scheier et al., 2006). Individuals with a higher sense of purpose appear to engage in healthier behaviours (Hill et al., 2019; Kim et al., 2014), and sense of purpose has been shown to predict a variety of health outcomes, such as risk for future disability (Boyle et al., 2010), cardiovascular issues (Kim et al., 2013), and mortality (Cohen et al., 2016). Conscientiousness is defined as being more organized, reliable, and self-regulated (John & Srivastava, 1999). Higher conscientiousness has been consistently linked with better health outcomes and lower risk of mortality (Hill et al., 2011; Kern & Friedman, 2008; Roberts et al., 2007). Again, a primary pathway seems to be through the adoption of healthier behaviours (Bogg & Roberts, 2004), such as self-reported adherence to medication regimens and other physician recommendations in chronic health conditions (Hill & Roberts, 2011; Molloy et al., 2014). Agreeableness reflects individual differences in sympathy, kindness, trust, and cooperativeness (John & Srivastava, 1999). Although agreeableness typically has at best a modest relation with health outcomes (Chapman et al., 2014; Roberts et al., 2007; Steel et al., 2008), agreeableness may favour a positive relationship with a health care provider in this context. Indigenous communities honour and respect connections and community as healthy values and strengths, and a strong rapport with a care provider has been shown to be beneficial to health (Lavallee & Clearsky, 2006; McCormick, 1997; van Uchelen et al., 2009).

Thus far, these three constructs have been understudied with those living with low SES and Indigenous communities. However, it is possible that personality characteristics could be especially predictive of health for these populations. For instance, research suggests that personality characteristics may be more predictive of health outcomes for individuals with lower SES than for those with higher SES (Elliot et al., 2017). The same may be true for individuals with lower rather than higher levels of education (Jaconelli et al., 2013; Turiano et al., 2014). However, one study that included a substantial number of Indigenous Hawaiians found relatively similar associations between personality traits and dietary behaviours among those with high or low SES (Weston et al., 2020). Given the paucity of existing work, there is a clear need to investigate the role of disposition among communities with low SES, particularly for sense of purpose, as little is known. Determining these associations may provide insight into personalized and equitable programs or amendments to care provision that could improve health and wellness in communities that face many unique challenges.

Understanding the Canadian history of colonization, it is crucial that research and programs with Indigenous communities be culturally safe and appropriate through the meaningful inclusion of Indigenous practices, knowledge, and people in every aspect (Flicker et al., 2015; Schnarch, 2004). Utilizing a “Two-Eyed Seeing” approach that incorporates both Indigenous ways of knowing and Western medicine allows for reconciliation by supporting ownership and capacity among communities, and by creating more meaningful findings (Schnarch, 2004). In a culturally safe way, we sought to determine: (a) whether measures to assess purpose, conscientiousness, and agreeableness exhibit single-factor structures and good reliability in low SES and Indigenous communities living in Vancouver, Canada; (b) whether these three dispositions correlate with self-rated health and well-being in this sample; (c) whether these correlations hold predictive value when controlling for known demographic predictors of health (i.e., income, sex, etc.); and (d) whether correlations are similar between Indigenous and non-Indigenous groups. We hypothesized that measures used to assess purpose, conscientiousness, and agreeableness would be valid, reliable, and similarly correlated with measures of health and well-being between groups in low SES and Indigenous communities on the Traditional, Ancestral, unceded lands of the Coast Salish (Vancouver, Canada).

Method

Community Collaboration

In a community-based approach, our team of Indigenous Elders, community members, health care providers, and academics gathered to plan and conduct the study in a “Good Way,” which is a phrase used by many Indigenous Peoples to encompass when a practice includes Indigenous ways of knowing, persons, traditions, and spirit (Flicker et al., 2015). Collaboration and consultation with Indigenous Elders is a key part of conducting research in a Good Way, as Elders are the knowledge keepers of their communities and have immense expertise on traditional medicines and methods of healing (Flicker et al., 2015; Lavallée, 2009; Redvers et al., 2019). The healing and support that Elders can provide amends the spiritual, emotional, and mental well-being of an individual. Indigenous Elders guided our team, holding us in ceremony, honouring cultural safety, and doing this work in a Good Way in all aspects of the study. We indigenized our writing style by using capitalization to describe Indigenous Peoples and ceremonial terms (Younging, 2018). We followed the Canadian guidelines on working with Indigenous persons (Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, Canadian Institutes of Health Research, 2018), and the ownership, control, access, and possession principles in study design through to knowledge translation (Schnarch, 2004). Elders and health care providers who provide care to Indigenous clients assessed questionnaires and provided appropriate amendments. After we provided teachings on Indigenous protocols, we received ethics approval from the Research Ethics Board at the University of British Columbia (H17–01792).

Two Sharing Circles were held to gather and honour knowledge from community experts on study design and Indigenous involvement: one with Indigenous women, n = 8, mean age (± SD): 55.6 (± 6.6) years; and one with Indigenous men, n = 10, mean age (± SD): 53.1 (± 4.9) years. Each Sharing Circle was designed and led by Elders from the community, voice recorded for transcription, and visually recorded via infographics for knowledge translation. Elders provided opening and closing ceremony, smudge, support to participants, and traditional medicines for participants including sage, cedar, sweet grass, and tobacco. A non-Indigenous health care provider and research coordinator were in attendance with permission of the attendees, and they helped to explain the purpose of the research and to take notes during. Sharing Circle community experts reviewed the questionnaire including measures of personal disposition that were to be assessed and provided input on study design and cultural safety.

Sharing Circle community experts expressed a desire to be more involved in the research, and two were hired and trained as Peer Research Associates (PRAs) to assist with questionnaire conduction and knowledge translation and exchange. As such, we created and hosted five workshops that provided PRA training to two women’s Sharing Circle participants and one men’s Sharing Circle participant who showed great interest in becoming further involved in the project and research in general. Two of the PRAs assisted with questionnaire conduction to validate measures of personal disposition, and all three assisted in end-of-study knowledge translation/exchange efforts.

Questionnaire Design

Demographics

We collected self-reported age at study visit, gender, sex, ethnicity, first language, education attainment (<high school, high school grad, college/trade school, or university), and income (>$15,000 or ≤$15,000 per year).

Sense of Purpose

Purpose was assessed using the Oregon Brief Purpose Measure, a four-item measure on scale from 1 (strongly disagree) to 5 (strongly agree; Hill et al., 2016). Examples of purpose items are: “There is a direction in my life” and “My life is guided by a clear set of commitments.” This measure has demonstrated positive associations with health (Hill et al., 2016) and health behaviours (Hill et al., 2021) in previous studies.

Conscientiousness and Agreeableness

The mini-IPIP (International Personality Item Pool) measure of Big Five personality traits was used to assess aspects of conscientiousness (four items, plus four additional items, in case revisions were needed) and agreeableness (four items) on a scale from 1 (strongly agree) to 5 (strongly disagree; Donnellan et al., 2006). Examples of conscientiousness items are: “I set high standards for myself and others” and “I work hard”; and examples of agreeableness items are: “I sympathize with others’ feelings” and “I am not really interested in others.” The mini-IPIP has demonstrated strong psychometric properties and associations with health behaviours in previous work (Baldasaro et al., 2013).

Health

The six-item Short-Form (SF-6) measure of general health was used to assess the general health of participants with six items on a 5-point scale (Ware & Sherbourne, 1992). Example health items are: “My health is excellent” and “I am as healthy as anybody I know.” The SF-6 measure of general health is widely used and has been shown to be valid and reliable in various socioeconomic, ethnic, and disease contexts, including low SES and ethnic minority groups (Daergo et al., 2008; Franks et al., 2003; Martikainen et al., 2004).

Well-Being

To measure well-being, measures of life satisfaction, positive affect, and negative affect were included. Life satisfaction was assessed using a five-item Likert scale from 1 (strongly disagree) to 7 (strongly agree; Diener et al., 1985). An example item is “In most ways my life is close to my ideal.” Positive and negative affect were assessed by participants indicating how frequently they experience various emotions on a 5-point Likert scale from 1 (very slightly or not at all) to 5 (extremely), with 10 items each, for a total of 20 items (Watson et al., 1988). Example items for positive affect included interested, excited, and proud, and for negative affect were guilty, hostile, and upset. (See Supplemental Material, for full questionnaire.)

Questionnaire Participant Recruitment and Demographics

We recruited 149 Indigenous Peoples and 151 non-Indigenous Peoples to complete the questionnaires from various clinics/centres in Vancouver’s Downtown Eastside, one of the poorest postal codes in Canada where there are high rates of housing and food insecurity. Participants were age 19 and above and able to understand and communicate in English. Indigenous Peoples included anyone who self-identified as Indigenous, Aboriginal, Metis, Inuit, First Nations, or other term that describes a person whose ancestors were among the First Peoples on the land now called Canada. Low SES participants were considered to be anyone with income ≤$15,000 per year, as per previous studies in Vancouver to be just above the yearly amount given through the BC Employment and Assistance Program (Donaldson et al., 2019; O’ Neil et al., 2012). Participants provided verbal consent after reviewing a letter of introduction/consent. Questionnaires were completed in person, facilitated by community researchers, and took approximately 20 min to complete. Participants who completed the questionnaire received a $20 honorarium.

For our demographic analysis, we compared age, gender, ethnicity, educational attainment, and income between Indigenous and non-Indigenous participants, and between participants with income ≤ and >$15,000/year. As only one Indigenous participant self-identified as nonbinary gender, sex was used to stratify groups instead of gender. Age (p = .52) and sex (p = .09) were similar between Indigenous and non-Indigenous groups. In both groups, the majority of participants (81.9% of Indigenous and 56.2% of non-Indigenous participants) reported having low income (≤$15,000/year), speaking to the barriers experienced by this population. However, there were significantly more Indigenous Peoples with lower income (p = .01) and educational attainment (p = .01; Table 1).

Table 1.

Participant Demographics

Characteristics	Category	Indigenous (n = 149)	Non-Indigenous (n = 151)	p value for (t or χ2 test)
Ethnicity, n (%)	Indigenous	149 (100)	0
	White	0	117 (77.5)
	Black	0	12 (7.9)
	Asian	0	11 (7.3)
	Other	0	11 (7.3)
Mean age ± SD (years)		48.0 ±11.0	48.8 ± 11.5	.52
Sex	Male	77	96	.10
	Female	71	55
Education, n (%)	<High school	72 (48.3)	39 (25.8)	.01
	High school grad	31 (20.8)	41 (27.2)
	College/trade	32 (21.5)	37 (24.5)
	University	14 (9.4)	34 (22.5)
Income/year, n (%)	≤$15,000	113 (81.9)	78 (56.2)	.01
	>$15,000	25 (18.1)	61 (43.8)

Note. Bold indicates statistically significant at the .05 level.

Questionnaire Analysis Plan

For income comparisons, participants were grouped as individuals with a household income of ≤$15,000 per year or >$15,000 per year. For each measure, participants missing >one item were removed from analyses involving that measure, which led to at most three participants removed. α was set to 0.05 for all analyses.

Factor Analyses and Reliability of Measures

Factor analyses extracting a single-factor solution and reliability analyses were conducted for the scales of interest—sense of purpose, conscientiousness, and agreeableness—in the Indigenous and low SES samples. Measures of health, life satisfaction, positive affect, and negative affect were also assessed for validity and reliability to determine consistency with other study samples. Measures were adjusted to remove items to create measures that demonstrated single-factor structures with Indigenous and low SES groups. Adjusted measures were included in the correlational analyses described below.

Associations With Health and Well-Being

Mean composite scores for each factor were compared using an independent samples t test between the Indigenous and non-Indigenous groups and again between low- and high-income groups to determine equality of means. Pearson correlations were conducted to determine associations of personal dispositions with measures of health and well-being for each group via correlation coefficients. Multiple linear regression analyses were conducted to assess associations between personal disposition and health measures while controlling for demographic factors including sex, age, income, ethnicity, and educational attainment. Income was included only for regressions for Indigenous versus non-Indigenous groups, and ethnicity only with regressions for the income groups.

Results

Sharing Circles—Indigenous Community Perspectives on Questionnaires and Researching Personal Disposition

Sharing Circles informed questionnaire content. The facilitating Indigenous Elder read each of the questions from the questionnaire aloud to the participants. All of the demographic questions were approved until the question: “In the household of your upbringing, were you considered very poor, poor, average, well off, or very well off?,” which was considered to be activating of trauma from colonization impacts and unnecessary for research findings. Thus, we removed the question on childhood household income and only asked about current income in the questionnaire. When asked what participants thought about measuring personal disposition, participants had no concerns and thought it was a good idea. In regards to the measures of disposition, health, and well-being, participants understood the questions and did not have any concerns in regards to them.

Confirmatory Factor and Reliability Analyses

Given the lack of concerns with the disposition measures, we proceeded to consider the measurement properties of the scales in these groups. Across all groups, items loaded well onto one factor (all loadings >0.4; Table 2) and reliabilities were strong (α > 0.70; Table 3) for measures of sense of purpose, health, life satisfaction, positive affect, and negative affect. Factor loadings were inconsistent with a single-factor solution across items in conscientiousness and agreeableness, based on lower eigenvalues and percent variance explained, and suggested four items to be included for conscientiousness and three items for agreeableness (see Supplemental Tables 1–9, for detailed factor analysis results for each factor); adjusted measures are included in Tables 2 and 3. α reliabilities and interitem correlations for the adjusted measure of conscientiousness and agreeableness were moderate to satisfactory for all participant groups, given the brevity of the measures (α > 0.5, and r > 0.2; Table 3).

Table 2.

Confirmatory Factor Analysis Results for Using Single-Factor Solutions for Each Factor Eithin Each Participant Group

Participant group	Factor loading range	Eigenvalue	Percent explained variance (%)
Indigenous
Sense of purpose	0.78–0.88	2.86	71.40
Conscientiousness	0.50–0.77	1.71	42.76
Agreeableness	0.47–0.87	1.58	52.60
Life satisfaction	0.53–0.91	3.02	60.42
Health	0.51–0.78	2.63	43.76
Positive affect	0.54–0.80	5.10	51.10
Negative affect	0.57–0.79	4.70	47.02
Non-Indigenous
Sense of purpose	0.87–0.91	3.22	80.43
Conscientiousness	0.49–0.79	1.87	46.77
Agreeableness	0.65–0.81	1.62	54.00
Life satisfaction	0.74–0.83	3.16	63.26
Health	0.41–0.85	2.68	44.71
Positive affect	0.62–0.78	4.90	48.60
Negative affect	0.55–0.78	4.80	48.43
≤$15,000/year
Sense of purpose	0.83–0.89	2.98	74.50
Conscientiousness	0.48–0.72	1.68	41.92
Agreeableness	0.59–0.84	1.54	51.38
Life satisfaction	0.61–0.86	2.97	59.35
Health	0.51–0.77	2.56	42.74
Positive affect	0.55–0.80	4.80	48.30
Negative affect	0.59–0.77	4.60	45.90
>$15,000/year
Sense of purpose	0.84–0.94	3.33	66.61
Conscientiousness	0.45–0.90	2.13	53.31
Agreeableness	0.57–0.85	1.74	57.89
Life satisfaction	0.75–0.88	3.23	80.65
Health	0.35–0.89	2.76	45.94
Positive affect	0.66–0.84	5.40	53.60
Negative affect	0.48–0.84	5.20	51.90

Table 3.

Descriptive Statistics and Reliability Analysis Results for Each Factor in Each Participant Group

Group	Composite M ± SD	Skewness	Kurtosis	Alpha reliability (α)	Inter-item correlate mean (r)
Indigenous
Sense of purpose	3.74 ± 1.02	−0.60	−0.42	0.87	0.62
Conscientiousness	3.72 ± 0.83	−0.43	−0.17	0.53	0.23
Agreeableness	3.60 ± 0.95	−0.21	−0.82	0.52	0.27
Life satisfaction	4.34 ± 1.49	−0.29	−0.69	0.82	0.49
Health	3.28 ± 0.83	−0.26	−0.53	0.73	0.32
Positive affect	3.55 ± 0.81	−0.17	−0.47	0.89	0.45
Negative affect	2.14 ± 0.80	0.95	0.79	0.87	0.41
Non-Indigenous
Sense of purpose	3.53 ± 1.13	−0.46	−0.66	0.92	0.74
Conscientiousness	3.69 ± 0.85	−0.52	0.10	0.61	0.28
Agreeableness	3.78 ± 0.87	−0.35	−0.24	0.57	0.31
Life satisfaction	4.03 ± 1.49	−0.04	−0.94	0.85	0.54
Health	3.31 ± 0.78	−0.36	−0.01	0.74	0.32
Positive affect	3.39 ± 0.76	−0.09	−0.43	0.88	0.43
Negative affect	1.99 ± 0.74	0.85	0.35	0.88	0.42
≤$15,000/year
Sense of purpose	3.54 ± 1.12	−0.40	−0.77	0.89	0.66
Conscientiousness	3.61 ± 0.85	−0.37	−0.11	0.53	0.22
Agreeableness	3.56 ± 0.84	−0.27	−0.53	0.51	0.26
Life satisfaction	3.99 ± 1.51	−0.01	−0.85	0.82	0.49
Health	3.19 ± 0.80	−0.30	−0.31	0.72	0.31
Positive affect	3.44 ± 0.81	0.03	−0.55	0.88	0.42
Negative affect	2.11 ± 0.78	0.77	0.39	0.87	0.40
>$15,000/year
Sense of purpose	3.86 ± 1.04	−1.04	0.60	0.92	0.74
Conscientiousness	3.90 ± 0.84	−0.73	0.29	0.68	0.35
Agreeableness	3.88 ± 0.87	−0.18	−1.09	0.62	0.36
Life satisfaction	4.62 ± 1.44	−0.45	−0.77	0.87	0.58
Health	3.54 ± 0.76	−0.25	−0.68	0.74	0.32
Positive affect	3.53 ± 0.81	−0.44	−0.27	0.90	0.48
Negative affect	1.95 ± 0.76	1.28	1.81	0.89	0.45

Note. Interitem correlate mean is the mean score of the correlations for all of the items within each factor.

Associations With Health and Well-Being

There were no significant mean differences across variables between Indigenous and non-Indigenous participants; however, participants in the >$15,000/year group had a significantly higher mean for purpose, life satisfaction, health, conscientiousness, and agreeableness than the ≤$15,000/year group (Table 4). Correlations with health were similar between Indigenous and non-Indigenous groups: SF-6 was significantly correlated with sense of purpose (rs = 0.28 and 0.34, p < .001), and conscientiousness (0.19, p = .02, and 0.18, p = .03), but not with agreeableness (−0.08, p = .34, and 0.17, p = .04; Table 5). Life satisfaction was significantly correlated with sense of purpose in both groups (0.55, p < .001, and 0.58, p < .001), with conscientiousness significantly correlated in the non-Indigenous group, although correlations were similar for both (0.13, p = .12, and 0.18, p < .001), and with agreeableness in neither group (−0.04, p = .60, and 0.09, p = .28). Positive affect was significantly correlated with sense of purpose, conscientiousness, and agreeableness in both groups. Negative affect was significantly negatively correlated with sense of purpose in both groups, but only with conscientiousness in the Indigenous group, and not with agreeableness in either group. Correlation results were similar for the ≤$15,000/year and >$15,000/year groups (Table 5). As shown in Table 5, the magnitudes of the associations were markedly similar for all group comparisons by Indigenous identity or by income level. Indeed, the only significant difference found between correlations was that agreeableness was more associated with self-rated health for non-Indigenous than Indigenous participants (z = −1.98, p = .048).

Table 4.

Comparison of Means of Factors Between Indigenous and Non-Indigenous Participants, and by Income

Variable of interest	M ± SD Indigenous (n = 149)	M ± SD Non-Indigenous (n = 151)	p value
Sense of purpose	3.74 ± 1.02	3.53 ± 1.13	.09
Life satisfaction	4.34 ± 1.49	4.03 ± 1.49	.07
Health	3.28 ± 0.83	3.31 ± 0.78	.76
Positive affect	3.55 ± 0.81	3.39 ± 0.76	.09
Negative affect	2.13 ± 0.80	1.99 ± 0.74	.11
Conscientiousness	3.72 ± 0.83	3.69 ± 0.85	.74
Agreeableness	3.63 ± 0.85	3.82 ± 0.79	.60
	≤$15,000/year (n = 191)	>$15,000/year (n = 86)
Sense of purpose	3.54 ± 1.12	3.86 ± 1.04	.02
Life satisfaction	3.99 ± 1.51	4.62 ± 1.44	.001
Health	3.19 ± 0.80	3.54 ± 0.76	.001
Positive affect	3.44 ± 0.81	3.53 ± 0.81	.46
Negative affect	2.11 ± 0.78	1.95 ± 0.76	.11
Conscientiousness	3.61 ± 0.85	3.90 ± 0.84	.01
Agreeableness	3.67 ± 0.93	3.97 ± 0.71	.01

Note. Bold indicates statistically significant at the .05 level.

Table 5.

Correlations of Dispositional Characteristics With Measures of Health and Well-Being Among Each Participant Group

Factors	Indigenous (n = 149)		Non-Indigenous (n = 151)		≤$15,000/year (n = 191)		>$15,000/year (n = 86)
	r	p value	r	p value	r	p value	r	p value
Correlation with health
Sense of purpose	0.28	<.001	0.34	<.001	0.29	<.001	0.33	.002
Conscientiousness	0.19	.02	0.18	.03	0.17	.02	0.20	.07
Agreeableness	−0.08	.35	0.17	.04	−0.04	.59	0.18	.11
Correlation with life satisfaction
Sense of purpose	0.55	<.001	0.58	<.001	0.53	<.001	0.67	<.001
Conscientiousness	0.13	.12	0.18	.03	0.11	.13	0.22	.04
Agreeableness	−0.04	.60	0.09	.28	−0.07	.31	0.12	.26
Correlation with positive affect
Sense of purpose	0.48	<.001	0.56	<.001	0.50	<.001	0.60	<.001
Conscientiousness	0.28	<.001	0.27	.001	0.31	<.001	0.15	.17
Agreeableness	0.10	.25	0.20	.02	0.12	.09	0.18	.10
Correlation with negative affect
Sense of purpose	−0.21	.01	−0.28	.001	−0.23	.002	−0.22	.05
Conscientiousness	−0.23	.01	−0.15	.06	−0.20	.01	−0.16	.16
Agreeableness	0.04	.60	−0.07	.40	0.06	.44	−0.11	.31

Note. Bold indicates statistically significant at the .05 level.

Regression Associations With Health and Well-Being

After controlling for demographic factors (age, income, sex, education attainment), sense of purpose remained significantly associated with health, life satisfaction, positive affect, and negative affect (all p < .01) in separate regression models by health factor for all participant groups (Table 6). When also controlling for conscientiousness and agreeableness, sense of purpose remained significantly associated with the health factors for all groups (Table 7). Conscientiousness sometimes served as a predictor in one group but not the other; however, the magnitudes of the effect sizes again were similar between Indigenous versus non-Indigenous groups and ≤$15,000 versus >$15,000 groups (Table 8). Associations with agreeableness remained the same in the regression analysis (Supplemental Table 10).

Table 6.

Results of Sense of Purpose in Linear Regression Models Performed Separately for Associations With Each Health Factor, Controlling for Demographics, Among Each Participant Group

Purpose	Unstandardized coefficients		Standardized coefficients β	t	p value
	B	SE
Indigenous (n = 149)
Life satisfaction	0.77	0.11	0.53	7.33	<.001
Health	0.22	0.07	0.27	3.27	.001
Positive affect	0.38	0.06	0.47	6.23	<.001
Negative affect	−0.14	0.07	−0.18	−2.09	.04
Non-Indigenous (n = 151)
Life satisfaction	0.73	0.09	0.55	8.10	<.001
Health	0.23	0.05	0.34	4.18	<.001
Positive affect	0.38	0.05	0.57	7.92	<.001
Negative affect	−0.20	0.05	−0.32	−3.77	<.001
>$15,000/year (n = 86)
Life satisfaction	0.93	0.11	0.67	8.19	<.001
Health	0.22	0.08	0.31	2.95	.004
Positive affect	0.47	0.07	0.60	6.66	<.001
Negative affect	−0.17	0.08	−0.23	−2.07	.04
≤$15,000/year (n = 191)
Life satisfaction	0.70	0.08	0.52	8.34	<.001
Health	0.21	0.05	0.29	4.08	<.001
Positive affect	0.35	0.05	0.48	7.74	<.001
Negative affect	−0.15	0.05	−0.22	−3.06	.003

Note. SE = standard error.

Table 7.

Results of Sense of Purpose in Linear Regression Models Performed Separately for Associations With Each Health Factor, Controlling for Demographics, Conscientiousness, and Agreeableness, Among Each Participant Group

Purpose	Unstandardized coefficients		Standardized coefficients β	t	p value
	B	SE
Indigenous (n = 149)
Life satisfaction	0.75	0.11	0.51	7.06	<.001
Health	0.19	0.07	0.23	2.82	.01
Positive affect	0.35	0.06	0.44	5.93	<.001
Negative affect	−0.11	0.07	−0.14	−1.63	.11
Non-Indigenous (n = 151)
Life satisfaction	0.79	0.09	0.60	8.39	<.001
Health	0.22	0.06	0.33	3.81	<.001
Positive affect	0.35	0.05	0.52	6.92	<.001
Negative affect	−0.19	0.06	−0.31	−3.41	.001
>$15,000/year (n = 86)
Life satisfaction	0.97	0.13	0.70	7.62	<.001
Health	0.18	0.09	0.25	2.13	.04
Positive affect	0.50	0.08	0.63	6.22	<.001
Negative affect	−0.15	0.09	−0.20	−1.61	.11
≤$15,000/year (n = 191)
Life satisfaction	0.68	0.09	0.51	8.01	<.001
Health	0.19	0.05	0.26	3.59	<.001
Positive affect	0.33	0.04	0.46	7.58	<.001
Negative affect	−0.13	0.05	−0.18	−2.54	.01

Note. SE = standard error. Bold indicates statistically significant at the .05 level.

Table 8.

Results of Conscientiousness in Linear Regression Models Performed Separately for Associations With Each Health Factor, Controlling for Demographics, Among Each Participant Group

Conscientiousness	Unstandardized coefficients		Standardized coefficients β	t	p value
	B	SE
Indigenous (n = 149)
Life satisfaction	0.20	0.15	0.11	1.30	.20
Health	0.21	0.09	0.21	2.48	.01
Positive affect	−0.20	0.08	−0.21	−2.47	.02
Negative sffect	−0.20	0.08	−0.21	−2.47	.02
Non-Indigenous (n = 151)
Life satisfaction	0.27	0.15	0.15	1.86	.07
Health	0.14	0.08	0.16	1.82	.07
Positive affect	0.22	0.08	0.25	2.92	.004
Negative affect	−0.16	0.07	−0.18	−2.09	.04
>$15,000/year (n = 86)
Life satisfaction	0.42	0.19	0.25	2.28	.03
Health	0.20	0.10	0.22	2.01	.05
Positive affect	0.17	0.11	0.17	1.55	.13
Negative affect	−0.15	0.10	−0.16	−1.45	.15
<$15,000/year (n = 191)
Life satisfaction	0.17	0.13	0.10	1.33	.19
Health	0.16	0.07	0.17	2.33	.02
Positive affect	0.28	0.07	0.29	4.33	<.001
Negative affect	−0.19	0.07	−0.20	−2.82	.01

Note. SE = standard error. Bold indicates statistically significant at the .05 level.

Discussion

Indigenous and low SES communities experience disproportionately worse health outcomes than the general population in Canada due to barriers experienced (Adelson, 2005; Berger et al., 2019; Braveman et al., 2011; Vliegenthart et al., 2016). Yet, when considering factors that may help promote health for these groups, little is known about the relationship between personal disposition and health and well-being in these groups. This study was one of the first to examine the reliability and validity of measures of dispositional characteristics, health, and well-being, as well as the associations between these measures, among and compared between Indigenous and low SES communities on Coast Salish Territories (Vancouver, Canada). We found that measures of sense of purpose, health, and well-being were reliable and valid. However, adjustments to scales of conscientiousness and agreeableness were required to improve reliability, and even so, the reliabilities remained less-than-ideal and further adjustments may be required for future use. Sense of purpose was correlated with health and well-being across all groups, whereas results for conscientiousness varied and results for agreeableness showed no associations. Furthermore, composite scores for all factors were similar between Indigenous and non-Indigenous groups and higher in our higher income group than the lower income group.

Individuals who had a greater sense of purpose were more likely to report better health and well-being, even when controlling for sociodemographic factors, similar to previous studies (Cohen et al., 2016; Hill, Sin, et al., 2018; Hill & Turiano, 2014; Kim et al., 2013). Accordingly, opportunities to improve the sense of purpose of individuals may lead to healthier outcomes in our groups, which is particularly important for Indigenous and low SES communities who face disproportionately worse health than the general population (Adelson, 2005; Braveman et al., 2011). Given that sense of purpose in life involves goal directedness and pursuit (McKnight & Kashdan, 2009; Ryff, 1989), programs to encourage goal setting may work to empower individuals to have autonomy in their health care. However, this must go alongside supporting the social determinants of health that may act as barriers to people achieving their goals. In addition, research is needed to understand the consequences of the marginalization and discrimination faced by the Indigenous and low SES population on their ability to develop a sense of purpose, as work has shown the potential deleterious effects for discrimination on sense of purpose (Hill et al., 2021).

Strengthening sense of purpose among Indigenous communities may go beyond health enhancements and may also help healing from intergenerational trauma. Past research has demonstrated that traumatic experiences do not necessarily lead to long-term decrements in sense of purpose (Hill, Turiano, & Burrow, 2018). Purpose-based programs with Indigenous populations may wish to encourage individuals to consider how their personal purpose connects with their historical experiences, starting with recognizing when individual cultural engagements yield momentary sense of direction. Related work emphasizes the resilience that Indigenous communities embody as they heal from intergenerational trauma. Engagement in traditional culture and spirituality works to improve overall wellness, and thus reduce the inequity of disease rates compared to the general population (Allan & Smylie, 2015; Lavallee & Clearsky, 2006; Panter-Brick & Eggerman, 2012). Similarly, improving sense of purpose may work to enhance the healing and overall wellness of Indigenous communities. Future research is needed to determine whether improving purpose can support healing and empowerment by and with Indigenous communities.

In regards to conscientiousness and agreeableness, adjustments to the measures were required to improve validity and reliability in our study groups. However, it is worth noting that (a) low reliabilities were similar and consistent across all of our groups and (b) Indigenous and non-Indigenous groups did not significantly differ in composite scores for all of the factors. Given these similarities, it is likely that our lower reliabilities were largely the result of employing short scales. Our intent was to deliver short, useable measures for participants, researchers, and care providers, which aligns with the goals and recommendations of efforts to integrate psychosocial variables into electronic health records (Condon et al., 2017; Matthews et al., 2016). Thus, it would be important to study larger sample sizes and include longer measures with more items, in order to better assess the reliability of measures of the Big Five personal dispositions in these groups.

As in previous research (Goodwin & Friedman, 2006; Kern & Friedman, 2008; Roberts et al., 2007; Steel et al., 2008), conscientiousness was positively correlated with measures of health in all groups, though its associations varied for well-being. Agreeableness was only positively correlated with health and positive affect in the non-Indigenous group. When interpreting the mixed evidence for these traits and well-being, it is worth noting that life satisfaction is seldom strongly correlated with conscientiousness or agreeableness (Fagley, 2012; Steel et al., 2008). We had speculated that agreeableness might have been relevant to health of Indigenous Peoples in this study, as sense of community and social ties are highly valued among Indigenous communities (Cousin & Schmid Mast, 2013; Lavallee & Clearsky, 2006; McCormick, 1997; Teng & Hsu, 2012; van Uchelen et al., 2009). Although this hypothesis was not supported, our findings align with the literature, as agreeableness often shows little-to-no correlation with health outcomes (Chapman et al., 2014; Roberts et al., 2007; Steel et al., 2008). In general, correlations with conscientiousness and agreeableness were similar in magnitude between our groups. Although previous research has suggested that personality characteristics may be more predictive of health outcomes for individuals with lower SES relative to higher SES participants (Elliot et al., 2017), it is worth noting that the current sample included a greater representation of participants in lower SES groups. Overall, it appears that conscientiousness may be a factor worth considering when understanding and improving the health of low SES and Indigenous communities.

These findings suggest opportunity to utilize a personalized medicine approach to health care with Indigenous and low SES communities. Researchers have noted the great potential for dispositional traits to guide personalized medicine approaches (Chapman et al., 2011). One noted benefit of including disposition in health screenings is the potential for helping identify which individuals are at greater risk for health concerns in the future. Our findings point to how medical professionals need to account for mean-level differences in disposition levels among Indigenous and low SES communities when creating cutoff criteria for assessing patients’ health risk. Another benefit is that disposition assessments can help improve patient–provider relationships by providing health care providers with information on how to improve medical care. For instance, health care providers may benefit greatly from understanding how purposeful patients feel in order to tailor their health messaging in ways that underscore why healthy lifestyle behaviours can assist them towards achieving their long-term goals.

Assessing personal disposition also can assist with determining how to best support an individual in a more holistic approach (Boersma et al., 2011). This could be particularly beneficial for Indigenous Peoples, as addressing mind, body, heart (emotional), and spirit health, in addition to physical aspects, aligns better with Indigenous views of wellness (Flicker et al., 2015; Hill, 2009). As our findings may inform programs to address or utilize measures of personal disposition among Indigenous communities, we strongly emphasize the necessity that Indigenous persons and practices be respected and meaningfully included in each step of the process. In a Two-Eyed Seeing approach, programs could address purpose, conscientiousness, and health while also working to recognize intergenerational trauma and improve the meaning and accessibility for Indigenous persons (Marsh et al., 2015; Smye & Browne, 2002). In addition, including Indigenous persons in larger and leading roles in any of these potential programs is vital to building capacity and providing ownership to the community (Adelson, 2005; Schnarch, 2004). Furthermore, part of enacting this Two-Eyed Seeing approach involves educating non-Indigenous researchers and care providers in cultural safety practices to create a safer space for Indigenous Peoples (Papps & Ramsden, 1996). If such programs practice cultural safety, it leads to improved participant engagement, trust, empowerment, and opportunity to work towards healing (Waldram et al., 2006).

In addition, as mean composite scores of measures of health, personal disposition, and well-being were lower in our lower income than higher income group, it is evident that income plays a role in overall outcomes. This aligns with the existing literature emphasizing the necessity to support lower SES individuals to improve overall health equity (Butkus et al., 2020; Ingram et al., 2014). Programs need to actively address social determinants of health by improving access to affordable housing, healthy food, employment, and health care in an equitable, antiracist, respectful way. This may help to decrease the health and income gaps between low and high SES groups (Butkus et al., 2020; Ingram et al., 2014; Syed et al., 2013).

Our findings, however, are not without limitations. Given our focus on addressing health promotion among individuals underrepresented in health promotion research, our sample may provide limited generalizability to other contexts, as participants were recruited on the Coast Salish Lands (Vancouver, BC), and thus may not be applicable to other areas. In addition, our Indigenous participant group was made up of an urban Indigenous population, and thus findings may not be generalizable to Indigenous communities on reserves or in rural areas. To broaden our understanding of the correlations between personal disposition and health in Indigenous and low SES communities, it would be beneficial to utilize different measures of health and well-being, such as health reports from friends and family to avoid self-report biases (Bauhoff, 2011; Jackson et al., 2015). Though based on previous research, our cutoff for the lower income group was quite low (≤$15,000/year), and thus several, if not most, individuals in the “higher income” group (>$15,000/year) still received a very low income for a Canadian setting (Donaldson et al., 2019; O’Neil et al., 2012). Furthermore, there was great overlap in the income and Indigenous identity groups that merits attention in future studies that are able to capture a wider variety of income levels with Indigenous and non-Indigenous groups.

Conclusion

With low SES and Indigenous communities, measures of sense of purpose, conscientiousness, agreeableness, health, and well-being may be reliable and valid; however, adjustment of measures of conscientiousness and agreeableness were required. When exploring health and well-being of Indigenous and low SES communities, purpose and personal disposition are factors to consider alongside social determinants of health. Our findings can inform the development of wholistic programs to empower and improve the health and well-being of these communities.

Public Significance Statement.

The study demonstrates the importance of considering individual dispositions for advancing our understanding of how to promote the health, equity, and well-being of Indigenous and low socioeconomic status groups.