In our study, Aboriginal women wanted to participate in SDM and identified coaching as an essential element in their decision making process. Coaching used in the individual interviews enabled participants to more fully integrate the adapted OPDG into their decision making process: Specifically, they used the OPDG as a talking guide, used the dialogue with the decision coach as a means to bridge health literacy issues, and found the oral interaction with the decision coach to resonate with their own cultural approach to problem solving. Participants reported that the adapted OPDG with accompanying decision coaching support permitted them to choose their level of involvement in the decision making process and supported a more fulsome engagement in decision making. Of equal importance, our study also found that
participants must feel empowered to indicate the ways in which they want to be involved. We found that participants expressed a need for an approach that was reflective of their own unique cultural approach to decision making and reflective of who they are as Aboriginal people (that is, First Nations, Métis or Inuit). Such an approach places emphasis on dialogue, community-based decision support and consultation, and the need for a trusted source of information/ support. Participants emphasized the importance of the coaching role as a central feature of an effective decision making process, which reflects the cultural importance of relationality, with mutual learning and building of knowledge together. This need for expansion of the coaching role to support women in ways that address the broader context in which they are making health decisions, including empowerment, support, and access to resources has been identified elsewhere [49].