Nuya kankantawa (we are feeling healthy): Understandings of health and wellbeing among Shawi of the Peruvian Amazon.

Promoting and supporting Indigenous health includes ensuring health services reflect local concepts of health. There is, therefore, a need to better understand context-specific Indigenous understandings of health in order to design culturally appropriate health services. To this end, this study characterized two Shawi communities' understandings of what it means to be healthy. Using a community-based participatory research approach, 40 semi-structured interviews and a series of informal interviews were conducted and analysed thematically, using a constant comparative method. The Shawi definition of health extended beyond individual physical welfare and focused on emotional, collective, and environmental wellbeing. The primary factors underlying Shawi perceptions of health and wellbeing included providing for the family, ensuring the welfare of others, maintaining positive social relationships, preserving traditional values and practices, and living harmoniously with the natural environment. Conversely, Shawi classified illnesses according to their cause or treatment. These included illnesses caused by sorcery, those caused by spirits of the forest, and 'new diseases,' that first appeared in the communities when they were contacted by the Western civilization, for which no traditional remedies existed. Consequently, according to Shawi, sociocultural, environmental, and climatic changes are posing imminent health threats. This study highlights the differences between biomedical and Indigenous Shawi health understandings, and therefore emphasizes the importance of acknowledging and embracing Shawi culture and beliefs within the formal healthcare system.