Indigenous knowledge-informed HVAC design for reserve health facilities: a mixed-method case study on Prairie reserves

Background Health facility construction on Canadian reserves takes place within complex environmental, social, and cultural contexts. Heating, ventilation, and air conditioning (HVAC) systems influence indoor air quality, thermal comfort, and the ability of buildings to support cultural practices such as smudging, gathering, and flexible use of interior spaces. Conventional engineering design processes often follow linear technical decision pathways that give limited attention to Indigenous knowledge or community patterns of building use. This can contribute to mismatches between installed systems and the ways facilities are used and experienced in practice. Methods This study uses a community-engaged mixed-method case study on HVAC design considerations in reserve health facilities on the Canadian Prairies. A scoping review of HVAC design and building performance was combined with semi-structured interviews with Indigenous knowledge holders, facility managers, engineers, and building users. Findings from both were examined together to identify recurring design challenges and community-defined priorities. These findings were organized using a Function–Context–Behaviour–Principle–State–Structure analytical framework and used to develop a preliminary Indigenous Knowledge Informed Design (IKID) decision-support framework for HVAC planning. Results The analysis identified areas of misalignment between standard HVAC configurations and community priorities in reserve facilities. These included limited accommodation for ceremonial ventilation, uneven thermal comfort across activity spaces, and operational constraints related to climate conditions and building management capacity. The combined findings informed design considerations for HVAC planning, including ceremony-responsive ventilation strategies and localized thermal comfort zones that reflect patterns of use. Contributions and implications This study presents a preliminary IKID-informed design framework that places community-identified priorities alongside engineering considerations in HVAC planning. The framework is intended as a decision-support concept rather than a validated engineering tool. It highlights how community-engaged research can inform culturally responsive infrastructure design and identifies areas for further testing, co-development with communities, and application in future health facility planning.