T he health status of First Nations people in Canada is well below the national average. [1][2][3] Contact with Europeans brought outbreaks of infectious diseases (e.g., influenza, measles and smallpox) to which First Nations people had no immunity. 4 First Nations people lost traditional lands to settlements for trade relationships based on harvesting furs. 5 The shift from a seasonal economy based on traditional food gathering to the fur trade led to exploitation of wildlife and land. 5,6 Locating reserve lands in remote areas served to isolate First Nations, impoverishing their communities by limiting access to traditional resources. 6,7 The British North America Act of 1867 8 allowed Canada to pass laws that subjugated all First Nations people and their land, replacing their traditional governments and taking control of valuable resources on reserve lands. 7 It also disrupted First Nations culture and families by imposing European concepts of marriage, parenting and land ownership 7 in the belief that First Nations people were "savage" and less than human. 7,9,10 The Indian Act 11 restricted First Nations people from leaving reserve lands and prohibited outsiders from doing business with First Nations people, thus marginalizing them. 7 It also disrupted the transmission of culture from generation to generation, reinforcing learned helplessness among First Nations people in Canada by making participation in traditional cultural events (e.g., the potlatch and sun dance) a criminal offence. 7,11 The residential school system was designed to assimilate First Nations people into the culture of the white majority. 7,12 The needs of First Nations children were neglected, and many were physically, sexually and emotionally abused in the schools. 13,14 Over 500 years of domination, displacement and assimilation have prevented First Nations from nurturing a model of health determinants congruent with their culture. 12 Although Health Canada has selected the key determinants of health, developed by the Agency (Table 1), as the benchmark model to address the health status of all Canadians, a growing body of work suggests that these determinants of health are not suitable for most First Nations peoples. 9,[15][16][17] In response, the Four Worlds Institute developed 14 determinants of well-being and health (14 health determinants) (Table 1) relevant to First Nations people using their guiding principles: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. 9,18 To improve the overall health status of First Nations people in Canada, it is vital that Health Canada adopt a model of health determinants that incorporates the worldview of Indigenous peoples. 9,[19][20][21][22]

The Old-fashioned Prejudiced Attitudes Toward Aboriginals Scale (O-PATAS) and Modern Prejudiced Attitudes Toward Aboriginals Scale (M-PATAS) are two new measures of prejudicial attitudes toward Aboriginal people (i.e., Inuit, Métis, and First Nations) developed using the Theory of Modern Prejudice. This cross-validation study evaluated the psychometric properties of the O-PATAS and M-PATAS among 367 Canadian university students. The results of this investigation provided evidence attesting to the construct validity of the O-PATAS and M-PATAS. Both scales yielded a high degree of scale score reliability and demonstrated convergence with two established measures known to predict prejudice. Confirmatory factor analysis replicated the original factor structures with three of the four goodness-of-fit statistics indicating model fit. The results obtained support the construct validity of the O-PATAS and M-PATAS as measures of prejudiced attitudes toward Aboriginal people among undergraduate students.

Objectives: To report the capabilities of a patient satisfaction questionnaire in capturing factors which are important to patients in their evaluations of the quality of care they receive.Design: An experienced research officer introduced the study to all patients with defined tracer conditions in the Saskatoon Health Region from Jan to April of 2009. Patients who agreed to participate returned their completed questionnaire directly to the research officer or placed them in a special box held by the nursing unit clerk on their unit. Measures:The instrument contained: 18 items of the General Practice Assessment Questionnaire for physicians and nurses; as well as single items capturing patient observations regarding: attentiveness of nurses; tidiness of facilities; efficiency of tests and treatments; patient comments; and a grading scale assessing overall quality of care. Contextual items covered health status, expenses, insurance and demographics. A provider care model and a client satisfaction model were constructed and tested.Results: Almost 96 percent of eligible patients (n=378) completed the questionnaire. The provider care model explained 84.2 percent of the variation in patients' assessments of overall quality; and the client satisfaction model explained 67.6 percent of the variation. The qualities of nursing and medical care were the most important factors; however, attentiveness, tidiness, efficiency, and quantified comments each explained small but significant percentages of variance in overall quality. Conclusions:Patients consider separate dimensions in their assessments of overall quality of care. While quality of care by professionals trumps other considerations, patients also consider attentiveness, tidiness and efficiency to be important.