A qualitative exploration of Indigenous patients’ experiences of racism and perspectives on improving cultural safety within health care

Abstract

Background: In Canada, Indigenous Peoples continue to experience persistent health inequities, resulting in disproportionately poorer health outcomes compared with non-Indigenous Canadians. This study engaged Indigenous patients accessing health care in Vancouver, Canada, about their experiences of racism and improving cultural safety within health care. Methods: A research team consisting of Indigenous and non-Indigenous researchers committed to employing a Two-Eyed Seeing approach and conducting culturally safe research hosted 2 sharing circles in May 2019 with Indigenous people recruited from urban health care settings. Talking circles were led by Indigenous Elders, and thematic analysis was used to identify overarching themes. Results: A total of 26 participants attended 2 sharing circles, which included 25 self-identifying women and 1 self-identifying man. Thematic analysis resulted in the identification of 2 major themes: negative experiences in health care and perspectives on promising health care practices. For the first major theme, subthemes included the following: experiences of racism lead to poorer care experiences and health outcomes, Indigenous-specific racism results in mistrust in the health care system, and participants experience discrediting of traditional medicine and Indigenous perspectives on health. For the second major theme, subthemes included the following: Indigenous-specific services and supports improve trust in health care, Indigenous cultural safety education is necessary for all health care–involved staff, and providing welcoming, Indigenized spaces for Indigenous patients encourages health care engagement. Interpretation: Despite participants’ racist health care experiences, receiving culturally safe care was credited with improving trust in the health care system and well-being. The continued expansion of Indigenous cultural safety education, the creation of welcoming spaces, recruitment of Indigenous staff, and Indigenous self-determination over health care services can improve Indigenous patients’ health care experiences.

Two-Eyed Seeing Application in Research Analysis: An Integrative Review

“…Though most articles did not identify the frequency of meetings, Martin et al (2017), state that they met every 3 months to discuss the research protocols and preliminary results. Four articles ( n = 4/32; 13%) engaged in reflexivity during data analysis (Carter et al, 2017; Pilarinos et al, 2023; Vorobyova et al, 2022; Whitty-Rogers et al, 2016). Carter et al (2017), reported that the research team engaged in dialogical reflexivity where positionality was written in a story format and openly discussed and questioned by the research team to identify how social positions, values, and ideologies affected the way the research and data analysis was conducted.…”

“…Nine articles (Bruner et al, 2019;Carter et al, 2017;Hall et al, 2015;Hatala et al, 2020;Jacklin et al, 2020;Martin et al, 2018;Stelkia et al, 2021;Vorobyova et al, 2022;Wright et al, 2019c) used two of the strategies and three articles (Latimer et al, 2020;Marsh et al, 2015;Rowan et al, 2015) used three strategies to involve Indigenous community members. Overall, all but five article (Jaworsky, 2023;Pilarinos et al, 2023;Sam et al, 2022;Shrivastava et al, 2020;Sylliboy, 2021) used a strategy to involve Indigenous community members during data analysis.…”

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

“…There is an urgent need to address mental health service access to address the negative psychological and emotional impacts of the pandemic and to the improve the health of marginalized Indigenous women and Two-Spirit Peoples beyond COVID-19. Mental health services need to be enhanced to ensure these services are appropriate and culturally safe, for example, the inclusion of Elders and ceremony spaces in healthcare settings has been shown to create safer and more culturally appropriate environments for Indigenous Peoples ( 34 , 45 ). Inequities in Indigenous reproductive rights have been historically colonial, and it is crucial to identify how Indigenous women and Two-Spirit Peoples can be supported during and beyond COVID-19 to access equitable and culturally safe sexual and reproductive health services.…”

“…There is conclusive global evidence demonstrating that Indigenous Peoples have worse access to quality healthcare than other populations around the world and Indigenous Peoples face unique barriers to accessing health care services (32)(33)(34). It is important to note that research on the health differences between Indigenous and non-Indigenous Peoples does not mean that Indigenous Peoples are inherently more likely to be sick but rather they are experiencing the ongoing impacts of colonial violence, for example, residential schools, the sixties scoop, intergenerational trauma, and ongoing racism (35).…”

Patient-Oriented Research to Improve Internet-Delivered Cognitive Behavioural Therapy for People of Diverse Ethnocultural Groups in Routine Practice

“…Unfortunately, this leads to many Canadians enduring physical and mental disability and suffering, economic productivity losses, and an elevated risk of mortality by suicide due to unmet mental health care needs [9,10,12,13]. Underutilization of mental health care appears to be even greater among PDEGs compared to other Canadians, e.g., [13][14][15], and PDEGs often struggle to overcome cultural barriers (e.g., stigma, perceived lack of cultural fit, help sought within family), which leads to poor access to, and utilization of existing formal mental health services [16][17][18][19][20]. Moreover, due to differences in cultural backgrounds, level of acculturation, lived experiences, and place of dwelling (urban vs. rural), not all PDEGs in Canada have the same understanding of, access to, or the perceived need for the same type and quality of mental health care and services, e.g., see [19,[21][22][23].…”