Appraising Indigenous cultural safety within healthcare: Protocol of a scoping review of reviews

Chakanyuka, Christina; Bacsu, Juanita; DesRoches, Andrea; Walker, Jennifer; O’Connell, Megan E; Dame, Jessy; Carrier, Leah; Symenuk, Paisly; Crowshoe, Lynden; Bearskin, Lisa Bourque

doi:10.1111/jan.15096

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…The Aboriginal member of the SQCoE research team (SE) improved the trustworthiness and safety-checking of the reporting, analysis and interpretation of story providers’ voices. The respectful and reciprocal approach to helped to disrupt the historical dominance of Eurocentric approaches in Aboriginal and Torres Strait Islander health research was challenged[ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Better cardiac care – the patient experience – a qualitative study

Jennings

Egert

Fisher

et al. 2023

Int J Equity Health

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Background In 2015, a Brisbane tertiary hospital’s cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients’ voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members. Methods This descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones’ hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants’ stories to be heard and understood from their perspectives. Results Relationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys. Conclusions Empowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient’s needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality.

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Section: Methodsmentioning

confidence: 99%

Better cardiac care – the patient experience – a qualitative study

Jennings

Egert

Fisher

et al. 2023

Int J Equity Health

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“…55 73 74 Several literature reviews and at least ten additional PROS-PERO registrations address cultural safety. These reviews focus on describing culturally safe interventions for specific health issues, [9][10][11][12][13][14][15][16] how to improve healthcare practices (medicine, nursing, midwifery), [17][18][19][20][21][22][23] eHealth applications, 24 the presence of cultural safety in health research, 25 narrative descriptions of what cultural safety is [26][27][28][29][30][31][32] and the experiences of beneficiaries. 33 34 A limited literature on intercultural approaches to health emphasises communication issues.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review

Sarmiento,

Rojas-Cárdenas,

Zuluaga

et al. 2024

BMJ Open

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IntroductionCultural safety, interculturality and antiracism are crucial concepts in addressing health disparities of minority and diverse groups. Measuring them is challenging, however, due to overlapping meanings and their highly contextual nature. Community engagement is essential for evaluating these concepts, yet the methods for social inclusion and protocols for participation remain unclear. This review identifies experimental studies that measure changes resulting from culturally safe, intercultural or antiracist healthcare. The review will describe outcomes and additional factors addressed in these studies.Methods and analysisThe study focuses on epidemiological experiments with counterfactual comparisons and explicit interventions involving culturally safe, intercultural or antiracist healthcare. The search strategy covers PubMed, CINAHL, Scopus, Web of Science, ProQuest, LILACS and WHO IRIS databases. We will use critical appraisal tools from the Joanna Briggs Institute to assess the quality of randomised and non-randomised experimental studies. Two researchers will screen references, select studies and extract data to summarise the main characteristics of the studies, their approach to the three concepts under study and the reported effect measures. We will use fuzzy cognitive mapping models based on the causal relationships reported in the literature. We will consider the strength of the relationships depicted in the maps as a function of the effect measure reported in the study. Measures of centrality will identify factors with higher contributions to the outcomes of interest. Illustrative intervention modelling will use what-if scenarios based on the maps.Ethics and disseminationThis review of published literature does not require ethical approval. We will publish the results in a peer-reviewed journal and present them at conferences. The maps emerging from the process will serve as evidence-based models to facilitate discussions with Indigenous communities to further the dialogue on the contributing factors and assessment of cultural safety, interculturality and antiracism.PROSPERO registration numberCRD42023418459.

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“…Marginalized Indigenous women and Two-Spirit Peoples face intersecting and compounding forms of oppression, and we hypothesize that psychological and emotional stress may further impact healthcare access and utilization. Considering how the intersection of gender and Indigeneity impact access to healthcare, gender diverse[ 3 ] and Two-Spirit populations face mental, physical, and sexual health disparities ( 28 ) as well as high rates of racism, stigma, and discrimination from healthcare providers that impact their access to healthcare services ( 24 , 29 , 30 ). Sex workers and women living with HIV who identify as a minority gender face increased barriers to accessing healthcare in Vancouver, BC ( 9 , 31 ).…”

Section: Introductionmentioning

confidence: 99%

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

Perry,

Goldenberg,

Deering

et al. 2023

Preprint

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Objectives Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic. Methods Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020–August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months. Results Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33–16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33–11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43–15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06–6.94) had higher odds of experiencing recent difficulty accessing routine healthcare. Discussion Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.

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Appraising Indigenous cultural safety within healthcare: Protocol of a scoping review of reviews

Cited by 4 publications

References 21 publications

Better cardiac care – the patient experience – a qualitative study

Better cardiac care – the patient experience – a qualitative study

Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review

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

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