Finding the Balance: Embracing the Two-Eyed Seeing Approach to Understand what Cultural Safety in Care Means to Older Adults Living with HIV

Abstract

Older adults living with HIV (OALHIV) are a fast-growing demographic who rely on home and community care (HCC) services. Cultural safety (an environment free of racism that fosters feelings of safety and respect) is integral to HCC services. We conducted 27 semi-structured interviews with OALHIV in Vancouver, British Columbia about their HCC experiences. Excerpts about cultural safety were qualitatively analyzed using Two-Eyed Seeing. Our themes—Voices from across Turtle Island, Voices from the African continent, Western Perspectives, and Universal Principles—indicate that cultural safety is important yet lacking. While specific aspects of culturally safe HCC services varied between and within cultural groups, some aspects were shared by participants across groups (e.g., respect, compassion, and non-judgment).

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.…”

“…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. Other authors reported keeping reflexive notes or journals to allow time to create space to reflect and gain perspective (Vorobyova et al, 2022; Whitty-Rogers et al, 2016). Finally, one article ( n = 1/32; 3%), reported prolonged engagement with participants, during the analysis phase of research (Quinn, 2022).…”

“…Indigenous community member involvement during research analysis involved 28 ( n = 28/32; 88%) articles (Bruner et al, 2019; Cabrera et al, 2015; Carter et al, 2017; Clark, 2014; Danto et al, 2021; Galway et al, 2022; Hall et al, 2015; Hatala et al, 2020; Hunt et al, 2018; Jacklin et al, 2020; Kurtz et al, 2017; Latimer et al, 2020; Marsh et al, 2015; Martin et al, 2017, 2018; Quinn, 2022; Rand, 2016; Rowan et al, 2015; Stelkia et al, 2021; Sylliboy, 2021; Tarasuk et al, 2021; VanEvery et al, 2022; Vorobyova et al, 2022; Ward et al, 2023; Wekerie et al, 2022; Whiting et al, 2018; Whitty-Rogers et al, 2016; Wright et al, 2019). This theme was divided into four sub-themes including: (a) analysis results presented to an Indigenous advisory group for feedback and comment, (b) Indigenous community member(s) involved with coding and analysis, (c) analysis results reviewed with research participants via member checking, and (d) partnership with an Elder or Knowledge Keeper during analysis.…”

“…In an article by Marsh et al (2015), the Elders and Aboriginal advisory group provided input into the cultural components of the data to gain more accurate meaning of the analysis. 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.…”

Obstacles and Pathways on the Journey to Access Home and Community Care by Older Adults Living With HIV/AIDS in British Columbia, Canada: Thrive, a Community-Based Research Study

“…), to name a few. 32 From before referral through to receiving HCC services, public policy development and client-centered, culturally safe care improvements are vital in the HCC provision to OALHIV and the general population. These public policies and HCC services require a sustainable foundation and multigenerational strategy that withstands election cycles and shifting political priorities.…”