Indigenous Cultural Safety Training for Applied Health, Social Work and Education Professionals: A PRISMA Scoping Review

Abstract

Background: Anti-Indigenous racism is a widespread social problem in health, social work, and education systems in English-speaking Colonized countries such as Canada, with profound negative impacts to the health and education of Indigenous peoples. In 2015, Canada's Truth and Reconciliation Commission recognized the legacy and impact of Colonization and recommended training programs for these professions on cultural competency and curricula, and on the colonial history of Canada. Yet there is little evidence on best practices for such training, highlighting the need to synthesize existing findings on how these training programs are developed, implemented, and evaluated. Methods: This scoping review explored the academic literature on Indigenous cultural safety and competence training in the health, social work, and education fields. Medline, EMBASE, CINAHL, ERIC and ASSIA were searched for articles published between 1996-2020 in Canada, United States, Australia, and New Zealand. The Joanna Briggs Institute's three-step search strategy was used as was the PRISMA extension for Scoping Reviews. Data was charted and synthesized in three stages. Results: 134 were included in this review. Data was extracted on four themes: 1) Article Characteristic; 2) Cultural Safety Concepts, Critiques and Rationale; 3) Characteristics of Cultural Safety Training; and 4) Evaluation Details of Cultural Safety Training. Findings suggest that research on cultural safety training programs in health, social work and education has grown significantly. Nursing and medicine professions have received a significant proportion of cultural training programs, compared with general/allied health, social work, and education. Across fields, professionals and students were targeted equally by training programs. Only half of evaluations of cultural safety and related intervention identified methodological limitations. Implications: Considering, comparing, and contrasting literature on cultural safety and related concepts and how they are applied in practice would advance this scholarly work, as would more robust evaluations of cultural safety and similar training interventions to understand their impact at the individual level. Finally, commitment to meaningfully engage Indigenous communities to develop, implement and evaluate such programs is urgently needed.

Designing Accountability Measures for Health Professionals: Results from a community-based micro-credential: Case Study on Indigenous Cultural Safety

“…In designing the tool, we incorporated Indigenous approaches to evaluation (34,(38)(39)(40), knowledge of the Indigenous cultural safety continuum (12), and the Transtheoretical model (41). We had discussions with First Nations and Métis Elders, community members and organizations to determine what would be indicators of public health staff incorporating cultural safety knowledge into their daily practice.…”

“…We also consulted with public health staff and scholars to determine competencies and indicators for successfully working with Indigenous peoples broadly. Finally, we conducted an environmental scan in June 2021 showing a dearth of information about cultural safety indicators and evaluation of incorporation (41). The tool was grounded in the following intervention assumptions: (1) staff who increase their knowledge and awareness of Indigenous peoples and cultural safety will increase their motivation to support Indigenous communities through programs, policy, and advocacy; and (2) staff who increase their knowledge, including self-awareness, through completion of the course will increase their con dence and skills in Indigenous cultural safety.…”

Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States

“…Of the Truth and Reconciliation Commission of Canada’s seven Calls to Action in the domain of health, two address the need to provide ‘cultural competency’ training for healthcare providers 21. These policy recommendations have been accompanied by a rapid growth of interventions designed to interrupt anti-Indigenous racism, primarily through educational interventions for healthcare providers and trainees 22 23. On engagement with this literature,22 it became apparent to our team that the approach, content and evaluations of existing cultural competency trainings vary widely.…”