Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies

Abstract

Background Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Aim To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes. Methods We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles. Results From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability. Conclusion The prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities. Patient or public contribution This paper is a review of evaluation studies and did not involve patients or the public.

Equity in prenatal healthcare services globally: an umbrella review

“…Non-White/European patients experience greater unfair, discriminatory treatment compared to White individuals which leads to a greater risk of adverse birth outcomes [ 69 , 70 ]. Cultural (i.e., smoking as a spiritual practice) or religious (i.e., not have other people examine one’s body) norms and perceptions of distrust and patriarchy in the western healthcare system and lack of healthcare professionals with similar ethnic or cultural background leads to delayed initiation of prenatal care by patients and feelings of being unwelcome, patronized, and an unsafe pregnancy [ 43 , 44 , 49 – 51 , 53 , 58 , 68 , 70 – 76 ]. Cultural norms of family members making decisions on behalf of the patient leads to uninformed decisions [ 50 , 68 , 77 ].…”

“…Maternity care services (e.g., midwifery) adapted to patient′s expectations enhance the patient experience by reducing anxiety, creating a sense of cultural safety, and allowing patients to feel valued and to take control of their pregnancy. Examples of adaptations include interpretation services, social support, cultural knowledge, cross-cultural training of healthcare professionals, and relevant and easy to understand information [ 42 – 44 , 49 , 51 , 71 , 74 , 75 ]. Virtual health innovations that incorporate local language use improve access to care and ease of use [ 81 ].…”

“…CHWs improve health education and reduce smoking, for low-income patients [ 55 ]. Social Capital Barriers Personal/family priorities including childcare may conflict with available innovations, especially with lack of family support, and those who are socially excluded face barriers including lack of knowledge [ 45 , 50 , 51 , 75 ]. Nepotism and personal connections influence availability of services [ 46 ].…”

“…Additionally, family involvement has an even greater impact on these outcomes [ 107 ]. Innovations that encourage significant relationships, family and partner support, peer support, and community support, positively influence the patient’s well-being and health habits (e.g., smoking abstinence) and their relationship with their baby [ 49 , 51 , 59 , 64 , 71 , 83 , 89 , 93 , 108 ]. Tailored psychosocial support innovations co-developed or led by patients improve pregnancy and birth outcomes, improve cultural appropriateness, and are valued by patients [ 51 , 59 , 63 , 64 , 75 , 88 , 108 ].…”

“…Innovations that encourage significant relationships, family and partner support, peer support, and community support, positively influence the patient’s well-being and health habits (e.g., smoking abstinence) and their relationship with their baby [ 49 , 51 , 59 , 64 , 71 , 83 , 89 , 93 , 108 ]. Tailored psychosocial support innovations co-developed or led by patients improve pregnancy and birth outcomes, improve cultural appropriateness, and are valued by patients [ 51 , 59 , 63 , 64 , 75 , 88 , 108 ]. Virtual health innovations that incorporate an interactive online community improves interaction between patients and with healthcare professionals [ 60 , 78 , 81 ].…”