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Dubé E, Renaud MP, Lyonnais MC, Pelletier C, Fletcher C. "The needle is already ready to go": communities' and health care professionals' perceptions of routine vaccination in Nunavik, Canada. Int J Circumpolar Health 2024; 83:2295042. [PMID: 38105644 PMCID: PMC10732179 DOI: 10.1080/22423982.2023.2295042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Canada
- Département d’anthropologie, Université Laval, Québec, Canada
| | - Marie-Pierre Renaud
- École d’études autochtones, Université du Québec en Abitibi-Témiscamingue, Québec, Canada
| | | | - Catherine Pelletier
- Axe Maladies infectieuses et immunitaires, Centrre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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Cassidy-Matthews C, Pearce M, Hussaini T, Spittal P, Caron N, Daley C, Alfred R, Yoshida EM. "My feelings and my thoughts are my lived experience, not the numbers they show me on a piece of paper": Indigenous experiences of liver transplantation in British Columbia, Canada. Int J Circumpolar Health 2024; 83:2359747. [PMID: 38805610 PMCID: PMC11136460 DOI: 10.1080/22423982.2024.2359747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
Indigenous Peoples in Canada face healthcare inequities impacting access to solid organ transplantation. The experiences of Indigenous patients during the liver transplant process, and how transplant professionals perceive challenges faced by Indigenous Peoples, has not been studied. Thirteen semi-structured qualitative interviews were conducted via telehealth with Indigenous liver transplant patients (n = 7) and transplant care providers (n = 6) across British Columbia, Canada between April 2021-May 2022. Themes were identified to inform clinical approaches and transplant care planning and validated by Indigenous health experts. Among patient participants: transplants occurred between 1992-2020; all were women; and the mean age at the time of interview was 60 years. Among transplant care provider participants: roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: Indigenous strengths and resources, systemic and structural barriers, and inconsistent care and cultural safety across health professions impact Indigenous patient care during liver transplantation. This study contributes insights into systemic barriers and Indigenous resilience in the liver transplant journey. Dismantling structural barriers to early linkage to care is needed, and training for transplant clinicians on Indigenous histories, cultural protocols, and cultural safety is strongly recommended.
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Affiliation(s)
- Chenoa Cassidy-Matthews
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Margo Pearce
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Trana Hussaini
- The Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Patricia Spittal
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Nadine Caron
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- The Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Cole Daley
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- The Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ruth Alfred
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Eric M. Yoshida
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- The Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Borwick K, Loignon C, Viscogliosi C, Courtois B, Battista MC, D'Aragon F. Culturally Safe Care Barriers and Facilitators in Organ Transplantation and Donation According to First Nations and Health Professionals in Quebec, Canada. Prog Transplant 2024:15269248241268672. [PMID: 39140978 DOI: 10.1177/15269248241268672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Introduction: First Nations are most at risk of developing end-stage kidney disease. Kidney transplantation is the best treatment option for these patients; however, First Nations donors are underrepresented. The aim of this study was to describe and understand barriers and facilitators of culturally safe organ transplantation and donation from the perspective of First Nations and Health Professionals in the Province of Quebec, Canada. Methods/Approach: This was a qualitative descriptive study using the decolonizing Two-Eyed Seeing approach. The sample consisted of First Nations people and health professionals living in Quebec, Canada, who have had an experience of organ transplantation or donation. Semi-structured interviews were conducted between May and September 2021 with 11 people, including 5 healthcare professionals and 6 First Nations people. Findings: This study enrolled 11 participants. Several individual and contextual factors influencing culturally safe organ transplantation and donation among First Nations people were identified: language barrier, impacts of relocation, lack of knowledge about transplantation, mistrust of the healthcare system, family support and accompaniment, and transplant testimonials. Discussion: This study identified several avenues for reinforcing culturally safe transplantation and donation among First Nations, including the presence of a companion in medical consultations, focusing on access to culturally safe accommodation and sharing transplant testimonials. Further work in partnership with First Nations is needed to improve access to culturally safe organ transplantation.
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Affiliation(s)
- Kimberly Borwick
- Centre de recherche Charles-Le Moyne, CISSS de la Montérégie-Centre, Longueuil, Québec, Canada
| | - Christine Loignon
- Centre de recherche Charles-Le Moyne, CISSS de la Montérégie-Centre, Longueuil, Québec, Canada
- Département de médecine de famille et d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Chantal Viscogliosi
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche sur le vieillissement du CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada
| | | | - Marie-Claude Battista
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Frédérick D'Aragon
- Département d'anesthésiologie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du CHUS, Sherbrooke, Québec, Canada
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Vargas-Costales JA, Rosero CYDLMV, Mazin SC, Candido-Dos-Reis FJ, Nogueira AA, Rosa-E-Silva JC, Poli-Neto OB. Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador. BMC Womens Health 2024; 24:388. [PMID: 38965526 PMCID: PMC11223279 DOI: 10.1186/s12905-024-03189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Chronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The lack of data on this condition in several countries, particularly those in development and in socially and biologically vulnerable populations such as the indigenous, makes it difficult to guide public policies. OBJECTIVES To evaluate the prevalence of chronic pelvic pain (dysmenorrhea, dyspareunia, non-cyclical pain) and identify which variables are independently associated with the presence of the condition in indigenous women from Otavalo-Ecuador. DESIGN A cross-sectional study was carried out including a sample of 2429 women of reproductive age between 14 and 49 years old, obtained from April 2022 to March 2023. A directed questionnaire was used, collected by bilingual interviewers (Kichwa and Spanish) belonging to the community itself; the number of patients was selected by random sampling proportional to the number of women estimated by sample calculation. Data are presented as case prevalence, odds ratio, and 95% confidence interval, with p < 0.05. RESULTS The prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%.all forms of chronic pain were independently associated with each other. Additionally, dysmenorrhoea was independently associated with hypertension, intestinal symptoms, miscegenation, long cycles, previous pregnancy, use of contraceptives and pear body shape. Pain in other sites, late menarche, exercise, and pear body shape were associated with non-cyclic pelvic pain. And, urinary symptoms, previous pregnancy loss, miscegenation, and pear body shape were associated with dyspareunia. CONCLUSION The prevalence of primary dysmenorrhea and non-cyclical chronic pelvic pain was notably high, in contrast with the frequency of reported dyspareunia. Briefly, our results suggest an association between dysmenorrhoea and conditions related to inflammatory and/or systemic metabolic disorders, including a potential causal relationship with other manifestations of pelvic pain, and between non-cyclical pelvic pain and signs/symptoms suggesting central sensitization. The report of dyspareunia may be influenced by local cultural values and beliefs.
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Affiliation(s)
- José Antonio Vargas-Costales
- Department of Pharmacology, School of Medicine, Faculty of Medical Sciences, Central University of Ecuador, Quito, Ecuador
| | | | - Suleimy Cristina Mazin
- Department of Obstetrics and Gynecology, Laboratory for Translational Data Science, Ribeirão Preto Medical School of the University of São Paulo USP, Bandeirantes Avenue. Monte Alegre. Ribeirão Preto, Ribeirão Preto, SP, 3900, 049-900, Brazil
| | - Francisco José Candido-Dos-Reis
- Department of Obstetrics and Gynecology, Laboratory for Translational Data Science, Ribeirão Preto Medical School of the University of São Paulo USP, Bandeirantes Avenue. Monte Alegre. Ribeirão Preto, Ribeirão Preto, SP, 3900, 049-900, Brazil
- Laboratory for Translational Data Science, CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), Brasília, Brazil
| | - Antonio Alberto Nogueira
- Department of Obstetrics and Gynecology, Laboratory for Translational Data Science, Ribeirão Preto Medical School of the University of São Paulo USP, Bandeirantes Avenue. Monte Alegre. Ribeirão Preto, Ribeirão Preto, SP, 3900, 049-900, Brazil
| | - Julio Cesar Rosa-E-Silva
- Department of Obstetrics and Gynecology, Laboratory for Translational Data Science, Ribeirão Preto Medical School of the University of São Paulo USP, Bandeirantes Avenue. Monte Alegre. Ribeirão Preto, Ribeirão Preto, SP, 3900, 049-900, Brazil
- Laboratory for Translational Data Science, CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), Brasília, Brazil
| | - Omero Benedicto Poli-Neto
- Department of Obstetrics and Gynecology, Laboratory for Translational Data Science, Ribeirão Preto Medical School of the University of São Paulo USP, Bandeirantes Avenue. Monte Alegre. Ribeirão Preto, Ribeirão Preto, SP, 3900, 049-900, Brazil.
- Laboratory for Translational Data Science, CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), Brasília, Brazil.
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Pham LA, Clark PJ, Macdonald GA, Thomas JA, Dalais C, Fonda A, Kendall BJ, Thrift AP. Colorectal cancer screening participation in First Nations populations worldwide: a systematic review and data synthesis. EClinicalMedicine 2024; 73:102666. [PMID: 38828132 PMCID: PMC11139771 DOI: 10.1016/j.eclinm.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024] Open
Abstract
Background First Nations populations have poorer colorectal cancer (CRC) survival compared to non-First Nations populations. Whilst First Nations populations across the world are distinct, shared experiences of discrimination and oppression contribute to persistent health inequities. CRC screening improves survival, however screening rates in First Nations populations are poorly described. This study seeks to define participation rates in CRC screening in First Nations populations worldwide. Methods A systematic literature search was conducted of PubMed, Embase, Cochrane Library, CINAHL, MEDLINE, grey literature, national registries and ClinicalTrials.gov. All sources were searched from their inception date to 18 February 2024. Studies were included if they reported CRC screening rates in adult (≥18 years) First Nations populations. We aimed to undertake a meta-analysis if there were sufficient data. Quality of papers were assessed using the Joanna Briggs Institute (JBI) appraisal tool. The study was registered with PROSPERO, CRD42020210181. Findings The literature search identified 1723 potentially eligible published studies. After review, 57 studies were included, 50 from the United States (US), with the remaining studies from Australia, Aotearoa New Zealand (NZ), Canada, Dominica and Guatemala. Additionally, eleven non-indexed reports from national programs in Australia and NZ were included. There were insufficient data to undertake meta-analysis, therefore a systematic review and narrative synthesis were conducted. CRC screening definitions varied, and included stool-based screening, sigmoidoscopy and colonoscopy. US First Nations screening rates ranged between 4.0 and 79.2%, Australia reported 10.6-35.2%, NZ 18.4-49%, Canada 22.4-53.4%, Guatemala 2.2% and Dominica 4.2%. Fifty-five studies were assessed as moderate or high quality and two as low quality. Interpretation Our findings suggested that there is wide variation in CRC screening participation rates across First Nations populations. Screening data are lacking in direct comparator groups and longitudinal outcomes. Disaggregation of screening data are required to better understand and address First Nations CRC outcome inequities. Funding None.
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Affiliation(s)
- Lily A. Pham
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul J. Clark
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Graeme A. Macdonald
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - James A. Thomas
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Christine Dalais
- University of Queensland Library, The University of Queensland, Brisbane, Australia
| | - Annie Fonda
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Brisbane, Australia
| | - Bradley J. Kendall
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, United States
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, United States
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Lermytte E, Bracke P, Ceuterick M. Healthcare Professionals' Discursive Constructions of Parental Vaccine Hesitancy: A Tale of Multiple Moralities. QUALITATIVE HEALTH RESEARCH 2024:10497323241245646. [PMID: 38881208 DOI: 10.1177/10497323241245646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Healthcare professionals play a crucial role in addressing the concerns of vaccine-hesitant parents since they form a trusted source for vaccine-related information. An increasing body of evidence suggests that healthcare professionals are faced with complexities when navigating the sensitive topic of parental vaccine hesitancy, as they balance their own vaccine- and context-specific concerns with institutional and societal pressures to vaccinate. Furthermore, health choices, such as parental choices for childhood vaccination, are often linked to moralisation. Given the emphasis on effective communication with vaccine-hesitant parents in the patient-centred care literature, it is important to consider healthcare professionals' interpretations of parental vaccine hesitancy. Hence, a deeper understanding of how healthcare professionals make sense of, and moralise, childhood vaccination can help us understand how moralisation might appear in their communication with hesitant parents (in)directly. Drawing on a critical social-psychological framework for discourse analysis, this study analyses 39 semi-structured interviews with healthcare professionals in Flanders, Belgium, and presents the discursive patterns articulated by healthcare professionals on parental vaccine hesitancy. The findings elucidate how healthcare professionals perpetuate, or resist, moral discourse in their accounts of vaccine hesitancy by constructing five different interpretative repertoires, that is, a "good" or "bad" parenting repertoire, a freedom of choice repertoire, an individual risk-benefit repertoire, a public health repertoire, and an accessibility repertoire. Our study highlights the complexities healthcare professionals experience in negotiating vaccine hesitancy, as their understandings of vaccine hesitancy are affected by, and contribute to, existing moral dilemmas and dominant discourses surrounding health and parenting.
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Affiliation(s)
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
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Halberg N, Larsen TS, Holen M. Overwork as a concept to understand health inequities for ethnicised patients in health care. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38822818 DOI: 10.1111/1467-9566.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/02/2024] [Indexed: 06/03/2024]
Abstract
Health inequities for ethnically minoritised patients are well-documented. In this ethnographic study, we follow thirteen patients categorised as 'ethnic minorities' in Danish health care during hospitalisation in three orthopaedic wards across two hospitals. The categorisation of 'ethnic minority patient' has been problematised for its Eurocentric origin and practices within Westernised health care. We use ethnicised to emphasise the process of becoming minoritised based on markers of physical appearance, religious symbols, language or names. Access to health care also rely on perceived legitimacy as health-care recipients which requires work by patients. We demonstrate the workings patients categorised as 'ethnic minorities' engage in by (re)producing othering ideas about non-Danishness, including distancing from other patients perceived as problematic. These were then (counter)produced by positioning oneself as the opposite, as deserving health-care receivers by displaying welfare reciprocity, supporting egalitarian ideas by discounting discriminatory experiences, showing gratitude and identifying staff with good vibes. We propose these doings as creating overwork. This theoretical approach enables a sensitivity towards subtle and covert workings for patients placed in the margins of health care. In this study, overwork is closely related to notions of Danishness and takes on specific forms within a modernised and universalised Danish health-care system.
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Affiliation(s)
- Nina Halberg
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Orthopaedic Surgery, The Research Unit of Orthopaedic Nursing, Copenhagen University Hospital, Hvidovre, Denmark
| | - Trine Schifter Larsen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Orthopaedic Surgery, The Research Unit of Orthopaedic Nursing, Copenhagen University Hospital, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mari Holen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
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Aguilar-Rodríguez MA, Castro-Porras LV. COVID-19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis. Birth 2024; 51:432-440. [PMID: 38037260 DOI: 10.1111/birt.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico. METHODS We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits. RESULTS During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference. CONCLUSIONS According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.
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Affiliation(s)
| | - Lilia V Castro-Porras
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Kaur G, Masket D, Reddy T, Revankar S, Satish P, Paquin A, Mulvagh S, O'Donoghue ML, Zieroth S, Farkouh M, Gulati M. Socioeconomic Disparities in Women's Cardiovascular Health in the United States and Canada. Can J Cardiol 2024; 40:1056-1068. [PMID: 38593915 DOI: 10.1016/j.cjca.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Cardiovascular disease has been the leading cause of death in the United States and Canada for decades. Although it affects millions of people across a multitude of backgrounds, notable disparities in cardiovascular health are observed among women and become more apparent when accounting for race and socioeconomic status. Although intrinsic sex-specific physiologic differences predispose women to poorer outcomes, social determinants of health (SDOH) and biases at both the individual provider and the larger health care system levels play an equal, if not greater, role. This review examines socioeconomic disparities in women compared with men regarding cardiovascular risk factors, treatments, and outcomes. Although various at-risk subpopulations exist, we highlight the impact of SDOH in specific populations, including patients with disabilities, transgender persons, and South Asian and Indigenous populations. These groups are underrepresented in studies and experience poorer health outcomes owing to structural barriers to care. These findings emphasise the significance of understanding the interplay of different socioeconomic factors and how their stacking can negatively affect women's cardiovascular health. To address these disparities, we propose a multipronged approach to augment culturally sensitive and patient-centred care. This includes increased cardiovascular workforce diversity, inclusion of underrepresented populations into analyses of cardiovascular metrics, and greater utilisation of technology and telemedicine to improve access to health care. Achieving this goal will necessitate active participation from patients, health care administrators, physicians, and policy makers, and is imperative in closing the cardiovascular health gap for women over the coming decades.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diane Masket
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Tina Reddy
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shruti Revankar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Priyanka Satish
- Ascension Texas Cardiovascular, University of Texas at Austin Dell School of Medicine, Austin, Texas, USA
| | - Amelie Paquin
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelley Zieroth
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Farkouh
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
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Sehgal A, Henderson R, Murry A, Crowshoe LL, Barnabe C. Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework. BMC PRIMARY CARE 2024; 25:144. [PMID: 38684966 PMCID: PMC11057171 DOI: 10.1186/s12875-024-02362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. METHODS A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. RESULTS A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. CONCLUSIONS The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
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Affiliation(s)
- Anika Sehgal
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Rita Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Adam Murry
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Malkin J, Jessiman-Perreault G, Alberga Machado A, Teare G, Snider J, Tirmizi SF, Youngson E, Wang T, Law J, Bandara T, Rathwell M, Neudorf C, Allen Scott L. Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study. JMIR Public Health Surveill 2024; 10:e45508. [PMID: 38536211 PMCID: PMC11007603 DOI: 10.2196/45508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/06/2023] [Accepted: 01/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. OBJECTIVE The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. METHODS Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. RESULTS The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. CONCLUSIONS Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.
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Affiliation(s)
- Jennifer Malkin
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Geneviève Jessiman-Perreault
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Amanda Alberga Machado
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Gary Teare
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Joanne Snider
- Communicable Disease Control, Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Syed Farhan Tirmizi
- Communicable Disease Control, Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Ting Wang
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Jessica Law
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Thilina Bandara
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Lisa Allen Scott
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
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Metersky K, Chandrasekaran K, Ezekiel S. Undergraduate Nursing Student Reflections on Indigenous Peoples' Experiences With the Canadian Health Care System. Nurs Educ Perspect 2024:00024776-990000000-00218. [PMID: 38451153 DOI: 10.1097/01.nep.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIM The aim of this study was to analyze nursing student level of knowledge and understanding of current experiences of Indigenous people within the Canadian health care system to identify curricular gaps that need to be addressed. BACKGROUND In response to the 2015 Truth and Reconciliation Commission of Canada, nursing schools have begun incorporating Indigenous health content into curricula. However, few studies about the implementation and effectiveness of this education exist. METHOD Students wrote a reflection and engaged with colleagues' reflections after watching a video from the Aboriginal Peoples Television Network. Fifteen reflections were selected using systematic, random sampling to undergo thematic analysis. RESULTS Two themes were identified: 1) students' understanding of barriers Indigenous populations face when accessing the health care system and 2) students' perceptions of strategies to ensure culturally safe care for Indigenous populations. CONCLUSION Analysis of students' learning through a reflection activity can improve the Indigenous health content curriculum.
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Affiliation(s)
- Kateryna Metersky
- About the Authors Kateryna Metersky, PhD, RN, is an assistant professor of nursing, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada. Kaveenaa Chandrasekaran, BScN, RN, is a candidate for a master's degree in nursing, Daphne Cockwell School of Nursing, Toronto Metropolitan University. Suzanne Ezekiel, MN, BScN, RN, is a clinical nurse specialist, Unity Health, Toronto, Ontario. The authors are grateful to the second-year nursing students who participated in this study. For more information, contact Dr. Metersky at
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Crockett K, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Martinez-Rueda R, Aiyer H, Carnegie B, Custer M, McIntosh S, Bath B. "Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain. Can J Pain 2024; 8:2318706. [PMID: 38616950 PMCID: PMC11008541 DOI: 10.1080/24740527.2024.2318706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
Background Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.
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Affiliation(s)
- Katie Crockett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology, & Health, Royal Institute of Technology, Stockholm, Sweden
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terrence McDonald
- Department of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Calgary, Alberta, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rosmary Martinez-Rueda
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harini Aiyer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Zhang L, Hou XY, Liu Y. Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01899-6. [PMID: 38270837 DOI: 10.1007/s40615-023-01899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.
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Affiliation(s)
- Lihong Zhang
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yan Liu
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia.
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Manson E, Ryding E, Taylor W, Peekeekoot G, Gloeckler SG, Allard P, Johnny C, Greenway KT, Dames S. Indigenous Voices in Psychedelic Therapy: Experiential Learnings from a Community-Based Group Psychedelic Therapy Program. J Psychoactive Drugs 2023; 55:539-548. [PMID: 37723666 DOI: 10.1080/02791072.2023.2258120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
Novel and traditional psychedelic medicines are attracting interest as potential treatments of mental illness. Before psychedelic therapies can be made available in culturally safe and effective ways to diverse peoples, the field must grapple with the complex legacies of colonialism and ongoing clashes between biomedical and Indigenous Ways of Knowing. This article presents results of a pilot program offering group-based therapy augmented by three sessions of ketamine at a psychedelic dose, for a group of Indigenous participants. This unique project was undertaken in partnership between Roots to Thrive and the Snuneymuxw First Nation to assess this approach's effectiveness and safety for Indigenous peoples. Thematic analysis of qualitative interviews and anonymous feedback received throughout the program from eight participants and two Elders provided rich information on participant motivations, perceived barriers, appreciated and beneficial aspects of the program, and the psychedelic experiences, as well as important directions for further improvement. In addition to challenges, participants attributed significant benefits to the program while highlighting the importance of the involvement of Indigenous team members, the incorporation of traditional approaches to healing, and the cultivation of open and authentic relationships between group participants and facilitators. We discuss important lessons learned and the essential work of reconciliation in, and beyond, psychedelic therapies.
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Affiliation(s)
- Emmy Manson
- Snuneymuxw First Nation, British Columbia, Canada
| | - Erin Ryding
- RTT-KaT Program, Roots to Thrive Society for Psychedelic Therapy, Nanaimo, British Columbia, Canada
| | - Wes Taylor
- RTT-KaT Program, Roots to Thrive Society for Psychedelic Therapy, Nanaimo, British Columbia, Canada
- Faculty of Health and Human Services, Vancouver Island University, Nanaimo, British Columbia, Canada
| | - Gail Peekeekoot
- RTT-KaT Program, Roots to Thrive Society for Psychedelic Therapy, Nanaimo, British Columbia, Canada
| | - Sara G Gloeckler
- Department of Psychiatry, Faculty of Medicine, McGill University, Quebec, Canada
- Department of Psychiatry, Lady Davis Institute, Jewish General Hospital, Quebec, Canada
| | - Pearl Allard
- Faculty of Health and Human Services, Vancouver Island University, Nanaimo, British Columbia, Canada
| | | | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Quebec, Canada
- Department of Psychiatry, Lady Davis Institute, Jewish General Hospital, Quebec, Canada
| | - Shannon Dames
- RTT-KaT Program, Roots to Thrive Society for Psychedelic Therapy, Nanaimo, British Columbia, Canada
- Faculty of Health and Human Services, Vancouver Island University, Nanaimo, British Columbia, Canada
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Hsiao R, Youngson E, Lafontaine A, Fathimani K, Williams DC. Comparison of outcomes after appendectomy in First Nations and non-First Nations patients in Northern Alberta. Can J Surg 2023; 66:E540-E549. [PMID: 37967970 PMCID: PMC10664803 DOI: 10.1503/cjs.011222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Internationally, Indigenous Peoples experience worse surgical outcomes than non-Indigenous patients, but equity of surgical care is less well studied in Canada. This study compares outcomes after appendectomy in First Nations and non-First Nations patients. METHODS In this population-based study, we reviewed administrative data of patients who underwent appendectomy between Apr. 1, 2004, and Mar. 31, 2017, in Northern Alberta. Demographic variables and characteristics of surgical care for First Nations and non-First Nations patients were collected. We identified adverse outcomes by the presence of predefined administrative codes. We identified variables related to a complex postoperative course (at least 1 of wound dehiscence, surgical site infection, abscess, bowel obstruction, pneumonia, deep vein thrombosis, sepsis, emergency department visit, readmission or death within 30 d after appendectomy) through a logistic regression model, and those related to longer length of stay using a Cox proportional hazards model. RESULTS A total of 28 453 patients met the selection criteria, of whom 1737 (6.1%) had First Nations status. Compared to non-First Nations patients, First Nations patients were younger, lived farther away from the hospital of their appendectomy, were in lower socioeconomic quintiles, and had higher rates of obesity and diabetes (all p < 0.001). After adjustment for age, sex, distance to hospital, socioeconomic deprivation and comorbidities, First Nations status remained independently associated with higher rates of adverse outcomes (odds ratio 1.548, 95% confidence interval [CI] 1.384-1.733) and longer lengths of stay (hazard ratio 0.877, 95% CI 0.832-0.924). CONCLUSION Although rurality, comorbidities and socioeconomic status contributed to worse outcomes after appendectomy for First Nations patients, First Nations status remained independently associated with worse surgical outcomes. Surgical care, an integral component of health care delivery, must be improved for First Nations patients in order to achieve equitable health care.
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Affiliation(s)
- Ralph Hsiao
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - Erik Youngson
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - Alika Lafontaine
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - Kamran Fathimani
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - David C Williams
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
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Perry C, Goldenberg S, Deering K, Patrick L, Braschel M, Shannon K, Bingham B. Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3450143. [PMID: 37961370 PMCID: PMC10635380 DOI: 10.21203/rs.3.rs-3450143/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
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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Pitcher CF, Browne AJ. The potential influence of critical pedagogy on nursing praxis: Tools for disrupting stigma and discrimination within the profession. Nurs Inq 2023; 30:e12573. [PMID: 37455327 DOI: 10.1111/nin.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
Nursing work centers around attending to a person's health during many of life's most vulnerable moments, from birth to death. Given the high-stakes nature of this work, it is essential for nurses to critically reflect on their individual and collective impact, which can range from healing to harmful. The purpose of this paper is to use a philosophical inquiry approach and a critical lens to explore the potential influence of critical pedagogy (how we learn what we learn) on nursing praxis (why we do what we do) with the aim of disrupting stigma and discrimination within the profession. This paper draws on the works of Paulo Freire, Henry Giroux, and bell hooks to alert readers to particular windows of opportunity where an intentional adoption of critical pedagogy in nursing praxis may help the profession think differently about two important and related topics: relational violence and peer-led knowledge mobilization. As a practice-based and theoretically grounded profession, nurses often strive to bridge the theoretical with the practical and the individual with the systemic. Thus, developing a robust and philosophically rooted disciplinary body of knowledge is particularly important to help us defensibly grapple with the notions of truth and ethics that shape our work's very essence and impact.
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Affiliation(s)
- Claire F Pitcher
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Wegenast BF, Whitten TA, Bakal JA, Bill L, Loyola-Sanchez A. Epidemiology and healthcare utilization of First Nations peoples living with spinal cord injury in Alberta: an observational study to explore health inequities. Spinal Cord Ser Cases 2023; 9:48. [PMID: 37679339 PMCID: PMC10484972 DOI: 10.1038/s41394-023-00603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
STUDY DESIGN Retrospective observational cohort study. OBJECTIVES Estimate spinal cord injury (SCI) prevalence in First Nations and non-First Nations populations and compare healthcare utilization as an indirect marker of health inequities. SETTING Alberta, Canada. METHODS We created a prevalent adult SCI cohort by identifying cases between April 1, 2002 and December 31, 2017 who were followed for common SCI complications and location of healthcare access from January 1, 2018 to December 31, 2019 using administrative data sources housed within Alberta Health Services (AHS). First Nations and non-First Nations SCI cohorts were divided into SCI etiology: traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Statistical analyses compared prevalence, demographics, healthcare utilization, and SCI complication rates. A secondary analysis was performed using case matching for demographics, injury type, injury level, and comorbidities. RESULTS TSCI prevalence: 248 and 117 per 100,000 in First Nations and non-First Nations cohorts, respectively. NTSCI prevalence: 74 and 50 per 100,000 in First Nations and non-First Nations cohorts, respectively. Visit rates were higher in the TSCI First Nations cohort for visits to General Practitioner (GP), Emergency Department (ED), inpatient visits, and inpatient days with higher complication rates due to pulmonary, genitourinary, skin, and 'other' causes after case matching. Visits rates were higher in the NTSCI First Nations cohort for GP and specialists without differences in complication types after case matching. CONCLUSIONS Significant differences exist between First Nations and non-First Nations cohorts living with SCI in Alberta, suggesting healthcare inequities against First Nations Peoples in this province.
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Affiliation(s)
| | | | | | - Lea Bill
- Alberta First Nations Information Governance Center, Edmonton, AB, Canada
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Srugo SA, Ricci C, Leason J, Jiang Y, Luo W, Nelson C. Disparities in primary and emergency health care among "off-reserve" Indigenous females compared with non-Indigenous females aged 15-55 years in Canada. CMAJ 2023; 195:E1097-E1111. [PMID: 37640405 PMCID: PMC10462408 DOI: 10.1503/cmaj.221407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Access to primary care protects the reproductive and non-reproductive health of females. We aimed to quantify health care disparities among "off-reserve" First Nations, Métis and Inuit females, compared with non-Indigenous females of reproductive age. METHODS We used population-based data from cross-sectional cycles of the Canadian Community Health Survey (2015-2020), including 4 months during the COVID-19 pandemic. We included all females aged 15-55 years. We measured health care access, use and unmet needs, and quantified disparities through weighted and age-standardized absolute prevalence differences compared with non-Indigenous females. RESULTS We included 2902 First Nations, 2345 Métis, 742 Inuit and 74 760 non-Indigenous females of reproductive age, weighted to represent 9.7 million people. Compared with non-Indigenous females, Indigenous females reported poorer health and higher morbidity, yet 4.2% (95% confidence interval [CI] 1.8% to 6.6%) fewer First Nations females and 40.7% (95% CI 34.3% to 47.1%) fewer Inuit females had access to a regular health care provider. Indigenous females waited longer for primary care, more used hospital services for nonurgent care, and fewer had consultations with dental professionals. Accordingly, 3.2% (95% CI 0.3% to 6.1%) more First Nations females and 4.0% (95% CI 0.7% to 7.3%) more Métis females reported unmet needs, especially for mental health (data for Inuit females not reported owing to high variability). INTERPRETATION During reproductive age, Indigenous females in Canada face many disparities in health care access, use and unmet needs. Solutions aimed at increasing access to primary care are urgently needed to advance health care reconciliation.
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Affiliation(s)
- Sebastian A Srugo
- Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta.
| | - Christina Ricci
- Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta
| | - Jennifer Leason
- Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta
| | - Ying Jiang
- Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta
| | - Wei Luo
- Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta
| | - Chantal Nelson
- Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta
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Livergant RJ, Stefanyk K, Binda C, Fraulin G, Maleki S, Sibbeston S, Joharifard S, Hillier T, Joos E. Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001805. [PMID: 37585444 PMCID: PMC10431673 DOI: 10.1371/journal.pgph.0001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10-1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12-1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02-1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.
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Affiliation(s)
- Rachel J. Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey Stefanyk
- Faculty of Medicine, University of British Columbia, Prince George, British Columbia, Canada
| | - Catherine Binda
- Faculty of Medicine, University of British Columbia, Terrace, British Columbia, Canada
| | - Georgia Fraulin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sasha Maleki
- Faculty of Pharmaceutical Sciences, Lower Mainland Pharmacy Services, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Sibbeston
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Northwest Territory Métis Nation, Yellowknife, Northwest Territories, Canada
| | - Shahrzad Joharifard
- Department of Pediatric and Thoracic Surgery, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Tracey Hillier
- Mi’kmaq Qalipu First Nation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Emilie Joos
- Division of General Surgery, Branch for Global Surgical Care, Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Adebisi YA, Ogunkola IO. The global antimicrobial resistance response effort must not exclude marginalised populations. Trop Med Health 2023; 51:33. [PMID: 37287083 DOI: 10.1186/s41182-023-00524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 06/09/2023] Open
Abstract
Antimicrobial resistance (AMR), a rising global health crisis causing about 700,000 deaths annually and potentially 10 million deaths by 2050, disproportionately impacts marginalised populations. Due to socioeconomic, ethnic, geographic, and other barriers, these communities often have restricted healthcare access, compounding the AMR threat. Unequal access to effective antibiotics, inadequate living conditions, and a lack of awareness exacerbate the crisis in marginalised communities, making them more susceptible to AMR. A broader, inclusive response is needed to ensure equitable access to antibiotics, improved living conditions, education, and policy changes to challenge the root socio-economic disparities. Ignoring marginalised populations in the fight against AMR is both a moral and strategic failure. Therefore, inclusivity must be a central tenet in combating AMR. This article not only critically dissects this prevailing oversight but also urgently calls for comprehensive action to address this significant shortcoming in our response efforts.
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Affiliation(s)
- Yusuff Adebayo Adebisi
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Global Health Focus, Kigali, Rwanda.
| | - Isaac Olushola Ogunkola
- Global Health Focus, Kigali, Rwanda
- Department of Public Health, University of Calabar, Calabar, Cross River, Nigeria
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23
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Simpson C, Lee-Ameduri K, Hartwick M, Shaul RZ, Kanji A, Healey A, Murphy NB, Pope TM. Navigating disagreement and conflict in the context of a brain-based definition of death. Can J Anaesth 2023; 70:724-735. [PMID: 37131031 PMCID: PMC10202992 DOI: 10.1007/s12630-023-02417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/03/2022] [Accepted: 09/20/2022] [Indexed: 05/04/2023] Open
Abstract
In this paper, we discuss situations in which disagreement or conflict arises in the critical care setting in relation to the determination of death by neurologic criteria, including the removal of ventilation and other somatic support. Given the significance of declaring a person dead for all involved, an overarching goal is to resolve disagreement or conflict in ways that are respectful and, if possible, relationship preserving. We describe four different categories of reasons for these disagreements or conflicts: 1) grief, unexpected events, and needing time to process these events; 2) misunderstanding; 3) loss of trust; and 4) religious, spiritual, or philosophical differences. Relevant aspects of the critical care setting are also identified and discussed. We propose several strategies for navigating these situations, appreciating that these may be tailored for a given care context and that multiple strategies may be helpfully used. We recommend that health institutions develop policies that outline the process and steps involved in addressing situations where there is ongoing or escalating conflict. These policies should include input from a broad range of stakeholders, including patients and families, as part of their development and review.
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Affiliation(s)
- Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada.
- Canadian Blood Services, Ottawa, ON, Canada.
| | - Katarina Lee-Ameduri
- St. Boniface Hospital, Reseau Compassion Network, Winnipeg, MB, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Hartwick
- Department of Medicine, Divisions of Critical Care and Palliative Medicine, University of Ottawa, Ottawa, ON, Canada
- Trillium Gift of Life, Ottawa, ON, Canada
| | - Randi Zlotnik Shaul
- Bioethics Department, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Aly Kanji
- McGill University, Montreal, QC, Canada
| | - Andrew Healey
- Trillium Gift of Life Network, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nicholas B Murphy
- Departments of Medicine and Philosophy, Western University, London, ON, Canada
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24
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Lin JC, Toombs E, Sanders C, Sinoway C, Amirault M, Mushquash CJ, Barkman L, Deschamps M, Young M, Gauvin H, Benoit AC. Looking beyond the individual-The importance of accessing health and cultural services for Indigenous women in Thunder Bay, Ontario. PLoS One 2023; 18:e0282484. [PMID: 36857373 PMCID: PMC9977040 DOI: 10.1371/journal.pone.0282484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Access to cultural activities and culturally relevant healthcare has always been significant for achieving holistic Indigenous health and continues to be a key factor in shaping the health journey of Indigenous individuals and communities. Previous research has indicated the importance of cultural practices and services in sustaining cultural identity for Indigenous peoples, which is a major influence on their wellbeing. This study marks the first phase in a project aimed at establishing an Indigenous healing program and uses a qualitative research approach to understand the health and cultural services that Indigenous women want and require in Thunder Bay, Ontario. During interviews, participants (n = 22) answered questions around their understandings of health and wellbeing, and how they are able to incorporate cultural practices into their circle of care. Thematic analysis was performed on interview transcripts, and 4 key themes were identified: 'independence and self-care', 'external barriers to accessing services', 'finding comfort in the familiar' and 'sense of community'. Together these themes illustrate how Indigenous women feel a strong sense of personal responsibility for maintaining their health despite the multiple environmental factors that may act as barriers or supports. Furthermore, the necessity of embedding cultural practices into Indigenous women's circle of care is highlighted by the participants as they describe the mental, spiritual, social, and emotional health benefits of engaging in cultural activities within their community. The findings demonstrate the need for current modes of care to look beyond the individual and consider the impacts that socio-environmental factors have on Indigenous women. To accomplish this, we hope to increase access to health and cultural services through the creation of an Indigenous healing program that can be adequately incorporated into Indigenous women's circle of care if they wish to do so.
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Affiliation(s)
- Jonathan C. Lin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Marni Amirault
- Communities, Alliances & Networks, Dartmouth, Nova Scotia, Canada
| | | | | | | | - Meghan Young
- Ontario Aboriginal HIV/AIDS Strategy, Toronto, Ontario, Canada
| | | | - Anita C. Benoit
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- * E-mail:
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25
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Smye V, Browne AJ, Josewski V, Keith B, Mussell W. Social Suffering: Indigenous Peoples' Experiences of Accessing Mental Health and Substance Use Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3288. [PMID: 36833982 PMCID: PMC9958899 DOI: 10.3390/ijerph20043288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
In this paper, we present findings from a qualitative study that explored Indigenous people's experiences of mental health and addictions care in the context of an inner-city area in Western Canada. Using an ethnographic design, a total of 39 clients accessing 5 community-based mental health care agencies were interviewed, including 18 in-depth individual interviews and 4 focus groups. Health care providers also were interviewed (n = 24). Data analysis identified four intersecting themes: normalization of social suffering; re-creation of trauma; the challenge of reconciling constrained lives with harm reduction; and mitigating suffering through relational practice. The results highlight the complexities of experiences of accessing systems of care for Indigenous people marginalized by poverty and other forms of social inequity, and the potential harms that arise from inattention to the intersecting social context(s) of peoples' lives. Service delivery that aims to address the mental health concerns of Indigenous people must be designed with awareness of, and responsiveness to, the impact of structural violence and social suffering on peoples' lived realities. A relational policy and policy lens is key to alleviate patterns of social suffering and counter the harms that are unwittingly created when social suffering is normalized.
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Affiliation(s)
- Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
| | - Annette J. Browne
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Viviane Josewski
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | | | - William Mussell
- Sal’i’shan Institute, 800 Wellington Ave, Chilliwack, BC V2P 6H7, Canada
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26
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Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, Howard AF, Kaur J, McKenzie M, Stajduhar KI, Thorne S. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Health 2023; 22:20. [PMID: 36709295 PMCID: PMC9883825 DOI: 10.1186/s12939-023-01829-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. METHODS A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. RESULTS Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. CONCLUSION Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
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Affiliation(s)
- Leah K. Lambert
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Tara C. Horrill
- grid.21613.370000 0004 1936 9609College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Scott M. Beck
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada
| | - Amber Bourgeois
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Annette J. Browne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - A. Fuchsia Howard
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jagbir Kaur
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Michael McKenzie
- Radiation Therapy Program, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Kelli I. Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Sally Thorne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
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27
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Hummel B, Bierstone D, Newhook D, Jetty R. Exploring the perspectives of caregivers of urban Inuit children on child health knowledge mobilisation. Int J Circumpolar Health 2022; 81:2120174. [PMID: 36097880 PMCID: PMC9481130 DOI: 10.1080/22423982.2022.2120174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our study sought to explore the experiences of caregivers of urban Inuit children with respect to child health knowledge acquisition to develop community-specific best practices for health promotion initiatives. A needs assessment was conducted to understand how caregivers access child health knowledge and services; what child health issues require improved knowledge mobilisation; and how caregivers would like to access this knowledge. Four focus groups were held with twenty-four parents and caregivers of Inuit children. Child health knowledge acquisition was influenced by dynamics of trust and discrimination, making caregivers' social networks and Indigenous health services highly valued sources. Health topics identified as requiring improved knowledge mobilisation were those in which caregivers faced tensions between Indigenous and non-Indigenous ways of knowing. Such topics included parenting and development, adolescent mental and sexual health, common childhood illnesses, infant care, and nutrition. Caregivers preferred a multi-modal approach to health promotion, highlighting importance of in-person gatherings while also valuing accessible multi-media components. The presence of Elders as facilitators was especially important for child development, parenting, and nutrition. For health promotion to be effective, it must consider community-specific health knowledge sharing processes; tensions between Indigenous and non-Indigenous ways of knowing; and community ownership in health promotion endeavors.
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Affiliation(s)
- Brian Hummel
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa ON, Canada
| | - Daniel Bierstone
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa ON, Canada
| | - Dennis Newhook
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa ON, Canada
| | - Radha Jetty
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa ON, Canada
| | -
- Inuuqatigiit Centre for Inuit Children, Youth and Families, Ottawa ON, Canada
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28
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Gonzalez M, Zeidan J, Lai J, Yusuf A, Wright N, Steiman M, Karpur A, Shih A, Elsabbagh M, Shikako K. Socio-demographic disparities in receipt of clinical health care services during the COVID-19 pandemic for Canadian children with disability. BMC Health Serv Res 2022; 22:1434. [PMID: 36443767 PMCID: PMC9706900 DOI: 10.1186/s12913-022-08672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about the experience of receiving in-person and virtual clinical health care services during the COVID-19 pandemic for Canadian children with developmental disabilities and delays facing multiple layers of vulnerability (e.g., low income, low educational attainment families). We examined the relationship between socio-demographic factors and the receipt of these services (physical and mental health services) during COVID-19 for Canadian children with these conditions. METHODS Data collected in Canada for the Global Report on Developmental Delays, Disorders and Disabilities were used. The survey: (1) was developed and disseminated in collaboration with caregivers of children with disabilities, (2) included topics such as response to the pandemic and receipt of services and supports, and (3) documented the experiences of a non-random convenience sample of caregivers of children (any age) with these conditions during and prior to the pandemic. We used four logistic regression models to assess the association between socio-demographic factors and receipt of services. RESULTS Being a single parent, having low educational attainment (high school or less), having low income (making less than $40,000 per year), working less than full time (working part-time, working reduced hours due to COVID, retired, stay home parent or student), as well as male gender and older age of the child with disability were factors associated with decreased likelihood of receiving services. CONCLUSION Our findings point to the need for tailoring services for families of children with disabilities, particularly low socioeconomic status families, to ensure continuity of care during public health emergencies.
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Affiliation(s)
- Miriam Gonzalez
- Faculty of Medicine, Montreal Neurological Institute-Hospital, McGill University, Rue University, 3775, H3A 2B4, Montréal, Canada. .,Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, H4A 3J1, Montréal, Canada.
| | - Jinan Zeidan
- Faculty of Medicine, Montreal Neurological Institute-Hospital, McGill University, Rue University, 3775, H3A 2B4, Montréal, Canada
| | - Jonathan Lai
- Autism Alliance of Canada, 1111-23 Sheppard Ave E, M2N OC8, Toronto, ON, Canada
| | - Afiqah Yusuf
- Faculty of Medicine, Montreal Neurological Institute-Hospital, McGill University, Rue University, 3775, H3A 2B4, Montréal, Canada.,Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, H4A 3J1, Montréal, Canada
| | - Nicola Wright
- Department of Biostatistics and Health Informatics, King's College London, WC2R 2LS, London, UK
| | - Mandy Steiman
- Faculty of Medicine, Montreal Neurological Institute-Hospital, McGill University, Rue University, 3775, H3A 2B4, Montréal, Canada.,Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, H4A 3J1, Montréal, Canada
| | - Arun Karpur
- Autism Speaks, 1060 State Rd #1446, 08540, Princeton, Princeton, NJ, NJ, USA
| | - Andy Shih
- Autism Speaks, New York 1 E 33rd St, 10016, New York, NY, USA
| | - Mayada Elsabbagh
- Faculty of Medicine, Montreal Neurological Institute-Hospital, McGill University, Rue University, 3775, H3A 2B4, Montréal, Canada.,Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, H4A 3J1, Montréal, Canada
| | - Keiko Shikako
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, H4A 3J1, Montréal, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Canada
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29
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Fazelipour M, Leung L, Min J, Ryan TS. Building practice-informed indigenous health curricula: A systematic review of pharmacy services for indigenous peoples. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1448-1460. [PMID: 36180334 DOI: 10.1016/j.cptl.2022.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND An increased need is recognized to improve Indigenous cultural safety curriculum. This review aimed to inform curriculum development by identifying and categorizing challenges and opportunities that underlie existing practices. This entails policies, pharmacy services, and health workers' perspectives associated with pharmacy services for Indigenous peoples of Australia, Canada, New Zealand, and the United States. METHODS Four academic databases were screened including PubMed, Embase, CINAHL, and Web of Science. This search was complemented by grey literature database searches. Thematic analysis by NVivo, version 12 (QSR International) was utilized to analyze qualitative data, and a narrative strategy guided common theme consolidation. This approach was prefaced and supplemented using Endnote X9 (Clarivate) and SUMARI 2019 (JBI) and according to the Joanna Briggs Institute's guidelines. An Indigenous Curriculum Advisory Committee at the University of British Columbia Pharmaceutical Sciences was queried for suggestions, potential cross-cultural interpretation, and guidance for explicit content in the context of pharmacy service delivery in Indigenous communities. RESULTS Fourteen studies were included and classified into three categories: (1) Indigenous patients', pharmacists', and health care providers' perspectives, (2) policies and practices, (3) pharmacy-based programs. Thematic analysis portrayed several themes with overlapping presentation of challenges and opportunities. It is important to utilize evidence-based strategies for improving the effectiveness of culturally-safe pharmacy services for Indigenous populations and for optimizing education and practice-informed curriculum development. IMPLICATIONS This information can inform pharmacists, educators, and faculty members in understanding and delivering optimal care and education engaging Indigenous insights and perspectives at systems and curricular levels.
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Affiliation(s)
- Mojan Fazelipour
- University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Larry Leung
- University of British Columbia, Faculty of Pharmaceutical Sciences, 3515 Pharmaceutical Sciences Building, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Jason Min
- Pharmaceutical Sciences, UBC School of Nursing, Faculty of Applied Science, 6524 Pharmaceutical Sciences Building, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Teresa Sm'hayetsk Ryan
- Forest and Conservation Sciences, UBC Forestry, 3035 - 2424 Main Mall, Vancouver, BC V6T 1Z4, Canada.
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30
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Equitable Healthcare for Indigenous Peoples: Development of the "Sharing Circle" Web Site to Provide a Culturally Safe Method to Communicate Wound, Ostomy, and Continence Information and Resources. J Wound Ostomy Continence Nurs 2022; 49:572-573. [PMID: 36417383 DOI: 10.1097/won.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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31
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Santos JDM, Fowler S, Jennings D, Brass C, Porter L, Porter R, Sanderson R, Peña-Sánchez JN. Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada. CMAJ Open 2022; 10:E964-E970. [PMID: 36319027 PMCID: PMC9633056 DOI: 10.9778/cmajo.20220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Indigenous people in Canada often face barriers to access specialized care, with limited data in evaluating health care utilization among Indigenous people with inflammatory bowel disease (IBD). We aimed to compare health care utilization between First Nations patients and those in the general population diagnosed with IBD in Saskatchewan. METHODS We conducted a patient-oriented, population-based, retrospective cohort study by linking administrative health databases of Saskatchewan between fiscal years 1998/99 and 2017/18. We designed and completed this study in partnership with Indigenous patients and family advocates. We applied a validated algorithm to identify IBD incident cases and then used the self-declared First Nations status variable to divide those cases. We applied a 1:5 ratio for age and sex matching and used Cox proportional models to assess associations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS We created a matched cohort with 696 IBD incident cases: 116 First Nations patients and 580 patients in the general population. We observed differences between the groups for IBD-specific hospital admissions (HR 1.33, 95% CI 1.01-1.75), IBD-related hospital admissions (HR 1.55, 95% CI 1.20-2.01), medication claims for IBD (HR 0.52, 95% CI 0.41-0.65) and 5-aminosalicylic acid claims (HR 0.56, 95% CI 0.45-0.71) adjusting by rural or urban residence and diagnosis type. There were no significant differences in the hazard rate of outpatient gastroenterology visits (HR 1.13, 95% CI 0.90-1.41), colonoscopies (HR 1.14, 95% CI 0.92-1.41) and surgeries for IBD (HR 1.14, 95% CI 0.80-1.64). INTERPRETATION We identified that First Nations patients diagnosed with IBD had a higher rate of hospital admissions owing to IBD than patients in the general population diagnosed with IBD. We also found an inverse association between First Nations status and having prescription medication claims for IBD.
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Affiliation(s)
- José Diego Marques Santos
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Sharyle Fowler
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Derek Jennings
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Colten Brass
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Linda Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Robert Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Rhonda Sanderson
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Juan Nicolás Peña-Sánchez
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask.
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Anishinabek sources of strength: Learning from First Nations people who have experienced mental health and substance use challenges. Soc Sci Med 2022; 309:115197. [DOI: 10.1016/j.socscimed.2022.115197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/09/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022]
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Sehgal A, Barnabe C, Crowshoe L(L. Patient complexity assessment tools containing inquiry domains important for Indigenous patient care: A scoping review. PLoS One 2022; 17:e0273841. [PMID: 36044532 PMCID: PMC9432764 DOI: 10.1371/journal.pone.0273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.
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Affiliation(s)
- Anika Sehgal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden (Lindsay) Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Horrill T. Toward equitable access to oncology care for Indigenous Peoples in Canada: Implications for nursing. Can Oncol Nurs J 2022; 32:437-443. [PMID: 38919674 PMCID: PMC11195594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
As a result of overlapping social, economic, historical, and political influences, and intersecting experiences of racism, stigma and discrimination within healthcare, Indigenous Peoples in Canada experience inequitable access to healthcare and oncology care. The aim of this paper is to highlight some of the barriers contributing to inequitable access to oncology care, research examining oncology nurses' perspectives on these barriers and their roles in addressing barriers, and implications for nursing practice. Importantly, the role of nurses is not often considered in relation to healthcare access. By highlighting recent research evidence, I aim to open space to see the valuable work of oncology nurses, and to consider where and how we, as a profession, could better address inequities in access to oncology care for Indigenous Peoples.
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Affiliation(s)
- Tara Horrill
- Postdoctoral Research Fellow, University of British Columbia, School of Nursing, T201-2211 Westbrook Mall, Vancouver, BC V6T 2B5
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Horrill T. Vers un accès équitable aux soins oncologiques pour les peuples autochtones du Canada : implications pour la pratique infirmière. Can Oncol Nurs J 2022; 32:444-451. [PMID: 38919668 PMCID: PMC11195593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Les peuples autochtones du Canada ne disposent pas d’un accès équitable aux soins de santé et aux soins oncologiques à cause de facteurs sociaux, économiques, historiques et politiques qui se recoupent tous les uns les autres, et auxquels s’ajoutent éventuellement le racisme, les préjugés et la discrimination qu’ils subissent dans le système de santé. Le but du présent article est de faire ressortir certains des obstacles empêchant un accès équitable aux soins oncologiques, de présenter les recherches portant sur ces mêmes obstacles vus selon la perspective des infirmières en oncologie et le rôle qu’elles jouent pour les abolir, et de décrire les implications pour la pratique infirmière. Plus important encore, la question de l’accès aux soins est rarement abordée sous l’angle du rôle des infirmières. Cet article se veut un espace pour souligner le précieux travail des infirmières en oncologie et pour examiner comment et où nous pourrions, comme profession, mieux combattre les inégalités d’accès aux soins oncologiques pour les peuples autochtones.
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Affiliation(s)
- Tara Horrill
- Boursière de recherche postdoctorale, École de soins infirmiers de l'Université de la Colombie-Britannique, T201-2211 Westbrook Mall, Vancouver, Colombie-Britannique V6T 2B5
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36
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Elliott SA, Kreutz J, Wright KS, Di Lallo S, Scott SD, Hartling L. Adapting Child Health Knowledge Translation Tools for Indigenous Communities: A Qualitative Study Exploring Healthcare Provider Perspectives (Preprint). JMIR Form Res 2022; 6:e36353. [PMID: 36197711 PMCID: PMC9582909 DOI: 10.2196/36353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Our research groups have developed a number of parental knowledge translation (KT) tools to help families understand common childhood illnesses and make informed decisions regarding when to seek urgent care. We have developed a series of videos to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency health care services. It is unclear whether the videos in their current form and language are useful for a wider range of populations, including Indigenous groups. Objective The purpose of this study was to explore whether and understand how our KT tools could be adapted for use with Indigenous communities. Methods Health care providers (HCPs) serving Indigenous families in Alberta, Canada, were asked to review 2 of our KT tools (one on croup and one on acute otitis media), complete a demographic survey, and participate in a one-on-one semistructured interview. HCPs were asked to reflect on the usability of the KT tools within their practice and what cultural adaptation considerations they felt would be needed to develop KT tools that meet the needs of Indigenous clients. Audio recordings from the interviews were transcribed verbatim and analyzed for relevant themes using thematic analysis. Results A total of 18 HCPs (n=15, 83% women and n=3, 17% men) from various health professions (eg, physician, registered nurse, and licensed practical nurse) were interviewed. Of these 18 HCPs, 7 (39%) self-identified as Indigenous. Four overarching themes were identified as important when considering how to adapt KT tools for use by Indigenous communities: accessibility, relatability, KT design, and relationship building. Access to tangible resources and personal and professional connections were considered important. Accessibility affects the types of KT tools that can be obtained or used by various individuals and communities and the extent to which they can implement recommendations given in those KT tools. In addition, the extent to which users relate to the depictions and content within KT tools must be considered. The environments, portrayals of characters, and cultural norms and values presented within KT tools should be relevant to users to increase the relatability and uptake of recommendations. Most importantly, fostering genuine and sustainable relationships with users and communities is a vital consideration for KT tool developers. Conclusions These findings serve to cultivate a greater understanding of the various components that HCPs consider important when developing or culturally adapting KT tools for use by Indigenous families. This information will help support the effective adaptation and distribution of KT tools for use by a broad audience. Careful consideration of the themes identified in this study highlights the importance of working together with the knowledge users (health care consumers) when developing KT tools.
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Affiliation(s)
- Sarah A Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
| | - Jason Kreutz
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kelsey S Wright
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sherri Di Lallo
- Stollery Awasisak Indigenous Health, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Vervoort D, Kimmaliardjuk DM, Ross HJ, Fremes SE, Ouzounian M, Mashford-Pringle A. Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review. CJC Open 2022; 4:782-791. [PMID: 36148252 PMCID: PMC9486860 DOI: 10.1016/j.cjco.2022.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Indigenous peoples in Canada are at an increased risk of cardiovascular disease compared to non-Indigenous people. Contributing factors include historical oppression, racism, healthcare biases, and disparities in terms of the social determinants of health. Access to and inequity in cardiovascular care for Indigenous peoples in Canada remain poorly studied and understood. A rapid review of the literature was performed using the PubMed/MEDLINE, Web of Science, and Indigenous Studies Portal (iPortal) databases to identify articles describing access to cardiovascular care for Indigenous peoples in Canada between 2002 and 2021. Included articles were presented narratively in the context of delays in seeking, reaching, or receiving care, or as disparities in cardiovascular outcomes, and were assessed for their successful engagement in indigenous health research using a preexisting framework. Current research suggests that gaps most prominently present as delays in receiving care and as poorer long-term outcomes. The literature is concentrated in Alberta, Manitoba, and Ontario, as well as among First Nations people, and is largely rooted in a biomedical worldview. Additional community-driven research is required to better elucidate the gaps in access to holistic cardiovascular care for Indigenous peoples in Canada. Healthcare professionals, researchers, and policymakers should reflect further upon their actions and privilege, educate themselves about historical facts and the Truth and Reconciliation Commission, tackle prevailing disparities and systemic barriers in the healthcare systems, and develop culturally safe and ethically appropriate healthcare interventions to improve the health of all Indigenous peoples in Canada.
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Affiliation(s)
- Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Dominique Vervoort, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, Ontario M5T 3M6, Canada. Tel.: +1-416-989-7874.
| | - Donna May Kimmaliardjuk
- Division of Cardiovascular Surgery, Eastern Health, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Heather J. Ross
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Angela Mashford-Pringle
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Acharibasam JB, Chapados M, Langan J, Starblanket D, Hagel M. Exploring health and wellness with First Nations communities at the "knowing your health symposium". Healthc Manage Forum 2022; 35:265-271. [PMID: 35612601 PMCID: PMC9425725 DOI: 10.1177/08404704221084042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Indigenous older adults living in rural communities require accessibility to and readiness for new technologies to support the monitoring of health data and health status, as well as dementia education. Morning Star Lodge partnered with the File Hills Qu'Appelle Tribal Council, a Community Research Advisory Committee and All Nations Hope Network to bring a diverse group of First Nations community members to the “Knowing Your Health Symposium” to learn about traditional health and First Nations’ wellness. Indigenous research methods and community-based involvement informed and guided the research. An environmental scan was conducted relating to co-researchers’ nutrition, exercise, and self-management of health and health issues through an anonymous survey distributed at the symposium. The purpose of the symposium was to provide communities with information about healthy lifestyles as it relates to dementia and equip community members with the ability to make constructive decisions regarding their health.
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Affiliation(s)
| | - Meghan Chapados
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jennifer Langan
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Mikayla Hagel
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Lauzière J, Fletcher C, Gaboury I. Cultural Safety as an Outcome of a Dynamic Relational Process: The Experience of Inuit in a Mainstream Residential Addiction Rehabilitation Centre in Southern Canada. QUALITATIVE HEALTH RESEARCH 2022; 32:970-984. [PMID: 35350939 PMCID: PMC9189595 DOI: 10.1177/10497323221087540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Few addiction treatment options are available in Arctic Canada, leading many Inuit to seek treatment programs in southern cities. We conducted a case study to understand what contributes to a culturally safe experience for Inuit in a mainstream addiction rehabilitation centre in Southern Canada. We carried out more than 700 hours of participant observation, in addition to semi-structured interviews and member-checking activities with 20 Inuit residents, 18 staff and four managers. Data were analysed using an inductive interpretative process. Throughout their journey in the program, Inuit navigated through contrasting situations and feelings that we grouped under six broad themes: having Inuit peers, having limitations imposed on one's ways of being and doing, facing ignorance and misperceptions, having conversations and dialogue, facing language barriers and being in a supportive and caring environment. This study highlights how cultural safety varies according to people, context and time, and relates to developing trustful relationships.
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Affiliation(s)
- Julie Lauzière
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Longueuil, QC, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Quebec, QC, Canada
| | - Isabelle Gaboury
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Longueuil, QC, Canada
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40
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Donald EE, Whitlock K, Dansereau T, Sands DJ, Small D, Stajduhar KI. A codevelopment process to advance methods for the use of patient-reported outcome measures and patient-reported experience measures with people who are homeless and experience chronic illness. Health Expect 2022; 25:2264-2274. [PMID: 35411709 PMCID: PMC9615092 DOI: 10.1111/hex.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/12/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction People who experience social disadvantage including homelessness suffer from numerous ill health effects when compared to the general public. Use of patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs) enables collection of information from the point of view of the person receiving care. Involvement in research and health care decision‐making, a process that can be facilitated by the use of PROMs and PREMs, is one way to promote equity in care. Methods This article reports on a codevelopment and consultation study investigating the use of PROMs and PREMs with people who experience homelessness and chronic illness. Data were analysed according to interpretative phenomenological analysis. Results Committee members with lived experience identified three themes for the role of PROMs and PREMs in health care measurement: trust and relationship‐building; health and quality of life; and equity, alongside specific recommendations for the design and administration of PROMs and PREMs. The codevelopment process is reported to demonstrate the meaningful investment in time, infrastructure and relationship‐building required for successful partnership between researchers and people with lived experience of homelessness. Conclusion PROMs and PREMs can be meaningful measurement tools for people who experience social disadvantage, but can be alienating or reproduce inequity if they fail to capture complexity or rely on hidden assumptions of key concepts. Patient or Public Contribution This study was conducted in active partnership between researchers and people with experience of homelessness and chronic illness, including priority setting for study design, data construction, analysis and coauthorship on this article.
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Affiliation(s)
- Erin E Donald
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Faculty of Human and Social Development, School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Faculty of Human and Social Development, School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Fitzpatrick K, Sehgal A, Montesanti S, Pianarosa E, Barnabe C, Heyd A, Kleissen T, Crowshoe L. Examining the role of Indigenous primary healthcare across the globe in supporting populations during public health crises. Glob Public Health 2022; 18:2049845. [PMID: 35343868 DOI: 10.1080/17441692.2022.2049845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 - March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic.
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Affiliation(s)
- Kayla Fitzpatrick
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Anika Sehgal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Emilie Pianarosa
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amber Heyd
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tessa Kleissen
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Crowshoe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Horrill TC, Browne AJ, Stajduhar KI. Equity-Oriented Healthcare: What It Is and Why We Need It in Oncology. Curr Oncol 2022; 29:186-192. [PMID: 35049692 PMCID: PMC8774995 DOI: 10.3390/curroncol29010018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services.
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Affiliation(s)
- Tara C. Horrill
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Correspondence:
| | - Annette J. Browne
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kelli I. Stajduhar
- School of Nursing, University of Victoria, Victoria, BC V8P 5C2, Canada;
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Fitzpatrick KM, Wild TC, Pritchard C, Azimi T, McGee T, Sperber J, Albert L, Montesanti S. Health Systems Responsiveness in Addressing Indigenous Residents' Health and Mental Health Needs Following the 2016 Horse River Wildfire in Northern Alberta, Canada: Perspectives From Health Service Providers. Front Public Health 2021; 9:723613. [PMID: 34957001 PMCID: PMC8704385 DOI: 10.3389/fpubh.2021.723613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/31/2021] [Indexed: 12/03/2022] Open
Abstract
Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Métis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.
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Affiliation(s)
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Caillie Pritchard
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tara Azimi
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tara McGee
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jodi Sperber
- Kee Tas Kee Now Tribal Council, Atikameg, AB, Canada
| | | | - Stephanie Montesanti
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, AB, Canada
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Fraser SL, Parent V, Weetaltuk C, Hunter J. Families navigating community resources: understanding and supporting Nunavimmiut families. Int J Circumpolar Health 2021; 80:1935594. [PMID: 34596482 PMCID: PMC8491701 DOI: 10.1080/22423982.2021.1935594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
In a project aiming to develop community-led resources for families in northern Quebec, Canada, members (Inuit and non-Inuit) of the project decided to meet with Inuit parents to hear their experiences and needs, and to better understand how family dynamics might be related to ways of using resources within communities. In this article, we present secondary analyses of interviews conducted in 2015 with 14 parents living in a community of Nunavik, northern Quebec, accompanied by participatory analysis sessions. A dual data analysis strategy was adopted. Non-Inuit researchers and research assistants with significant lived experience in Nunavik explored what they learned from the stories that Inuit parents shared with them through the interviews and through informal exchanges. Inuit partners then discussed the large themes identified by the research team to guide non-Inuit researchers in their analysis. The aim was to better inform non-Inuit service providers and people whose mandate it is to support community mobilisation in relation to the heterogeneous realities of Inuit families, and the ways in which they can be of support to families based on their specific realities and needs.
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Affiliation(s)
- Sarah L. Fraser
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
| | - Valérie Parent
- Communication, École de Communication, Université de Montréal, Montreal, Canada
| | | | - Jennifer Hunter
- Nunavik Regional Board of Health and Social Services, Québec, Canada
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Haozous EA, Jaramillo ET, Willging CE. Getting to Know: American Indian Elder Health Seeking in an Under-funded Healthcare System. SSM. QUALITATIVE RESEARCH IN HEALTH 2021; 1:100009. [PMID: 34988544 PMCID: PMC8725791 DOI: 10.1016/j.ssmqr.2021.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
American Indian (AI) Elders are the heart of the community. Existing research explores links between specific health behaviors and social determinants of health, but there is little theory explaining patient behaviors in the context of the Indian Health Service (IHS) system of care. We drew from a multiyear mixed-methods participatory study of Elder healthcare experiences to identify the systemic, interpersonal, and historic factors in the IHS that impact their health-seeking behaviors. We conducted an interpretive grounded theory analysis guided by Indigenous methodologies to analyze interviews with 96 AI Elders from two Southwestern states. Our resulting theory, Getting to Know, explains how Elders knew, owned, accessed, and were denied information and resources in their efforts to receive care. Findings highlight how Elders' health-seeking behaviors reflect longstanding inequities, the many ways Elder knowledge was incongruent with Western knowledge embedded in the IHS system, and how this conflict contributed to Elder discomfort in clinical settings. Future work will test the applicability of Getting to Know in other AI communities and design culturally safe care to meet Elder needs. By applying an Indigenous-centered analysis to the voices of Elders, we identified key influences on health outcomes not previously observed in the literature. By illuminating these influences, we show how culturally safe care can be better formulated to meet the needs of Elders, ultimately improving health for AI communities.
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Affiliation(s)
- Emily A Haozous
- Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque NM 87106-4341, USA
| | - Elise Trott Jaramillo
- Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque NM 87106-4341, USA
| | - Cathleen E Willging
- Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque NM 87106-4341, USA
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Schultz A, Nguyen T, Sinclaire M, Fransoo R, McGibbon E. Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What's Reconciliation Got to Do With It? CJC Open 2021; 3:S149-S164. [PMID: 34993444 PMCID: PMC8712585 DOI: 10.1016/j.cjco.2021.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/12/2021] [Indexed: 12/04/2022] Open
Abstract
Colonization and enforced genocidal strategies have collectively fractured and changed Indigenous people by attempting to erase and dismiss their voices and knowledge. Nearly a decade ago, we were reminded by Dr Ku Young of the cardiovascular health disparities, in evidence among Indigenous people in Canada. compared with White people. He went on to say that beyond a biomedical understanding of this health status is the ongoing impact of long-standing marginalization and oppression faced by Indigenous people. Limited attention has been afforded to advance our understanding of these colonial impacts on Indigenous people and their heart health. This article contributes to our collective understanding of Indigenous people and their cardiac health by covering the following topics: layers of foundational truths of relevance to healthcare contexts and Indigenous people; a critical reflection of Western (biomedical) perspectives concerning cardiac health among Indigenous people; and materials from 2 studies, funded by the Canadian Institutes of Health Research, in which Indigenous voices and experiences were privileged concerning the heart and caring for the heart. In the final section, 3 topics are offered as starting points for self-reflection and acts of reconciliation within healthcare practice, decision-making, and research: reflections on self and one's worldview; anti-racist healthcare practice; and 2-eyed seeing approaches to work within healthcare contexts. A common thread is the imperative for "un-silencing" Indigenous people's voices, experiences, and knowledge, which is a requirement if addressing the identified cardiovascular health disparities is truly a health priority.
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Affiliation(s)
- Annette Schultz
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba (UM), Winnipeg, Manitoba, Canada
- St Boniface Research Centre, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Cardiac Sciences Manitoba, Asper Clinical Research Institute, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba (UM), Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, Faculty of Health Sciences, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
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Abstract
Background. The Truth and Reconciliation Commission of Canada outlines the need for health care professionals to create more welcoming spaces for Indigenous Peoples. The scope of occupational therapy is continually expanding-yet the profession itself is grounded in and derived from a dominant Eurocentric worldview, and practice is designed to serve a homogenous Western populace. Purpose. To critically examine the Canadian Model of Client-Centered Enablement (CMCE) for its value within Indigenous contexts. Key Issues. The CMCE is positioned as a client-centered model, however there is a clear hierarchical client-professional relationship threaded throughout. Concepts such as enable, advocate, educate, coach, and coordinate demonstrate paternalistic authority, lacking reciprocity, knowledge-sharing, and power redistribution. Implications. Reimagining health care relationships as entrenched in social interconnectedness demands critical reflection and action. A model of practice that endorses social change and actively addresses colonial power inequities must root its paradigmatic foundations in postcolonial views of health care as a social relationship.
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Affiliation(s)
| | - Tara Pride
- Tara Pride, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada.
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Rieger KL, Bennett M, Martin D, Hack TF, Cook L, Hornan B. Digital Storytelling as a Patient Engagement and Research Approach With First Nations Women: How the Medicine Wheel Guided Our Debwewin Journey. QUALITATIVE HEALTH RESEARCH 2021; 31:2163-2175. [PMID: 34238067 PMCID: PMC8564217 DOI: 10.1177/10497323211027529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
When research is conducted from a Western paradigm alone, the findings and resultant policies often ignore Indigenous peoples' health practices and fail to align with their health care priorities. There is a need for decolonized approaches within qualitative health research to collaboratively identify intersecting reasons behind troubling health inequities and to integrate Indigenous knowledge into current health care services. We engaged with First Nations women to explore to what extent digital storytelling could be a feasible, acceptable, and meaningful research method to inform culturally safe health care services. This novel approach created a culturally safe and ethical space for authentic patient engagement. Our conversations were profound and provided deep insights into First Nations women's experiences with breast cancer and guidance for our future qualitative study. We found that the digital storytelling workshop facilitated a Debwewin journey, which is an ancient Anishinabe way of knowing that connects one's heart knowledge and mind knowledge.
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Affiliation(s)
- Kendra L. Rieger
- Trinity Western University, Langley, British
Columbia, Canada
- University of Manitoba, Winnipeg, Manitoba,
Canada
| | | | - Donna Martin
- University of Manitoba, Winnipeg, Manitoba,
Canada
| | | | | | - Bobbie Hornan
- Pimicikamāk Nīhithawī First Nation, Manitoba,
Canada
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Adams SJ, Babyn P, Burbridge B, Tang R, Mendez I. Access to ultrasound imaging: A qualitative study in two northern, remote, Indigenous communities in Canada. Int J Circumpolar Health 2021; 80:1961392. [PMID: 34347560 PMCID: PMC8344228 DOI: 10.1080/22423982.2021.1961392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Ultrasound imaging is an essential component of healthcare services. This study sought to explore perceptions of access, and factors which shape access, to ultrasound imaging in two northern, remote, Indigenous communities in Canada. Using interpretive description as a methodological approach and a multi-dimensional conceptualisation of access to care as a theoretical framework, 15 semi-structured interviews were conducted in the northern Canadian communities of Stony Rapids and Black Lake, Saskatchewan. All participants had an obstetrical or non-obstetrical ultrasound exam performed in the past 10 years. Interviews were audio recorded and interview transcripts were analysed using constant comparative analysis. Geographic isolation from imaging facilities was a central barrier to participants accessing ultrasound imaging. Other barriers became apparent when participants had to travel for ultrasound, including fear of air travel, isolation from family, financial means, and unfamiliarity with larger cities. Barriers such as family and work responsibilities were exacerbated by the barrier of geography. Participants overcame these barriers as they were motivated by potential diagnostic benefits of ultrasound imaging. This study highlights disparities in access to ultrasound for northern, remote, Indigenous populations. Future efforts to improve access to imaging should consider barriers of distance to imaging facilities and strategies to bridge these barriers.
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Affiliation(s)
- Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Brent Burbridge
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Tang
- Canadian Hub for Applied and Social Research, University of Saskatchewan, 9 Campus Drive, Saskatoon, Canada
| | - Ivar Mendez
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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Horrill TC, Martin DE, Lavoie JG, Schultz ASH. A critical exploration of nurses' perceptions of access to oncology care among Indigenous peoples: Results of a national survey. Nurs Inq 2021; 29:e12446. [PMID: 34342080 PMCID: PMC9286560 DOI: 10.1111/nin.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives.
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Affiliation(s)
- Tara C Horrill
- Nursing & Allied Health Research and Knowledge Translation, BC Cancer, Vancouver, BC, Canada
| | - Donna E Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josée G Lavoie
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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