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Healey Akearok GK, Chaliak AJ, Cueva K, Cook D, Larsen CVL, Jóhannsdóttir L, Nilsson LM, San Sebastián M, Peterson M, Timlin U, Broderstadt AR, Dagsvold I, Siri S, Olesen I, Stoor JPA, Rautio A, Rink E, Lavoie JG. Diverse methodological approaches to a Circumpolar multi-site case study which upholds and responds to local and Indigenous community research processes in the Arctic. Int J Circumpolar Health 2024; 83:2336284. [PMID: 38573784 PMCID: PMC10997363 DOI: 10.1080/22423982.2024.2336284] [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: 10/12/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.
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Affiliation(s)
| | | | - Katie Cueva
- Department of Psychology, University of Alaska, Anchorage, AK, USA
| | - David Cook
- Environment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland
| | - Christina VL Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Lára Jóhannsdóttir
- Environment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland
| | - Lena Maria Nilsson
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Miguel San Sebastián
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Malory Peterson
- Department of Human Development and Community Health, Montana State University, Bozeman, MT, USA
| | - Ulla Timlin
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ann Ragnhild Broderstadt
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Inger Dagsvold
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Susanna Siri
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Ingelise Olesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Jon Petter A. Stoor
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Arja Rautio
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Elizabeth Rink
- Department of Human Development and Community Health, Montana State University, Bozeman, MT, USA
| | - Josée G. Lavoie
- Ongomiizwin Research, University of Manitoba, Winnipeg, MB, Canada
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Maloney SI, Idoate R, Zuffante M, Masotti P, Bañuelos K, Seneca C, Miranda LR. Foundational features of indigenous pregnancy care: Lessons learned from indigenous pregnancy care providers. Midwifery 2024; 135:104025. [PMID: 38838399 DOI: 10.1016/j.midw.2024.104025] [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: 11/29/2023] [Revised: 03/21/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
PROBLEM Indigenous populations experience higher odds of poor maternal and infant health outcomes than non-Hispanic White mothers yet have lower odds of receiving adequate prenatal care. BACKGROUND Many Indigenous communities rely on modern Western medical institutions to provide pregnancy related health care. These systems were not developed with or for Indigenous communities and often fail to meet the needs of Indigenous pregnant patients. Offering culturally congruent models of care may increase prenatal care utilization. QUESTION, HYPOTHESIS OR AIM This paper used qualitative inquiry to identify Indigenous approaches to caring for pregnancy. METHODS Our team conducted 16 semi-structured individual interviews and one group interview with a total of 19 respondents. To arrive at thematic categories, the research team engaged in a modified pile sorting technique. The final set of categories, along with sub-themes, descriptions and example quotes, were sent to interviewees for approval. FINDINGS Ten Foundational Features of Indigenous Pregnancy Care were identified. These covered themes related to Indigenous cultural practices, relationships, Indigenous sovereignty, local Indigenous community, full spectrum care, wholistic care, birthing person's wisdom, power and autonomy, flexibility, historical trauma, and cultural awareness. DISCUSSION Modern midwifery care delivered by Indigenous practitioners may partially bridge the cultural gap; however, intentional effort is needed to integrate Indigenous ways into medical doctor practice models and facilities. CONCLUSION This paper identifies ten foundational features of Indigenous pregnancy care and demonstrates the importance of recognizing the effects of trauma and providing opportunities for healing, upholding sovereignty, and centering relationships when caring for Indigenous pregnancies.
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Affiliation(s)
- Shannon I Maloney
- University of Nebraska Medical Center, Maurer College of Public Health, 984355 Medical Center, Omaha, NE 68198-4355, United States.
| | - Regina Idoate
- University of Nebraska Medical Center, Maurer College of Public Health, 984355 Medical Center, Omaha, NE 68198-4355, United States
| | - Mona Zuffante
- Winnebago Public Health Department, 225 S Bluff St, Winnebago, NE 68071, United States
| | - Paul Masotti
- Native American Health Center, 3124 International Blvd. Oakland, CA 94601, United States
| | - Karina Bañuelos
- Friendship House Association of American Indians of San Francisco, 56 Julian Avenue, San Francisco, CA, 94103, United States
| | - Cheyenne Seneca
- Seattle Indian Health Board, 611 12th Ave S, Seattle, WA 98144, United States
| | - Laura Rojas Miranda
- Native American Health Center, 3124 International Blvd. Oakland, CA 94601, United States
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Monteith H, Checholik C, Galloway T, Sahak H, Shawanda A, Liu C, Hanley AJG. Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature. BMC Public Health 2024; 24:1583. [PMID: 38872131 PMCID: PMC11170823 DOI: 10.1186/s12889-024-19060-1] [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: 01/04/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open. RESULTS Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes. CONCLUSIONS This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.
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Affiliation(s)
- Hiliary Monteith
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical, King's College Circle, Sciences Building, 5th Floor, Room 5253A, Toronto, ON, M5S 1A8, Canada
| | - Carly Checholik
- Department of Anthropology, University of Toronto Mississauga Campus, Terrence Donnelly Health Sciences Complex, Room 354, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada
| | - Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga Campus, Terrence Donnelly Health Sciences Complex, Room 354, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada
| | - Hosna Sahak
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical, King's College Circle, Sciences Building, 5th Floor, Room 5253A, Toronto, ON, M5S 1A8, Canada
| | - Amy Shawanda
- Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada
| | - Christina Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical, King's College Circle, Sciences Building, 5th Floor, Room 5253A, Toronto, ON, M5S 1A8, Canada
| | - Anthony J G Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical, King's College Circle, Sciences Building, 5th Floor, Room 5253A, Toronto, ON, M5S 1A8, Canada.
- Epidemiology Division, University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada.
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada.
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Healey Akearok GK, Rana Z. Community perspectives on COVID-19 outbreak and public health: Inuit positive protective pathways and lessons for Indigenous public health theory. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:395-407. [PMID: 38653866 PMCID: PMC11133288 DOI: 10.17269/s41997-024-00863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/25/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Indigenous public health theory and the voices of Canadian Indigenous communities remain under-represented in the literature despite the Canadian Truth and Reconciliation Calls to Action, and the perspectives of Inuit are further under-represented in this literature. The goal of this paper is to explore the perspectives of Iqalungmiut (people of Iqaluit), frontline staff, and decision-makers on the management of the COVID-19 outbreak in Iqaluit in April to June 2021 and to identify lessons learned and contributions to public health policy and practice specific to Inuit populations in Canada. METHODS This study used the Piliriqatigiinniq Community Health Research Model which was developed by Nunavummiut to guide community-based health and well-being research. Interviews were conducted with 44 individuals: 22 community members and shelter users; 17 frontline workers; and 5 decision-makers representing municipal and territorial government. Participants were asked about their experiences during the outbreak, sources of information, and strengths and challenges during outbreak management. RESULTS Challenges included overcrowding, physical disconnection from family members, and mental health and trauma. Community-identified strengths included strong interagency cooperation, food hamper and COVID-19 care kit deliveries, and travel restrictions. Several Inuit positive health-protective pathways were identified including Ilaginniq; Silativut; Inuuqatigiittiarniq; Piliriqatigiinniq; Ikajurniq; and Pijitsirniq. CONCLUSION Outbreaks of infectious illness are not new to Nunavut communities and Inuit protective pathways have and continue to be critical avenues to adapt to and mitigate such challenges. This exploratory study provides clear direction for Inuit public health policy and practice in Canada, while contributing to the body of literature on Indigenous public health theory.
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Affiliation(s)
| | - Zoha Rana
- Qaujigiartiit Health Research Centre, Iqaluit, Nunavut, Canada
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Egger EE, Basile Ibrahim B, Nyhan K, Desibhatla M, Gleeson D, Hagaman A. Patient-Defined Cultural Safety in Perinatal Interventions: A Qualitative Scoping Review. Health Equity 2024; 8:164-176. [PMID: 38559847 PMCID: PMC10979693 DOI: 10.1089/heq.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 04/04/2024] Open
Abstract
Problem Cultural safety is an approach to patient care designed to facilitate respect of patients' cultural needs and address inequities in care in culturally diverse situations. Background Much literature considers culturally safe care during the perinatal period, yet little is known about how patients experience and understand cultural safety. This is despite patient-defined care being one of the definitions of cultural safety. Question Hypothesis or Aim This scoping review investigates what is known from existing qualitative literature about patients' experience of cultural safety frameworks in perinatal interventions. Methods A search for "cultural safety" OR "culturally safe" in PubMed, Ovid Medline, Ovid Embase, Cumulated Index to Nursing and Allied Health Literature, Scopus, Scielo, and Latin America and the Caribbean Literature on Health Sciences returned 2233 results after deduplication. Title-abstract and full-text screenings were conducted to identify qualitative studies of cultural safety from perinatal patients' perspectives. Seven studies were included in the final analysis. Data were open coded using NVivo. Findings Three themes were identified: (1) care that acknowledged that their lives were different from patients in the dominant culture, (2) receiving care in community, and (3) care providers who respected their choices and culturally specific knowledge. Discussion This research shows how cultural safety intersects with other equity-based frameworks used in midwifery and obstetrics. Conclusion Building on this research could lead to new protocols that address complex social and physical needs of marginalized people during the perinatal period.
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Affiliation(s)
- Emilie E. Egger
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Kate Nyhan
- Cushing/Whitney Medical Library, Yale University Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Mukund Desibhatla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Dara Gleeson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Lognos B, Oude Engberink A, Gonzalez L, Leandri J, Charlot Pisoni C, Rachedi N, Clary B, Bourrel G, Bayen S, Million E. Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study. Heliyon 2024; 10:e24881. [PMID: 38318039 PMCID: PMC10840009 DOI: 10.1016/j.heliyon.2024.e24881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Objective Vulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' 'perinatality' plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. Methods The study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). Findings Concerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. Conclusion We identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care.
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Affiliation(s)
- Béatrice Lognos
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Agnès Oude Engberink
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluri professionnelle universitaire Avicenne, 2 rue IBN Sinaï dit Avicenne 66 330 Cabestany, France
| | - Lorène Gonzalez
- Centre médical, Rue de la Brèche, 34630 Saint-Thibéry, France
| | - Julia Leandri
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Carla Charlot Pisoni
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Nadia Rachedi
- Département de L’Hérault, Hôtel du Département mas d’Alco, 1977 avenue du mas de Moulin 34087 Montpellier, France
| | - Bernard Clary
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de Santé Professionnelle 20 route Minervois, 11800 Trèbes, France
| | - Gérard Bourrel
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
| | - Sabine Bayen
- Department of General Practice, Pôle formation Faculté médecine H. Warembourg 59045 Lille CEDEX 1, University of Lille, 1, place de Verdun, 59045, France
| | - Elodie Million
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
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Smylie J, Rotondi MA, Filipenko S, Cox WTL, Smylie D, Ward C, Klopfer K, Lofters AK, O'Neill B, Graham M, Weber L, Damji AN, Devine PG, Collins J, Hardy BJ. Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training. BMC Med 2024; 22:3. [PMID: 38191406 PMCID: PMC10775432 DOI: 10.1186/s12916-023-03193-y] [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: 07/20/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. METHOD Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. RESULTS Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. CONCLUSIONS Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. TRIAL REGISTRATION Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.
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Affiliation(s)
- Janet Smylie
- Well Living House, Unity Health Toronto - St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Michael A Rotondi
- School of Kinesiology and Health Science, York University, 364 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Sam Filipenko
- Well Living House, Unity Health Toronto - St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | | | - Diane Smylie
- Ontario Federation of Indigenous Friendship Centres, 219 Front Street East, Toronto, ON, M5A 1E8, Canada
| | - Cheryl Ward
- Anti-Indigenous Racism Consultant, Nanaimo, BC, Canada
| | - Kristina Klopfer
- Well Living House, Unity Health Toronto - St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Aisha K Lofters
- Womens College Hospital, Women's College Hospital, 77 Grenville St, Toronto, TO, M5B 2S1, Canada
| | - Braden O'Neill
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Melissa Graham
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Linda Weber
- St. Josephs Heath Centre Family Medicine/Urban Family Health Team, 30 The Queensway, Toronto, ON, M6R 1B5, Canada
| | - Ali N Damji
- Credit Valley Family Health Team, 2300 Eglinton Avenue W Suite 105, Mississauga, ON, L5M2V8, Canada
| | - Patricia G Devine
- Department of Psychology, University of Wisconsin - UW-Madison, 1202 W Johnson St, Madison, WI, 53706, USA
| | | | - Billie-Jo Hardy
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
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Monchalin R, Jubinville D, Pérez Piñán AV, Paul W, Wells M, Ross A, Law K, Chaffey M, Pruder H. "I would love for there not to be so many hoops … ": recommendations to improve abortion service access and experiences made by Indigenous women and 2SLGTBQIA+ people in Canada. Sex Reprod Health Matters 2023; 31:2247667. [PMID: 37799036 PMCID: PMC10561563 DOI: 10.1080/26410397.2023.2247667] [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] [Indexed: 10/07/2023] Open
Abstract
Acknowledging the barriers in accessing sexual and reproductive health services that disproportionately impact Indigenous women and 2SLGTBQIA+ people, coupled with the lack of knowledge surrounding Indigenous peoples' experiences with abortion, we present qualitative findings from a pilot study investigating Indigenous experiences of accessing abortion services in Canada. We focus on findings related to participant recommendations for improving safety and accessibility of abortion services made by and for Indigenous people in Canada. Informed by an Indigenous Advisory Committee consisting of front-line service providers working in the area of abortion service access and/ or support across Canada, the research team applied an Indigenous methodology to engage with 15 Indigenous people across Canada utilising a conversational interview method, between September and November 2021. With representation from nine provinces and territories across Canada, participants identified with Anishinaabe, Cree, Dene, Haudenosaunee, Inuit, Métis and/ or Mi'kmaq Nations. Five cross-cutting recommendations emerged, including: (1) location, comfort, and having autonomy to choose where the abortion takes place; (2) holistic post-abortion supports; (3) accessibility, availability, and awareness of non-biased and non-judgemental information; (4) companionship, advocacy, and logistical help before and during the abortion from a support person; and (5) cultural safety and the incorporation of local practices and knowledges. Recommendations demonstrate that Indigenous people who have experienced an abortion carry practical solutions for removing barriers and improving access to abortion services in the Canadian context.
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Affiliation(s)
- Renée Monchalin
- Assistant Professor, School of Public Health and Social Policy, University of Victoria, Victoria, BCV8P 5C2, Canada
- Affiliate Scientist, Well Living House, Li Ka Shing Knowledge Institute of Unity Health Toronto, Toronto, ON, Canada
- Assistant Professor (Status Only), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Danette Jubinville
- PhD Candidate, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Full-Spectrum Doula, ekw’í7tl Doula Collective, Vancouver, BC, Canada
| | - Astrid V. Pérez Piñán
- Assistant Professor, School of Public Administration, University of Victoria, Victoria, BC, Canada
| | - Willow Paul
- Masters Candidate, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Madison Wells
- Research Coordinator, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Arie Ross
- Masters Candidate, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Kimberly Law
- Nurse Practitioner, Northern Health Authority, British Columbia, Canada
| | - Meagan Chaffey
- Abortion Doula, Abortion Support Services Atlantic, Halifax, NS, Canada
| | - Harlie Pruder
- Founder, Northern Reproductive Justice Network, Thompson, MB, 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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Hagaman A, Gonzalez Rodriguez H, Egger E, Bitewulign B, Case H, Alemayehu AK, Rhodes EC, Estifanos AS, Singh K, Woldesenbet Keraga D, Zahid M, Magge H, Barrington C. Navigating and manipulating childbirth services in Afar, Ethiopia: A qualitative study of cultural safety in the birthing room. Soc Sci Med 2023; 331:116073. [PMID: 37481879 PMCID: PMC10410251 DOI: 10.1016/j.socscimed.2023.116073] [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: 02/09/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
Access to maternal health services has increased in Ethiopia during the past decades. However, increasing the demand for government birthing facility use remains challenging. In Ethiopia's Afar Region, these challenges are amplified given the poorly developed infrastructure, pastoral nature of communities, distinct cultural traditions, and the more nascent health system. This paper features semi-structured interviews with 22 women who were purposively sampled to explore their experiences giving birth in government health facilities in Afar. We used thematic analysis informed by a cultural safety framework to interpret findings. Our findings highlight how women understand, wield, and relinquish power and agency in the delivery room in government health facilities in Afar, Ethiopia. We found that Afari women are treated as 'others', that they manipulate their care as they negotiate 'cultural safety' in the health system, and that they use trust as a pathway towards more cultural safety. As the cultural safety framework calls for recognizing and navigating the diverse and fluid power dynamics of healthcare settings, the onus of negotiating power dynamics cannot be placed on Afari women, who are already multiply marginalized due to their ethnicity and gender. Health systems must adopt cultural safety in order to ensure health quality. Providers, particularly in regions with rich cultural diversity, must be trained in the cultural safety framework in order to be aware of and challenge the multidimensional power dynamics present in health encounters.
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Affiliation(s)
- Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA; Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, USA.
| | - Humberto Gonzalez Rodriguez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
| | - Emilie Egger
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA; Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, USA.
| | | | - Haley Case
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA; Centers for Disease Control and Prevention 1600 Clifton Road, Atlanta, GA, 30329, USA.
| | | | - Elizabeth C Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia.
| | - Kavita Singh
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Dorka Woldesenbet Keraga
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia.
| | - Mahrukh Zahid
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
| | - Hema Magge
- Bill & Melinda Gates Foundation, Seattle, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599, USA; Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA.
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11
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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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Lavoie JG, Clark W, McDonnell L, Nickel N, Dutton R, Kanayok J, Anawak J, Anawak C, Brown L, Clark GV, Evaluardjuk-Palmer M, Ford F, Fowler-Woods M, Wong S, Sanguins J, Katz A. Kivalliq Inuit women travelling to Manitoba for birthing: findings from the Qanuinngitsiarutiksait study. BMC Pregnancy Childbirth 2022; 22:870. [PMID: 36434515 PMCID: PMC9694830 DOI: 10.1186/s12884-022-05214-9] [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: 04/13/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Qanuinngitsiarutiksait study aimed to develop detailed profiles of Inuit health service utilization in Manitoba, by Inuit living in Manitoba (approximately 1,500) and by Inuit from the Kivalliq region of Nunavut who travel to Manitoba to access care not available in Nunavut (approximately 16,000 per year). METHODS We used health administrative data routinely collected in Manitoba for all services provided and developed an algorithm to identify Inuit in the dataset. This paper focused on health services used by Inuit from the Kivalliq for prenatal care and birthing. RESULTS Our study found that approximately 80 percent of births to women from the Kivalliq region occur in Manitoba, primarily in Winnipeg. When perinatal care and birthing are combined, they constitute one third of all consults happening by Kivalliq residents in Manitoba. For scale, hospitalizations for childbirths to Kivalliq women about to only 5 percent of all childbirth-related hospitalizations in Manitoba. CONCLUSIONS The practice of evacuating women from the Kivalliq for perinatal care and birthing is rooted in colonialism, rationalized as ensuring that women whose pregnancy is at high risk have access to specialized care not available in Nunavut. While defendable, this practice is costly, and does not provide Inuit women a choice as to where to birth. Attempts at relocating birthing to the north have proven complex to operationalize. Given this, there is an urgent need to develop Inuit-centric and culturally appropriate perinatal and birthing care in Manitoba.
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Affiliation(s)
- Josée G. Lavoie
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | - Wayne Clark
- grid.17089.370000 0001 2190 316XUniversity of Alberta, Edmonton, AB Canada
| | - Leah McDonnell
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | - Nathan Nickel
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | | | | | | | | | | | | | | | | | | | - Sabrina Wong
- grid.17091.3e0000 0001 2288 9830University of British Columbia, Vancouver, BC Canada
| | | | - Alan Katz
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
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13
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Corso M, DeSouza A, Brunton G, Yu H, Cancelliere C, Mior S, Taylor-Vaisey A, MacLeod-Beaver K, Côté P. Integrating Indigenous healing practices within collaborative care models in primary healthcare in Canada: a rapid scoping review. BMJ Open 2022; 12:e059323. [PMID: 35710234 PMCID: PMC9207893 DOI: 10.1136/bmjopen-2021-059323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada. ELIGIBILITY CRITERIA We included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models. SOURCES OF EVIDENCE We searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021. CHARTING METHODS Our data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics. RESULTS We identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear. CONCLUSIONS We found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.
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Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Astrid DeSouza
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Carolina Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
- Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
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14
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Flemington T, Fraser J, Gibbs C, Shipp J, Bryant J, Ryan A, Wijetilaka D, Marks S, Scarcella M, Tzioumi D, Ramanathan S, Clague L, Hartz D, Lonne B, Lock (Ngiyampaa) M. The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5381. [PMID: 35564775 PMCID: PMC9102959 DOI: 10.3390/ijerph19095381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced "Dahl-beer-weer gum-um-be-goo" in the Gumbaynggirr language means 'safe children') model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety in health care settings, and privileges the cultural voices of many diverse Aboriginal peoples. When adapted appropriately for local clinical and cultural contexts, it will contribute to a patient journey experience of respect, dignity and empowerment.
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Affiliation(s)
- Tara Flemington
- Nursing, Midwifery and Service Reform, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jennifer Fraser
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
- Nursing, Midwifery and Education, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
| | - Clinton Gibbs
- Health Reform, Opportunities and Transition, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joanne Shipp
- Integrated Child, Youth and Family Wellbeing, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joe Bryant
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Amanda Ryan
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Devika Wijetilaka
- Paediatrics, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Susan Marks
- Child Protection Unit, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Mick Scarcella
- Aboriginal Health, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Dimitra Tzioumi
- Child Protection Unit, The Sydney Children’s Hospitals Network, Randwick, NSW 2031, Australia;
- Child Protection and Wellbeing, Ministry of Health, St Leonards, NSW 2065, Australia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia;
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Liesa Clague
- School of Nursing, Midwifery, Health Science and Physiotherapy, The University of Notre Dame, Darlinghurst, NSW 2010, Australia;
| | - Donna Hartz
- School of Nursing and Midwifery, College of Medicine Health & Wellbeing, University of Newcastle, Gosford, NSW 2250, Australia;
| | - Bob Lonne
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Mark Lock (Ngiyampaa)
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
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Wodtke L, Hayward A, Nychuk A, Doenmez C, Sinclair S, Cidro J. The need for sustainable funding for Indigenous doula services in Canada. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221093928. [PMID: 35438029 PMCID: PMC9021521 DOI: 10.1177/17455057221093928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To interview representatives from Indigenous doulas across Canada in order to document how they manage the logistics of providing community-based doula care and understand their challenges. These objectives inform the development of an Indigenous doula pilot programme as part of the project, 'She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas'. METHODS In 2020, semi-structured interviews were conducted with members of five Indigenous doula collectives across Canada. Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS Our article explores one of the main themes that emerged from these interviews: sustainable funding for Indigenous doula services. Within this theme we identified two sub-themes: (1) limitations on and regulations for available funding and (2) negative impacts of limited funding on doula service. CONCLUSION A major challenge to providing Indigenous community-based doula services is sustainable funding. Current models of funding for this work often do not provide livable wages and are bound by limited durations and regulations that are unsustainable and can be culturally inappropriate. Due to this lack of sustainable funding, Indigenous doula service in Canada faces challenges that include high staff turnover and burnout and lack of time and resources to provide culturally safe care, pursue professional development and additional training, and keep their services affordable for the families who need them. Future research is needed to ascertain potential programmes and funding streams for sustainable Indigenous doula support in Canada, including possible integration of doula care into the universal public health care system despite the jurisdictional challenges in providing health care for Indigenous peoples.
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Affiliation(s)
- Larissa Wodtke
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
| | - Ashley Hayward
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
- Department of Peace and Conflict Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Alexandra Nychuk
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
| | - Caroline Doenmez
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
- Department of Anthropology, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Sinclair
- Department of Native Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Jaime Cidro
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
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Smith M, Silva E Silva V, Schick-Makaroff K, Kappel J, Bachynski JC, Monague V, Paré GC, Ross-White A. Furthering Cultural Safety in Kidney Care Within Indigenous Communities: A Systematic and Narrative Review. Kidney Med 2021; 3:896-904. [PMID: 34938999 PMCID: PMC8664704 DOI: 10.1016/j.xkme.2021.04.023] [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: 11/13/2022] Open
Abstract
Rationale & Objective Cultural Safety is being prioritized within health care around the world. As a concept, Cultural Safety centers upon power relations between health providers and indigenous recipients of care, ensuring that all people feel safe and respected in the health care system. In this article, we explored the breadth of the literature regarding Cultural Safety within the context of indigenous kidney health care. Study Design & Populations As a systematic narrative review, this work engaged widely across a diverse range of the available literature to broaden understanding of Cultural Safety within indigenous kidney health care and indigenous populations from Australia, New Zealand, Canada, and the United States. Search Strategy & Analytical Approach Guided by the research question focused on how Cultural Safety occurs within care for indigenous people with kidney disease, an initial database search by the university librarian resulted in retrieval of 2,232 articles, of which 96 potential articles were screened by the research team. Results 15 articles relevant to the research question were identified and study findings were assembled within 3 broad clusters: relationality, engagement, and health care self-determination; systemic issues, barriers, and access; and addressing legacies of colonialism for health care providers. Limitations The review summarizes mainly qualitative articles given the paucity of articles found specific to Cultural Safety within indigenous contexts. Conclusions Of particular interest to health care providers are the collation of solutions by cluster and the findings of this review that contribute to further understanding of the concept of Cultural Safety in health care for indigenous people with kidney disease. Also, findings address the importance of community-driven kidney care in which language, ways of knowing and being, and traditional ways of healing are prioritized.
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Affiliation(s)
- Mary Smith
- School of Nursing, Queen's University, Kingston, Ontario
| | | | | | - Joanne Kappel
- University of Saskatchewan, Saskatoon.,Saskatchewan Health Authority, Saskatoon
| | | | | | | | - Amanda Ross-White
- Queen's University Library, Queen's University, Kingston, Ontario, Canada
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17
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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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