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Harfield S, Purcell T, Schioldann E, Ward J, Pearson O, Azzopardi P. Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA. BMC Health Serv Res 2024; 24:553. [PMID: 38693527 PMCID: PMC11062015 DOI: 10.1186/s12913-024-10796-5] [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: 08/18/2023] [Accepted: 02/28/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. METHODS We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. RESULTS A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. CONCLUSION This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.
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Affiliation(s)
- Stephen Harfield
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia.
- School of Public Health, University of Queensland, Herston, Australia.
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia.
- School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Tara Purcell
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Eliza Schioldann
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia
| | - Odette Pearson
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Peter Azzopardi
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Fraser SL, Lyonnais MC, Riva M, Fletcher C, Beauregard N, Thompson J, Mickpegak R, Bouchard LA. Culturally and contextually adaptive indicators of organizational success: Nunavik, Quebec. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:44-55. [PMID: 36449222 PMCID: PMC10831023 DOI: 10.17269/s41997-022-00704-x] [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: 10/07/2021] [Accepted: 09/19/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE This study aimed to develop a preliminary guide to culturally and contextually relevant indicators to assess community resources in the 14 communities of the Inuit territory of Nunavik, Quebec. METHODS As part of the Community Component of Qanuilirpitaa? of the 2017 Nunavik Health Survey, data were collected from 354 organizations located across Nunavik. Data were collected via short structured interviews with representatives of the organization. An inductive qualitative analysis was conducted to identify emerging themes describing the contexts that influence organizations, how key informants conceptualized what is a successful resource, and the facilitators and needs to achieving these indicators of success. Inuit partners were involved throughout the project to offer insight and to ascertain its pertinence and validity. RESULTS Interviews revealed structural and community realities that influenced organizations. Three main indicators were used to describe successes: (1) team efficiency and dynamics; (2) accessibility of the resource; and (3) ability to impact clients and the community. The third indicator was by far the most discussed indicator of success. Participants and leaders offer suggestions as to how to achieve these indicators and advocate for the conditions necessary for organizational sustainability. CONCLUSION This data-driven framework suggests that the measures of success that are frequently used by funding agencies (e.g., number of people reached, number of activities) may not fully represent the potential of local services in a given community. Indeed, services may be creating job opportunities for Inuit, instilling pride, offering cultural opportunities, and increasing capital (human, economic, health) within the community, all of which are equally important indicators of success that may more adequately further improve the social determinants of health among communities.
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Affiliation(s)
- Sarah Louise Fraser
- Centre de Recherche en Santé Publique (CReSP), University of Montreal and CIUSSS du centre Sud-de-l'Île de Montréal, Montreal, Quebec, Canada.
- School of Psychoeducation, University of Montreal, Montreal, Quebec, Canada.
| | | | - Mylene Riva
- Department of Geography, McGill University, Montreal, Quebec, Canada
| | - Christopher Fletcher
- Centre de Recherche CHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Nancy Beauregard
- Centre de Recherche en Santé Publique (CReSP), University of Montreal and CIUSSS du centre Sud-de-l'Île de Montréal, Montreal, Quebec, Canada
- École de Relations Industrielles, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Thompson
- Centre de Recherche en Santé Publique (CReSP), University of Montreal and CIUSSS du centre Sud-de-l'Île de Montréal, Montreal, Quebec, Canada
| | | | - Laury-Ann Bouchard
- School of Psychoeducation, University of Montreal, Montreal, Quebec, Canada
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Nadeau L, Gaulin D, Johnson-Lafleur J, Levesque C, Fraser S. The challenges of decolonising participatory research in indigenous contexts: the Atautsikut community of practice experience in Nunavik. Int J Circumpolar Health 2022; 81:2087846. [PMID: 35979584 PMCID: PMC9397418 DOI: 10.1080/22423982.2022.2087846] [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] [Indexed: 11/25/2022] Open
Abstract
Historically, research involving Indigenous peoples has been the scene of power imbalances between Indigenous communities and researchers. Indigenous peoples have often been put in the position of passive subjects of research rather than participants or collaborators with agency, a situation that the current movement of decolonisation of research and practices in the field of Indigenous health aims to counteract. Participatory research seeks a better balance of input, decision-making and power between research participants and research teams and values participants’ knowledges. As such, it is a particularly relevant approach for researchers to involve community members and support self-determination of Indigenous people. Yet, if its explicit intentions are aiming at a decolonising approach, the socio-structural context of participatory research initiatives in Indigenous communities brings obstacles to the approach’s success. The development and implementation of the participatory project Atautsikut: A Community of Practice in Youth Mental Health and Wellness in Nunavik, has been an occasion to document certain barriers that take place in participatory research. This article describes Atautsikut as a starting point for a reflection on the challenges of decolonising participatory research. It discusses how, despite intentions, structural barriers, blind spots and unexpected contextual elements may challenge the journey towards decolonising research.
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Affiliation(s)
- Lucie Nadeau
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Dominique Gaulin
- École de travail social, Université de Montréal, Montreal, QC, Canada
| | | | | | - Sarah Fraser
- Department of Psychoeducation, Université de Montréal, Montreal, QC, Canada
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Collaboration in Mental Healthcare for Indigenous Children and Youth: Using Actor-Network Analyses to Better Understand Dynamics, Strengths, and Ongoing Challenges in Collaboration. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00942-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Belaid L, Budgell R, Sauvé C, Andersson N. Shifting paradigm from biomedical to decolonised methods in Inuit public health research in Canada: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2021-008311. [DOI: 10.1136/bmjgh-2021-008311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundThe National Inuit Strategy on Research focuses on advancing Inuit governance in research, increasing ownership over data and building capacity. Responding to this call for Inuit self-determination in research, academic researchers should consider cultural safety in research and ways to promote Inuit-led methods.MethodsThis scoping review collated academic literature on public health research in Inuit communities in Canada between 2010 and 2022. A critical assessment of methods used in public health research in Inuit communities examined cultural safety and the use of Inuit-attuned methods. Descriptive and analytical data were summarised in tables and figures. Knowledge user engagement in the research process was analysed with thematic analysis.Results356 articles met the inclusion criteria. Much of the published research was in nutrition and mental health, and few initiatives reported translation into promotion programmes. Almost all published research was disease or deficit focused and based on a biomedical paradigm, especially in toxicology, maternal health and chronic diseases. Recent years saw an increased number of participatory studies using a decolonial lens and focusing on resilience. While some qualitative research referred to Inuit methodologies and engaged communities in the research process, most quantitative research was not culturally safe. Overall, community engagement remained in early stages of co-designing research protocols and interventions. Discussion on governance and data ownership was limited. Recent years saw emerging discussions on these issues. Knowledge user capacity-building was limited to brief training on conventional data collection methods.ConclusionsThe last decade of published public health research has not responded to the National Inuit Strategy on Research. Participatory research is gaining ground, but has not reached its full potential. A shift from biomedical to decolonised methods is slowly taking place, and public health researchers who have not yet embraced this paradigm shift should do so.
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Santella C, Tratt E, Nyamiaka J, Whiteley Tukkiapik L, Styffe C, Gamelin R, Macdonald ME, Brassard P. Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik, Northern Quebec. QUALITATIVE HEALTH RESEARCH 2022; 32:1259-1272. [PMID: 35621363 DOI: 10.1177/10497323221090805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.
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Affiliation(s)
- Christina Santella
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Elyse Tratt
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Joy Nyamiaka
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | | | - Claire Styffe
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Rachel Gamelin
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Mary Ellen Macdonald
- Oral Health and Society Research Unit, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Paul Brassard
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
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Ouellet L, Grandisson M, Fletcher C. Development of rehabilitation services in an Inuit sociocultural context: challenges, strategies and considerations for the future. Int J Circumpolar Health 2022; 81:2058694. [PMID: 35354359 PMCID: PMC8973344 DOI: 10.1080/22423982.2022.2058694] [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: 12/03/2022] Open
Abstract
In recent years, a new rehabilitation programme has been developed on the Hudson Bay coast of Nunavik. The purpose of this article is to reflect on the experience of an occupational and physical therapy programme development in an Inuit sociocultural context. To do so, the challenges encountered during the first years following the implementation of rehabilitation services and the strategies implemented by the professionals to overcome them were identified, examined in the light of the literature, and discussed with members of the rehabilitation team. The challenges encountered and strategies implemented were divided into 10 major themes: (1) diverse clinical needs; (2) communication issues; (3) acquisition of cross-cultural interaction and population-specific knowledge; (4) adaptation of clinical practice to Nunavimmiut; (5) client engagement in rehabilitation; (6) professional isolation; (7) lack of awareness around the objectives and scope of rehabilitation practice; (8) use of culturally safe assessment tools; (9) staff turnover; (10) large geographic area to be served. This exercise highlighted the need to adapt clinical rehabilitation practices to Nunavimmiut’s worldviews and culture, as well as to adopt a reflective practice in order to improve the quality, relevance and effectiveness of rehabilitation services.
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Affiliation(s)
- Lauriane Ouellet
- Département de réadaptation, Centre de santé Inuulitsivik, Nunavik, QC, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada
| | - Marie Grandisson
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Département de réadaptation, Université Laval, Québec, QC, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada
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Lévesque M. Une histoire des services de santé, des services sociaux et des services de protection de la jeunesse au Nunavik : portrait de la littérature (Note de recherche). ÉTUDES/INUIT/STUDIES 2022. [DOI: 10.7202/1096505ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Fraser SL, Gaulin D, Fraser WD. Dissecting systemic racism: policies, practices and epistemologies creating racialized systems of care for Indigenous peoples. Int J Equity Health 2021; 20:164. [PMID: 34261500 PMCID: PMC8278742 DOI: 10.1186/s12939-021-01500-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/17/2021] [Indexed: 11/03/2022] Open
Abstract
In this paper we explore some of the ways systemic racism operates and is maintained within our health and social services. We look at a very specific context, that of Nunavik Quebec, land and home to 13,000 Nunavimmiut, citizens of Quebec and Canada, signatories of the James Bay and Northern Quebec Agreement. We operationalize some of the ways in which policies and practices create and support social hierarchies of knowledges, also called epistemic racism, and how it impacts our ability to offer quality care that Indigenous peoples can trust and use.
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Affiliation(s)
- Sarah Louise Fraser
- School of Psychoeducation, University of Montreal, Pavillon Marie-Victorin, C. P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
- Centre de Recherche en Sante Publique (CReSP), University of Montreal and CIUSSS du Centre Sud-de-L'Île de Montreal, Montreal, Canada.
| | | | - William Daibhid Fraser
- Centre de Recherche en Sante Publique (CReSP), University of Montreal and CIUSSS du Centre Sud-de-L'Île de Montreal, Montreal, Canada
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