Canadian Aboriginal communities and medical service patterns for the management of injured patients a basis for surveillance

Abstract

Growing attention has been placed on injury as a major public health problem which has served to highlight the need for relevant injury data for preventive purposes at the community level. In the case of reserve-based Aboriginal communities in Canada, available injury data, from large datasets, often has little or no relevance at the community level. In addition, the availability of local data is complicated by unique health service and community infrastructures. As such, a prerequisite to establishing injury surveillance requires an understanding of Medical Service Patterns (MSPs) for injured patients intrinsic to a community's health service infrastructure. In determining patterns, cultural and environmental contexts are integral to methodological considerations as historically, Canada's Aboriginal population has been 'controlled' by others in the areas of health, education and social services. The objective of the study was to investigate MSPs in a Canadian Aboriginal community, specific to the management of injured patients, for the purpose of identifying data sites, sources, and collectors. The method relied on a four-step qualitative process designed explicitly for the study community, comprising: (1) semi-structured interviews with key informants; (2) a flow diagram process; (3) focus group discussions; and (4) a summary matrix diagram. This methodology was later replicated with three additional pilot communities. Three major MSPs were identified from nine original patterns generated through the initial data collection process. MSPs were found to be most directly impacted by severity of injury and the proximity of health service providers. Data collection practices were inconsistent, sporadic and poorly coordinated. Data was exclusive to respective data sources and off-reserve documentation was not reported back to the community. MSPs identified key data sites, sources, and collectors relevant to the study population. In conclusion, the four-step qualitative methodology employed in the study was found to be reliable and feasible in identifying community MSPs. Empirical findings confirm the need to investigate MSPs in communities considering surveillance activities, as intra-national differences may be considerable given social inequalities, geographic uniqueness and cultural factors. The use of sophisticated methodologies may detract rather than promote collaborative efforts.

Acute gastrointestinal illness in two Inuit communities: burden of illness in Rigolet and Iqaluit, Canada

“…In addition, effective and timely public health surveillance for Indigenous populations can be challenging, particularly in rural or remote communities due to limited accessibility of healthcare services [19,22]. This lack of access to these services can result in reduced care-seeking behaviour, which can compromise the quality and quantity of available surveillance data [19,[22][23][24].…”

Improving Aboriginal health data capture: evidence from a health registry evaluation

“…This lack of data availability is due in part to gaps in the process of health data collection, which in turn is reflected in generally poor quality of captured data. In some countries health databases and registries do not capture ethnicity/cultural # data that would allow for targeted investigations of their Aboriginal population's health [11][12][13]. Furthermore, even when ethnicity/cultural information is collected in population health databases, the quality of data captured on Aboriginal health can be compromised by lack of uniform reporting [11,12,14], incomplete records [15], high monetary costs of patient follow-up [16], and lack of coding validity [3,17].…”

Using local injury surveillance for community-based injury prevention: an analysis of Scandinavian WHO Safe Community and Canadian Safe Community Foundation programmes

“…However, scant attention has been given to the difficulties that community-based injury prevention programmes experience accessing and linking IS data to local action (Auer andAndersson 2001, Horan andMallonee 2003). In fact, there are few studies on the use and usefulness of community-level IS systems .…”