Culturally safe interventions in primary care for the management of chronic diseases of urban Indigenous People: a scoping review

Abstract

ObjectivesChronic conditions represent an important source of major health issues among Indigenous People. The same applies to those, who live off-reserve and in urban areas. However, very few healthcare services are considered culturally safe, resulting in some avoidance of the public healthcare system. Our goal was to review the literature on culturally safe practices available to urban Indigenous People who suffer from chronic diseases.DesignWe conducted a scoping review to determine what culturally safe healthcare services are currently offered for the management of chronic conditions in urban Indigenous populations, to contribute to a tailored, holistic and safe space in mainstream healthcare systems.Eligibility criteriaPeer-reviewed original research articles had to be published by 27 October 2020, in English or French.Information source: In October 2020, we searched five academic databases (EBSCO, PsycArticles, SocINDEX, MEDLINE and PsycINFO) and also reviewed grey literature and the websites of organisations or governments. The data were extracted and collected in an EXCEL spreadsheet. Two reviewers independently screened 326 titles and abstracts, followed by an independent evaluation of 48 full text articles. A total of 19 studies were included in this scoping review, as well as 5 websites/documents from the grey literature.ResultsIn total, 19 studies were included in our analysis. We found that Elders, family and the assistance of an interpreter are crucial elements to include to make urban Indigenous feel safe when they seek healthcare services. With this scoping review, we report interventions that are successful in terms of healthcare delivery for this population. Our findings provide insight on what services should be in place in mainstream healthcare settings to create a culturally safe experience for urban Indigenous People.ConclusionsIn recent years, there appears to be a growing awareness of the need to provide culturally safe health services. This scoping review identified multiple strategies to promote cultural safety in this context, as well as barriers and facilitators to their implementation. These elements, which have been extensively documented in the literature, should be included in the chronic diseases management interventions to be developed by urban and primary care settings.

The cultural safety of reports of research on primary healthcare use by Indigenous Peoples: a systematic review

“…Another review by Poitras et al investigated cultural safety interventions in primary care amongst urban Indigenous Peoples for chronic disease. (59) Findings revealed healthcare professionals need to be more aware of Indigenous Peoples' history and culture and include family, appropriate visual aids, and consideration of spirituality in their practices. (59) Their ndings also emphasised the importance of involving Elders as traditional healers and guides for Indigenous Peoples to provide guidance between different spheres of holistic health, which is a facilitator for Indigenous health.…”

“…(59) Findings revealed healthcare professionals need to be more aware of Indigenous Peoples' history and culture and include family, appropriate visual aids, and consideration of spirituality in their practices. (59) Their ndings also emphasised the importance of involving Elders as traditional healers and guides for Indigenous Peoples to provide guidance between different spheres of holistic health, which is a facilitator for Indigenous health. (59) Whilst these interventions are based on healthcare practices, they must also be utilised in research outputs to produce research that leads to equitable access.…”

Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review

“…55 73 74 Several literature reviews and at least ten additional PROS-PERO registrations address cultural safety. These reviews focus on describing culturally safe interventions for specific health issues, [9][10][11][12][13][14][15][16] how to improve healthcare practices (medicine, nursing, midwifery), [17][18][19][20][21][22][23] eHealth applications, 24 the presence of cultural safety in health research, 25 narrative descriptions of what cultural safety is [26][27][28][29][30][31][32] and the experiences of beneficiaries. 33 34 A limited literature on intercultural approaches to health emphasises communication issues.…”

Pathways for Healthcare Organizations to Strengthen Indigenous Nurse Retention

“…Healthcare organizations and healthcare providers must take care to ensure that they respect the diversity and distinctness between Indigenous Peoples, communities and nations in Canada ( Ongoing education is necessary so that healthcare providers can continually strengthen their ability to promote cultural safety (Bourque Bearskin et al 2020;CNA and Aboriginal Nurses Association of Canada 2014;Doria et al 2021;Joy-Correll et al 2022;McCalman et al 2019). Cultural safety is an outcome to care that balances power within the therapeutic relationship by empowering the client to be the sole evaluator as to whether culturally safety is achieved (Northern Health Indigenous Health n.d.; Poitras et al 2022;Ward et al 2016). Therefore, cultural safety is not an intervention that can be applied by healthcare providers but instead is achieved through the application of relevant approaches when caring for and interacting with Indigenous Peoples (Bourque Bearskin et al 2020;Browne et al 2016;Poitras et al 2022).…”

“…Cultural safety is an outcome to care that balances power within the therapeutic relationship by empowering the client to be the sole evaluator as to whether culturally safety is achieved (Northern Health Indigenous Health n.d.; Poitras et al 2022;Ward et al 2016). Therefore, cultural safety is not an intervention that can be applied by healthcare providers but instead is achieved through the application of relevant approaches when caring for and interacting with Indigenous Peoples (Bourque Bearskin et al 2020;Browne et al 2016;Poitras et al 2022). Organizations striving to promote culturally safe environments should include Indigenous cultural safety training and an evaluative process to ensure accountability, sustainability and critical praxis within the existing workforce and structures of the organization (Northern Health 2020; Northern Health Indigenous Health n.d.).…”