Defining culturally safe primary care for people who use substances: a participatory concept mapping study

Abstract

Background People who use substances experience high levels of substance-related stigma, both within and outside of health care settings, which can prevent people from help-seeking and contribute further to health inequities. Recognizing and respecting how political, social, economic, and historical conditions influence health and health care, cultural safety, with origins in addressing Indigenous racism, is a potential strategy for mitigating stigma and marginalization in health care. Using a participatory research approach, we applied the concept of cultural safety to develop a model of safe primary care from the perspective of people who use substances. Methods People who use or used substances were involved in all phases of the research and led data collection. Study participants (n = 75) were 42.5 years old on average; half identified as female and one quarter as Indigenous. All were currently using or had previous experience with substances (alcohol and/or other drugs) and were recruited through two local peer-run support agencies. Concept mapping with hierarchical cluster analysis was used to develop the model of safe primary care, with data collected over three rounds of focus groups. Results Participants identified 73 unique statements to complete the focus prompt: “I would feel safe going to the doctor if …” The final model consisted of 8 clusters that cover a wide range of topics, from being treated with respect and not being red-flagged for substance use, to preserving confidentiality, advocacy for good care and systems change, and appropriate accommodations for anxiety and the effects of poverty and criminalization. Conclusions Developing a definition of safe care (from the patient perspective) is the necessary first step in creating space for positive interactions and, in turn, improve care processes. This model provides numerous concrete suggestions for providers, as well as serving as starting point for the development of interventions designed to foster system change.

A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada

“…However, this study suggests that substance use screening should be applied more broadly and intentionally integrated as youth may not present external signs of problematic substance use and may not feel comfortable bringing it up unless explicitly asked or in crisis. Providing service providers with training on how to provide culturally safe care to youth who use substances is imperative for this approach to be effective and maintain trusting relationships with youth, given young people’s fears of being stigmatized and judged when accessing services [ 53 , 54 ].…”

Identifying behaviours for survival and wellness among people who use methamphetamine with opioids in British Columbia: a qualitative study

“…One half of participants self-reported Indigenous ancestry, including First Nations and Métis. As services are expanded to meet the harm reduction and treatment needs of people who concurrently use methamphetamine and opioids, it will be critical for researchers, clinicians, and decision-makers to work with a diversity of Indigenous peoples and communities to create services that are equitable and accessible and culturally safe for Indigenous people who use drugs [ 36 , 37 ].…”

Identifying behaviours for survival and wellness among people who use methamphetamine with opioids in British Columbia: A qualitative study

“…As services are expanded to meet the harm reduction and treatment needs of people who concurrently use MA and opioids, it will be critical for researchers, clinicians, and decision-makers to work with a diversity of Indigenous peoples and communities to create services that are equitable and accessible and culturally safe for Indigenous people who use drugs [37,38].…”