Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States

Abstract

ObjectiveTo synthesise and appraise the design and impact of peer-reviewed evaluations of Indigenous cultural safety training programmes and workshops for healthcare workers in Australia, Canada, New Zealand and/or the United States.DesignSystematic review.Data sourcesOvid Medline, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Bibliography of Indigenous Peoples in North America, Applied Social Sciences Index & Abstracts, ERIC (Education Resources Information Center), International Bibliography of the Social Sciences, ProQuest Dissertations & Theses Global, Sociological Abstracts, and Web of Science’s Social Sciences Citation Index and Science Citation Index from 1 January 2006 to 12 May 2022.Eligibility criteriaStudies that evaluated the outcomes of educational interventions for selecting studies: designed to improve cultural safety, cultural competency and/or cultural awareness for non-Indigenous adult healthcare professionals in Canada, Australia, New Zealand or the United States.Data extraction and synthesisOur team of Indigenous and allied scientists tailored existing data extraction and quality appraisal tools with input from Indigenous health service partners. We synthesised the results using an iterative narrative approach.Results2442 unique titles and abstracts met screening criteria. 13 full texts met full inclusion and quality appraisal criteria. Study designs, intervention characteristics and outcome measures were heterogeneous. Nine studies used mixed methods, two used qualitative methods and two used quantitative methods. Training participants included nurses, family practice residents, specialised practitioners and providers serving specific subpopulations. Theoretical frameworks and pedagogical approaches varied across programmes, which contained overlapping course content. Study outcomes were primarily learner oriented and focused on self-reported changes in knowledge, awareness, beliefs, attitudes and/or the confidence and skills to provide care for Indigenous peoples. The involvement of local Indigenous communities in the development, implementation and evaluation of the interventions was limited.ConclusionThere is limited evidence regarding the effectiveness of specific content and approaches to cultural safety training on improving non-Indigenous health professionals’ knowledge of and skills to deliver quality, non-discriminatory care to Indigenous patients. Future research is needed that advances the methodological rigour of training evaluations, is focused on observed clinical outcomes, and is better aligned to local, regional,and/or national Indigenous priorities and needs.

Exploring how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients: a mixed method study

“…Most cultural safety (or similar) training has a focus on understanding the impact of colonisation on Aboriginal and Torres Strait Islander people [ 31 ]. Yet only one registrar discussed this when defining cultural safety.…”

Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training

“…Evidence synthesis focused on understanding the impacts of Indigenous focused clinician training initiatives reveals varied approaches and evaluation measures that are almost exclusively learner focused as opposed to patient derived and oriented [ 14 ], even though clinician self-assessment is known to be poorly correlated with observational or patient outcome reporting [ 15 , 16 ]. This gap in the assessment of patient care outcomes has been similarly noted across the broader domain of clinician anti-bias training [ 17 ].…”

Improving Indigenous health equity within the emergency department: a global review of interventions

“…Health inequities for Indigenous people are interactional and multifactorial and are perpetuated by the longstanding impacts of colonialism, anti-Indigenous racism, structural and systemic barriers, and the colonial foundation of Western healthcare [ 5 , 6 ]. There have been notable efforts to effect positive change including advancements in cultural safety programming [ 7 ], increasing Indigenous-led research and prioritization of Indigenous-led healthcare initiatives [ 8 ].…”