Factors influencing the provision of care for Inuit in a mainstream residential addiction rehabilitation centre in Southern Canada, an instrumental case study into cultural safety

Julie Lauzière,Isabelle Gaboury,Christopher Fletcher

doi:10.1186/s13011-021-00387-6

Julie Lauzière, Isabelle Gaboury + Show 1 more

Open Access

https://doi.org/10.1186/s13011-021-00387-6

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Abstract

BackgroundProvision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction. The factors that influence the provision of culturally safe care remain understudied. This paper explores the factors influencing the efforts of a mainstream residential addiction rehabilitation centre to provide culturally appropriate and quality care for Inuit.MethodsAn instrumental case study was conducted, informed by ethnographic and creative research methods. Over 700 h of participant observation were carried out between March 2018 and January 2020, in addition to qualitative semi-structured interviews (34 participants) and/or member-checking activities (17 participants) conducted with a total of 42 individuals: 20 Inuit residents, 18 clinical/specialized staff, and 4 clinical/administrative managers. An interpretive thematic analysis was performed to examine the factors that may influence the provision of culturally safe care for Inuit residents.ResultsTen categories of interrelated factors were identified and classified according to whether they relate to individual, programmatic, organizational, or systemic levels. These categories covered: (1) residents’ and staff’s life experiences; (2) personal and relational qualities and skills; (3) the model of care; (4) model flexibility; (5) ways in which relational aspects were considered; (6) sensitivity of the organization towards the population served; (7) human resources and professional development issues; (8) social climate; (9) political, relational, and funding climate; and (10) legislative, regulatory, and professional environment. While system-level factors generally had a negative effect on experiences of cultural safety, most factors at other levels had both favourable and unfavourable effects, depending on the context and dimensions examined.ConclusionsThe results offer insight into the interplay between the challenges and barriers that mainstream organizations face when working with Inuit, and the opportunities and enablers that organizations can build on to improve their services. This paper contributes to a better understanding of the challenges and opportunities to providing culturally safe addiction programs to Inuit within a complex intervention setting. It concludes by highlighting some areas for improvement to advance cultural safety in this context.

Highlights

Provision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction
As part of a larger project that explores the contribution of cultural safety in identifying ways to improve the quality of and access to services offered to Inuit, this paper examines factors that may enable or limit the provision of culturally safe care for Inuit in a mainstream residential addiction rehabilitation centre
The analyses identified ten categories of interrelated factors that may influence the provision of culturally safe programs for Inuit residents

Summary

Introduction

Provision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction. At present, when seeking relief from addictions, many Inuit find themselves in mainstream or First Nations addiction treatment centres in southern cities2 These environments are marked by a sometimes deep sociocultural, conceptual and linguistic distances, and power differentials between those providing services and the people receiving them. Failure to take these factors into account in the delivery of care risks perpetuating the inequities inherent in health systems by limiting access to care for Indigenous populations [6]. For care providers and organizations, fostering cultural safety requires a continual process of self-reflection that permits self-awareness about the biases, attitudes, discourses, and practices that can influence their practice, and which are manifested as subtle to overt discriminatory events encoding the power imbalance between client and provider, indigenous and nonindigenous person [14, 15]

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