Healthcare For Indigenous People Research Articles

Cuidados à criança indígena Tembé no acompanhamento do crescimento e desenvolvimento: um estudo de reflexão

Abstract Objective to reflect on health care for the indigenous child of the Tembé ethnicity, to monitor their growth and development. Method theoretical-reflexive study, based on the authors’ experiences and anchored in the literature on Tembé culture and health care for indigenous peoples. Results studies about ethnicity and culture are starting points to produce notes about technical care in relation to the child, based on those already performed by Tembé women. The care based on ethnic issues signals cultural dynamics and is placed, in health policies and in their processes, as primordial to direct instruments, technologies and actions of multidisciplinary teams, with the pertinent participation of indigenous people and/or indigenous health professionals in their development. Conclusions and Implications for Practice Equity in health care for the Tembé indigenous child requires the development of specific procedures and devices that consider their particularities, well-being, and cosmology. There is a need for approaching, deepening, and respecting the specificity of this ethnic group. By reflecting on the health care of Tembé children, it becomes possible to understand divergences and convergences with the content of the Ministry of Health manuals.

There is no health without cultural safety: why cultural safety matters

Background: Nurses and midwives predominately work in western-centric health care settings, which may not align with Indigenous perspectives of health and wellbeing. Nurses and midwives will also view care through their own cultural lens. Culturally inappropriate health care can reduce access and engagement in services and contribute to reduced health outcomes for Indigenous peoples. Australian codes of conduct for nurses and midwives now advocate for care that is holistic, free of bias and racism, challenges beliefs based on assumption, and is culturally safe for Indigenous peoples. However, there are varying understandings of cultural care, what it looks like, and how to best achieve it. Aim: To highlight the importance of cultural safety in health care and discuss the integration into nursing and midwifery practice. Design: Discussion paper. Discussion: Cultural safety has emerged in Australia as the framework to improve the access and quality of health care for Indigenous people and to improve disparities in health care outcomes. However, the application of these principles for nurses and midwives has not been widely explored. Misconceptions around the concept remain despite the inclusion in national standards and practice frameworks. Conclusion: Evaluation and research that contributes to evidence-based knowledge specifically on the integration of cultural safety in nursing and midwifery practice is required. Impact Statement: This paper provides an overview of the importance of cultural safety in nursing and midwifery practice. Although cultural safety is now embedded in professional codes and standards, there is limited evidence of how this is translated to clinical care. Research and evaluation are needed to evaluate the application of cultural safety principles by nurses and midwives.

The need for sustainable funding for Indigenous doula services in Canada.

Objectives:To interview representatives from Indigenous doulas across Canada in order to document how they manage the logistics of providing community-based doula care and understand their challenges. These objectives inform the development of an Indigenous doula pilot programme as part of the project, ‘She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas’.Methods:In 2020, semi-structured interviews were conducted with members of five Indigenous doula collectives across Canada. Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes.Results:Our article explores one of the main themes that emerged from these interviews: sustainable funding for Indigenous doula services. Within this theme we identified two sub-themes: (1) limitations on and regulations for available funding and (2) negative impacts of limited funding on doula service.Conclusion:A major challenge to providing Indigenous community-based doula services is sustainable funding. Current models of funding for this work often do not provide livable wages and are bound by limited durations and regulations that are unsustainable and can be culturally inappropriate. Due to this lack of sustainable funding, Indigenous doula service in Canada faces challenges that include high staff turnover and burnout and lack of time and resources to provide culturally safe care, pursue professional development and additional training, and keep their services affordable for the families who need them. Future research is needed to ascertain potential programmes and funding streams for sustainable Indigenous doula support in Canada, including possible integration of doula care into the universal public health care system despite the jurisdictional challenges in providing health care for Indigenous peoples.

Teaching Culturally Safe Care in Simulated Cultural Communication Scenarios During the COVID-19 Pandemic: Virtual Visits with Indigenous Animators.

Clinical learning activities involving Indigenous patient actors that specifically address the development of culturally safe care skills among medical students are important in order to improve health care for Indigenous people. In 2020, the COVID-19 pandemic led to strict physical distancing regulations and regional lockdowns that made the in-person delivery of Simulated Cultural Communication Scenarios (SCCS) with Indigenous patient actors impossible due to the disproportionate risk that public health emergencies pose for Indigenous communities. As the pandemic continued in 2021, we co-created a Virtual Visit approach to SCCS for the education of culturally safe care to pre-clerkship medical students. We report on student and tutor evaluation of these virtual sessions and contextualize our findings with our previous results delivering In-Person SCCSs. We found that Virtual Visit SCCS were highly effective in providing authentic exposure to and feedback from Indigenous patients. However, students rated their learning outcomes with Virtual Visit lower than the In-person approach to SCCS. We recommend formal training on interacting with patients in virtual care scenarios prior to Virtual Visit SCCS. We also found that exposure to SCCS with Indigenous animators has the potential to conjure up a diverse spectrum of sometimes unresolved negative feelings related to colonialism among students and tutors including discomfort, embarrassment, and anxiety. Our findings underscore the importance of resolving these sentiments within the safe environment of a classroom. To prepare Indigenous as well as non-Indigenous students and tutors adequately, it is important to acknowledge and critically deconstruct the embodiment of colonialism and Indigenous-settler relations when teaching physicians, as well as future physicians, preparedness for culturally safe care of Indigenous peoples.

Digging Deep: Barriers to HIV Care Among Indigenous Women

Indigenous women experience a disproportionate burden of ill health, including high rates of HIV. To reduce disparities in disease burden and health outcomes, identification of the barriers preventing access to health care is necessary. Identifying and discussing these barriers can assist service providers in the provision of care, influence policies for health and social well-being, and advance the discourse on equitable health care for Indigenous Peoples. Our research goal was to identify evidence-based, community-driven and asset-based solutions from the perspective of Indigenous women living with HIV. We also aimed to identify the role of the social determinants of health that influence the rates of HIV among Indigenous women. We used a combination of community-based participatory research methodology and Indigenous storytelling during 148 one-on-one interviews with HIV- and/or HCV-positive Indigenous women. Nine additional interviews were executed with healthcare professionals, health directors, and Knowledge Keepers and Elders. The interviews included qualitative, open-ended questions. We utilized NVivo for data analysis as well as Nanâtawihowin Âcimowina Kika-Môsahkinikêhk Papiskîci-Itascikêwin Astâcikowina (NAKPA), an Indigenous method for qualitative data analysis. Through the analysis, we identified nine barriers to care including expenses for daily living and health care-associated costs, time, access to computers and/or internet, transportation, childcare, homelessness and missed appointments, age, experiences with healthcare professionals and the health care system, and language. These barriers prevent access to and engagement in health care, leading to poor HIV related health outcomes. Healthcare providers have an essential role in identifying barriers to care, improving access to care in a patient-centered approach, and working to improve culturally safe practices.

Barriers to Including Indigenous Content in Canadian Health Professions Curricula

Indigenous peoples in Canada continue to face health care inequities despite their increased risk for various negative health outcomes. Evidence suggests that health professions students and faculty do not feel their curriculum adequately prepares learners to address these inequities. The aim of this study was to identify barriers that hinder the inclusion of adequate Indigenous content in curricula across health professions programs. Semi-structured interviews were conducted with 33 faculty members at a university in Canada from various health disciplines. Employing thematic analysis, four principal barriers were identified: (1) the limited number and overburdening of Indigenous faculty, (2) the need for non-Indigenous faculty training and capacity, (3) the lack of oversight and direction regarding curricular content and training approaches, and (4) the limited amount of time in curriculum and competing priorities. Addressing these barriers is necessary to prepare learners to provide equitable health care for Indigenous peoples.
 Keywords: Indigenous health, health professions, curricula, faculty perspectives, barriers, Canada

CommunityFirst solutions for COVID-19: decolonising health crises responses

CommunityFirst solutions for COVID-19: decolonising health crises responses

A community‐led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders

ObjectiveTo generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression. MethodsThree focus group sessions and two semi‐structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification. ResultsThree focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions. ConclusionsA treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public healthAny systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community‐led design and delivery.

Role of Indigenous health workers in the delivery of comprehensive primary health care in Canada, Australia, and New Zealand: a scoping review protocol.

The aim of this review is to identify and describe Indigenous health workers' roles, functions, activities, and involvement in decision-making in the provision of primary health care for Indigenous peoples and communities in Canada, Australia, and New Zealand. The Indigenous health worker workforce is the cornerstone to providing culturally safe, primary health care for Indigenous peoples and communities. Yet, wide-ranging role variation has created a general lack of understanding of who Indigenous health workers are, what Indigenous health workers do, and how to best coordinate their roles and skills with other care providers to further improve the health care experience and outcomes for Indigenous peoples and communities. This review will consider full text, peer-reviewed publications and gray literature that include Indigenous health workers who identify as belonging to, and are recognized as such by their communities, any First Peoples group in Canada (First Nations, Inuit, Métis), Australia (Aboriginal, Torres Strait Islander), and New Zealand (Māori); and who describe their role as the provision of primary health care to Indigenous peoples and communities, in clinical and non-clinical settings, in both mainstream health systems and within community-controlled primary health care sectors. MEDLINE, CINAHL, Scopus, Embase, Informit (Indigenous Collection, New Zealand Collection, Rural and Remote Health Database, APAIS-ATSIS, Aboriginal and Torres Strait Islander health bibliography), Sociological Abstracts, and Australian Indigenous HealthInfoNet will be searched for studies. Additional sources of unpublished literature, including government websites and community-controlled health organization websites in Canada, Australia, and New Zealand, will also be searched. Articles in English and French will be included, with no set date restrictions. Screening and selection will follow JBI methodology and findings will be summarized in tabular form accompanied by narrative text.

Findings Associated With a Novel Program Designed to Support Indigenous Faculty Members of U.S. Health Professions Schools


 
 
 Purpose: Recent studies on programs designed to support Indigenous faculty are lacking. Expanding numbers of successful Indigenous health faculty could help to improve delivery of culturally appropriate/responsive health care for Indigenous people. Methods: We enrolled nine American Indian/Alaska Native (AIAN) faculty participants in 2017 and 53 in 2018 in an Indigenous Faculty Forum (IFF). We provided instruction on academic advancement, addressed unique cultural considerations, and fostered networking and ongoing career support for AIAN faculty. We used a post-session survey, including the 22-item Diversity and Engagement Survey (DES) and focus groups, to assess initial reactions to the program and a follow-up survey to assess change at 1 year. Findings: Participants in both IFF sessions were predominantly female, most often aged 35–44 and from primary care disciplines. Two faculty members rose to a higher rank during the 1-year follow-up period. Findings from the DES illustrated that Common Purpose, Equitable Reward and Recognition, Cultural Competence, Trust, a Sense of Belonging, and Appreciation of Individual Attributes increased slightly from post-session to 1 year. The greatest change was for Respect, which increased from a mean of 3.42 (SD = 0.77) to 3.76 (SD = 0.67), p = .05. Focus group findings revealed that mentoring that includes the cultural perspectives of AIAN is lacking, as is respect for these faculty from the academic community, though survey findings showed respect improved over time. Conclusions: More tailored work is needed to support AIAN in U.S. academic settings if they are to achieve academic success and become role models for others entering academic settings.
 
 

Acute health care among Indigenous patients in Canada: a scoping review

ABSTRACT A recent report by the Chief Public Health Officer of Canada demonstrates the inferior health status of Indigenous Peoples in Canada when compared to non-Indigenous populations. This scoping review maps out the available literature concerning acute health care for Indigenous Peoples in Canada in order to better understand the health care issues they face. All existing articles concerning health care provided to Indigenous Peoples in Canada in acute settings were included in this review. The targeted studied outcomes were access to care, health care satisfaction, hospital visit rates, mortality, quality of care, length of stay and cost per hospitalisation. 114 articles were identified. The most studied outcomes were hospitalisation rates (58.8%), length of stay (28.0%), mortality (25.4%) and quality of care (24.6%) Frequently studied topics included pulmonary disease, injuries, cardiovascular disease and mental illness. Indigenous Peoples presented lower levels of satisfaction and access to care although they tend to be over-represented in hospitalisation rates for acute care. Greater inclusion of Indigenous Peoples in the health care system and in the training of health care providers is necessary to ensure a better quality of care that is culturally safe for Indigenous Peoples.

Medicina tradicional indígena em tempos de pandemia da COVID-19

Objetivo: Discutir sobre a medicina tradicional indígena em tempos de pandemia da COVID-19. Revisão bibliográfica: Apesar de difundida nos últimos anos, a implementação da medicina tradicional indígena no sistema oficial de saúde ainda é precária e carente de iniciativas mais eficientes. Em tempos de pandemia da COVID-19, os povos indígenas podem enfrentar algumas dificuldades nas suas práticas culturais, sobretudo na utilização da sua medicina tradicional, a qual deve ser respeitada conforme a Política Nacional de Atenção à Saúde dos Povos Indígenas. Considerações finais: A medicina tradicional indígena, objeto da política indigenista de saúde, está sendo utilizada como prática preventiva e de tratamento da COVID-19, na forma de práticas espirituais e uso de plantas medicinais por exemplo. Contudo, algumas dificuldades são evidenciadas como: manter o isolamento social, preocupações com os hábitos e cultura da população, associação entre a medicina tradicional com o modelo biomédico e o manejo dos cadáveres.

In the eyes of Indigenous people in Canada: exposing the underlying colonial etiology of hepatitis C and the imperative for trauma-informed care.

The distribution of hepatitis C (HCV) infection in Canada signals a widening gap between Indigenous and non-Indigenous people. Current evidence demonstrates that the rate of HCV infection among Indigenous people is at least five times higher than the rest of Canada. This analysis provides a reconciliatory response, which exposes the colonial etiology of the HCV gap in Canada and proposes potential anti-colonial approaches to HCV wellness and health care for Indigenous people. This analysis applies Two-Eyed Seeing as a reconciliatory methodology to advance the understanding of HCV burden and identify the key elements of responsive HCV care in the context of Indigenous nations in Canada. The analysis underlines the colonial distribution of HCV burden in Canada, highlights Indigenous perspectives on HCV infection, hypothesizes a clinical pathway for the underlying colonial etiology of HCV infection, and identifies Indigenous healing as a promising anti-colonial conceptual approach to HCV wellness and health care among Indigenous people. In the eyes of Indigenous people, HCV infection is a colonial illness that entails healing as an anti-colonial approach to achieving wellness and gaining health. Future empirical research should elaborate on the colonial HCV pathway hypothesis and inform the development of a framework for HCV healing among Indigenous people in Canada.

Critical analysis of interculturality in the National Policy for the Care of Indigenous Peoples in BrazilAnálisis crítico de la interculturalidad en la Política Nacional de Atención a las Poblaciones Indígenas en Brasil

RESUMOA preocupação com um cuidado culturalmente apropriado e intercultural, baseado na articulação e complementariedade entre saberes em saúde, vem sendo uma prioridade para garantir a atenção primária à saúde (APS) dos povos indígenas desde a Conferência de Alma-Ata. No Brasil, país de significativa variedade sociocultural no contexto indígena sul-americano, existe há 16 anos uma Política Nacional de Atenção à Saúde das Populações Indígenas (PNASPI) focada no conceito de atenção diferenciada. Esse conceito, considerado como incompleto e contraditório, é variavelmente operacionalizado na APS de indígenas. Sendo assim, o presente artigo propõe uma análise da formulação e operacionalização desse conceito na PNASPI. Essa análise torna evidente o caráter etnocêntrico da PNASPI, as numerosas contradições e negligências que não contemplam de fato o intercâmbio e articulação com o saber tradicional e as visões êmicas indígenas de saúde e dos processos de padecimento/cura. A reversão dessas limitações exigirá maior reflexividade, questionamento e vigilância epistemológicos tanto das ciências sociais e políticas quanto dos movimentos sociais e de controle social indígenas para redefinir em termos interculturais a APS de indígenas no Brasil.

Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review.

Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.

Access to primary health care services for Indigenous peoples: A framework synthesis.

BackgroundIndigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services.MethodsTo be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague’s accessibility framework.ResultsIssues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs.ConclusionsIndigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague’s accessibility framework should be broadened to include factors related to the health care system such as funding.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0450-5) contains supplementary material, which is available to authorized users.

Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review.

This article describes the characteristics and reviews the methodological quality of interventions designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA. A total of 17 electronic databases and 13 websites for the period of 2002-13. Studies were included if they evaluated an intervention strategy designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, the USA or Canada. Information on the characteristics and methodological quality of included studies was extracted using standardized assessment tools. Sixteen published evaluations of interventions to improve cultural competency in health care for Indigenous peoples were identified: 11 for Indigenous peoples of the USA and 5 for Indigenous Australians. The main types of intervention strategies were education and training of the health workforce, culturally specific health programs and recruitment of an Indigenous health workforce. Main positive outcomes reported were improvements in health professionals' confidence, and patients' satisfaction with and access to health care. The methodological quality of evaluations and the reporting of key methodological criteria were variable. Particular problems included weak study designs, low or no reporting of consent rates, confounding and non-validated measurement instruments. There is a lack of evidence from rigorous evaluations on the effectiveness of interventions for improving cultural competency in health care for Indigenous peoples. Future evaluations should employ more rigorous study designs and extend their measurement of outcomes beyond those relating to health professionals, to those relating to the health of Indigenous peoples.

Indigenous nurses: participation of nursing technicians and auxiliary in indigenous health care services

The aim of this study was to analyze the participation of Indigenous nursing technicians and aides in Indigenous health care services offered in the Xapecó Reserve, Santa Catarina, Brazil, focusing on the training and activities executed. Data collection (participant observation and interviews) and analysis were based on the ethnographic method. Sixteen key informants were interviewed, including nursing technicians and aides, training instructors, staff nurses and health service users. The training courses contained little or no emphasis on local knowledge and health practices. Other than the role of facilitator and mediator between the health team and community, the activities performed by the Indigenous nursing technicians and aides differed little from those of non-Indigenous people in the same categories. In this context, both the training of these workers and the activities executed by them reinforce the clinical curative model, which hinders articulation with local knowledge and Indigenous health practices, a principle of the National Policy of Health Care for Indigenous People.

Amazingly resilient Indigenous people! Using transformative learning to facilitate positive student engagement with sensitive material

If health professionals are to effectively contribute to improving the health of Indigenous people, understanding of the historical, political, and social disadvantage that has lead to health disparity is essential. This paper describes a teaching and learning experience in which four Australian Indigenous academics in collaboration with a non-Indigenous colleague delivered an intensive workshop for masters level post-graduate students. Drawing upon the paedagogy of Transformative Learning, the objectives of the day included facilitating students to explore their existing understandings of Indigenous people, the impact of ongoing colonisation, the diversity of Australia’s Indigenous people, and developing respect for alternative worldviews. Drawing on a range of resources including personal stories, autobiography, film and interactive sessions, students were challenged intellectually and emotionally by the content. Students experienced the workshop as a significant educational event, and described feeling transformed by the content, better informed, more appreciative of other worldviews and Indigenous resilience and better equipped to contribute in a more meaningful way to improving the quality of health care for Indigenous people. Where this workshop differs from other Indigenous classes was in the involvement of an Indigenous teaching team. Rather than a lone academic who can often feel vulnerable teaching a large cohort of non-Indigenous students, an Indigenous teaching team reinforced Indigenous authority and created an emotionally and culturally safe space within which students were allowed to confront and explore difficult truths. Findings support the value of multiple teaching strategies underpinned by the theory of transformational learning, and the potential benefits of facilitating emotional as well as intellectual student engagement when presenting sensitive material.

Improving Cardiovascular Care for Indigenous Populations

The challenges and opportunities for provision of, and access to, reliable chronic cardiovascular health care for Indigenous people were addressed by expert speakers from New Zealand and Australia. It is well recognised that cardiovascular disease is a life-long concern, requiring reliable follow-up, early transition of clinical research into practice and ongoing support of patients. The clinical outcomes and long-term prognosis of individuals with cardiovascular disease are critically dependent upon the quality and availability of follow-up and chronic care facilities. This paper summarises the principal issues identified by the expert speakers for the provision of chronic cardiovascular health care to Indigenous peoples in Australia and New Zealand; identifies common challenges and describes important initiatives which the Cardiac Society of Australia and New Zealand (CSANZ), in partnership with health care professionals, communities and governments, can undertake in order to achieve the goals of uniform and equitable health care for chronic cardiovascular disease in all the Indigenous peoples, relevant to the needs of these peoples, in New Zealand and Australia. The issues addressed by the meeting include: 1) Determination of appropriate models for effective delivery of cardiovascular health care. (2) Who should deliver cardiovascular health care and what are the workforce requirements. (3) What support systems and infrastructure are required. (4) How can primary care and secondary specialist services be effectively integrated.