Health Outcomes For Indigenous Populations Research Articles

The activism of David Dennis

In 2019, Canadian First Nations activist David Dennis challenged the 6-month alcohol abstinence requirement when he was denied placement on the liver transplant list. While Mr. Dennis was eventually placed on the waitlist, he passed away before receiving a transplant. As Canadian transplant programs seek to reduce healthcare inequities experienced by Indigenous patients—First Nations, Métis, and Inuit—this analysis sheds much needed light on the inconvenient truths of settler colonialism and the need for impactful reconciliation in Canadian healthcare. This analysis examines Dennis’ activism and his argument about the inequities in transplant medicine experienced by Indigenous patients. Dennis’ activism highlighted how the Canadian healthcare systems underserve Indigenous populations, including in transplant medicine; fails to address racial biases within healthcare; and does little to consider and address negative inter-generational determinants of health that perpetuate poor health outcomes for Indigenous populations. This analysis provides direction to decision makers in transplant and additions medicine, to Ministries of Health, and to First Nations, Métis, and Inuit healthcare leaders for improved healthcare for Indigenous patients living with alcohol-related liver disease. Without concerted and coordinated efforts to address the needs of this patient population, we will continue to see rapid deterioration of their health status and high rates of mortality will persist among this patient population.

Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens.

Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems. To describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care. A group of five Māori NPs worked alongside a Māori nurse researcher to explore their perceptions of patient safety. Together, they held an online hui (focus group) in early 2024. Data were analysed collectively, informed by kaupapa Māori principles, using reflexive thematic analysis. Māori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Māori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Mātauranga tuku iho: the knowledge from within, where safe practice was strongly informed by traditional knowledge and cultural practice; (3) Te Ao hurihuri: walking in two worlds, where Māori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care. The Māori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Māori patients and families and incorporating cultural perspectives into practice, Māori NPs contribute to a more comprehensive and inclusive approach to patient safety that goes beyond westernized principles and practices. No patient or public contribution.

Kaniuwatewara (when we get sick): understanding health-seeking behaviours among the Shawi of the Peruvian Amazon

BackgroundDetailed qualitative information regarding Indigenous populations’ health-seeking behaviours within Peru’s plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru.MethodsCommunity-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation.ResultsShawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care.ConclusionsThese findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes.

Housing conditions and adverse birth outcomes among Indigenous people in Canada.

ObjectivesPoor housing conditions and household crowding have been identified as important health concerns for Indigenous populations in many countries but have not been explored in relation to adverse birth outcomes in these populations. We investigated housing conditions and adverse birth outcomes in a nationally representative sample of Indigenous people in Canada.MethodsData were from a cohort of births between May 2004 and May 2006 created by linking birth and infant death registration data with the 2006 Canadian census. Log-binomial regression was used to examine associations between housing variables (persons per room and needed household repairs) and three adverse birth outcomes: preterm birth (PTB), small-for-gestational-age (SGA) birth, and infant mortality. Separate regression models were run for First Nations, Métis and Inuit mothers, with adjustment for parity and parental socio-economic variables.ResultsNeed for major household repairs was associated with a slightly increased risk of PTB among First Nations and Métis mothers (adjusted RRs 1.12 and 1.13, respectively; 95% CI 0.94–1.34 and 0.89–1.44, respectively) and a moderately increased risk of infant death in all three groups (aRR = 1.69, 95% CI 1.00–2.85). Household crowding was also associated with a slightly elevated risk of PTB in all three groups (aRR = 1.10, 95% CI 0.95–1.29) and with an increased risk of infant mortality among First Nations (aRR = 1.57, 95% CI 0.97–2.53).ConclusionThis study highlights the need to improve understanding of links between housing conditions and perinatal health outcomes in Indigenous populations, including examining cause-specific infant mortality in relation to housing characteristics.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00527-2.

The impact of historical trauma on health outcomes for indigenous populations in the USA and Canada: A systematic review.

Beginning in the mid-1990s, the construct of historical trauma was introduced into the clinical and health science literatures to contextualize, describe, and explain disproportionately high rates of psychological distress and health disparities among Indigenous populations. As a conceptual precursor to racial trauma, Indigenous historical trauma (IHT) is distinguished by its emphasis on ancestral adversity that is intergenerationally transmitted in ways that compromise descendent well-being. In this systematic review of the health impacts of IHT, 32 empirical articles were identified that statistically analyzed the relationship between a measure of IHT and a health outcome for Indigenous samples from the United States and Canada. These articles were categorized based on their specific method for operationalizing IHT, yielding 19 articles that were grouped as historical loss studies, 11 articles that were grouped as residential school ancestry studies, and three articles that were grouped as "other" studies. Articles in all three categories included diverse respondents, disparate designs, varied statistical techniques, and a range of health outcomes. Most reported statistically significant associations between higher indicators of IHT and adverse health outcomes. Analyses were so complex, and findings were so specific, that this groundbreaking literature has yet to cohere into a body of knowledge with clear implications for health policy or professional practice. At the conceptual level, it remains unclear whether IHT is best appreciated for its metaphorical or literal functions. Nevertheless, the enthusiasm surrounding IHT as an explanation for contemporary Indigenous health problems renders it imperative to refine the construct to enable more valid research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Challenging research assumptions from an Indigenous perspective

Given the disparities in health outcomes for Indigenous populations in Canada, He and colleagues’[1][1] work into infant morbidities in Quebec populations is an important contribution to the understanding of the problem. The sizable cohort allowed for good comparison between Indigenous and non-

The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: a multiple case study

BackgroundThe inequality in health outcomes between Indigenous (Throughout the paper, the term Indigenous will be used to represent both Aboriginal Australians and Torres Strait Islander Australians.) and non-Indigenous Australians continues to be a major public health issue. Chronic conditions are responsible for the majority of the gap in life expectancy for this population. Evidence suggests that chronic condition management models focusing on self-management have led to improved health outcomes in Indigenous populations. The Flinders Closing the Gap Program (FCTGP) is a chronic condition care planning tool which aims to engage Indigenous people in self-managing their chronic conditions. Indigenous health workers (IHWs) can provide culturally appropriate self-management support; however there is paucity in current literature describing specific barriers and facilitators that they may experience when attempting to deliver this support. This study aimed to explore IHWs’ perceptions of the effectiveness and appropriateness of the FCTGP, as an evidence-based example of self-management support, and to explore the barriers and facilitators that IHWs experience in their workplace and communities in providing self-management support.MethodsIn-depth interviews were undertaken with five IHWs, drawn from five different states in Australia. Their selection was aided by key informants from the FCTGP training unit. Interviews were recorded and transcribed verbatim, and were analysed using thematic analysis.ResultsThe following themes were identified. IHWs reported that the FCTGP was appropriate, flexible and acceptable in their communities. Facilitators included factors improving client and worker empowerment, and activities around sharing knowledge. Barriers included competing priorities that clients experience relating to social determinants of health, and negative experiences within mainstream health services. IHW burnout from time pressures, lack of support, and high staff turnover were also considered important barriers.ConclusionsThis study contributes an insight into the experiences of IHWs who are considered important stakeholders in implementation and sustainability of chronic condition management programs, including the FCTGP. Recommendations focus on supporting and supplementing the role of IHWs and identify the FCTGP as a facilitator in providing self-management support to a population with complex needs.

Exploring policy driven systemic inequities leading to differential access to care among Indigenous populations with obstructive sleep apnea in Canada.

BackgroundIn settler societies such as Australia, Canada, New Zealand and the United States, health inequities drive lower health status and poorer health outcomes in Indigenous populations. This research unravels the dense complexity of how historical policy decisions in Canada can influence inequities in health care access in the 21st century through a case study on the diagnosis and treatment of obstructive sleep apnea (OSA). In Canada, historically rooted policy regimes determine current discrepancies in health care policy, and in turn, shape current health insurance coverage and physician decisions in terms of diagnosis and treatment of OSA, a clinical condition that is associated with considerable morbidity in Canada.MethodsThis qualitative study was based in Saskatchewan, a Western Canadian province which has proportionately one of the largest provincial populations of an Indigenous subpopulation (status Indians) which is the focus of this study. The study began with determining approaches to OSA care provision based on Canadian Thoracic Society guidelines for referral, diagnosis and treatment of sleep disordered breathing. Thereafter, health policy determining health benefits coverage and program differences between status Indians and other Canadians were ascertained. Finally, respirologists who specialized in sleep medicine were interviewed. All interviews were audio-recorded and the transcripts were thematically analyzed using NVIVO.ResultsIn terms of access and provision of OSA care, different patient pathways emerged for status Indians in comparison with other Canadians. Using Saskatchewan as a case study, the preliminary evidence suggests that status Indians face significant barriers in accessing diagnostic and treatment services for OSA in a timely manner.ConclusionsIn order to confirm initial findings, further investigations are required in other Canadian jurisdictions. Moreover, as other clinical conditions could share similar features of health care access and provision of health benefits coverage, this policy analysis could be replicated in other provincial and territorial health care systems across Canada, and other settler nations where there are differential health coverage arrangements for Indigenous peoples.

Papua New Guinea midwives transferring birthing knowledge and skills to village birth attendants and village child health volunteers

International reports highlight that improvements to health outcomes for Indigenous populations is linked to greater participation by Indigenous people in the provision of health service delivery. Australian government policies underline the need to increase the number of practising Indigenous midwives as a strategy for delivering culturally appropriate healthcare that will help improve health outcomes for Aboriginal and Torres Strait Islander families. One of the key components of the ‘Close the Gap’ initiative includes enabling Aboriginal and Torres Strait Islander people to enter the healthcare workforce. Indigenous midwives and nurses’ lived experiences, along with their knowledge of health service delivery, provides them with unique insight of the health system. It is recognised that it is essential to increase the numbers of Aboriginal and Torres Strait Islander people with tertiary level qualifications in order to provide culturally appropriate healthcare thatwill ultimately lead to increaseduptake and subsequent health improvements. In this presentation, we share the stories told to us as part of a small, qualitative study that explored the experiences of a sample of Indigenous Australian women and Indigenous student midwives who participated in a ‘follow through’ journey as part of a Bachelor of Midwifery program in northern Australia. The findings of our study highlight the urgent need for improved strategies andpolicies that recruit and retain Indigenousmidwifery students as their contribution is key to improving health outcomes for Indigenous childbearing women and their families.

Exploring the experiences of Indigenous women and Indigenous students who participated in a ‘follow through’ journey within a Bachelor of Midwifery Program

International reports highlight that improvements to health outcomes for Indigenous populations is linked to greater participation by Indigenous people in the provision of health service delivery. Australian government policies underline the need to increase the number of practising Indigenous midwives as a strategy for delivering culturally appropriate healthcare that will help improve health outcomes for Aboriginal and Torres Strait Islander families. One of the key components of the 'Close the Gap' initiative includes enabling Aboriginal and Torres Strait Islander people to enter the healthcare workforce. Indigenous midwives and nurses' lived experiences, along with their knowledge of health service delivery, provides them with unique insight of the health system. It is recognised that it is essential to increase the numbers of Aboriginal and Torres Strait Islander people with tertiary level qualifications in order to provide culturally appropriate healthcare that will ultimately lead to increased uptake and subsequent health improvements. In this presentation, we share the stories told to us as part of a small, qualitative study that explored the experiences of a sample of Indigenous Australian women and Indigenous student midwives who participated in a 'follow through' journey as part of a Bachelor of Midwifery program in northern Australia. The findings of our study highlight the urgent need for improved strategies and policies that recruit and retain Indigenous midwifery students as their contribution is key to improving health outcomes for Indigenous childbearing women and their families.

Introductory Essay: An Rx for Indigenous Health Inequality: The Social Determinants of Health

It is with great pleasure that I am able to serve as the first Special Guest Editor (health) of the Inter-national Indigenous Policy Journal. This special edition is a compilation of some of the best research con-ducted on Indigenous populations. Moving beyond the disturbing trends so many of us are already well aware of, this body of research provides new theoretical, policy, and practical approaches for researchers, decision makers, and communities seeking to improve health outcomes for Indigenous populations.

Improving Medication Uptake in Aboriginal and Torres Strait Islander Peoples

Poor medication adherence is associated with adverse health outcomes. Improving access and adherence to pharmacological therapy is important in achieving optimal health outcomes for Indigenous populations. In spite of the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence and evidence based practice are less well refined and the challenges for Indigenous populations are more pronounced. To identify factors impacting on medication adherence in Aboriginal Australians and identify solutions to improve the quality use of medicines. The World Health Organization adherence model was used to classify barriers to adherence. Key elements of this model are (1) health care team/health system; (2) socio-economic factors; (3) therapy; (4) patient; and (5) condition related. Entrenched socio-economic differentials aggravate challenges to medication adherence amongst Aboriginal Australians. Initiatives to promote the quality use of medicines, such as the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People (QUMAX) Program, are important strategies to promote adherence. Medication adherence is a complex issue and addressing modifiable factors is imperative to improve health outcomes. Subsidised access to medications whether living in urban, regional, rural or remote areas is an important strategy in Closing the Gap.