Jacklin Kristen M, Henderson Rita I, Green Michael E, Walker Leah M, Calam Betty, Crowshoe Lynden J
Northern Ontario School of Medicine (Jacklin), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Henderson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University, Kingston, Ont.; School of Population and Public Health, Faculty of Medicine (Walker), Department of Family Practice, Faculty of Medicine (Calam), University of British Columbia, Vancouver, BC; Department of Family Medicine (Crowshoe), Cumming School of Medicine, University of Calgary, Calgary, Alta.
CMAJ. 2017 Jan 23;189(3):E106-E112. doi: 10.1503/cmaj.161098.
Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. We sought to examine the health care experiences of Indigenous people with type 2 diabetes to understand how such determinants are embodied and enacted during clinical encounters.
Sequential focus groups and interviews were conducted in 5 Indigenous communities. Focus groups occurred over 5 sessions at 4 sites; 3 participants were interviewed at a 5th site. Participants self-identified as Indigenous, were more than 18 years of age, lived with type 2 diabetes, had received care from the same physician for the previous 12 months and spoke English. We used a phenomenological thematic analysis framework to categorize diabetes experiences.
Patient experiences clustered into 4 themes: the colonial legacy of health care; the perpetuation of inequalities; structural barriers to care; and the role of the health care relationship in mitigating harm. There was consistency across the diverse sites concerning the root causes of mistrust of health care systems.
Patients' interactions and engagement with diabetes care were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. These experiences led to nondisclosure during health care interactions. Our findings show that health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and have a role in mitigating past harms.
包括殖民化持续影响在内的本土健康社会决定因素，导致慢性病发病率上升，以及原住民健康公平差距加大。我们试图研究2型糖尿病原住民的医疗保健经历，以了解这些决定因素在临床接触中是如何体现和发挥作用的。
在5个原住民社区进行了连续的焦点小组讨论和访谈。焦点小组讨论在4个地点分5次进行；在第5个地点对3名参与者进行了访谈。参与者自我认定为原住民，年龄超过18岁，患有2型糖尿病，在过去12个月里接受过同一位医生的治疗，且会说英语。我们使用现象学主题分析框架对糖尿病经历进行分类。
患者经历归纳为4个主题：医疗保健的殖民遗产；不平等的持续存在；医疗保健的结构性障碍；以及医疗保健关系在减轻伤害方面的作用。不同地点在对医疗保健系统不信任的根本原因上存在一致性。
患者与糖尿病护理的互动和参与受到与医疗保健提供者的个人和集体历史经历以及当代接触文化上不安全的医疗保健的影响。这些经历导致在医疗保健互动中不透露信息。我们的研究结果表明，医疗保健关系对于解决原住民医疗保健中持续存在的殖民动态至关重要，并且在减轻过去的伤害方面发挥作用。
