School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8V 2Y2, Canada.
Department of Psychology, Rural Dementia Action Research (RaDAR) Team, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, SK, S7N 4N3, Canada.
Soc Sci Med. 2022 Jan;293:114658. doi: 10.1016/j.socscimed.2021.114658. Epub 2021 Dec 16.
Globally, health inequities experienced by Indigenous communities are often described and documented in terms of deficits and disease. However, health disparities are complex and involve numerous underlying issues beyond the social determinants of health. Indigenous Peoples face unique barriers to accessing culturally safe and equitable healthcare, including racism, systemic injustice, and a historical legacy of colonialism. There is a paucity of knowledge on Indigenous-specific cultural safety interventions to support health and dementia care. The objective of this scoping review of reviews was to appraise the existing literature to identify key elements, conceptualizations, and interventions of cultural safety to improve health services and dementia care for Indigenous Peoples. Guided by Indigenous principles of relationality, we conducted a scoping review of reviews published between January 2010 to December 2020. We searched CINAHL, PubMed, Scopus, Web of Science, and Google Scholar. Given the limited literature focusing specifically on Indigenous people with dementia, our inclusion criteria focused broadly on Indigenous cultural safety in healthcare. A collaborative and relational rights-based approach co-led by Indigenous cisgender, Two-Spirit, and non-Indigenous cisgender health care providers was used to re-center Indigenous ways of knowing. A total of seventeen articles met our inclusion criteria. Our review identified a range of cultural safety themes from education initiatives to collaborative partnerships with Indigenous communities. Themes emerged at three levels: person-centered/individual level, health practitioner/student level, and healthcare organizational level. Few reviews described specific interventions, implementation strategies, evaluation methods, or the concept of sex and gender to improve cultural safety in healthcare delivery. Findings from this review can help to inform future research, inspire innovative collaborative methodologies, and enhance cultural safety interventions. In moving forward, there is an urgent need for anti-racism education, self-determination, and authentic partnerships to achieve Indigenous-specific cultural safety inclusive of sex and gender considerations in health and dementia care.
从全球范围来看，原住民社区所经历的健康不平等问题通常被描述为缺陷和疾病。然而，健康差距是复杂的，涉及到健康的社会决定因素之外的许多潜在问题。原住民在获得文化安全和平等的医疗保健方面面临着独特的障碍，包括种族主义、制度不公正和殖民主义的历史遗留问题。对于支持原住民健康和痴呆症护理的特定文化安全干预措施，知识还很匮乏。本项综述的目的是评估现有文献，以确定文化安全在改善原住民健康服务和痴呆症护理方面的关键要素、概念和干预措施。本研究遵循原住民的关系原则，对 2010 年 1 月至 2020 年 12 月期间发表的综述进行了综述。我们在 CINAHL、PubMed、Scopus、Web of Science 和 Google Scholar 上进行了搜索。鉴于专门针对患有痴呆症的原住民的文献有限，我们的纳入标准广泛关注医疗保健中的原住民文化安全。我们采用了一种合作和关系型的基于权利的方法，由原住民顺性别者、双性恋者和非原住民顺性别者医疗保健提供者共同领导，以重新关注原住民的认知方式。共有 17 篇文章符合我们的纳入标准。我们的综述确定了一系列文化安全主题，从教育倡议到与原住民社区的合作伙伴关系。主题出现在三个层面：以人为本/个人层面、医疗保健提供者/学生层面和医疗保健组织层面。很少有综述描述了具体的干预措施、实施策略、评估方法或性别概念，以改善医疗保健服务中的文化安全。本综述的结果可以帮助为未来的研究提供信息，激发创新的合作方法，并增强文化安全干预措施。在前进的过程中，需要进行反种族主义教育、自决和真正的伙伴关系，以实现包括性别考虑因素在内的原住民特定的文化安全，以促进健康和痴呆症护理。
