Interdisciplinary Studies Graduate Program (Pilarinos), University of British Columbia; Indigenous Health (Pilarinos, Field, Bonshor, Bingham), Vancouver Coastal Health Authority, Vancouver, BC; Faculty of Health Sciences (Vasarhelyi), Simon Fraser University, Burnaby, BC; Department of Family and Community Practice (Vasarhelyi, Hall), Vancouver Coastal Health; Faculty of Medicine (Hall, Bingham), University of British Columbia; Xʷməθkʷəy̓əm (Musqueam) First Nation (Fox), Vancouver, BC; Snuneymuxw First Nation (Price), Nanaimo, BC; Cowichan First Nation (Price), Lake Cowichan, BC.
Interdisciplinary Studies Graduate Program (Pilarinos), University of British Columbia; Indigenous Health (Pilarinos, Field, Bonshor, Bingham), Vancouver Coastal Health Authority, Vancouver, BC; Faculty of Health Sciences (Vasarhelyi), Simon Fraser University, Burnaby, BC; Department of Family and Community Practice (Vasarhelyi, Hall), Vancouver Coastal Health; Faculty of Medicine (Hall, Bingham), University of British Columbia; Xʷməθkʷəy̓əm (Musqueam) First Nation (Fox), Vancouver, BC; Snuneymuxw First Nation (Price), Nanaimo, BC; Cowichan First Nation (Price), Lake Cowichan, BC
CMAJ Open. 2023 May 2;11(3):E404-E410. doi: 10.9778/cmajo.20220135. Print 2023 May-Jun.
In Canada, Indigenous Peoples continue to experience persistent health inequities, resulting in disproportionately poorer health outcomes compared with non-Indigenous Canadians. This study engaged Indigenous patients accessing health care in Vancouver, Canada, about their experiences of racism and improving cultural safety within health care.
A research team consisting of Indigenous and non-Indigenous researchers committed to employing a Two-Eyed Seeing approach and conducting culturally safe research hosted 2 sharing circles in May 2019 with Indigenous people recruited from urban health care settings. Talking circles were led by Indigenous Elders, and thematic analysis was used to identify overarching themes.
A total of 26 participants attended 2 sharing circles, which included 25 self-identifying women and 1 self-identifying man. Thematic analysis resulted in the identification of 2 major themes: negative experiences in health care and perspectives on promising health care practices. For the first major theme, subthemes included the following: experiences of racism lead to poorer care experiences and health outcomes, Indigenous-specific racism results in mistrust in the health care system, and participants experience discrediting of traditional medicine and Indigenous perspectives on health. For the second major theme, subthemes included the following: Indigenous-specific services and supports improve trust in health care, Indigenous cultural safety education is necessary for all health care-involved staff, and providing welcoming, Indigenized spaces for Indigenous patients encourages health care engagement.
Despite participants' racist health care experiences, receiving culturally safe care was credited with improving trust in the health care system and well-being. The continued expansion of Indigenous cultural safety education, the creation of welcoming spaces, recruitment of Indigenous staff, and Indigenous self-determination over health care services can improve Indigenous patients' health care experiences.
在加拿大，原住民持续面临着健康不平等问题，导致他们的健康状况明显不如非原住民加拿大人。本研究在加拿大温哥华，让原住民患者参与有关他们在医疗保健中遭遇种族主义和改善文化安全的体验。
一个由对采用“Two-Eyed Seeing”方法和进行文化安全研究有承诺的原住民和非原住民研究人员组成的研究团队，于 2019 年 5 月与从城市医疗保健环境中招募的原住民共同主持了 2 次分享圈会议。这些分享圈由原住民长老领导，并使用主题分析来确定总体主题。
共有 26 名参与者参加了 2 次分享圈会议，其中包括 25 名自我认同的女性和 1 名自我认同的男性。主题分析产生了 2 个主要主题：医疗保健中的负面体验和对有前途的医疗保健实践的看法。对于第一个主要主题，子主题包括以下内容：种族主义的经历导致较差的医疗体验和健康结果、特定于原住民的种族主义导致对医疗保健系统的不信任、以及参与者经历传统医学和原住民健康观点的信誉受损。对于第二个主要主题，子主题包括以下内容：特定于原住民的服务和支持提高了对医疗保健的信任、所有参与医疗保健的人员都需要进行文化安全教育、为原住民患者提供欢迎的、本土化的空间鼓励参与医疗保健。
尽管参与者在医疗保健方面有过种族主义经历，但接受文化安全的护理被认为有助于增强对医疗保健系统的信任和幸福感。持续扩大原住民文化安全教育、创造欢迎的空间、招聘原住民员工以及原住民对医疗保健服务的自主决定，可以改善原住民患者的医疗保健体验。
