BC Centre on Substance Use, Vancouver, BC, Canada.
First Nations Health Authority, West Vancouver, BC, Canada.
BMC Health Serv Res. 2024 Mar 2;24(1):266. doi: 10.1186/s12913-024-10672-2.
Indigenous people who use unregulated drugs (IPWUD) face significant barriers to care, including sparse availability of culturally safe health services. Integrating Indigenous traditional and cultural treatments (TCT) into health service delivery is one way to enhance culturally safe care. In a Canadian setting that implemented cultural safety reforms, we sought to examine the prevalence and correlates of client perceptions of primary care provider awareness of TCT among IPWUD.
Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and March 2020. A generalized linear mixed model with logit-link function was used to identify longitudinal factors associated with perceived provider awareness of TCT.
Among a sample of 507 IPWUD who provided 1200 survey responses, a majority (n = 285, 56%) reported their primary care provider was aware of TCT. In multiple regression analyses, involvement in treatment decisions always (Adjusted Odds Ratio [AOR] = 3.6; 95% confidence interval [CI]: 1.6-7.8), involvement in treatment decisions most or some of the time (AOR = 3.3; 95% CI: 1.4-7.7), comfort with provider or clinic (AOR = 2.7; 95% CI: 1.5-5.0), and receiving care from a social support worker (AOR = 1.5; 95% CI: 1.0-2.1) were positively associated with provider awareness of TCT.
We found high levels of perceived provider awareness of TCT and other domains of culturally safe care within a cohort of urban IPWUD. However, targeted initiatives that advance culturally safe care are required to improve healthcare and health outcomes for IPWUD, who continue to bear a disproportionate burden of substance use harms.
使用未经管制药物的原住民（IPWUD）在获得医疗服务方面面临着重大障碍，包括文化安全的卫生服务供应不足。将原住民传统和文化治疗（TCT）纳入医疗服务提供是增强文化安全护理的一种方式。在一个实施了文化安全改革的加拿大环境中，我们试图研究 IPWUD 中患者对初级保健提供者对 TCT 的认知的普遍性和相关因素。
数据来自于 2017 年 12 月至 2020 年 3 月期间在加拿大温哥华进行的两项前瞻性吸毒者队列研究。使用带有对数链接函数的广义线性混合模型来确定与感知提供者对 TCT 的认知相关的纵向因素。
在一个由 507 名 IPWUD 组成的样本中，他们提供了 1200 份调查答复，大多数（n = 285，56%）报告他们的初级保健提供者了解 TCT。在多项回归分析中，始终参与治疗决策（调整后的优势比 [AOR] = 3.6；95%置信区间 [CI]：1.6-7.8），大多数或有时参与治疗决策（AOR = 3.3；95% CI：1.4-7.7），对提供者或诊所感到舒适（AOR = 2.7；95% CI：1.5-5.0），以及接受社会支持工作者的护理（AOR = 1.5；95% CI：1.0-2.1）与提供者对 TCT 的认知呈正相关。
我们在一组城市 IPWUD 中发现了高水平的感知提供者对 TCT 和其他文化安全护理领域的认知。然而，需要采取有针对性的举措来推进文化安全护理，以改善 IPWUD 的医疗保健和健康结果，他们仍然承受着不成比例的药物使用危害负担。
