Hiyare-Hewage Amandi, Sinka Victoria, Grande Eleonora Dal, Kerr Marianne, Kim Siah, Mallitt Kylie-Ann, Dickson Michelle, Jaure Allison, Wilson Rhonda, Craig Jonathan C, Stephens Jacqueline H
Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
BMC Health Serv Res. 2024 Jul 31;24(1):873. doi: 10.1186/s12913-024-11314-3.
Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories.
Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool.
We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access.
Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs.
由社区推动的初级卫生保健（PHC）研究可能会减轻原住民的慢性病负担。本系统评价评估了来自四个有着相似殖民历史国家的原住民初级卫生保健使用情况研究报告的文化安全性。
对2002年1月1日至2023年4月4日期间的Medline、CINAHL和Embase进行系统检索。纳入的论文需为原创研究，以英文发表，并包含来自西方殖民国家的原住民用于慢性病（慢性肾病、心血管疾病和/或糖尿病）的初级卫生保健的数据（定量、定性和/或混合方法）。由两名作者独立进行研究筛选和数据提取，其中至少一名是原住民。使用描述性统计分析论文的基线特征。使用两种质量评估工具评估研究论文的文化安全方面：CONSIDER工具和CREATE工具（子集分析）。本系统评价按照评估系统评价方法学质量（AMSTAR）工具进行。
我们从澳大利亚、新西兰、加拿大和美国筛选出35篇论文。大多数论文是定量研究（n = 21），涉及42438人的数据。纳入论文的文化安全差异显著，在研究伙伴关系的充分报告、参与者明确的集体同意以及整个研究过程（特别是在传播方面）的原住民研究治理方面存在差距。大多数论文（94%，33/35）表示研究目标源自社区或实证证据。我们还发现，71.4%（25/35）的论文报告称通过考虑殖民化对初级卫生保健可及性降低的影响采用了基于优势的方法。
关于原住民初级卫生保健使用情况的研究应采用更具文化安全性的方式提供护理并产生与社区需求相关的研究成果，在包括传播在内的整个研究过程中重视原住民的声音。原住民利益相关者应在整个过程中更正式、明确地参与，以指导研究实践，包括原住民价值观和社区需求。
