Warne Donald, Baker Twyla, Burson Michael, Kelliher Allison, Buffalo Melissa, Baines Jonathan, Whalen Jeremy, Archambault Michelle, Jinnett Kimberly, Mohan Shalini V, Fineday Rebekah J
Johns Hopkins Bloomberg School of Public Health, and School of Nursing, Baltimore, MD, United States.
Nueta Hidatsa Sahnish College, New Town, ND, United States.
Front Health Serv. 2025 Apr 3;5:1469501. doi: 10.3389/frhs.2025.1469501. eCollection 2025.
Substantial healthcare barriers, especially to specialty and cancer care, exist for American Indian and Alaska Native (AI/AN) individuals and communities at all levels. The unique history of AI/AN Tribal Nations and resulting policies, treaties, and relationships with the US government and federal agencies have created specific barriers to healthcare and clinical trial access for AI/AN peoples. Commonly, AI/AN peoples harbor a long-standing mistrust of the healthcare system based on lived and historical experiences. The intersection of various barriers to care for AI/AN communities results in health inequities, lack of representation in clinical research, and other disparities faced by historically marginalized and underrepresented peoples. AI/AN patients face unique barriers in their healthcare journey due to a disproportionate burden of life-threatening and chronic diseases, including many cancers. Identifying barriers specific to AI/AN peoples and improving access to high-quality care, with a focus on building on the strengths and capacities in each AI/AN community are vital to improving health equity. In this review, we describe patient, provider, and institutional barriers to healthcare, particularly specialty care and clinical research, for AI/AN peoples, with a focus on the Northern Plains AI communities. Examples and best practices to improve AI/AN patient access to health services, including screening and specialty care, as well as to clinical research, are provided. We emphasize the importance of longitudinal community-based partnerships and strength- and trust-based approaches as essential components of promoting equitable access to high-quality specialty care and recruitment and participation of AI/AN individuals and communities in clinical research.
美国印第安人和阿拉斯加原住民（AI/AN）个人及社区在各个层面都面临着巨大的医疗保健障碍，尤其是在专科医疗和癌症护理方面。AI/AN部落国家的独特历史以及由此产生的政策、条约以及与美国政府和联邦机构的关系，给AI/AN人群获得医疗保健和参与临床试验造成了特定障碍。通常，基于生活经历和历史经验，AI/AN人群长期以来对医疗保健系统抱有不信任态度。AI/AN社区在获得护理方面存在的各种障碍相互交织，导致了健康不平等、在临床研究中缺乏代表性以及历史上被边缘化和代表性不足的人群所面临的其他差异。由于危及生命和慢性疾病（包括许多癌症）的负担过重，AI/AN患者在其医疗保健过程中面临着独特的障碍。识别AI/AN人群特有的障碍并改善获得高质量护理的机会，重点是基于每个AI/AN社区的优势和能力，对于改善健康公平至关重要。在本综述中，我们描述了AI/AN人群在医疗保健（特别是专科护理和临床研究）方面面临的患者、提供者和机构障碍，重点关注北部平原的AI社区。提供了改善AI/AN患者获得医疗服务（包括筛查和专科护理）以及参与临床研究的示例和最佳实践。我们强调基于社区的长期伙伴关系以及基于优势和信任的方法的重要性，这些是促进公平获得高质量专科护理以及AI/AN个人和社区参与临床研究招募和参与的重要组成部分。
