Furthering Cultural Safety in Kidney Care Within Indigenous Communities: A Systematic Narrative Review

The objective of this qualitative systematic review was to synthesize all evidence to understand the barriers and enablers to older Indigenous peoples (aged 40 years and older) engaging in physical activity. Four databases were searched. Study quality was assessed from an Indigenous perspective, using an Aboriginal and Torres Strait Islander quality appraisal tool. Data were analyzed using thematic synthesis. There were 4,246 articles screened with 23 articles and one report included from over 30 Indigenous communities across four countries. Cultural Safety and Security was a key enabler, including developing physical activity programs which are led by Indigenous communities and preference Indigenous values. Colonization was a key barrier that created mistrust and uncertainty. Social Determinants of Health, including cost, were supported by successful programs, but if not addressed, were demotivators of engagement. Older Indigenous peoples identified barriers and enablers that can direct the development of sustainable, culturally appropriate physical activity programs.

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Developing the Canadian Indigenous Cognitive Assessment for Use With Indigenous Older Anishinaabe Adults in Ontario, Canada

Innovation in Aging ◽

10.1093/geroni/igaa038 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Kristen Jacklin ◽

Karen Pitawanakwat ◽

Melissa Blind ◽

Megan E O’Connell ◽

Jennifer Walker ◽

...

Keyword(s):

Cognitive Assessment ◽

Indigenous Communities ◽

Cultural Safety ◽

Indigenous Populations ◽

Face Validity ◽

Advisory Council ◽

Cognitive Test ◽

Public Health Issue ◽

Research Approach ◽

Local Health

Abstract Background and Objectives Dementia is a growing public health issue for aging Indigenous populations. Current cognitive assessments present varying degrees of cultural, educational, and language bias, impairing their application in Indigenous communities. Our goal is to provide Anishinaabe communities in Canada with a brief cognitive test that can be administered within the community setting by community health workers or professionals. The purpose of this study was to adapt the Kimberly Indigenous Cognitive Assessment (KICA) for use as a brief cognitive test with Anishinaabe populations in Canada. Research Design and Methods We used a community-based participatory research approach coupled with two-eyed seeing to provide an equitable space for Indigenous knowledge. Adaptation of the KICA was accomplished over 22 months using an iterative cycle of monthly consultations between an 11-member expert Anishinaabe language group (EALG) and the investigators, with ad hoc consultations with an Indigenous Elder, a community advisory council, and the KICA authors. Face validity was established with two pilot studies using cognitive interviewing with Indigenous older adults (n = 15) and a focus group consultation with local health professionals (n = 7). Results Each question of the KICA was scrutinized by the EALG for cultural appropriateness, language and translation, and cultural safety. Every domain required adaptation to reflect cultural values, specificity of language, tone, and a culturally safe approach. Orientation, verbal comprehension and fluency, praxis, and naming domains required the most adaptations. The first pilot for face validity resulted in additional changes; the second confirmed satisfactory adaptation of all changes. Discussion and Implications The research resulted in the new Canadian Indigenous Cognitive Assessment. The findings reveal important cultural and linguistic considerations for cross-cultural cognitive assessment in Indigenous contexts. This new culturally appropriate and safe brief cognitive test may improve case finding accuracy and lead to earlier diagnosis and improved dementia care for Indigenous peoples.

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An Approach to Improve Dementia Health Literacy in Indigenous Communities

Journal of Cross-Cultural Gerontology ◽

10.1007/s10823-019-09388-2 ◽

2019 ◽

Vol 35 (1) ◽

pp. 69-83 ◽

Cited By ~ 2

Author(s):

Sharlene Webkamigad ◽

Wayne Warry ◽

Melissa Blind ◽

Kristen Jacklin

Keyword(s):

Health Promotion ◽

Health Literacy ◽

Indigenous Knowledge ◽

Health Care Providers ◽

Indigenous Communities ◽

Cultural Safety ◽

Evidence Based ◽

Culturally Appropriate ◽

Care Providers ◽

Indigenous Perspectives

AbstractThis project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada’s First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer’s and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed “What is Dementia? Indigenous Perspectives and Cultural Understandings” and “Signs and Symptoms of Dementia: An Indigenous Guide.” The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.

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Tailoring cultural safety training in health care to local context of Indigenous communities

Canadian Medical Association Journal ◽

10.1503/cmaj.1095780 ◽

2019 ◽

Vol 191 (30) ◽

pp. E845-E846 ◽

Cited By ~ 3

Author(s):

Brian Owens

Keyword(s):

Health Care ◽

Indigenous Communities ◽

Safety Training ◽

Cultural Safety ◽

Local Context

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Otsin: Sharing the spirit--Development of an indigenous rural nursing practice course

Journal of Nursing Education and Practice ◽

10.5430/jnep.v8n12p29 ◽

2018 ◽

Vol 8 (12) ◽

pp. 29 ◽

Cited By ~ 1

Author(s):

Sheila Blackstock

Keyword(s):

Indigenous Peoples ◽

Nursing Practice ◽

Cultural Practices ◽

Indigenous Communities ◽

Cultural Safety ◽

Student Centered ◽

Teaching Pedagogy ◽

Rural Nursing ◽

Undergraduate Nursing ◽

Northern Community

Otsin is the spirt of Gitxsan Peoples and is reflected by the Gitxsan author sharing the journey in the development of a unique third year undergraduate nursing practice course. The nursing practice course immerses students in a combined rural and an interdisciplinary indigenous nursing practice. The practice course is based on a student centered, context-based teaching pedagogy using a two-eyed seeing approach. The theoretical tenet of place is reconceptualized to reflect Indigenous communities and rural nursing practice. The metaphor of weaving together cedar strips is used to reflect a journey that takes students through the experiences of living and practicing in a rural northern community while embracing on the land experiences, cultural practices, traditions, language and ceremonies. The traditional academy curricula are challenged to broaden the lens beyond the classroom theatre walls to rural, indigenous nursing practice experiences. The weaving of the cedar strips together and allows students to construct their understanding of the impacts of colonization on Indigenous Peoples and an opportunity to be guided by the community to practice cultural safety.

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Ethical research engagement with Indigenous communities

Journal of Rehabilitation and Assistive Technologies Engineering ◽

10.1177/2055668320922706 ◽

2020 ◽

Vol 7 ◽

pp. 205566832092270

Author(s):

Carrie Bourassa ◽

Jennifer Billan ◽

Danette Starblanket ◽

Sadie Anderson ◽

Marlin Legare ◽

...

Keyword(s):

First Nations ◽

Advisory Committee ◽

Indigenous Health ◽

Indigenous Communities ◽

Cultural Safety ◽

Community Research ◽

Training Module ◽

Research Engagement ◽

Morning Star ◽

Tribal Council

Introduction Canada’s colonial policies and practices have led to barriers for Indigenous older adults’ access to healthcare and research. As a result, there is a need for Indigenous-led research and culturally safe practices. Morning Star Lodge is developing a training module to assist AgingTech researchers on ethical, culturally safe ways to engage Indigenous communities. This includes exploring Indigenous health research, community-based partnerships, reciprocal learning, and cultural safety; this is presented through a case study on ethically engaged research. Methods Morning Star Lodge developed a research partnership agreement with File Hills Qu’Appelle Tribal Council and established a Community Research Advisory Committee representing the eleven First Nations within the Tribal Council. The work designing the culturally safe training module is in collaboration with the Community Research Advisory Committee. Results Building research partnerships and capacities has changed the way the eleven First Nation communities within File Hills Qu’Appelle Tribal Council view research. As a result, they now disseminate the Knowledge within their own networks. Conclusions Indigenous Peoples are resilient in ensuring their sustainability and have far more community engagement and direction. Developing culturally safe approaches to care for Indigenous communities leads to self-determined research. Culturally safe training modules can be applied to marginalized demographics.

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Co-creating Simulated Cultural Communication Scenarios with Indigenous Animators: An Evaluation of Innovative Clinical Cultural Safety Curriculum

Journal of Medical Education and Curricular Development ◽

10.1177/2382120520980488 ◽

2020 ◽

Vol 7 ◽

pp. 238212052098048

Author(s):

Marion Maar ◽

Nicole Bessette ◽

Lorrilee McGregor ◽

Amy Lovelace ◽

Maurianne Reade

Keyword(s):

Qualitative Data ◽

Clinical Skills ◽

Learning Experience ◽

Deep Understanding ◽

Teaching Experience ◽

Indigenous Communities ◽

Cultural Safety ◽

Cultural Communication ◽

Structural Barriers ◽

Clinical Communication

Background: Building on partnerships with Indigenous communities and with the support of the Northern Ontario School of Medicine, faculty created groundbreaking, authentic cultural immersion curriculum designed to foster culturally safe interpersonal skills and cultural understanding. However, structural barriers to the teaching of clinical communication skills for culturally safe care to Indigenous patients persisted. To address this challenge, faculty collaborated with Indigenous animators on the co-creation of a new teaching modality of Simulated Cultural Communication Scenarios. We evaluated student learning experience, the faculty teaching experience, the attainment of teaching goals, benefits, and areas for improvement for this approach. Methods: We piloted 9 Simulated Cultural Communication Scenarios with 64 medical students and 17 tutors. We collected quantitative and qualitative data regarding their experiences and perceptions of the new curriculum. The quantitative data was statistically summarized, and the qualitative data was coded and thematically analyzed. Results: The emergent themes indicate that co-created Simulated Cultural Communication Scenarios support the acquisition of culturally safe clinical skills because the modality fosters authentic, safe, context rich, and anti-oppressive patient dialogue with Indigenous animators. Recommendations for optimizing the sessions included ensuring tutors have a deep understanding of the significance of cultural safety in patient care. As the pedagogy is different from the familiar standardized clinical skills sessions, tutors and students benefit from education on the pedagogical approach. Conclusion: Simulated Cultural Communication Scenarios, co-created with cultural insiders and academic educators, represent an authentic education approach to teaching culturally safe clinical encounters. The findings contribute to our understanding of translating social accountability into the clinical setting.

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Considerations in dementia care for Indigenous populations in Canada

Remote and Rural Dementia Care ◽

10.1332/policypress/9781447344957.003.0011 ◽

2020 ◽

pp. 241-264

Author(s):

Kristen M. Jacklin ◽

Jessica M. Chiovitte

Keyword(s):

Health Equity ◽

Indigenous Communities ◽

Dementia Care ◽

Cultural Safety ◽

Indigenous Populations ◽

Health Services Use ◽

Care Needs ◽

Cultural Frameworks ◽

Age Related ◽

Specific Care

Over the last decade age-related dementias emerged as a significant health concern for Indigenous populations in Canada. Current research suggest that Indigenous communities hold culturally grounded understandings of dementia that are important in determining health services use and needs. This chapter combines a cultural safety framework with a health equity lens to discuss Indigenous dementia care needs in rural and remote Indigenous communities. Based on qualitative ethnographic data from Canada supported by published accounts of Indigenous experiences with dementia and dementia care internationally, we discuss promising approaches grounded in cultural safety aimed at improving prevention, diagnosis and care practices. Developing Indigenous specific care tools and adapting best practice mainstream approaches to care to adequately address cultural frameworks for dementia and the impacts of colonial trauma are necessary steps in providing decolonized, culturally safe care for Indigenous patients and fundamental to health equity.

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Wise Practices for Cultural Safety in Electronic Health Research and Clinical Trials With Indigenous People: Secondary Analysis of a Randomized Clinical Trial (Preprint)

10.2196/preprints.14203 ◽

2019 ◽

Author(s):

Marion A Maar ◽

Valerie Beaudin ◽

Karen Yeates ◽

Lisa Boesch ◽

Peter Liu ◽

...

Keyword(s):

Clinical Trial ◽

Indigenous Peoples ◽

Indigenous Communities ◽

Lessons Learned ◽

Cultural Safety ◽

Controlled Clinical Trial ◽

Data Set ◽

Evaluation Data ◽

Electronic Health ◽

Wise Practices

BACKGROUND There is a paucity of controlled clinical trial data based on research with Indigenous peoples. A lack of data specific to Indigenous peoples means that new therapeutic methods, such as those involving electronic health (eHealth), will be extrapolated to these groups based on research with other populations. Rigorous, ethical research can be undertaken in collaboration with Indigenous communities but requires careful attention to culturally safe research practices. Literature on how to involve Indigenous peoples in the development and evaluation of eHealth or mobile health apps that responds to the needs of Indigenous patients, providers, and communities is still scarce; however, the need for community-based participatory research to develop culturally safe technologies is emerging as an essential focus in Indigenous eHealth research. To be effective, researchers must first gain an in-depth understanding of Indigenous determinants of health, including the harmful consequences of colonialism. Second, researchers need to learn how colonialism affects the research process. The challenge then for eHealth researchers is to braid Indigenous ethical values with the requirements of good research methodologies into a culturally safe research protocol. OBJECTIVE A recent systematic review showed that Indigenous peoples are underrepresented in randomized controlled trials (RCTs), primarily due to a lack of attention to providing space for Indigenous perspectives within the study frameworks of RCTs. Given the lack of guidelines for conducting RCTs with Indigenous communities, we conducted an analysis of our large evaluation data set collected in the Diagnosing Hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous Peoples and Low- and Middle- Income Countries (DREAM-GLOBAL) trial over a period of five years. Our goal is to identify wise practices for culturally safe, collaborative eHealth and RCT research with Indigenous communities. METHODS We thematically analyzed survey responses and qualitative interview/focus group data that we collected over five years in six culturally diverse Indigenous communities in Canada during the evaluation of the clinical trial DREAM-GLOBAL. We established themes that reflect culturally safe approaches to research and then developed wise practices for culturally safe research in pragmatic eHealth research. RESULTS Based on our analysis, successful eHealth research in collaboration with Indigenous communities requires a focus on cultural safety that includes: (1) building a respectful relationship; (2) maintaining a respectful relationship; (3) good communication and support for the local team during the RCT; (4) commitment to co-designing the innovation; (5) supporting task shifting with the local team; and (6) reflecting on our mistakes and lessons learned or areas for improvement that support learning and cultural safety. CONCLUSIONS Based on evaluation data collected in the DREAM-GLOBAL RCT, we found that there are important cultural safety considerations in Indigenous eHealth research. Building on the perspectives of Indigenous staff and patients, we gleaned wise practices for RCTs in Indigenous communities. CLINICALTRIAL ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226

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Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-037922 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037922

Author(s):

Iván Sarmiento ◽

Sergio Paredes-Solís ◽

Martin Morris ◽

Juan Pimentel ◽

Anne Cockcroft ◽

...

Keyword(s):

Maternal Health ◽

Latin American ◽

Scoping Review ◽

Cognitive Mapping ◽

Grey Literature ◽

Indigenous Communities ◽

Ethics Committees ◽

Cultural Safety ◽

Local Stakeholder ◽

Google Search

IntroductionIndigenous mothers often receive culturally unsafe services that do not fully respond to their needs. The objective of this scoping review is to collate and assess evidence that identifies factors, including the role and influence of traditional midwives, that affect maternal health in indigenous communities in the Americas. The results will map Western perspectives reflected in published and unpublished literature to indicate the complex network of factors that influence maternal outcomes. These maps will allow for comparison with local stakeholder knowledge and discussion to identify what needs to change to promote culturally safe care.Methods and analysisA librarian will search studies with iterative and documented adjustments in CINAHL, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE, Embase and Google Scholar without any time restrictions, and use Google search engine for grey literature. Included studies will be empirical (quantitative, qualitative or mixed); address maternal health issues among indigenous communities in the Americas; and report on the role or influence of traditional midwives. Two researchers will independently screen and blindly select the included studies. The quality assessment of included manuscripts will rely on the Mixed Methods Appraisal Tool (MMAT). Two independent researchers will extract data on factors promoting or reducing maternal health in indigenous communities, including the role or influence of traditional midwives. Fuzzy cognitive mapping will summarise the findings as a list of relationships between identified factors and outcomes with weights indicating strength of the relationship and the evidence supporting this.Ethics and disseminationThis review is part of a proposal approved by the ethics committees at McGill University and the Centro de Investigación de Enfermedades Tropicales in Guerrero. Participating indigenous communities in Guerrero State approved the study in 2015. The results of the scoping review will contribute to the field of cultural safety and intercultural dialogue for the promotion of maternal health in indigenous communities.

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