Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review

Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users’ socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.

Romani Women and Health. The Need for a Cultural Safety-Based Approach

The Romani are the main European ethnic minority. The Romani people’s situation of social vulnerability and their difficulties in accessing the health system, make their health indicators worse than those of the non-Romani population. The present study will delve into the health beliefs and experiences with health services and their professionals through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers in the access to the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.

Are cultural safety definitions culturally safe? A review of 42 cultural safety definitions in an Australian cultural concept soup

Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health and wellbeing. Are definitions of cultural safety, in themselves, culturally safe? A purposive search of diverse sources in Australian identified 42 definitions of cultural safety. Structuration theory informed the analytical framework and was applied through an Indigenist methodology. Ten themes emerged from this analysis, indicating that cultural risk is embedded in cultural safety definitions that diminish (meddlesome modifications and discombobulating discourse), demean (developmentally dubious and validation vacillations), and disempower (professional prose, redundant reflexivity, and scholarly shenanigans) the cultural identity (problematic provenance and ostracised ontology) of First Nations Australians. We offer four guidelines for future definitional construction processes, and methodology and taxonomy for building consensus based of definitions of cultural safety. Using this approach could reduce cultural risk and contribute to improved workforce ability to respond to the cultural strengths of First Nations Australians.

Between the Tides: Developing an Indigenous-Informed Cultural Safety Training Impact Assessment Survey Tool for Post-Secondary Institutions on Vancouver Island, BC

This paper highlights the development of an Indigenous Cultural Safety Training (ICST) impact assessment survey tool working in collaboration with Indigenous leaders, Elders, faculty, staff, and students from across four post-secondary institutions on the traditional lands of the Songhees, Esquimalt and WSÁNEĆ Peoples on Vancouver Island, British Columbia. What emerged from a series of Indigenous-led workshops was the development of an ICST impact assessment survey tool to measure the impact of the training as well as for ICST participants to reflect on their own cognitive and behavioural change within their practice over a 12-month period. In addition, a validation process with ICST experts, facilitators, staff, faculty, Elders, and participants was carried out to help refine the proposed co-constructed assessment variables, statements, and questions underpinning the survey tool. The finalized ICST impact assessment survey tool will not only improve the quality of ICST in post-secondary settings, but will also enable staff, faculty, and leaders to reflect on how the ICST improves their personal and professional practice working with Indigenous students in these settings.

Introduction: Charting Provocations and Exploring New Directions for Pacific Research in Aotearoa–New Zealand from Pacific Early Career Academic (PECA) Perspectives

“Uplifting Moana Perspectives: Emerging Pacific Researchers and New Directions in New Zealand-Based Pacific Research” presents a shared vision for the future of Pacific research by Pacific early career academics (PECA) primarily based in Aotearoa–New Zealand. The task of charting new directions in imagining possibilities for Pacific research is a critical one, which speaks to our communities’ long and storied history in Aotearoa: a reality incongruent with the lack of Pacific scholars employed in permanent positions in New Zealand universities.[i] This special issue challenges the idea that there is a dearth of Pacific research, asserting rather that our underrepresentation in academia is a structural issue, not necessarily one of scarcity. As special issue editors, we intentionally draw in a cross-section of emerging Pacific researchers in our country to confidently write with emerging Pacific scholars on the other side of our Moana-Oceania region, writing back to the exclusionary nature of conventional disciplinary norms and divides that we are forced to navigate. In doing so, our contributors challenge and transcend disciplinary boundaries and push against the Eurocentrism of our tertiary education system. This work is crucial, as the ability to build an academy that prioritises and centres our ways of knowing, doing, relating, and being is a key component of addressing cultural safety and inclusiveness in university lecture theatres, curriculums, and epistemological norms for both PECA and Pacific students in Aotearoa–New Zealand.