Dataset Information

First Nations, Inuit and Metis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review.

ABSTRACT: In Canada, approximately 52% of First Nations, Inuit and Métis (Indigenous) peoples live in urban areas. Although urban areas have some of the best health services in the world, little is known about the barriers or facilitators Indigenous peoples face when accessing these services. This review aims to fill these gaps in knowledge. Embase, Medline and Web of Science were searched from 1 January 1981 to 30 April 2020. A total of 41 studies identified barriers or facilitators of health service access for Indigenous peoples in urban areas. Barriers included difficult communication with health professionals, medication issues, dismissal by healthcare staff, wait times, mistrust and avoidance of healthcare, racial discrimination, poverty and transportation issues. Facilitators included access to culture, traditional healing, Indigenous-led health services and cultural safety. Policies and programs that remove barriers and implement the facilitators could improve health service access for Indigenous peoples living in urban and related homelands in Canada.

SUBMITTER: Graham S

PROVIDER: S-EPMC10252616 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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First Nations, Inuit and Métis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review.

Graham Simon S Muir Nicole M NM Formsma Jocelyn W JW Smylie Janet J

International journal of environmental research and public health 20230525 11

In Canada, approximately 52% of First Nations, Inuit and Métis (Indigenous) peoples live in urban areas. Although urban areas have some of the best health services in the world, little is known about the barriers or facilitators Indigenous peoples face when accessing these services. This review aims to fill these gaps in knowledge. Embase, Medline and Web of Science were searched from 1 January 1981 to 30 April 2020. A total of 41 studies identified barriers or facilitators of health service acc ...[more]

PMID: 37297560

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Project description:BackgroundFirst Nations, Inuit and Métis Peoples across geographies are at higher risk of SARS-CoV-2 infection and COVID-19 because of high rates of chronic disease, inadequate housing and barriers to accessing health services. Most Indigenous Peoples in Canada live in cities, where SARS-CoV-2 infection is concentrated. To address gaps in SARS-CoV-2 information for these urban populations, we partnered with Indigenous agencies and sought to generate rates of SARS-CoV-2 testing and vaccination, and incidence of infection for First Nations, Inuit and Métis living in 2 Ontario cities.MethodsWe drew on existing cohorts of First Nations, Inuit and Métis adults in Toronto (n = 723) and London (n = 364), Ontario, who were recruited using respondent-driven sampling. We linked to ICES SARS-CoV-2 databases and prospectively monitored rates of SARS-CoV-2 testing, diagnosis and vaccination for First Nations, Inuit and Métis, and comparator city and Ontario populations.ResultsWe found that SARS-CoV-2 testing rates among First Nations, Inuit and Métis were higher in Toronto (54.7%, 95% confidence interval [CI] 48.1% to 61.3%) and similar in London (44.5%, 95% CI 36.0% to 53.1%) compared with local and provincial rates. We determined that cumulative incidence of SARS-CoV-2 infection was not significantly different among First Nations, Inuit and Métis in Toronto (7364/100 000, 95% CI 2882 to 11 847) or London (7707/100 000, 95% CI 2215 to 13 200) compared with city rates. We found that rates of vaccination among First Nations, Inuit and Métis in Toronto (58.2%, 95% CI 51.4% to 64.9%) and London (61.5%, 95% CI 52.9% to 70.0%) were lower than the rates for the 2 cities and Ontario.InterpretationAlthough Ontario government policies prioritized Indigenous populations for SARS-CoV-2 vaccination, vaccine uptake was lower than in the general population for First Nations, Inuit and Métis Peoples in Toronto and London. Ongoing access to culturally safe testing and vaccinations is urgently required to avoid disproportionate hospital admisson and mortality related to COVID-19 in these communities.

Project description:BackgroundTo gain culturally appropriate awareness of First Nations, Inuit and/or Métis Health, research suggests that programs focus on sending more trainees to First Nations, Inuit and/or Métis communities Working within this context provides experiences and knowledge that build upon classroom education and support trainees' acquisition of skills to engage in culturally safe healthcare provision. This study examines residents' and faculty members' perceptions of how residency training programs can optimize First Nations, Inuit and/or Métis health training and support residents in gaining the knowledge, skills, and experiences for working in and with First Nations, Inuit and/or Métis communities.MethodsA qualitative approach was used, guided by a relational lens for collecting data and a constructivist grounded theory for data interpretation. Theoretical sampling was used to recruit 35 participants from three main study sites across two western Canadian provinces. Recruitment, data collection, and analysis using constructivist grounded theory occurred concurrently to ensure appropriate depth of exploration.ResultsOur data analysis revealed five themes: Five themes were generated: Complexity of voluntourism as a concept; Diversity of knowledge representation required for developing curriculum; Effective models of care for First Nations, Inuit and/or Métis health; Essential traits that residents should have for working in First Nations, Inuit and/or Métis communities; and Building relationships and trust by engaging the community.ConclusionsFirst Nations, Inuit and/or Métis Health should be prioritized within Canadian postgraduate medical education. Equipping trainees to provide holistic care, immersing in and learning from First Nations, Inuit and/or Métis communities is essential for developing the next generation of clinicians and preceptors. We present educational recommendations for residency programs to optimize First Nations, Inuit and/or Métis health educational experiences and provide residents with skills to provide effective and culturally safe care.

Project description:IntroductionDecades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses.Methods and analysisOur nations-based approach focuses on FN/M/I populations with separate study arms for each group. Linked administrative health data on COVID-19 diagnostic testing and vaccinations are available on a weekly basis. We will conduct surveillance to monitor trends in testing and vaccination among each FN/M/I population and all other Manitobans, map the geographic distribution of these outcomes by health region and tribal council, and identify barriers to testing and vaccination to inform public health strategies. We will follow the course of the pandemic starting from January 2020 and report findings quarterly.Ethics and disseminationEthics approvals have been granted by the University of Manitoba Research Ethics Board and from each of our FN/M/I partners' organisations. Our team is committed to engaging in authentic relationship-based research that follows First Nations, Metis and Inuit research ethics principles. Our FN/M/I partners will direct the dissemination of new information to leadership in their communities (health directors, community health organisations) and to decision-makers in the provincial Ministry of Health. We will also publish in open-access journals. The study will create ongoing capacity to monitor Manitoba's pandemic response and ensure potential health inequities are minimised, with learnings applicable to other jurisdictions where detailed administrative data may not be available.

Project description:ObjectiveThis study aims to explore physical therapists' perspectives on providing physical therapy to First Nations peoples in Canada via telehealth, specifically to understand (1) their perspectives on the feasibility of telehealth as a medium for health care delivery and (2) their experiences building trusting therapeutic relationships via telehealth care.MethodsThis study included 13 physical therapists who provided clinical care via telehealth for First Nations individuals in northern British Columbia in the past 3 years, and 7 master of physical therapy students undergoing or who completed their Indigenous Health clinical placement in the past 3 years and utilized telehealth. In-depth semi-structured interviews were conducted. Interview questions explored: telehealth usage and acceptance, experiences with telehealth, and overall recommendations for telehealth. Audio recordings were transcribed, and reflexive thematic analysis was conducted.ResultsThree overarching themes were identified: "Telehealth can make a huge difference, but it is widely underutilized;" "Telehealth is a little bit less personal and in-depth;" and "There is a time and place for telehealth."ConclusionTelehealth shows promise in the delivery of physical therapy to First Nations communities in Canada, enhancing accessibility, offering flexible scheduling options, and optimizing therapist time efficiency. However, successful implementation in these communities is contingent upon addressing several challenges, including building trusting therapeutic relationships. Technological glitches, the absence of physical interaction, and a history of trauma may hinder the development of the therapeutic relationship in telehealth encounters. To mitigate these challenges, cultural safety training, initial in-person appointments, community familiarity, and in-person support from a caregiver or other health care provider may play pivotal roles.ImpactThis study not only sheds light on the underutilization of telehealth but also underscores its potential to significantly improve the accessibility and efficiency of physical therapy to First Nations peoples in Canada. The findings emphasize the nuanced dynamics of therapeutic relationships in telehealth, offering critical insights for the integration of culturally sensitive practices. Addressing the challenges pinpointed can enhance the quality of telehealth care for First Nations individuals, promote more equitable health care delivery, and foster positive health outcomes.

Dataset Information

First Nations, Inuit and Metis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review.

Publications

First Nations, Inuit and Métis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review.

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