Indigenous identity identification in administrative health care data globally: A scoping review.

OBJECTIVE: Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally. METHODS: A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective. RESULTS: In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research. CONCLUSION: There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.

Adverse childhood experiences and health among indigenous persons experiencing homelessness.

BACKGROUND: Current literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups. METHODS: To address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. While the primary focus of the study was to assess the relationship between ACEs and health status, we also assessed reports on use and perceptions of health care services to test for potential illness-mitigating factors. RESULTS: Results indicated that reported number of ACEs was significantly associated with reported levels of mental illness (p < .001, d = 1.12). Significant associations were not observed for physical illness or patterns of substance use. We also found that the number of reported ACEs was significantly correlated with the number of formal health care services that an individual used (r = 0.32). CONCLUSIONS: Our results reveal that the relationship between ACEs and adult illness is not as deterministic as the current literature suggests. Access to formal health care services may allow individuals to mitigate their adverse health, thereby eliminating some of the effects of ACEs. Conversely, current tools used to measure ACEs may not translate to an Indigenous population, which speaks to a need to revise ACE related surveys to include additional adversity categories.

Exploring Canadian Physicians' Experiences With Type 2 Diabetes Care for Adult Indigenous Patients.

OBJECTIVES: The perspectives of physicians caring for Indigenous patients with diabetes offer important insights into the provision of health-care services. The purpose of this study was to describe Canadian physicians' perspectives on diabetes care of Indigenous patients, a preliminary step in developing a continuing medical education intervention described elsewhere. METHODS: Through in-depth semistructured interviews, Canadian family physicians and specialists with sizeable proportions of Indigenous clientele shared their experiences of working with Indigenous patients who have type 2 diabetes. Recruitment involved a purposive and convenience sampling strategy, identifying participants through existing research and the professional relationships of team members in the provinces of British Columbia, Alberta and Ontario. Participants addressed their understanding of factors contributing to the disease, approaches to care and recommendations for medical education. The research team framed a thematic analysis through a collaborative, decolonizing lens. RESULTS: The participants (n=28) included 3 Indigenous physicians, 21 non-Indigenous physicians and 4 non-Indigenous diabetes specialists. They practised in urban, reserve and rural adjacent-to-reserve contexts in 5 Canadian provinces. The physicians constructed a socially framed understanding of the complex contexts influencing Indigenous patients with diabetes in tension with structural barriers to providing diabetes care. As a result, physicians adapted care focusing on social factors and conditions that take into account the multigenerational impacts of colonization and the current social contexts of Indigenous peoples in Canada. CONCLUSIONS: Adaptations in diabetes care by physicians grounded in the historical, social and cultural contexts of their Indigenous patients offer opportunities for improving care quality, but policy and health system supports and structural competency are needed.

Health care experiences of Indigenous people living with type 2 diabetes in Canada.

BACKGROUND: Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. We sought to examine the health care experiences of Indigenous people with type 2 diabetes to understand how such determinants are embodied and enacted during clinical encounters. METHODS: Sequential focus groups and interviews were conducted in 5 Indigenous communities. Focus groups occurred over 5 sessions at 4 sites; 3 participants were interviewed at a 5th site. Participants self-identified as Indigenous, were more than 18 years of age, lived with type 2 diabetes, had received care from the same physician for the previous 12 months and spoke English. We used a phenomenological thematic analysis framework to categorize diabetes experiences. RESULTS: Patient experiences clustered into 4 themes: the colonial legacy of health care; the perpetuation of inequalities; structural barriers to care; and the role of the health care relationship in mitigating harm. There was consistency across the diverse sites concerning the root causes of mistrust of health care systems. INTERPRETATION: Patients' interactions and engagement with diabetes care were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. These experiences led to nondisclosure during health care interactions. Our findings show that health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and have a role in mitigating past harms.

Mini-med school for Aboriginal youth: experiential science outreach to tackle systemic barriers.

INTRODUCTION: Addressing systemic barriers experienced by low-income and minority students to accessing medical school, the University of Calgary's Cumming School of Medicine has spearheaded a year-round, mini-med school outreach initiative for Aboriginal students. METHOD: Junior and senior high school youth generally attend the half-day program in classes or camps of 15-25, breaking into small groups for multisession activities. Undergraduate medical education students mentor the youth in stations offering experiential lessons in physical examination, reading x-rays, and anatomy. All resources from the medical school are offered in-kind, including a pizza lunch at midday, whereas community partners organize transportation for the attendees. RESULTS: Opening the medical school and its resources to the community offers great benefits to resource-constrained schools often limited in terms of science education resources. The model is also an effort to address challenges among the medical professions around attracting and retaining students from underserved populations. CONCLUSION: The prospect of increasing admission rates and successful completion of medical education among students from marginalized communities poses a real, though difficult-to-measure, possibility of increasing the workforce most likely to return to and work in such challenging contexts. A mini-medical school for Aboriginal youth highlights mutual, long-term benefit for diverse partners, encouraging medical educators and community-based science educators to explore the possibilities for deepening partnerships in their own regions.