Introduction
Indigenous people are more likely to live with chronic diseases, such as cardiovascular diseases and diabetes, than non-Indigenous people.1–5 Lack of adequate self-management programmes, support for chronic health conditions and difficulty in accessing care, often result in poor health and ultimately, death.1 5 6 These factors lead to higher proportion of overweight and obesity, higher smoking and less physical activity.2 7
Historically, colonialism has had an impact on health disparities and inequities that Indigenous People still experience to this day.8 As for racial discrimination, the link with one’s health status is documented and established as an important determinant of health.9 The concept of historical trauma refers to an intergenerational transmission of behaviours, unresolved grief and wounds, among other issues, that directly impact physical, emotional, mental and spiritual aspects of indigenous health.10 Morbidity, multimorbidity (co-occurrence of two or more unrelated chronic diseases) and mortality rates are significantly higher in Indigenous populations than in non-Indigenous ones.5 11
Over the last few years, an increasing number of Indigenous People have chosen to live in cities, as high as 55% in some urban areas, whether it is to study or for work.12 13 In addition, numbers are underestimated due to the difficulty in reaching Indigenous populations to complete censuses.14 Indigenous People in urban areas are more likely to experience food insecurity and poverty than Indigenous People living in rural areas or on-reserve, as well as compared with non-Indigenous people.15
This migration to urban centres leads to increased primary healthcare needs since it increases the number of persons attended to in healthcare services. However, services offered in urban areas are not consistently appropriate for Indigenous People who often feel forgotten by the healthcare system.16 Moreover, cases where Indigenous People are verbally abused by staff in hospitals are reported regularly.17 In a study led by Poitras et al,16 urban Indigenous participants admitted having reservations about consulting in the publicly funded healthcare services,18 fearing being bullied by hospital staff based on past experiences. Limited access to healthcare is an important social determinant of health.19 Moreover, gaps exist between quality of care provided to Indigenous People, as opposed to that of non-Indigenous.20 While some indigenous organisations, such as Native Friendship Centres in Canada, provide culturally safe health and community services, this is still not common in mainstream healthcare systems. In a recent study, Tremblay et al21 described the concept of cultural safety in healthcare as a transformative approach. Through culturally safe healthcare services, Indigenous patients can expect their core values to be recognised and respected through an equitable partnership between both parties. Cultural safety means that health professionals consider and acknowledge the needs, rights and culture of their Indigenous patients. Because the indigenous view of health refers to holistic wellness, including the spiritual, physical, mental and emotional spheres,22 it sometimes conflicts with western primary care.18 23 Therefore, healthcare providers must include both indigenous and western perspectives in their approach to providing culturally safe care for Indigenous People.23
Thus, with a growing proportion of Indigenous People living in urban areas, the implementation of culturally safe healthcare is essential. Recent calls for action, launched by different indigenous organisations,24 outline the necessity of delivering culturally safe services, as well as the need for a shift in the approach to healthcare. Moreover, it has been demonstrated that the first steps toward reducing inequities in healthcare services are to implement and test interventions.25 In this sense, the objective of this scoping review was to report on culturally safe interventions for the management of chronic diseases among urban Indigenous People. This scoping review sought to examine types of interventions, proposed key elements to deliver culturally safe care, as well as reported facilitators and barriers.