Table 3

Strategies identified to promote cultural safety in chronic disease prevention and promotion

Relationships
  • Include the family for medical visits and for self-management (family’s responsibility rather than solely the individual’s)28 29 33 36 38 42 67

  • Include kinship and build strong and respectful relationships (crowshow)38 40 43 44

  • Ensure nonverbal responses are respectful40

  • Share meals with patients29

  • Accept Indigenous child behaviour40

  • Show interest in them and their lives27

  • Include grandchildren in care activities38

  • Spend adequate time with patients29 43

  • Avoid staff turn-over43

  • Hire Indigenous health providers and staff27 40

  • Invite other Indigenous people in group sessions33 38 39

  • Provide care with a staff trained for cultural safety19 41 43 66 67

Cultural landmarks
  • Have Indigenous cultural landmarks in clinics (eg, music, art pieces)30 33 40 66 and create a culturally familiar environment33

  • Use relevant and accessible wording31 33 35 38 44 and visuals31 44

  • Use pictorial layouts31 35 44

  • Offer health promotion bush trips39

  • Use storytelling and yarning approach29 31 44

Spirituality
and holistic health
  • Use indigenous traditional therapeutic approaches (eg, lomilomi (Hawaiian therapeutic massage) and medicine herbs)39 63–65 67

  • Focus on well-being rather than medical targets31 37 62

  • Focus on patient’s own goals27 43 and use a holistic approach27 37 38 43 63

  • Use Indigenous protocols and cultural processes, such as starting and ending meetings with prayer and songs29 38

  • Use smudging39 67

  • Not be constrained by Western models of disease33

  • Have an Elder involved (in medical visits or as a caregiver)29 32 34 35

  • Provide care at home37 41

Access to healthcare
  • Use technology (eg, audio-visual and social media) and electronic health tools to deliver health information at the time, in the place and in multiple formats and languages to meet consumers’ needs66

  • Make home visits (minimising the inconvenience and cost of having to travel to the clinic)27 37 41

  • Offer transportation to clinic, pharmacy, local laboratory for tests, etc33 37 65

  • Use relevant and accessible wording31 33 35 38 44 and translate health material65 66

  • Offer financial support for medication28 30 or drop it off to patients28

  • Cooperate with local pharmacy to ensure medication adherence41

  • Have an interpreter66 or indigenous liaison client representative65

  • Have an indigenous patient navigator64 67