Table 4

Barriers and facilitators in the implementation of culturally safe interventions

  • Negative past experiences of accessing care30

  • Staff turnover (loss of continuity of care and trust for patients)31 43

  • Inherent bombardment with referrals for patients newly diagnosed with diabetes31

  • Situations of power differentials43

  • Mistrust and fear of Western institutions43

  • Discrimination31

  • Lack of holistic approach42 43

  • Focus on following guidelines rather than on patient-centred approach32 43

  • Competing priorities27 31 44

  • Low food budget makes difficult to develop realistic and manageable goals36 43

  • Language barriers37 42 and excessive use of medical jargon43

  • Inconsistent levels of care after initial contact30 36 37

  • Lack of time35 37 38

  • Engaging clients or patients in the programme or in the use of the tool35

  • Lack of support from government42, managers and peers35

  • Resistance to change35

  • Misunderstanding role of interdisciplinary team members36

  • Family crises, lack of transportation and unemployment, drug and alcohol issues and mental illness of Indigenous patients31

  • Lack of basic understanding of sociocultural, historical and political contexts of Indigenous patients by colleagues43

  • Low education of Indigenous patients37

  • Support groups39

  • Community-based peer-led educational, cultural components44

  • Free medication41

  • Home visits37 41

  • Free or organised transport to clinic, pharmacy and local laboratory30 37

  • Community-based health activities40 (walking or art groups)36

  • Use of self-management tools31

  • Family support31

  • Appropriate language31

  • Recognition of culture38 42 43

  • Staff within the clinics that challenge the status quo62

  • Requiring little technology and few healthcare resources44

  • Reduced caseload36 42

  • Promoting a collaborative way of working across sectors27 42

  • Patient-centred care43 and social determinants-based approach43

  • Securing more time in health service interactions43

  • Use of case conferences27

  • Demedicalised approach31