Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study

This is an Accepted Manuscript of an article published by Taylor & Francis in Critical Public health on July 22, 2015, available online: http://dx.doi.org/10.1080/09581596.2015.1067671Regular Papanicolaou (Pap) screening has dramatically reduced cervical cancer incidence in Canada since the 1950s. However, Indigenous women’s rates of cervical cancer remain disproportionately high, a factor which is not acknowledged in national media or in educational materials reporting Canada’s new cervical cancer screening guidelines. Here, we present findings from a cervical cancer screening initiative in Northwestern Ontario. Based on participatory action research, we worked with 10 First Nations communities in the Robinson Superior Treaty area to increase awareness of cervical cancer risk, develop culturally sensitive tools for screening and education and test the efficacy of human papillomavirus (HPV) self-sampling as an alternative to Pap cytology. We conducted 16 interviews with health care professionals and 9 focus groups with 69 women from the communities. A central theme for both health care providers (HCPs) and community members was the colonial legacy and its influence on women’s experiences of cervical cancer screening. This was evidenced by a strong sense of body shyness, including shame related to sexuality and sexually transmitted infections, concerns about confidentiality in clinical encounters and distrust or caution around HCPs. Reaffirming women’s traditional caregiving and educational roles, enhancing mother and daughter communication, improving cultural sensitivity in health care and education and adoption of HPV self-sampling to increase women’s privacy and control of the cervical cancer screening experience were endorsed. We argue that education and screening initiatives must reflect the cultural preferences of Indigenous women, empowering them to take control of their experiences of health and body in cervical cancer screening

Rights and health versus rights to health: Bringing Indigenous Peoples’ legal rights into the spaces of health care services

The political-legal discourse of Indigenous rights continues to be separated from discussions of health care services in geographic scholarship, due to the ways in which political-legal, settler-colonial definitions of rights fail to take Indigenous understandings into account, as well as a distrust on the part of scholars of the limited and contingent notion of “rights.” While Indigenous rights, inherently tied in Canada to recognition by the settler-colonial state, have limited application in achieving social justice or decolonization for Indigenous peoples, we argue that Indigenous rights can be used as a complementary discourse to Indigenous resurgence, within broader discourses of Indigenous justice, to lend legal and political weight to arguments for cultural safety and human rights in health care. We draw on a study conducted with 50 Indigenous community members and 15 health services professionals in the northern city of Prince George, Canada, to elucidate how Indigenous peoples’ experiences in health care settings may be improved by giving attention to rights discourse and removing the geographic and identity-based limitations of Indigenous rights to health care in Canada

Understanding barriers to health care access through cultural safety and ethical space: Indigenous people\u27s experiences in Prince George, Canada

Almost 1.7 million people in the settler colonial nation of Canada identify as Indigenous. Approximately 52 per cent of Indigenous peoples in Canada live in urban areas. In spite of high rates of urbanization, urban Indigenous peoples are overlooked in health care policy and services. Because of this, although health care services are more plentiful in cities as compared to rural areas, Indigenous people still report significant barriers to health care access in urban settings. This qualitative study, undertaken in Prince George, Canada, examines perceived barriers to health care access for urban Indigenous people in light of how colonialism impacts Indigenous peoples in their everyday lives. The three most frequently reported barriers to health care access on the part of the 65 participating health care providers and Indigenous clients of health care services are: substandard quality of care; long wait times; and experiences of racism and discrimination. These barriers, some of which are common complaints among the general population in Canada, are interpreted by Indigenous clients in unique ways rooted in experiences of discrimination and exclusion that stem from the settler colonial context of the nation. Through the lenses of cultural safety and ethical space – frameworks developed by international Indigenous scholars in efforts to better understand and operationalize relationships between Indigenous and non-Indigenous individuals and societies in the context of settler colonialism – this study offers an understanding of these barriers in light of the specific ways that colonialism intrudes into Indigenous clients’ access to care on an everyday basis

Indigenous health organizations, Indigenous community resurgence, and the reclamation of place in urban areas

Research around the world has been nearly unanimous about the positive impacts of Indigenous-led health organizations on Indigenous peoples\u27 qualitative experiences in health care, in the face of often negative experiences in non-Indigenous-led health care settings. Urban environments, including health care environments, are areas of increasing attention with regard to Indigenous peoples\u27 health in Canada. In this study, which took place in the northern city of Prince George, British Columbia, 65 Indigenous community members and health services workers participated in interviews and focus groups, describing their experiences with urban Indigenous-led health organizations—defined in this study as non-governmental organizations that prioritize the values and practices of local Indigenous communities. Employing perspectives on place and relationships drawn from Indigenous critical theory and Indigenous community resurgence to analyze the findings of this qualitative study leads to a focus on how relationships impact and can even constitute places, enabling new understandings of the roles of Indigenous-led health organizations in urban Indigenous community resurgence

Focus on first peoples first thousand days : Cultural safety from the perspectives of select Aboriginal women in Regina, Saskatchewan

ABSTRACT Background. A wealth of data highlights the health disparities and barriers to health care experienced by Aboriginal women and children when compared to non-Aboriginal women and children. The first thousand days time period, from conception to the age of two, is an opportunity for health professionals to positively impact the health of Aboriginal children with effects lasting into adulthood. Cultural safety has been reported to improve access to health care for Aboriginal Canadians, but little is known about the significance of cultural safety from the perspective of Aboriginal women during the first thousand days. Methodology. An interpretive descriptive design and a postcolonial perspective guided this study. In-depth interviews were conducted with six Aboriginal women at a community health centre located in the inner-city of Regina, Saskatchewan, between June and July of 2015. Data was analyzed using principles of interpretive description to determine themes. Findings. Culturally safe and unsafe care was experienced during the first thousand days. Three themes common to participants included: the importance of being able to trust that they are safe when accessing health care, the overwhelming impact of poverty on their ability to achieve or maintain good health, and finally, the experience of worry related to the first thousand days including the worry about being worthy of respectful, culturally safe treatment by all employed in health environments. Discussion. The perception of culturally safe care was significant in affecting access to health care for this group of participants. Findings of this study suggest that more attention needs to be paid to the development of trust in health care encounters, and future research could explore the concept of trust for Aboriginal peoples. Emphasis on awareness of the social determinants of health, including colonialism and racism, should be included in educational programming for health professionals locally

‘I miss being honest’: sex workers’ accounts of silence and disclosure with health care providers in Ireland

In this paper, female sex workers tell stories of their interactions with health care providers (HCP) in four cities in the Republic of Ireland. While Irish society has made great progress in listening to the sexual stories of women that were historically silenced (e.g. stories of abortion, sexual abuse), sex workers have not benefited from this new climate. Regularly silenced by parliamentarians and non-governmental organisations who speak upon their behalf, sex workers are consigned within a narrative of victimhood and coercion. This paper draws from a participant action research study conducted in 2019–20 and explores women’s motivations in whether to disclose their sex work, and the strategies deployed to conceal it while seeking access to sexual health care. These strategies included traveling beyond their own communities for health care and STI home testing. The paper identifies women, particularly, migrants who felt their precarious position made it impossible for them to be truthful about their sex work to health care providers, exposing them to greater health risk. The paper understands this marginality within a context of structural violence where sex worker health is shaped by institutional power relations creating unequal health outcomes but is also challenged by stories of solidarity

The role of nurse practitioners in outreach services and facilitating access for marginalized adult women in British Columbia

Studies show that marginalized adult women experience significant barriers in the process of gaining access to health care in British Columbia. Their needs and risk factors have been studied extensively and much attention has been given to the ways in which the significant inequalities experienced by these women can be addressed. The purpose of this integrative literature review is to understand the role of Nurse Practitioners (NPs) working in outreach services in British Columbia, and to examine ways in which NPs can better facilitate access to health care for marginalized adult women with high-risk lifestyles. Due to the dearth of research on NPs in these practice settings, a review of the health literature was undertaken to identify research that examines the current barriers encountered by marginalized adult women, and the way in which outreach centers might serve as an entry point for access to health care. A rigorous literature search method revealed 18 articles, which were considered appropriate for analysis. The key findings identified the individual and structural barriers to health care access for marginalized women, and emphasized the significant role of outreach centers in facilitating access to health services. The role of NPs in outreach centers is examined by way of a feminist lens, one that is informed by the life experiences of these marginalized women in order to formulate an appropriate, person-centered treatment plan. Nurse Practitioners can facilitate access to health care for marginalized women by fostering a harm reduction philosophy in their practice, by establishing therapeutic relationships with women to overcome the fear and mistrust they have around the health care system and its providers, and by incorporating a person-centered approach to caring for women. Implications for research and education are discussed. --Leaf ii.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b197638

Examining Child Health and Health Care Support in a Group of Off-Reserve Canadian Indigenous Children Diagnosed with Epilepsy

In comparison to children with epilepsy in the general population, little is known about the profile and outcomes of Indigenous children with epilepsy. The 2006 Aboriginal Childrens Survey (ACS) was used to examine risk and resiliency factors in a sample of Indigenous children between one and five years of age. Logistic regressions were completed on a subset of the ACS population (epilepsy group N = 600; Control group N = 5890), where children were matched according to age, sex, and health status. Indigenous children in Canada had higher rates of epilepsy compared to the overall rate of epilepsy for children in Canada. Children with epilepsy compared to those without epilepsy had significantly higher rates of vision and hearing issues, allergies, asthma/bronchitis, and speech-language difficulties. Children with epilepsy were less likely to see a specialist than those without epilepsy. Children who received breast milk were significantly less likely to have epilepsy than those children who did not receive breast milk. If a child had a medical, neurodevelopmental or mental disorder, they were more likely to have epilepsy. Caregivers who rated themselves as healthy were less likely to have a child with epilepsy; even when comparing children with poor health status those caregivers who were healthy had less chance of having a child with epilepsy. In addition to caregiver health, those caregivers who were removed from the home as children were also more likely to have children with epilepsy regardless of the childs health status. Canada will continue to face challenges in providing care to Indigenous children, unless it addresses some important gaps in how health care is provided to this vulnerable population

Journey to wellness: Identifying culturally relevant supportive services for First Nations peoples in Northeastern Ontario during their cancer journey

This thesis is intended to identify culturally relevant supportive services for First Nations in Northeastern Ontario, as perceived by service providers, in order to improve access to cancer care services and the follow-through of treatment at the time of diagnosis and during treatment. The author interviewed thirteen front line health care providers who provide direct services to First Nations communities. The participants within the research study discussed the importance of relationships First Nations peoples have with family members and their community as well as to the land and water. The need for supportive services that incorporate family and community, as well as land and water based healing practices are integral in ensuring the psychosocial needs of First Nations cancer patients are being addressed in a culturally relevant and safe fashion and that these services are significant for the patient, family, and community. The results of this research will be useful in broadening the understanding of the needs of service providers in First Nations communities who are working with First Nations patients during their cancer journey.Master of Indigenous Relation

White-presenting Indigenous peoples

Indigenous individuals who physically appear White, or White-presenting Indigenous Peoples (WPIPs) are a growing and unique group. Previous research indicates multi-dimensional discrimination, coming from darker-skinned Indigenous peoples (DSIPs), WPIPs themselves, and White people (Lawrence, 2004). The purpose of this study was to understand the experiences of WPIPs utilizing a model of horizontal hostility (White, Schmitt, & Langer, 2006) and expectancy violation theory (e.g., Jussim, Coleman, & Lerch, 1987). Participants were 242 university of Saskatchewan students and community members (121 self-identifying as Indigenous and 121 self-identifying as White). All participants were randomly assigned to one of three conditions to view a medical school application: a WPIP target, a DSIP target, or a White target. Participants then rated the candidates on a series of traits. Results did not support horizontal hostility as modelled by White et al. (2006), whereby darker-skinned Indigenous participants would rate the WPIP candidate worse than the White candidate. Findings did, however, support the definition of horizontal hostility (White et al., 2006), as Indigenous participants rated the WPIP candidate worse than the DSIP candidate, and themes of horizontal hostility were identified in answers to open-ended questions. Findings also indicated support for in-group bias on behalf of Indigenous participants, and expectancy violation theory on behalf of White participants, as both Indigenous and White participants rated the Indigenous candidates better than the White candidate. Results are discussed within the context of lateral violence and modern prejudice