Indigenous Cultural Safety in Recognizing and Responding to Family Violence: A Systematic Scoping Review

Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review

INTRODUCTION

Cultural safety, interculturality and antiracism are crucial concepts in addressing health disparities of minority and diverse groups. Measuring them is challenging, however, due to overlapping meanings and their highly contextual nature. Community engagement is essential for evaluating these concepts, yet the methods for social inclusion and protocols for participation remain unclear. This review identifies experimental studies that measure changes resulting from culturally safe, intercultural or antiracist healthcare. The review will describe outcomes and additional factors addressed in these studies.

METHODS AND ANALYSIS

The study focuses on epidemiological experiments with counterfactual comparisons and explicit interventions involving culturally safe, intercultural or antiracist healthcare. The search strategy covers PubMed, CINAHL, Scopus, Web of Science, ProQuest, LILACS and WHO IRIS databases. We will use critical appraisal tools from the Joanna Briggs Institute to assess the quality of randomised and non-randomised experimental studies. Two researchers will screen references, select studies and extract data to summarise the main characteristics of the studies, their approach to the three concepts under study and the reported effect measures. We will use fuzzy cognitive mapping models based on the causal relationships reported in the literature. We will consider the strength of the relationships depicted in the maps as a function of the effect measure reported in the study. Measures of centrality will identify factors with higher contributions to the outcomes of interest. Illustrative intervention modelling will use what-if scenarios based on the maps.

ETHICS AND DISSEMINATION

This review of published literature does not require ethical approval. We will publish the results in a peer-reviewed journal and present them at conferences. The maps emerging from the process will serve as evidence-based models to facilitate discussions with Indigenous communities to further the dialogue on the contributing factors and assessment of cultural safety, interculturality and antiracism.

PROSPERO REGISTRATION NUMBER

CRD42023418459.

Indigenous Service Provider Perspectives of an Online Education Module to Support Safe Clinical Encounters about Family Violence in Canada

Given colonial genocide, Indigenous peoples are rightfully reticent to disclose their experiences of family violence to practitioners working within mainstream health care and social services. Health care and social service providers (HSSPs) have varied formal education on providing trauma-and-violence informed care to Indigenous and non-Indigenous families affected by family violence, including intimate partner violence and child maltreatment. The purpose of this study is to understand and describe the perspectives of Six Nations of the Grand River community members on the relevance of an education module to support HSSPs to provide physically and emotionally safe care to Indigenous families affected by family violence. Two-Eyed Seeing and Two Row Wampum approaches guided our qualitative study. Twenty-one (66.7% women) Indigenous HSSPs completed a semi-structured interview; 15 identified as a regulated HSSP, nine as a Knowledge Keeper/Cultural Holder, and three as a HSSP trainees. Conventional content analysis guided the development of codes and categories. The Violence, Evidence, Guidance, Action (VEGA)-Creating Safety education module was described as having elements consistent with Indigenous experiences and values, and supportive of Indigenous peoples seeking care from HSSPs for family violence related concerns. Participants described several suggestions to better adapt and align the module content with the diversity of values and beliefs of different Indigenous Nations. Collectively, the Creating Safety module may be used as an educational adjunct to Indigenous-focused, cultural safety training that can support HSSPs to provide physically, emotionally, and psychologically safe care to Indigenous peoples who have experienced family violence. Future work needs to consider the perspectives of other Indigenous communities and Nations.