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INTRODUCTION: Health services collect patient experience data to monitor, evaluate and improve services and subsequently health outcomes. Obtaining authentic patient experience information to inform improvements relies on the quality of data collection processes and the responsiveness of these processes to the cultural and linguistic needs of diverse populations. This study explores the challenges and considerations in collecting authentic patient experience information through survey methods with Australians who primarily speak First Nations languages. METHODS: First Nations language experts, interpreters, health staff and researchers with expertise in intercultural communication engaged in an iterative process of critical review of two survey tools using qualitative methods. These included a collaborative process of repeated translation and back translation of survey items and collaborative analysis of video-recorded trial administration of surveys with languages experts (who were also receiving dialysis treatment) and survey administrators. All research activities were audio- or video-recorded, and data from all sources were translated, transcribed and inductively analysed to identify key elements influencing acceptability and relevance of both survey process and items as well as translatability. RESULTS: Serious challenges in achieving equivalence of meaning between English and translated versions of survey items were pervasive. Translatability of original survey items was extensively compromised by the use of metaphors specific to the cultural context within which surveys were developed, English words that are familiar but used with different meaning, English terms with no equivalent in First Nations languages and grammatical discordance between languages. Discordance between survey methods and First Nations cultural protocols and preferences for seeking and sharing information was also important: the lack of opportunity to share the 'full story', discomfort with direct questions and communication protocols that preclude negative or critical responses constrained the authenticity of the information obtained through survey methods. These limitations have serious implications for the quality of information collected and result in frustration and distress for those engaging with the survey. CONCLUSION: Profound implications for the acceptability of a survey tool as well as data quality arise from differences between First Nations cultural and communication contexts and the cultural context within which survey methods have evolved. When data collection processes are not linguistically and culturally congruent there is a risk that patient experience data are inaccurate, miss what is important to First Nations patients and have limited utility for informing relevant healthcare improvement. Engagement of First Nations cultural and language experts is essential in all stages of development, implementation and evaluation of culturally safe and effective approaches to support speakers of First Nations languages to share their experiences of health care and influence change.

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AIM AND OBJECTIVES: This study aimed to explore inpatient healthcare delivery experiences of Maori (New Zealand's Indigenous people) patients and their whanau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Maori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well-being. BACKGROUND: Bi-annual Fundamentals of Care audits at the study site have shown that Maori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. DESIGN: Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. METHODS: Three hundred and fifty-four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Maori concepts of health and well-being. The research complies with the SRQR guidelines for reporting qualitative research. RESULTS: Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. CONCLUSION: The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. RELEVANCE TO CLINICAL PRACTICE: Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people.

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Obstetric violence is a pervasive phenomenon in reproductive health across the world. Denial of the choice in birth position is a common form of obstetric violence as horizontal positions are non-evidence based, yet routinely imposed. This contributes to the cultural barriers to access reproductive health care. The present study compares women's experiences in childbirth from the Quichua and Egyptian communities, exploring the intersectional factors that contribute to obstetric violence and the adoption of preferred birth positions to offer recommendations on implementing respectful and rights-based reproductive care. Two independent scoping reviews have been carried out and subsequently compared. The intersectional approach revealed how gender, race, and class have a multiplicative effect on the denial of choice in birth position as a form of obstetric violence. This phenomenon exacerbates the pre-existing health disparities that disproportionately affect women, indigenous and racialized groups, and people living in poverty. Culturally competent, multilevel, and multidisciplinary interventions, strengthening of health systems, and community participation are essential to combat discrimination and guarantee birth rights. Allowing women to choose their birth position is a low-hanging fruit to challenge the complex issue of obstetric violence and ensure a rights-based approach to reproductive health.

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BACKGROUND.: Indigenous peoples experience health inequities linked in part to lack of access to culturally-relevant health care. The Truth and Reconciliation Commission of Canada (TRC) calls on all health professionals, including occupational therapists, to reduce health inequities through improved work with Indigenous communities. PURPOSE.: This integrative review of the literature explores how occupational therapists can improve their work with Indigenous peoples. KEY ISSUES.: Communication and building relationships are central to effective work with Indigenous communities, along with reciprocity regarding knowledge exchange. Issues surrounding service provision are a significant concern, yet improvements are unlikely to be effective unless therapists can critically examine the (mainstream) Western cultural assumptions that infuse the profession and their own practices. IMPLICATIONS.: Though nascent, there are identified directions for occupational therapists to meet the TRC's calls for more competent health care. Researchers should explore best ways for therapists to critically interrogate taken-for-granted professional assumptions mired in Western colonialism.

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Resumo Este ensaio traz o discurso proferido por Ailton Krenak em 25 de março de 2020, na Banca de Doutorado de Nayara Scalco, sob orientação da professora Marília Louvison, no Programa de Pós-Graduação em Saúde Pública da Faculdade de Saúde Pública da Universidade de São Paulo, acrescido de trechos da palestra proferida no Seminário Internacional: A Saúde Indígena e a Ecologia de Saberes no Enfrentamento dos Desafios Atuais: "Tem que ser do nosso jeito"1, em 26 de março de 2020. Neste cenário, traz a importância do diálogo entre diferentes saberes e como o Subsistema de Atenção à Saúde Indígena se constitui. Com foco no debate sobre a relação entre Estado brasileiro e povos indígenas desde os tempos do Brasil colônia, a partir da produção das Epistemologias do Sul que guia a discussão da tese, propõe repensar a saúde e o cuidado para além do saber biomédico.

Abstract This essay presents the speech given by Ailton Krenak on March 25, 2020, at the PhD thesis' defense of Nayara Scalco, advisee of Professor Marília Louvison, in the Graduate Program in Public Health, School of Public Health, University of São Paulo, plus excerpts from the lecture given at the International Seminar: Indigenous Health and Ecology of Knowledges in Facing Current Challenges: "It has to be our way"1, on March 26, 2020. In this context, it highlights the importance of a dialogue between different knowledges and how the Indigenous Health Care Subsystem is constituted. Focusing on the debate about the relationship between the Brazilian State and indigenous peoples since colonial times, based on the production of Epistemologies of the South that guides the discussion of the dissertation, it proposes rethinking health and care beyond biomedical knowledge.

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Despite global strides made in prevention and treatment, tuberculosis (TB) remains an acute problem for Indigenous people in Canada. TB affects Indigenous communities at significantly higher rates than the general Canadian population, for whom it is a disease of the past. This paper suggests how colonialism and its history of violence have shaped the face of TB in Canada, and thus how TB is a telling point of analysis for considering the lack of equity and equality in healthcare delivery in Canada.

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