2.50
Hdl Handle:
http://hdl.handle.net/10755/211655
Type:
Research Study
Title:
ENGAGING THE LIMINAL
Abstract:
Background: Extensive documentation exists regarding the inequity of healthcare (HC) received by indigenous populations. These include decreased longevity, increased chronic diseases and rates of cancer for which screening is available. These findings are complicated by decreased access to care, particularly for remotely situated tribes/bands, decreased trust of HC providers, and unwillingness to access the medical system unless acutely ill. Purpose: The purpose of this study was to explore experiences with the HC system among remotely situated, coastal First Nations (FN) people of Western Canada, to shed light on elements considered crucial to healthcare delivery. Two priorities were considered essential. The first, to chronicle the experiences of individuals directly concerned, and second, for communities to engage in a creative vision for improvement, manifested from within. Methods: This critical ethnography was conducted with the assistance of two FN research partners over a period of five weeks in two communities: the first, a geographically isolated coastal village, and the second, the rural town that provided a small hospital, increased employment and shopping opportunities for a number of local tribes. Data was obtained first by simply developing relationships in the communities, and as trust developed, taped interviews based on narrative inquiry were obtained. In keeping with an ethnographic tradition additional data was collected through artwork, observation, multiple informal private and group conversations during several celebratory events, as well as day-to-day work and play. This study was conducted as the first step toward building a community-based participatory research project. Findings: While 15 taped interviews were obtained (n=15, average age 59, 100% self-identified as FN), the richest data came through informal gatherings, where entire families shared in the telling of specific experiences.  Findings demonstrated multiple perceptions: a) Widespread prejudice and disrespect; b) Higher quality of care in ER versus clinics, with all diagnostics completed at once; c) 90% of band members do not understand the HC provider; d) Multiple episodes of culturally-specific miscommunication increased morbidity/mortality and decreased trust; e) Inadequate training of  providers for the cultural and geographically isolated care required; f) Procedures completed without informed consent or permission; g) Family advocate or self-advocacy improved HC outcomes; and, h) Quiet assertion of voice in areas of culturally inappropriate research techniques, providing rich data only in formats of their choosing. Implications: 1) Underlying all findings were the painfully current repercussions of a colonial past, as well as the socioeconomic disadvantage of extreme geographic isolation and cultural marginalization; 2) Paternalism in HC ongoing; 3) Inadequate HC access and utilization by FN; 4) Advocacy programs important; 5) Cultural respect and knowledge of indigenous history critical to relationship; 6) Full spectrum FN centers may improve utilization; 7) Experiences contextually situated in historical reality, with a generational effect; 8) Essential for analysis of data to reflect the communal experience rather than individualistic; and, 9)The criticalist paradigm demands rigorous appraisal of Western scientific methodologies as some are a poor fit for indigenous studies.
Keywords:
Indigenous populations; Healthcare inequity
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5660
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleENGAGING THE LIMINALen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211655-
dc.description.abstractBackground: Extensive documentation exists regarding the inequity of healthcare (HC) received by indigenous populations. These include decreased longevity, increased chronic diseases and rates of cancer for which screening is available. These findings are complicated by decreased access to care, particularly for remotely situated tribes/bands, decreased trust of HC providers, and unwillingness to access the medical system unless acutely ill. Purpose: The purpose of this study was to explore experiences with the HC system among remotely situated, coastal First Nations (FN) people of Western Canada, to shed light on elements considered crucial to healthcare delivery. Two priorities were considered essential. The first, to chronicle the experiences of individuals directly concerned, and second, for communities to engage in a creative vision for improvement, manifested from within. Methods: This critical ethnography was conducted with the assistance of two FN research partners over a period of five weeks in two communities: the first, a geographically isolated coastal village, and the second, the rural town that provided a small hospital, increased employment and shopping opportunities for a number of local tribes. Data was obtained first by simply developing relationships in the communities, and as trust developed, taped interviews based on narrative inquiry were obtained. In keeping with an ethnographic tradition additional data was collected through artwork, observation, multiple informal private and group conversations during several celebratory events, as well as day-to-day work and play. This study was conducted as the first step toward building a community-based participatory research project. Findings: While 15 taped interviews were obtained (n=15, average age 59, 100% self-identified as FN), the richest data came through informal gatherings, where entire families shared in the telling of specific experiences.  Findings demonstrated multiple perceptions: a) Widespread prejudice and disrespect; b) Higher quality of care in ER versus clinics, with all diagnostics completed at once; c) 90% of band members do not understand the HC provider; d) Multiple episodes of culturally-specific miscommunication increased morbidity/mortality and decreased trust; e) Inadequate training of  providers for the cultural and geographically isolated care required; f) Procedures completed without informed consent or permission; g) Family advocate or self-advocacy improved HC outcomes; and, h) Quiet assertion of voice in areas of culturally inappropriate research techniques, providing rich data only in formats of their choosing. Implications: 1) Underlying all findings were the painfully current repercussions of a colonial past, as well as the socioeconomic disadvantage of extreme geographic isolation and cultural marginalization; 2) Paternalism in HC ongoing; 3) Inadequate HC access and utilization by FN; 4) Advocacy programs important; 5) Cultural respect and knowledge of indigenous history critical to relationship; 6) Full spectrum FN centers may improve utilization; 7) Experiences contextually situated in historical reality, with a generational effect; 8) Essential for analysis of data to reflect the communal experience rather than individualistic; and, 9)The criticalist paradigm demands rigorous appraisal of Western scientific methodologies as some are a poor fit for indigenous studies.en_GB
dc.subjectIndigenous populationsen_GB
dc.subjectHealthcare inequityen_GB
dc.date.available2012-02-20T12:06:37Z-
dc.date.issued2012-02-20T12:06:37Z-
dc.date.accessioned2012-02-20T12:06:37Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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