Transform[ing] heart failure professionals with Indigenous land-based cultural safety in Ontario, Canada.

Cardiovascular disease is a leading cause of death worldwide, with disproportionate impacts on Indigenous Peoples in Canada. In Spring 2022, a land-based learning program was piloted and evaluated as an Indigenous cultural safety training for professionals at a cardiac care centre and university in a large urban city. Baseline and endline surveys showed an increase in knowledge of Indigenous histories, cultures, and practices; increased reflection on positionality and intention to create change; and strengthened relationships with the land. Future work should explore the long-term effects of land-based cultural safety training on participant behaviours, and health outcomes for Indigenous Peoples.

Programs supporting incarcerated and previously incarcerated indigenous peoples: a scoping review protocol.

The overincarceration of Indigenous peoples and its impacts on individual and community health is a growing concern across Canada and the United States. Federally run Healing Lodges in Canada are an example of support services for incarcerated and previously incarcerated Indigenous peoples to reintegrate into community and support their healing journey. However, there is a need to synthesise research which investigates these programmes. We report a protocol for a scoping review that is guided by the following research question: What is known about culturally informed programmes and services available to incarcerated and previously incarcerated Indigenous peoples in Canada and the US? This scoping review will follow guidelines published by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. This review will only identify programmes that are guided by Indigenous ways of being and knowing in order to best serve Indigenous communities and our community partners. The results of this review will support the development of programmes that are necessary for understanding and addressing the diverse needs of incarcerated and previously incarcerated Indigenous peoples.

Frameworks, guidelines, and tools to develop a learning health system for Indigenous health: An environmental scan for Canada.

Introduction: First Nations, Inuit, and Métis (FNIM) peoples experience systemic health disparities within Ontario's healthcare system. Learning health systems (LHS) is a rapidly growing interdisciplinary area with the potential to address these inequitable health outcomes through a comprehensive health system that draws on science, informatics, incentives, and culture for ongoing innovation and improvement. However, global literature is in its infancy with grounding theories and principles still emerging. In addition, there is inadequate information on LHS within Ontario's health care context. Methods: We conducted an environmental scan between January and April 2021 and again in June 2022 to identify existing frameworks, guidelines, and tools for designing, developing, implementing, and evaluating an LHS. Results: We found 37 relevant sources. This paper maps the literature and identifies gaps in knowledge based on five key pillars: (a) data and evidence-driven, (b) patient-centeredness, (c) system-supported, (d) cultural competencies enabled, and (e) the learning health system. Conclusion: We provide recommendations for implementation accordingly. The literature on LHS provides a starting point to address the health disparities of FNIM peoples within the healthcare system but Indigenous community partnerships in LHS development and operation will be key to success.

Designing accountability measures for health professionals: results from a community-based micro-credential: case study on Indigenous cultural safety.

BACKGROUND: There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course. AIMS: To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training. INTERVENTION: We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators' intended goals as defined in our partnership agreement. OUTCOMES: The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness. IMPLICATIONS: Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions.

Background: Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy. Objective: We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations. Methods: An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018). Synthesis: Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery. Conclusion: The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

Mamwi Gidaanjitoomin/Together We Build It: A Systematic Review of Traditional Indigenous Building Structures in North America and Their Potential Application in Contemporary Designs to Promote Environment and Well-Being.

(1) Background: Housing has long been recognized as an essential determinant of health. Our sense of home goes beyond physical shelter and is associated with personal or collective connections with spaces and places. However, modern architecture has gradually lost its connections between people and places; (2) Methods: We examined traditional Indigenous architecture and how it can be utilized in contemporary settings to restore connections to promote the environment, health, and well-being. (3) Results: We found that traditional Indigenous building structures may be the best manifestation of the Indigenous interconnected and holistic worldviews in North America, containing thousands of years of knowledge and wisdom about the land and the connection between humans and the environment, which is the foundation of reciprocal well-being; (4) Conclusions: Learning from the traditional structures, we proposed that modern architects should consider the past, present, and future in every endeavor and design and to utilize traditional knowledge as a crucial source of inspiration in creating works that are beneficial for both current and future generations by taking collectivism, health and well-being, and the environment into consideration in designs.

Developing an Indigenous cultural safety micro-credential: initial findings from a training designed for public health professionals in southern Ontario.

Cultural safety training is a resource that healthcare institutions and staff can rely on to end anti-Indigenous racism in their organisations and to shift service providers' attitudes, beliefs, and knowledge of Indigenous people. The aim of this study was to understand the initial knowledge and interest about Indigenous Peoples that a southern Ontario public health unit's (PHU) staff hold. A cultural safety micro-credential project was developed in consultation with the PHU. An online survey was administered from January to March 2021 to those who were starting the micro-credential during this timeframe (n = 31). Thirty-one staff responded. A majority of the participants indicated that they had some knowledge of Indigenous Peoples and that this knowledge was relevant to their work. The number of interactions with Indigenous Peoples varied by role. Common themes for the open-ended responses included culture, relationships, and supports/services. Many of the open-ended responses highlighted feelings of not knowing enough and wanting to learn more about Indigenous Peoples. These results indicate a shift in attitudes, behaviours, and knowledge of Indigenous Peoples among the PHU staff. Cultural safety training can serve to address knowledge gaps and contribute to creating the systemic change needed to end anti-Indigenous racism in healthcare institutions.

An environmental scan of Indigenous Patient Navigator programs in Ontario.

Indigenous people in Canada continue to experience barriers accessing healthcare services including systemic racism and disproportionate healthcare disparities. Indigenous Patient Navigators (IPNs) and programs may mitigate these barriers by providing culturally safe care and support for Indigenous patients and their families navigating healthcare systems. Unfortunately, few IPNs and IPN programs exist in Ontario. We conducted an environmental scan of IPN resources and programs in Canada. Our aim was to determine evaluation frameworks, training, responsibilities of IPNs, and current IPN programs in Canada. We found 97 web sites or documents that were gathered between January and March 2021. We offer gaps in knowledge uncovered during the environmental scan. We conclude with recommendations for the implementation of IPN programs. Indigenous patient navigators have the potential to improve Indigenous healthcare experiences. Specific and sustained action is required to improve and create an equitable health system for Indigenous people across Canada.