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Introduction

 How well is Eastern Health doing with cultural diversity? What are the challenges, strategies, needs, and barriers related to providing effective and culturally competent health care?

 

This study examined patient and provider perspectives on the provision of effective and culturally competent care within the Eastern Health region of Newfoundland and Labrador (NL). We focused on two marginalized patient populations – the Indigenous and refugee communities of NL. Nationally, these two groups have experienced multiple barriers to accessing effective and culturally competent health care, including infrastructural, economic, socio-cultural, geographic, and linguistic barriers. There is a growing body of literature in Canada on the emerging challenges facing the health system by the influx of refugees; contributing to that literature is an important outcome of this study. The Truth and Reconciliation Commission has urged institutional leaders to move toward non-colonizing, culturally safe, and collaborative approaches to service provision for Indigenous communities in Canada, including in health care; this study also contributes to that agenda. The differences between the two groups – newly arrived refugees and Canada’s Indigenous communities – in terms of contextual features that pose barriers to effective care, are informative for understanding how and why barriers exist and how best to ensure care is provided effectively within our own health care system.

 

This research was driven by refugee and Indigenous patients and their health care advocates, along with service providers and Eastern Health decision makers.

Study Objectives

  1. An in-depth account of needs related to culturally competent health care, from the perspectives of patients and providers

  2. Recommendations for programming and staff diversity education, including

  3. Evaluation of and recommendations for Eastern Health’s existing diversity programs, with generalizability to similar programs across the nation and elsewhere

Scope

This study does not focus on diversity in its broadest sense: it focuses only on refugees and visible minority immigrants and on Indigenous groups that use Eastern Health’s services.


It does not specifically focus on the many other marginalized communities that comprise the diversity of the Eastern Health patient population. Two important and interfacing concerns – diversity within the health care workforce of providers, other staff, and health decision makers; and diversity with respect to other marginalized patient populations – were not within the scope of this project, though some of the findings may shed light on cultural safety within those larger communities.

Methodology & Design

This study elicits the expert knowledges of refugee and Indigenous patients and their advocates, diversity and cultural liaison professionals, and health decision-makers on the question: “What are the challenges, strategies, needs, and barriers related to the provision of effective and culturally competent health care?”

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This study uses a qualitative, ethnographic (a research method where researchers observe and/or interact with a study’s participants in their real-life environment) approach that is both critical and interpretative. Meaning, we take culture in its relation to power as our focus: our research is based on the understanding that culture permeates health and healing, including the ways that medicine constructs its objects of inquiry and ways of knowing, as well as the ways that disease is expressed and treatment is affected. This method is unique from traditional ethnography, which describes what is, in that a critical ethnography also asks what could be in order to disrupt perceived social inequalities. Such an approach is appropriate for the study of diversity competence in health care. This approach means that we pay attention not only to explicit beliefs and practices about culture and health, but also to who creates and defines these meanings and who “resists” or transforms them in new ways.

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Our research is also framed in terms of “two-eyed seeing”, a methodological approach that recognizes the need for both Western and Indigenous ways of knowing in research, knowledge translation, and program development. Here, we extend the use of this concept to the ethnic minority refugee communities we are collaborating with. Therefore, central to our methodology is the juxtaposition of the knowledges of knowledge users (patients) and knowledge holders, in a way that assumes at the outset that both types of knowledge are expert knowledge.

In sum, we:

  • Used â€‹interview-based data collection, supplemented by an initial scoping survey

    • Emphasis on full team (knowledge holders/patients, knowledge users, and health decision-makers) analysis utilizing a model that favours knowledge holders (patients) as knowledge producers.

  • Used a qualitative design

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