title: Dismantling sociocultural barriers to eye care with tele-ophthalmology: lessons from an Alberta Cree community.
abstract: OBJECTIVE
  There are significant disparities in access to health care amongst Aboriginal Canadians. The purpose of this study was to determine whether tele-ophthalmology services, provided to Aboriginal Canadians in a culturally-sensitive community-based clinic, could overcome social and cultural barriers in ways that would be difficult in the traditional hospital-based setting.
  
  
  METHODS
  The Aboriginal Diabetes Wellness Program of Alberta incorporates culturally-sensitive health-related activities and rituals as a component of a diabetic retinopathy tele-ophthalmology screening program. Metrics of program attendance were collected while stakeholders participated in a survey to identify barriers to healthcare delivery.
  
  
  RESULTS
  Aboriginal patients, cultural liaison, nurses and program administrators revealed economic, geographic, social and cultural barriers to healthcare faced by Aboriginal people. It was found that the introduction of culturally-sensitive programs led to increased appointment attendance; from 25% to 85%. Involvement of Aboriginal nurses, inclusion of culturally-sensitive activities and participation in spiritual ceremonies led to qualitative accounts of increased patient satisfaction, trust towards the healthcare team and communication amongst participants.
  
  
  CONCLUSIONS
  A culturally-sensitive model of healthcare delivery in a community-based health clinic improved access to tele-ophthalmology services. This was demonstrated by increased attendance at appointments and increased satisfaction amongst patients.
authors.affiliation: Royal Alexandra Hospital, University of Alberta, Department of Ophthalmology, Edmonton, Alberta, Canada.
authors.forename: Sourabh
authors.initials: S
authors.lastname: Arora
authors.forename: Ayaz K
authors.initials: AK
authors.lastname: Kurji
authors.forename: Matthew T S
authors.initials: MT
authors.lastname: Tennant
mesh_terms: D000416:Alberta; D003153:Community Health Services / Q000458:organization & administration; D003466:Cultural Characteristics; D054521:Cultural Competency; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000628:therapy; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000628:therapy; D006297:Health Services Accessibility; D006303:Health Services, Indigenous / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American; D007802:Language; D009885:Ophthalmology / Q000379:methods*; D010358:Patient Participation; D016730:Program Development; D015397:Program Evaluation; D026443:Spiritual Therapies; D017216:Telemedicine / Q000379:methods*