title: Visibility and Voice: Aboriginal People Experience Culturally Safe and Unsafe Health Care.
abstract: In Canada, cultural safety (CS) is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples' encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how CS for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted, and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, although less frequently reported, were described as interpersonal interactions with feelings visibility and therefore, treatment as a "human being."
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada rachelle.hole@ubc.ca.
authors.forename: Rachelle D
authors.initials: RD
authors.lastname: Hole
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Mike
authors.initials: M
authors.lastname: Evans
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Berg
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Bottorff
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Carlene
authors.initials: C
authors.lastname: Dingwall
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Carmella
authors.initials: C
authors.lastname: Alexis
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Jessie
authors.initials: J
authors.lastname: Nyberg
authors.affiliation: The University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D001955:British Columbia; D018595:Colonialism; D055812:Community-Based Participatory Research; D065246:Culturally Competent Care / Q000208:ethnology* / Q000592:standards; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006764:Hospitals, Community; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D011369:Professional-Patient Relations; D036301:Qualitative Research; D063505:Racism / Q000208:ethnology*; D066252:Sociological Factors; D014505:Urban Population; D055815:Young Adult
keywords: Aboriginal people, North America; community and public health; culture/cultural competence; health care, access to; health care, culture of; health care, primary; health care, users’ experiences; marginalized populations; participatory action research (PAR); qualitative analysis; quality improvement; quality of care; racism; relationships, health care; relationships, patient–provider; stigma; stress/distress; trauma