title: Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study.
abstract: Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. Although there has been a call for improved prenatal care, examples are scarce. Therefore, we explored the characteristics of effective care with First Nations women from the perspective of prenatal healthcare providers (HCPs).
  
  
  
  We conducted an ethnographic community-based participatory research study in collaboration with a large Cree First Nations community in Alberta, Canada. We carried out semi-structured interviews with 12 prenatal healthcare providers (HCPs) that were recorded, transcribed, and subjected to qualitative content analysis.
  
  
  
  According to the participants, relationships and trust, cultural understanding, and context-specific care were key features of effective prenatal care and challenge the typical healthcare model. HCPs that are able to foster sincere, non-judgmental, and enjoyable interactions with patients may be more effective in treating pregnant First Nations women, and better able to express empathy and understanding. Ongoing HCP cultural understanding specific to the community served is crucial to trusting relationships, and arises from real experiences and learning from patients over and above relying only on formal cultural sensitivity training. Consequently, HCPs report being better able to adapt a more flexible, all-inclusive, and accessible approach that meets specific needs of patients.
  
  
  
  Aligned with the recommendations of the Truth and Reconciliation Commission of Canada, improving prenatal care for First Nations women needs to allow for genuine relationship building with patients, with enhanced and authentic cultural understanding by HCPs, and care approaches tailored to women's needs, culture, and context.
authors: Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada. roster@ualberta.ca.
authors: Richard T
authors: RT
authors: Oster
authors: Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2R3, Canada.|Samson Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
authors: Grant
authors: G
authors: Bruno
authors: Samson Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
authors: Margaret
authors: M
authors: Montour
authors: Louis Bull Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
authors: Matilda
authors: M
authors: Roasting
authors: Ermineskin Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
authors: Rick
authors: R
authors: Lightning
authors: Samson Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
authors: Patricia
authors: P
authors: Rain
authors: Maskwacis Health Services, Maskwacis, AB, T0C 1N0, Canada.
authors: Bonny
authors: B
authors: Graham
authors: Faculty of Extension, Enterprise Square, University of Alberta, Edmonton, AB, T5J 4P6, Canada.
authors: Maria J
authors: MJ
authors: Mayan
authors: Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada.
authors: Ellen L
authors: EL
authors: Toth
authors: Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
authors: Rhonda C
authors: RC
authors: Bell
mesh_terms: D000328:Adult; D000416:Alberta / Q000208:ethnology; D000884:Anthropology, Cultural; D055812:Community-Based Participatory Research; D065246:Culturally Competent Care; D004645:Empathy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D010465:Perception; D010817:Physician-Patient Relations; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D036301:Qualitative Research
keywords: Community-based participatory research; Health care providers; Indigenous population; Prenatal care; Qualitative research