Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study

doi:10.1186/s12884-016-1013-x

. 2016 Aug 11;16(1):216.

doi: 10.1186/s12884-016-1013-x.

Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study

Richard T Oster¹, Grant Bruno^{2

3}, Margaret Montour³, Matilda Roasting⁴, Rick Lightning⁵, Patricia Rain³, Bonny Graham⁶, Maria J Mayan⁷, Ellen L Toth⁸, Rhonda C Bell²

Affiliations

¹ Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada. roster@ualberta.ca.
² Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
³ Samson Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
⁴ Louis Bull Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
⁵ Ermineskin Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
⁶ Maskwacis Health Services, Maskwacis, AB, T0C 1N0, Canada.
⁷ Faculty of Extension, Enterprise Square, University of Alberta, Edmonton, AB, T5J 4P6, Canada.
⁸ Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada.

PMID: 27514523
PMCID: PMC4982262
DOI: 10.1186/s12884-016-1013-x

Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study

Richard T Oster et al. BMC Pregnancy Childbirth. 2016.

. 2016 Aug 11;16(1):216.

doi: 10.1186/s12884-016-1013-x.

Authors

Richard T Oster¹, Grant Bruno^{2

3}, Margaret Montour³, Matilda Roasting⁴, Rick Lightning⁵, Patricia Rain³, Bonny Graham⁶, Maria J Mayan⁷, Ellen L Toth⁸, Rhonda C Bell²

Affiliations

¹ Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada. roster@ualberta.ca.
² Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
³ Samson Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
⁴ Louis Bull Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
⁵ Ermineskin Cree Nation, Maskwacis, AB, T0C 1N0, Canada.
⁶ Maskwacis Health Services, Maskwacis, AB, T0C 1N0, Canada.
⁷ Faculty of Extension, Enterprise Square, University of Alberta, Edmonton, AB, T5J 4P6, Canada.
⁸ Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada.

PMID: 27514523
PMCID: PMC4982262
DOI: 10.1186/s12884-016-1013-x

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Community-based participatory research; Health care providers; Indigenous population; Prenatal care; Qualitative research.

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References

1. Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011;41(6):158–176. doi: 10.1016/j.cppeds.2011.01.001. - DOI - PMC - PubMed
1. Shah PR, Zao J, Al-Wassia H, Shah V. Knowledge synthesis group on determinants of preterm/LBW births. Pregnancy and neonatal outcomes of aboriginal women: a systematic review and meta-analysis. Womens Health Issues. 2011;21(1):28–39. doi: 10.1016/j.whi.2010.08.005. - DOI - PubMed
1. Oster RT, King K, Morrish DW, Mayan MJ, Toth EL. Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis. BMC Pregnancy Childbirth. 2014;14(1):136. doi: 10.1186/1471-2393-14-136. - DOI - PMC - PubMed
1. Oster RT, Toth EL. Stillbirth epidemiology and risk factors among first nations and non-first nations pregnancies in Alberta, Canada from 2000 to 2009. J Obstet Gynaecol Can. 2015;37(2):117–121. doi: 10.1016/S1701-2163(15)30332-7. - DOI - PubMed
1. Statistics Canada . Aboriginal peoples in Canada in 2006. Ottawa: Statistics Canada; 2006.

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[1] Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011;41(6):158–176. doi: 10.1016/j.cppeds.2011.01.001. - DOI - PMC - PubMed

[2] Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011;41(6):158–176. doi: 10.1016/j.cppeds.2011.01.001. - DOI - PMC - PubMed

[3] Shah PR, Zao J, Al-Wassia H, Shah V. Knowledge synthesis group on determinants of preterm/LBW births. Pregnancy and neonatal outcomes of aboriginal women: a systematic review and meta-analysis. Womens Health Issues. 2011;21(1):28–39. doi: 10.1016/j.whi.2010.08.005. - DOI - PubMed

[4] Shah PR, Zao J, Al-Wassia H, Shah V. Knowledge synthesis group on determinants of preterm/LBW births. Pregnancy and neonatal outcomes of aboriginal women: a systematic review and meta-analysis. Womens Health Issues. 2011;21(1):28–39. doi: 10.1016/j.whi.2010.08.005. - DOI - PubMed

[5] Oster RT, King K, Morrish DW, Mayan MJ, Toth EL. Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis. BMC Pregnancy Childbirth. 2014;14(1):136. doi: 10.1186/1471-2393-14-136. - DOI - PMC - PubMed

[6] Oster RT, King K, Morrish DW, Mayan MJ, Toth EL. Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis. BMC Pregnancy Childbirth. 2014;14(1):136. doi: 10.1186/1471-2393-14-136. - DOI - PMC - PubMed

[7] Oster RT, Toth EL. Stillbirth epidemiology and risk factors among first nations and non-first nations pregnancies in Alberta, Canada from 2000 to 2009. J Obstet Gynaecol Can. 2015;37(2):117–121. doi: 10.1016/S1701-2163(15)30332-7. - DOI - PubMed

[8] Oster RT, Toth EL. Stillbirth epidemiology and risk factors among first nations and non-first nations pregnancies in Alberta, Canada from 2000 to 2009. J Obstet Gynaecol Can. 2015;37(2):117–121. doi: 10.1016/S1701-2163(15)30332-7. - DOI - PubMed

[9] Statistics Canada . Aboriginal peoples in Canada in 2006. Ottawa: Statistics Canada; 2006.

[10] Statistics Canada . Aboriginal peoples in Canada in 2006. Ottawa: Statistics Canada; 2006.

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Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study

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Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study

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