Improving Cultural Safety of Diabetes Care in Indigenous Populations of Canada, Australia, New Zealand and the United States: A Systematic Rapid Review

Abstract

Objectives: Our aim in this study was to identify interventions that improve cultural safety for Indigenous people living with diabetes in the health-care setting, and their potential impact on patients and health-care professionals.

Methods: Using a systematic approach, we conducted a rapid review of quantitative, qualitative and mixed studies between January 2000 and February 2018 in MEDLINE, Embase, Web of Science, ERIC, CINAHL and PsycINFO. Two reviewers independently identified, selected and reviewed studies relating to cultural safety in diabetes care for Indigenous populations in Canada, New Zealand, Australia and the United States.

Results: Of the 406 studies identified, we retained 7 articles (2 strong quality, 5 moderate quality) for analysis. The included studies evaluated 3 main types of strategies to improve cultural safety: educating health professionals, fostering culturally safe practices by modifying clinical environments and integrating Indigenous health professionals in the workforce. Studies showed that culturally safe interventions had positive effects on clinical outcomes for patients, increased patient satisfaction and health professional confidence in providing care as well as patient access to health care.

Conclusions: Although based on a small number of studies, this review establishes moderate evidence that interventions to improve cultural safety can have positive effects on treatment of diabetes in Indigenous populations. Further research with stronger study designs should be conducted to further validate our conclusions.

Keywords: Autochtones; Indigenous; cultural safety; culturally competent care; diabetes; diabète; health care; primary care; soins adaptés à la culture; soins de santé; soins de santé primaires; sécurité culturelle.