Anthropological perspectives on Miyupimaatisiiun and the integration of oral health in primary care in the Cree communities of Northern Quebec

Abstract

The integration of primary oral health care has a pivotal role in improving oral health outcomes and providing accessible and affordable health care. This article contributes to the deep understanding of the cultural aspects of the integration of oral health into primary health care at an Indigenous health organization. Proceeding from a collaborative and interdisciplinary research project evaluating the integration of oral health care within primary care in Eeyou Istchee, this research is based on group discussions (6) and individual interviews (36) with 74 participants (care providers, administrators, and patients) held in four Eastern James Bay Cree communities. This study anthropologically explored participants' perceptions about primary health care conceptualizations, culturally based approaches, and experiences of oral care services at this organization using a "two-eyed seeing" Indigenous framework. The study identified three key factors related to the integration of primary oral health care: Cree perception of primary health and oral health care, cultural safety, and health provider-patient communication and the role of silence. Study findings reflected a dichotomy of perception of primary health care and the relevant units of care between the Cree structural and cultural perspective and the non-Cree professional perspective. The Cree people perceived "household" as a unit of care in comparison to non-Cree who viewed "health care services" as units of care. Our results also underline the role of cultural safety agents to address the needs for cultural competence and the role of silence as implicit cultural protocol. Our anthropological analysis illustrates the potential for increasing the level of appreciation for both users and workers in oral care in the future by ameliorating communication skills and intercultural knowledge.