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. 2023 Oct 30;13(10):e073184.
doi: 10.1136/bmjopen-2023-073184.

Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta

Anika Sehgal  1 , Sara Scott  2 , Adam Murry  3 , Rita Henderson  4 , Cheryl Barnabe  5 , Lynden Lindsay Crowshoe  6
Affiliations

Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta

Anika Sehgal et al. BMJ Open. .

Abstract

Objectives: This study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada.

Design: Qualitative exploration with relational conversations.

Setting: Calgary, Alberta, Canada.

Participants: A total of nine urban Indigenous patients were recruited from a multidisciplinary primary healthcare clinic that serves First Nations, Métis and Inuit peoples. Recruitment and data collection took place between September and November 2021.

Results: Thematic analysis revealed three main themes, namely: sources of health complexity, psychological responses to adversity, and resilience, strengths, and protective factors. Key sources of health complexity arose from material resource disparities and adverse interpersonal interactions within the healthcare environment, which manifest into psychological distress while strengths and resilience emerged as protective factors.

Conclusion: The healthcare system remains inapt to address complexity among urban Indigenous peoples in Canada. Healthcare violence experienced by Indigenous peoples only further perpetuates health complexity. Future clinical tools to collect information about health complexity among urban Indigenous patients should include questions about the factors defined in this study.

Keywords: Health Equity; Patient-Centered Care; Primary Health Care.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Safford MM, Allison JJ, Kiefe CI. Patient complexity: more than comorbidity. The vector model of complexity. J Gen Intern Med 2007;22 Suppl 3(Suppl 3):382–90. 10.1007/s11606-007-0307-0 - DOI - PMC - PubMed
    1. Grant RW, Ashburner JM, Hong CS, et al. Defining patient complexity from the primary care physician’s perspective: a cohort study. Ann Intern Med 2011;155:797. 10.7326/0003-4819-155-12-201112200-00001 - DOI - PubMed
    1. Valderas JM, Starfield B, Sibbald B, et al. Defining comorbidity: implications for understanding health and health services. Ann Fam Med 2009;7:357–63. 10.1370/afm.983 - DOI - PMC - PubMed
    1. Rzewuska M, Charani E, Clarkson JE, et al. Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper. Clin Microbiol Infect 2021;27:41–7. 10.1016/j.cmi.2020.06.007 - DOI - PubMed
    1. Roberts N, Kidd L, Dougall N. The role of the ward manager in England: a scoping review. J Nurs Manag 2019;27:1328–41. 10.1111/jonm.12800 - DOI

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