Lynden Lindsay Crowshoe1, Rita I Henderson2, Michael E Green3, Kristen M Jacklin4, Leah M Walker5, Betty Calam6. 1. Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: crowshoe@ucalgary.ca. 2. Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada. 4. Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada. 5. School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 6. Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
OBJECTIVES: The perspectives of physicians caring for Indigenous patients with diabetes offer important insights into the provision of health-care services. The purpose of this study was to describe Canadian physicians' perspectives on diabetes care of Indigenous patients, a preliminary step in developing a continuing medical education intervention described elsewhere. METHODS: Through in-depth semistructured interviews, Canadian family physicians and specialists with sizeable proportions of Indigenous clientele shared their experiences of working with Indigenous patients who have type 2 diabetes. Recruitment involved a purposive and convenience sampling strategy, identifying participants through existing research and the professional relationships of team members in the provinces of British Columbia, Alberta and Ontario. Participants addressed their understanding of factors contributing to the disease, approaches to care and recommendations for medical education. The research team framed a thematic analysis through a collaborative, decolonizing lens. RESULTS: The participants (n=28) included 3 Indigenous physicians, 21 non-Indigenous physicians and 4 non-Indigenous diabetes specialists. They practised in urban, reserve and rural adjacent-to-reserve contexts in 5 Canadian provinces. The physicians constructed a socially framed understanding of the complex contexts influencing Indigenous patients with diabetes in tension with structural barriers to providing diabetes care. As a result, physicians adapted care focusing on social factors and conditions that take into account the multigenerational impacts of colonization and the current social contexts of Indigenous peoples in Canada. CONCLUSIONS: Adaptations in diabetes care by physicians grounded in the historical, social and cultural contexts of their Indigenous patients offer opportunities for improving care quality, but policy and health system supports and structural competency are needed.
OBJECTIVES: The perspectives of physicians caring for Indigenous patients with diabetes offer important insights into the provision of health-care services. The purpose of this study was to describe Canadian physicians' perspectives on diabetes care of Indigenous patients, a preliminary step in developing a continuing medical education intervention described elsewhere. METHODS: Through in-depth semistructured interviews, Canadian family physicians and specialists with sizeable proportions of Indigenous clientele shared their experiences of working with Indigenous patients who have type 2 diabetes. Recruitment involved a purposive and convenience sampling strategy, identifying participants through existing research and the professional relationships of team members in the provinces of British Columbia, Alberta and Ontario. Participants addressed their understanding of factors contributing to the disease, approaches to care and recommendations for medical education. The research team framed a thematic analysis through a collaborative, decolonizing lens. RESULTS: The participants (n=28) included 3 Indigenous physicians, 21 non-Indigenous physicians and 4 non-Indigenous diabetes specialists. They practised in urban, reserve and rural adjacent-to-reserve contexts in 5 Canadian provinces. The physicians constructed a socially framed understanding of the complex contexts influencing Indigenous patients with diabetes in tension with structural barriers to providing diabetes care. As a result, physicians adapted care focusing on social factors and conditions that take into account the multigenerational impacts of colonization and the current social contexts of Indigenous peoples in Canada. CONCLUSIONS: Adaptations in diabetes care by physicians grounded in the historical, social and cultural contexts of their Indigenous patients offer opportunities for improving care quality, but policy and health system supports and structural competency are needed.
Keywords:
Indigenous health; continuing medical education; diabète de type 2; formation médicale continue; healthcare policy; optique postcoloniale; perfectionnement professionnel; politiques en matière de soins de santé; post-colonial lens; professional development; santé des Autochtones; type 2 diabetes
Authors: Lynden Lindsay Crowshoe; Rita Henderson; Kristen Jacklin; Betty Calam; Leah Walker; Michael E Green Journal: Can Fam Physician Date: 2019-01 Impact factor: 3.275
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