Factors influencing the provision of care for Inuit in a mainstream residential addiction rehabilitation centre in Southern Canada, an instrumental case study into cultural safety

• Published in: Substance Abuse Treatment, Prevention, and Policy
• Main Authors: Julie Lauzière, Christopher Fletcher, Isabelle Gaboury
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2021
• Subjects: Indigenous peoples; Inuit; Substance use treatment; Cultural safety; Cultural competence; Health equity; Public aspects of medicine; RA1-1270; Social pathology. Social and public welfare. Criminology; HV1-9960; Canada; inuit
• Online Access: https://doi.org/10.1186/s13011-021-00387-6; https://doaj.org/article/786a85eddb87479bb478911111788aa4

Abstract Background Provision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction. The factors that influence the provision of culturally safe care remain understudied. This paper explores the factors influencing the efforts of a mainstream residential addiction rehabilitation centre to provide culturally appropriate and quality care for Inuit. Methods An instrumental case study was conducted, informed by ethnographic and creative research methods. Over 700 h of participant observation were carried out between March 2018 and January 2020, in addition to qualitative semi-structured interviews (34 participants) and/or member-checking activities (17 participants) conducted with a total of 42 individuals: 20 Inuit residents, 18 clinical/specialized staff, and 4 clinical/administrative managers. An interpretive thematic analysis was performed to examine the factors that may influence the provision of culturally safe care for Inuit residents. Results Ten categories of interrelated factors were identified and classified according to whether they relate to individual, programmatic, organizational, or systemic levels. These categories covered: (1) residents’ and staff’s life experiences; (2) personal and relational qualities and skills; (3) the model of care; (4) model flexibility; (5) ways in which relational aspects were considered; (6) sensitivity of the organization towards the population served; (7) human resources and professional development issues; (8) social climate; (9) political, relational, and funding climate; and (10) legislative, regulatory, and professional environment. While system-level factors generally had a negative effect on experiences of cultural safety, most factors at other levels had both favourable and unfavourable effects, depending on the context and dimensions examined. Conclusions The results offer insight into the interplay between the challenges and barriers that mainstream organizations face when working with Inuit, ...