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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 281-288 |
| Number of pages | 8 |
| Journal | Canadian Journal of Diabetes |
| Volume | 42 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jun 2018 |
Bibliographical note
Funding Information:This study was funded by the Canadian Institutes of Health Research (#IDP-103986) through an International Collaborative Indigenous Health Research Partnership grant, in partnership with the Health Research Council of New Zealand and the Australian Government National Health and Medical Research Council. The authors thank all interviewees for their involvement, as well as the research assistance of Ivan Semic, Ahn Ly, Elaine Boyling, JoAnne Parker, Sarah Elliot, Elaine Laflamme and Han Han.
Funding Information:
This study was funded by the Canadian Institutes of Health Research ( #IDP-103986 ) through an International Collaborative Indigenous Health Research Partnership grant, in partnership with the Health Research Council of New Zealand and the Australian Government National Health and Medical Research Council. The authors thank all interviewees for their involvement, as well as the research assistance of Ivan Semic, Ahn Ly, Elaine Boyling, JoAnne Parker, Sarah Elliot, Elaine Laflamme and Han Han.
Publisher Copyright:
© 2017 The Authors
Keywords
- Indigenous health
- continuing medical education
- healthcare policy
- post-colonial lens
- professional development
- type 2 diabetes
