It's a Journey Not a Check Box: Indigenous Cultural Safety From Training to Transformation

Indigenous Peoples in Canada continue to experience racism and discrimination when accessing health care. Competencies of health care staff urgently need to be improved through cultural safety education and training programs to inform culturally appropriate and safe care practice among care providers serving Indigenous individuals and families. This paper explores current educational strategies, the perspectives of Indigenous and non-Indigenous care providers on training approaches, and recommendations for improving training. Qualitative semi-structured interviews were conducted with 31 participants to explore the current provision of culturally appropriate and safe care. Interviews were voice recorded and transcribed verbatim, and a thematic analysis was completed. The three key themes related to training that emerged from data analysis were (a) addressing the knowledge gaps, (b) challenges of current training approaches, and (c) recommendations for improvements in training. Each key theme had three subthemes that were further explored. Cultural safety training is a long and iterative process that has the potential to change care providers' behaviours and attitudes. Various challenges to existing education and training included issues with implementation, limited follow up with health care staff to support practice changes, and/or limited commitment from senior leadership to change organizational policies and practices. As such, there is a clear need for systemic change within health care institutions to support staff participating in cultural safety training and to put that training into practice to create a culturally safe space for Indigenous individuals seeking health care.