背景:社区驱动的初级医疗保健(PHC)研究可能会减少土著人民的慢性病负担。本系统综述评估了来自四个具有相似殖民历史的国家的土著人民使用PHC研究报告的文化安全性。
方法:Medline,从2002年1月1日至2023年4月4日,对CINAHL和Embase进行了系统搜索。如果论文是原始研究,以英文出版,并包括数据(定量,定性和/或混合方法)关于慢性疾病(慢性肾脏疾病,心血管疾病和/或糖尿病),来自西方殖民地国家的土著人民。研究筛选和数据提取由两名作者独立进行,其中至少有一个是土著人。论文的基线特征采用描述性统计分析。使用两种质量评估工具对研究论文的文化安全方面进行了评估:CONSIDER工具和CREATE工具(子集分析)。本系统评价是根据评估系统评价的方法学质量(AMSTAR)工具进行的。
结果:我们确定了来自澳大利亚的35篇论文,新西兰,加拿大,和美国。大多数论文是定量的(n=21),包括42,438人的数据。纳入论文的文化安全性差异很大,在充分报告研究伙伴关系方面存在差距,在整个研究过程中提供参与者和土著研究治理的明确集体同意,特别是在传播方面。大多数论文(94%,33/35)指出,研究目标来自社区或经验证据。我们还发现,71.4%(25/35)的论文报告说,通过考虑定植对减少初级医疗保健的影响,使用基于优势的方法。
结论:关于土著PHC使用的研究应采用更文化安全的方式,通过在整个研究过程中赋予土著声音特权,提供与社区需求相关的护理和研究成果,包括传播。土著利益攸关方应在整个过程中更正式和明确地参与,以指导研究实践,包容土著价值观和社区需求。
BACKGROUND: Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories.
METHODS: Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool.
RESULTS: We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in
dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access.
CONCLUSIONS: Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including
dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs.