Co-designed cultural safety in Nunavik: proof-of-impact

Hospital care in Nunavik depends heavily on non-Inuit health professionals. This raises issues of cultural safety for Inuit, who need to feel their health care is spiritually, socially, emotionally and physically safe. Lack of cultural safety often accompanies interpersonal and systemic racism. There is no standard way to implement cultural safety, because it is specific to different groups and even to individual communities. It is also tricky to reduce systemic racism when the official position of the Quebec government is that this does not exist. Cultural safety in Nunavik must "walk on two legs", with Inuit patients and communities authoring cultural safety and non-Inuit health workers authoring alternatives to racism. Scoping reviews will collate literature on cultural safety and anti-racism interventions. Cognitive mapping will collate how Inuit and non-Inuit see cultural safety and racism. Focus groups or key informant interviews will clarify words and issues surfaced by the mapping. Surveys will measure experiences of cultural safety or its absence. This evidence will feed evidence into deliberative dialogue, allowing service providers and communities to co-design evidence-based solutions. A year4 repeat survey will compare (before/after) health and care seeking behaviours, and ripple effects like cultural continuity and job satisfaction of service providers. A narrative evaluation will document the most significant change for service providers and Inuit communities. We will develop multi-media training modules for non-Inuit and Inuit health workers and for other health facilities wanting to develop community-led cultural safety and anti-racism interventions. This participatory research engages Inuit communities and the hospitals serving them, the Nunavik Regional Board for Health and Social Services (TBC) and McGill Family Medicine. The project will last five years.