Using postcolonial theory and a cultural safety orientation to understand Inuit perspectives of public health TB policy and practice in Nunavut
Date
2024
Authors
Mckee, Donna Beverly
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Abstract
This research sought to understand Inuit perspectives of culturally safe public health tuberculosis policy and practice in Nunavut, Canada. The legacies of colonialism in Canada’s arctic north endure as harmful determinants of tuberculosis health, with Inuit of Nunavut continuing to experience inequitable rates of tuberculosis, up to three hundred times higher than Canadian-born non-Indigenous Canadians. Despite many studies investigating tuberculosis among Indigenous peoples, few studies have explored Inuit perspectives related to public health tuberculosis policy and practice. There is also lack of knowledge about what constitutes cultural safety related to TB policy and practice from Inuit perspectives, and thus the systemic issues that prevent Inuit from obtaining TB health services.
Given Canada’s colonial history and its impact on Inuit health, a postcolonial theoretical perspective was applied in this research to understand the key research objectives: 1) the factors communicated by Inuit, that would promote culturally safe TB policy and practice with Inuit communities, 2) ways Inuit understand how TB-related stigma shapes Inuit perspectives of public health TB programs and limits their participation, and 3) how Inuit envision mobilizing Inuit knowledge to inform and democratize Government of Nunavut public health policy and programs. Principles of community based participatory action research made space for Inuit voices to be recognized as knowledge holders involved in shaping policy and practice. I applied Inuit Qaujimajatuqangit principles and Inuit Tapiriit Kanatami’s research framework as a guide to promote culturally safe process and respect for Inuit self-determination.
Data were sourced from thirty conversational, semi-structured telephone interviews with twenty-five Inuit who were recognized as community knowledge holders, and five health care
professionals, three of whom were Inuit. Respondents were aged between 18-80 years of age, and self-identified as either men or women. Using Braun and Clarke’s Reflexive Thematic Analysis, the data were then used to identify and analyze seven themes that Inuit described as necessary for culturally safe public health tuberculosis policy and programs. Recommendations for addressing culturally safe TB policy and programs for Inuit of Nunavut are that: 1) Kablunaaq, non-Inuit, develop trust and respect towards Inuit; 2) Inuit social determinants of health are addressed; 3) TB-related stigma is addressed; 4) Kablunaaq respect the importance of Inuit Shamanism and spirituality; 5) intergenerational trauma informed care is provided; 6) Inuit Qaujimajatuqangit principles are recognised and used to guide health care policy and programs; and 7) Inuktut language can be used in health care. A three member Inuit Research Advisory Committee supported the research process, and after identification of the seven themes in the data, individual discussions were held with the committee members to probe the meanings of the data and ways to use the information that had been shared.
Methodologically, this research demonstrates and advances understandings of the applicability and use of cultural safety as an orientation to guide and inform researchers’ epistemological approaches to work with Indigenous peoples. In collaboration with Inuit, this research provides a pathway forward to improvement in the applicability of future public health TB policy and practice for Inuit.
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Keywords
postcolonial theory, cultural safety, Inuit, tuberculosis