A qualitative study of challenges and facilitators to implementing an Indigenous-led cultural safety education program within a large urban emergency department in Vancouver, Canada.

backgroundThere is growing recognition of the extent and harm of anti-Indigenous racism within public institutions, including healthcare settings. Despite efforts to expand access to Indigenous Cultural Safety (ICS) education programs for healthcare providers, there is limited research examining challenges and facilitators to the implementation of Indigenous-led and -delivered ICS education programs. This study sought to explore the barriers and facilitators to implementing an ICS education program within Western Canada's largest Emergency Departments.

methodsThis qualitative process evaluation was guided by a Two-Eyed Seeing approach, and the research team included both Indigenous and non-Indigenous researchers committed to conducting culturally safe research. An implementation team consisting of Indigenous and non-Indigenous administrators participated in an Elder-led sharing circle at the mid-point of the targeted delivery of an ICS education pilot program for nurses and allied health professionals in an urban Emergency Department in Vancouver, Canada. The sharing circle was audio recorded and transcribed, and general interpretivist study design and inductive thematic analysis approach were used.

resultsA total of 10 implementation team members, two from the Emergency Department and eight from Indigenous Health Department, participated in a 2-hour sharing circle hosted in May 2022. Several common challenges were identified, including external events and time constraints; program readiness and staff recruitment; and difficulty securing facilitators. Several facilitators to program implementation were also identified, including leader buy-in and cross-departmental communication; on-the-ground project management and coordination; flexible scheduling and accommodations; and facilitator and implementation team support.

conclusionsThese results reinforce the importance of centering Indigenous leadership in the design, implementation, and the evaluation of ICS education programs, while also highlighting the importance of allies in delivering curricula and that facilitators are supported. Efforts are also needed to ensure that programs are flexible and accommodating to address potential recruitment and attendance challenges, including through alternative educational modalities. Lastly, mandating attendance is one approach to addressing recruitment challenges, though compulsory approaches may discourage meaningful engagement. CLINICAL

trial registrationNot applicable.