The Impact of Indigenous Cultural-Safety Education Programs: A Literature Review

Background: Indigenous-awareness education programs have been implemented in healthcare organizations to improve culturally-safe healthcare practices across Canada. Although many education programs have supported healthcare providers to understand cultural-safety, it is also important to evaluate these programs and ensure that cultural-safety knowledge is translated effectively into practice with Indigenous peoples.Methods: Five systematic reviews were initially identified through a scoping review to understand the current body of evidence on cultural-safety education. Using systematic methods, a review was then conducted to identify evaluations of cultural-safety education programs that incorporated quantitative methods and were published in academic journals between 2009 and 2019. Medline, CINAHL, and PsycINFO databases were used. In total, 215 studies were identified and screened; full text articles were assessed for 27 studies; 14 studies that met all inclusion criteria were then selected for final review.Results: Five systematic reviews found variability in evaluation methods, pedagogical approaches, and student experiences and outcomes across studies that evaluated cultural-safety education interventions. The overall quality of the 14 included studies was fair, encompassing pre-post, cross-sectional and longitudinal quantitative designs, as well as mixed methods using qualitative components in some cases. A number of evaluation tools were used to report on outcomes related to culturally-safe practices. Across the studies, outcomes were described in knowledge, attitudes, perceptions, confidence, communication, collaboration, empathy, cultural competency, cultural capability, “cultural desire” and student engagement with Indigenous health opportunities. Changes in participant behaviour and practice were also described through the educational outcomes summarized. This review contributes to the literature by comparing quantitative outcomes across the available studies, and by summarizing Indigenous methods atn teaching where these were available.Discussion: Cultural-safety education evaluations have been previously criticized for their lack of rigour. As the studies included in this review did not use the most rigorous designs, more research using randomized controlled trials is needed to assess the impact of cultural-safety education, including how knowledge is applied in practice. Future studies could also make more use of qualitative techniques, as seen in the mixed-method studies summarized in this review, to examine how participants may reflect and critically examine their roles in creating culturally-safe environments for Indigenous people.Conclusions: For all healthcare providers, learning how to provide culturally-safe care with Indigenous patients is a lifelong journey. Future research should explore and support Indigenous-led approaches in developing new interventions and evaluation measures. Academic and healthcare institutions also need to ensure that students and providers are not only equipped with knowledge about cultural-safety but also able to apply their knowledge to improve the healthcare experiences of Indigenous patients.