Defining culturally safe primary care for people who use substances: a participatory concept mapping study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Anxiety Disorders* ; Primary Health Care*; Adult ; Delivery of Health Care ; Female ; Humans

Background: People who use substances experience high levels of substance-related stigma, both within and outside of health care settings, which can prevent people from help-seeking and contribute further to health inequities. Recognizing and respecting how political, social, economic, and historical conditions influence health and health care, cultural safety, with origins in addressing Indigenous racism, is a potential strategy for mitigating stigma and marginalization in health care. Using a participatory research approach, we applied the concept of cultural safety to develop a model of safe primary care from the perspective of people who use substances.
Methods: People who use or used substances were involved in all phases of the research and led data collection. Study participants (n = 75) were 42.5 years old on average; half identified as female and one quarter as Indigenous. All were currently using or had previous experience with substances (alcohol and/or other drugs) and were recruited through two local peer-run support agencies. Concept mapping with hierarchical cluster analysis was used to develop the model of safe primary care, with data collected over three rounds of focus groups.
Results: Participants identified 73 unique statements to complete the focus prompt: "I would feel safe going to the doctor if …" The final model consisted of 8 clusters that cover a wide range of topics, from being treated with respect and not being red-flagged for substance use, to preserving confidentiality, advocacy for good care and systems change, and appropriate accommodations for anxiety and the effects of poverty and criminalization.
Conclusions: Developing a definition of safe care (from the patient perspective) is the necessary first step in creating space for positive interactions and, in turn, improve care processes. This model provides numerous concrete suggestions for providers, as well as serving as starting point for the development of interventions designed to foster system change.

Soc Sci Med. 2017 Jul;184:23-26. (PMID: 28494318)
Clin Infect Dis. 2013 Aug;57 Suppl 2:S51-5. (PMID: 23884066)
MMWR Morb Mortal Wkly Rep. 2016 Jan 01;64(50-51):1378-82. (PMID: 26720857)
BMC Fam Pract. 2015 Oct 13;16:135. (PMID: 26463083)
Drug Alcohol Rev. 2011 Jan;30(1):26-32. (PMID: 21219494)
Can Nurse. 2009 Apr;105(4):16-22. (PMID: 19435252)
CJEM. 2016 Jul;18(4):301-5. (PMID: 26565079)
Health Promot Pract. 2006 Jul;7(3):312-23. (PMID: 16760238)
Health Promot Chronic Dis Prev Can. 2018 Jun;38(6):224-233. (PMID: 29911818)
Nurs Prax N Z. 2000 Mar;15(1):4-12. (PMID: 11221309)
Eval Program Plann. 2012 May;35(2):236-45. (PMID: 22221889)
Int J Drug Policy. 2007 Mar;18(2):107-17. (PMID: 17689353)
Int J Equity Health. 2012 Oct 13;11:59. (PMID: 23061433)
Int J Drug Policy. 2013 May;24(3):257-64. (PMID: 23036653)
Psychiatr Serv. 2009 Dec;60(12):1676-9. (PMID: 19952160)
ANS Adv Nurs Sci. 2015 Apr-Jun;38(2):121-35. (PMID: 25932819)
Int J Drug Policy. 2010 Jan;21(1):4-9. (PMID: 19747811)
Can HIV AIDS Policy Law Rev. 2004 Aug;9(2):13-9. (PMID: 15540324)
Drug Alcohol Depend. 2014 Jan 1;134:92-98. (PMID: 24099970)
Soc Sci Med. 2014 Apr;106:151-8. (PMID: 24561777)
Subst Abuse Treat Prev Policy. 2013 Oct 01;8:35. (PMID: 24079946)
Med Teach. 2015 Jan;37(1):94-6. (PMID: 25154410)
Int J Drug Policy. 2007 May;18(3):194-203. (PMID: 17689366)
Int J Drug Policy. 2010 Jul;21(4):321-9. (PMID: 20116989)
Drug Alcohol Depend. 2007 May 11;88(2-3):188-96. (PMID: 17118578)
Drug Alcohol Depend. 2013 Jul 1;131(1-2):23-35. (PMID: 23490450)
Int J Drug Policy. 2016 Jan;27:23-35. (PMID: 26359046)
Qual Health Res. 2015 Dec;25(12):1662-74. (PMID: 25583958)
Harm Reduct J. 2011 Jun 30;8:17. (PMID: 21718531)
Am J Public Health. 2010 Aug;100(8):1454-61. (PMID: 20558789)
Nurs Philos. 2009 Jul;10(3):167-79. (PMID: 19527438)
Int J Equity Health. 2015 Dec 14;14:152. (PMID: 26694168)
Soc Sci Med. 2009 Oct;69(7):1080-4. (PMID: 19692163)
Int J Drug Policy. 2010 May;21(3):255-8. (PMID: 19766474)
ANS Adv Nurs Sci. 2009 Oct-Dec;32(4):282-94. (PMID: 19934835)
Drug Alcohol Rev. 2005 Mar;24(2):143-55. (PMID: 16076584)
Am J Public Health. 2006 Mar;96(3):538-46. (PMID: 16449581)
Can J Occup Ther. 2012 Jun;79(3):151-8. (PMID: 22822692)
Subst Abus. 2008;29(4):61-4. (PMID: 19042199)
JAMA. 2017 Dec 19;318(23):2295-2296. (PMID: 29049472)
Qual Health Res. 2011 Mar;21(3):333-48. (PMID: 21075979)
Int J Drug Policy. 2010 Sep;21(5):418-21. (PMID: 20359877)
J Gen Intern Med. 2002 May;17(5):327-33. (PMID: 12047728)

PEG-151800 Canada CAPMC CIHR

Keywords: Canada; Community based participatory research; Concept mapping; Cultural safety; Primary care; Stigma; Substance use

Date Created: 20201124 Date Completed: 20210514 Latest Revision: 20240330

20250114

PMC7685616

10.1186/s12913-020-05915-x

33228650