Cultural Components of Safer Ways of Engagement in Health Research

The George & Fay Yee Centre for Healthcare Innovation hosts monthly seminars focused on patient engagement. The series, called Patient Engagement Lunchtime Learning, is geared to all levels of learners looking to understand patient engagement and how to incorporate these best practices into their research projects.

This session was presented on June 12, 2024 by CHI's Patient and Public Engagement Lead and special guest speakers.

1. 2023-2024 Patient Engagement Lunchtime Learning Series
CULTURAL COMPONENTS OF SAFER
WAYS OF ENGAGEMENT IN HEALTH
RESEARCH

2. We are gathered on the ancestral and current day lands and waters of the
Anishinaabeg, Cree, Ojibway -Cree, Dakota and Denesuline peoples, and
on the National Homeland of the Red River Métis. In northern Manitoba,
we acknowledge the ancestral lands of the Inuit and gratefully
acknowledge that our water is sourced from Shoal Lake 40 First Nation.
We respect the Treaties that were made on these lands, we acknowledge
the harms and mistakes of the past and present, and we dedicate
ourselves to move forward in partnership with Indigenous communities in
a spirit of reconciliation
and collaboration.

3. Mentimeter Activity

4. •It is the initial awareness and acknowledgment of cultural
differences and observing those difference.
Limitation:
•Focuses on the 'other' and the 'other culture.’
•No consideration regarding political or socio- economic
influences on cultural difference.
•Does not require an individual to reflect on one’s own cultural
perspectives, privileges, position and its impacts on other
cultural groups.

(Canadian Nurses Association., 2018; Curtis et al., 2019; Ward et al., 2016)
Stepping Forward Towards
Cultural Safety

5. Stepping Forward Towards
Cultural Safety

6. (Curtis et al., 2019; Heckenberg, 2020)
•The recognition of the need to respect cultural differences.
•Exhibiting "behaviours that are considered polite and respectful
by the [person of the other culture].”
•Similar to cultural awareness, cultural sensitivity focuses on the
'other' and the 'other culture.’
•Starting our journey towards self-exploration, own life
experiences and realities, and the impacts it may have on
others.
•It’s about seeing ourselves and ourselves in relation to others
Milton Bonnet
Cultural Sensitivity

7. Stepping Forward Towards
Cultural Safety

8. Cultural Competency
Karl Dennis (no picture found)
Terry Cross
Barbara Bazron
Mareasa R. Isaacs
•Cultural competency emerged in the 80’s as a
recognized approach to improving health provisions
and aiming to reduce health disparities.
•In the 90’s it was individually focused framework
(obtaining skills, knowledge, and attitudes to work with
folks in a more effective and respectful ways).

(Curtis et al., 2019; Heckenberg, 2020; Ward et al., 2016)

9. Cultural Competency
Critiqued for its limitations:
•It focused on acquiring knowledge without one’s own positionality, self-
reflection and reflexivity, as well as policies and institutional influences and
its impacts.
Shift in the framework:
•In the 2000’s there was shift in government policies and cultural
competency scholars began to express cultural competency in terms of
individual AND organizational/ institutional level interventions.
•Cultural Competency encourages to delve deeper into organizational
practices.
(Curtis et al., 2019; Heckenberg, 2020; Ward et al., 2016 )

10. Stepping Forward Towards
Cultural Safety

11. Cultural Humility
Melanie Tervalon
Jann Murray-Garcia
•Cultural humility values and encourages life- long learning and
self-critical reflection, along with respectful and inquisitive
approach.
•Practicing and incorporating cultural humility enables us to
work towards cultural safety.
•Cultural humility involves humbly acknowledging oneself as a
learner when it comes to understanding another's experience,
and dismantling power imbalances.
(Curtis et al., 2019; Heckenberg, 2020; Ward et al., 2016; Wheeler, 2018)

12. Cultural Humility
Key Attributes:
•A personallifelong commitment to self-evaluation and self-
critique
•Empathy and compassion
•Recognition of power dynamics and imbalances.
•Institutional accountability
(Yeager et al., 2013).

13. Stepping Forward Towards
Cultural Safety

14. Cultural Safety
Irihapeti Ramsden •Cultural safety is a term that was first coined by the
Maori nursing student Hinerangi Mohi, in New
Zealand, in the 80’s.
•Cultural Safety is an evolving concept.
•Cultural Safety is both most rigorous and extensive
within Indigenous contexts.
(Curtis et al., 2019; Heckenberg, 2020; Osie-Twum, 2019; Ward et al., 2016; Wheeler, 2018)

15. Cultural Safety
(Nixon, 2019)
•What sets Cultural Safety apart from the previous steps, is that working towards cultural safety
we must be prepared to critique unearned power structures.
•Challenge our own culture and cultural systems that might be perpetuating oppression and
furthering health inequities rather than prioritizing becoming an expert in the culture of others.
Coin Model of Privilege and Criticle Allyship

16. Stepping Forward Towards
Cultural Safety

17. Guiding Questions Towards
Cultural Safety in Research
•Have you considered the historical and current day context?
•What are the community’s cultural values, beliefs, and protocols?
•Have you reflected on your own cultural background?

19. CULTURE AND ITS CONTEXT THROUGH REAL LIFE
EXAMPLES
CREATING SAFER SPACES BUILT ON MUTUAL RESPECT,
SHARED UNDERTANSING, AND VALUING OUR
DIFFERNCES

20. The Continuum of Cultural
Maturity

21. References
Brooks-Cleator, L., Phillipps, B., & Giles, A. (2018). Culturally safe health initiatives for indigenous peoples in Canada: A scoping review. Canadian Journal of Nursing Research, 50(4), 202–
213. https://doi.org/10.1177/0844562118770334
Canadian Nurses Association (2018). “Promoting Cultural Competence inNursing.
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature
review and recommended definition. International Journal for Equity in Health, 18(1), 174. https://doi.org/10.1186/s12939- 019-1082-3
Cultural competency & cultural safety toolkit. (2016). Saskatoon Health Region. https://www.saskatoonhealthregion.ca/locations_services/Services/Health-Observatory/Documents/Resource-
Centre/CCCS%20Toolkit%20%20Reflection%20Infographic%20- %20combined.pdf
Cultural competency and safety: A guide for health care administrators, providers and educators. (2008). National Aboriginal Health Organization.
https://www.canada.ca/en/health- canada/services/publications/health-system-services/chief-public-health- officer-health- professional-forum-common-definitions-cultural-safety.html
Heckenberg, S. (2020). Cultural safety: A model and method that reflects us, respects us
and represents us.Journal of Australian Indigenous Issues,23(3-4), 48-66.
Nixon, S. A. (2019). The coin model of privilege and critical allyship: Implications for health. BMC Public Health, 19(1), 1637. https://doi.org/10.1186/s12889- 019-7884-9.
Osie-Twum, J., Pulfer, E., Banerjee, A. T. (2019). Exploring the applicability of indigenous cultural safety to immigrant health research. In B. K. Newbold & K. Willson (Eds.),A Research Agenda
for Migration and Health(pp. 138- 158).
Public Healht Agency of Canada. (2023). Common Definitons on Cultural Safety: Chief Public Health Officer Health Professional Forum. definitions-en2.pdf (canada.ca).
Ward, C., Fridkin, C. B., & Fridkin , A. (2016). What is Indigenous cultural safety—And why should I care about it? Visions: BC’s Mental Health and Substance Use Journal, 11(4), 29.
Wheeler, Michael. (2018). “Cultural Competence and Cultural Humility A Literature Review for Understanding and Action.”
Yeager, Katherine A., and Susan Bauer-Wu. (2013)."Cultural Humility: Essential Foundation For Clinical Researchers".Applied Nursing Research26 (4): 251- 256.