Donna Beverly McKee

Topic

Using Postcolonial Theory and a Cultural Safety Orientation to Understand Inuit Perspectives of Public Health TB Policy and Practice in Nunavut

School of Nursing

Date & location

• Tuesday, May 7, 2024
• 10:00 A.M.
• Human & Social Development Building, Room A451

Examining Committee

Supervisory Committee

• Dr. Nancy Clark, School of Nursing, University of Victoria (Supervisor)
• Dr. Marjorie MacDonald, School of Nursing, UVic (Member)
• Dr. Catherine Worthington, School of Public Health and Social Policy, UVic (Outside Member)

External Examiner

• Dr. Wendy Gifford, School of Nursing, University of Ottawa

Chair of Oral Examination

• Dr. Matthew Little, School of Public Administration, UVic

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 research objectives: 1) the factors that would promote culturally safe tuberculosis policy and practice with Inuit communities; 2) the ways tuberculosis-related stigma shapes Inuit experience of public health tuberculosis programs; and 3) the ways that Inuit envision mobilizing Inuit knowledge to inform and democratize Government of Nunavut public health tuberculosis 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 adopted an integrated knowledge translation approach to establish meaningful collaboration to enact change with Inuit communities. I also 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 male or female. 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: 1) the need for non-Inuit, known as Kablunaaq, to develop trust and respect towards Inuit; 2) the need to address Inuit social determinants of health; 3) the need to address TB-related stigma; 4) the need for Kablunaaq to respect the importance of Inuit Shamanism and spirituality; 5) the need to provide intergenerational trauma informed care; 6) the need for recognition and use of Inuit Qaujimajatuqangit principles in guiding health care policy and programs; and 7) the need for use of Inuktut language 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.