Exploring the cultural safety of rehabilitation interventions for indigenous adults with chronic conditions and their caregivers: a scoping review.

Abstract

Indigenous peoples experience disproportionately high rates of chronic illness alongside persistent systemic barriers to accessing healthcare. These inequities underscore the need for rehabilitation interventions that are culturally safe for Indigenous adults living with chronic conditions. This study aimed to assess the extent to which rehabilitation interventions for Indigenous adults with chronic conditions, and their caregivers, demonstrate cultural safety. Specifically, we examined whether interventions addressed six cultural safety themes [1]: collaboration and partnership [2]; power sharing [3]; consideration of the broader life context [4]; creation of a safe environment [5]; organizational and individual self-reflection; and [6] healthcare practitioner training. A scoping review was conducted following Joanna Briggs Institute methodology. Articles describing rehabilitation interventions for Indigenous adults with chronic conditions and/or caregivers were identified and analyzed using descriptive statistics and deductive content analysis. Twenty-seven articles describing 22 unique interventions met inclusion criteria. Only one intervention addressed all six cultural safety themes. On average, interventions addressed 3.2 ± 1.62 themes, and only one publication included family caregivers. Findings reveal a significant cultural safety gap in rehabilitation care for Indigenous adults with chronic conditions. Future interventions should explicitly integrate cultural safety frameworks and meaningfully involve caregivers in intervention development.