A cross-sectional analysis of the relationship between diabetes and health access barriers in an urban First Nations population in Canada

Michael Beckett · Michelle Firestone · Constance McKnight · Janet K. Smylie · Michael Anthony Rotondi

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Indigenous Health, Education, and Rights Diabetes Management and Education Indigenous Health and Education

Abstract

OBJECTIVE: This study explores the relationship between health access barriers and diabetes in an urban First Nations population in Canada. DESIGN: Data from a self-identified urban First Nations population were collected using respondent-driven sampling (RDS). As no clear approach for regression modelling of RDS data is available, two logistic regression modelling approaches, including survey-based logistic and generalised linear mixed models, were used to explore the relationship between diabetes and health barriers of interest, including access to healthcare, food, housing and socioeconomic factors. SETTING: Hamilton, Ontario, Canada. PARTICIPANTS: This cross-sectional study used data collected from the Our Health Counts study, in partnership with the De dwa da dehs nye>s Aboriginal Health Centre, which recruited 554 First Nations adults living in Hamilton using RDS. RESULTS: After adjusting for covariates, multivariable regression techniques showed a statistically significant relationship between a self-reported diagnosis of diabetes and a lack of culturally appropriate care among urban First Nations peoples (OR: 12.70, 95% CI 2.52 to 57.91). There was also a trend towards a relationship between diabetes and not having a doctor available in the area, feeling that healthcare provided was inadequate and a lack of available healthcare services in the area. CONCLUSIONS: Urban First Nations peoples who felt the health service they received was not culturally appropriate were more likely to have diabetes, compared with those who did not feel the service they received was culturally inappropriate. Establishing more healthcare services that integrate First Nations cultures and traditions could improve access to care and the course of treatment for urban First Nations peoples living with diabetes.

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References

2013The intergenerational effects of Indian Residential Schools: Implications for the concept of historical trauma 2009Cultural Safety Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness 1996Report of the Royal Commission on Aboriginal Peoples 2010Access to Primary Care From the Perspective of Aboriginal Patients at an Urban Emergency Department 2015Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for Indigenous populations in Canada 2017Health care experiences of Indigenous people living with type 2 diabetes in Canada 2009The crisis of chronic disease among Aboriginal Peoples: A challenge for public health, population health and social policy 2009Indigenous children's health report: health assessment in action.

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