Rural Indigenous Experiences of Healthcare Services: A Scoping Review.

INTRODUCTION: Indigenous peoples experience significant health inequities compared to non-Indigenous peoples. The reasons for this are multi-faceted. Access to healthcare for marginalised Indigenous peoples is made more difficult by living rurally; urban counterparts have improved healthcare access and health outcomes. OBJECTIVE: This review aimed to further understand the healthcare experiences of rural Indigenous peoples residing in New Zealand (Aotearoa), Australia, Canada or the United States of America (USA). INCLUSION CRITERIA: Participants were required to self-identify as Indigenous consumers of healthcare aged 18 years or older, with personal or family experiences of receiving healthcare. Contextually, rural healthcare service access in any healthcare setting was chosen. The countries chosen for inclusion were New Zealand, Australia, Canada, and the USA. Exclusion criteria included studies with non-Indigenous participants with healthcare experiences that were unable to be isolated and extracted, as well as studies involving both rural and urban healthcare experiences where the urban experiences were unable to be isolated and removed. METHODS: The electronic databases Scopus (Elsevier), CINAHL Complete (EBSCOhost) and Medline (OVID) were searched. Articles were screened by one author (TC) to identify primary research studies that reported patient lived experiences and included Indigenous participants who live rurally. Searches were completed in June 2024 and limited to full text, English language and date limited to 2004-2024. Articles were then analysed via thematic analysis. FINDINGS: Seven articles were analysed. The articles were located in Aotearoa, Australia, and Canada. No suitable studies from the USA were identified or included. Five themes were identified as having impacted the healthcare experiences of Indigenous peoples: distance to care; quality of care and racism; support from and impact on, whānau (family); health professional communication and knowledge sharing; and Indigenous solutions and holistic care. CONCLUSION: Ensuring that patient-centred care also involves wider family members has been shown to be beneficial, as has the engagement of Indigenous health professionals and health workers in providing culturally inclusive healthcare. Health professionals should consider language and communication techniques when engaging with people seeking healthcare and not make assumptions, for example around health knowledge.