Towards culturally safe holistic healthcare for Indigenous peoples experiencing homelessness in Montréal: a mixed-methods study among healthcare professionals

Indigenous peoples in Canada (Inuit, First Nations, and Métis) navigate adversity through family, community and cultural reconnection to better cope with ongoing colonialism. Structural factors have led to disproportionate levels of poverty and homelessness, particularly in urban areas. By 2022, Indigenous peoples represented 13% of Montréal’s homeless population, despite accounting for about 1% of the city’s residents. The Centre hospitalier de l’Université de Montréal (CHUM), in partnership with the Indigenous organisation Projets Autochtones du Québec (PAQ) carried out a collaborative research project among healthcare professionals to identify the conditions necessary for providing culturally safe, holistic healthcare to Indigenous peoples experiencing homelessness. Using a Two-Eyed Seeing approach, a mixed-methods study design and non-probabilistic sampling techniques, a survey ( n = 151) among clinical staff and semi-structured interviews ( n = 19) with service managers, heads of medical units and multidisciplinary clinical coordinators were conducted. Descriptive statistics and content analysis of collected narratives sought to characterise key components of ‘cultural safety in healthcare’: cultural humility, anti-racism and trauma-informed care. Findings showed limited practical knowledge of Indigenous realities and healing methods as well as a partial understanding of colonial intergenerational trauma among health professionals. Negative stereotypes and experiences of racism towards homeless Indigenous peoples were noted at the hospital, alongside difficulties in addressing complex health, social and cultural needs. Collaboration with specialised hospital resources and community workers emerged as key strategies to advance towards cultural safety in healthcare. Advancing cultural safety in healthcare requires the incorporation of Indigenous knowledge into clinical practice along with a better understanding of colonial intergenerational trauma among healthcare professionals. This approach should progressively lead to the deconstruction of negative stereotypes that underpin interpersonal racism against homeless Indigenous peoples. Cultural safety may also result in greater mutual empathy and respect within the hospital setting, more confidence towards the health system among homeless Indigenous peoples and less frustration among healthcare professionals. Ultimately, cultural safe care may contribute to improve both service quality and holistic wellbeing for homeless Indigenous peoples.