Governance, financing, and cultural safety in Taiwan’s indigenous long-term care: a CFIR/RE-AIM analysis of Wenjian stations

Taiwan’s Indigenous communities face profound health inequities driven by colonial legacies, rural ageing, and structurally misaligned long-term care policies. Life expectancy gaps approach 12 years compared to the general population. Indigenous Cultural Health Stations (ICHS; Wenjian Stations) provide community-based support for older adults, yet are constrained by fragmented funding cycles, undervalued cultural labour, and governance arrangements that impede culturally safe health promotion. This study aimed to investigate how governance arrangements, financing flows, and workforce norms shape the sustainability and equity of ICHS in Taiwan, and to assess the perceived acceptability and contextual prerequisites of culturally adapted dual-task training (DTT) within Atayal and Paiwan ICHS contexts. We conducted a qualitative study employing a decolonising research paradigm grounded in Indigenous research methodologies. Nine purposively sampled participants—community care attendants, programme leads, and one local government officer—from Atayal and Paiwan ICHS were interviewed between August and October 2025. Data were analysed via reflexive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Three themes emerged: (1) Cultural Adaptation and Cross-Cultural Competence—integration of Indigenous languages, traditions, and intergenerational practices enhances engagement and acceptability among older adults; (2) Sustainability and Equity in Community Health Services—structural misalignments in funding cycles, governance transitions, and resource allocation erode service continuity and coverage; (3) Implementation Mechanisms and Community Engagement—grassroots co-learning, home-visit outreach, and intergenerational programming build capacity for culturally safe service delivery. Cultural safety—operationalised as linguistic congruence, relational accountability, and protection of cultural knowledge—emerged as a specifiable and monitorable mechanism for RE-AIM reach and maintenance. Three structural barriers—funding conditionality, governance transition costs, and undervalued cultural labour—compromise ICHS equity and continuity. Aligning financing cadence, workforce recognition, and indicator design with cultural safety is the most direct path to closing the gap between statutory rights under the Indigenous Peoples Health Act and frontline ICHS practice. A CFIR/RE-AIM reform framework is proposed to support Indigenous-led commissioning. Future co-designed DTT implementation trials are required to confirm reach, elder-reported acceptability, and programme fidelity.