東華大學圖書館 |

Giving Birth in a Good Way: Co-Designing Culturally Safe Birthing Services With Inuit From Nunavik and Their Service Providers /

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Giving Birth in a Good Way: Co-Designing Culturally Safe Birthing Services With Inuit From Nunavik and Their Service Providers // Hilah Silver.
作者:	Silver, Hilah,
面頁冊數:	1 electronic resource (165 pages)
附註:	Source: Dissertations Abstracts International, Volume: 86-08, Section: B.
Contained By:	Dissertations Abstracts International86-08B.
標題:	Medicine. -
電子資源:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=31836703
ISBN:	9798304950329

Giving Birth in a Good Way: Co-Designing Culturally Safe Birthing Services With Inuit From Nunavik and Their Service Providers /
Silver, Hilah,

Giving Birth in a Good Way: Co-Designing Culturally Safe Birthing Services With Inuit From Nunavik and Their Service Providers /Hilah Silver. - 1 electronic resource (165 pages)

Source: Dissertations Abstracts International, Volume: 86-08, Section: B.

BackgroundIndigenous Peoples in remote regions of Canada are routinely transferred outside of their communities for birth - a practice known as childbirth evacuation. Recent evidence links childbirth evacuation with negative health and social impacts. Evacuation affects Inuit in Nunavik (Inuit territory in Northern Quebec), where at least 14% of people leave their communities for birth. Moreover, rapid population growth risks exceeding service capacity for local birthing in the region, recognized for its revitalization of Inuit midwifery and community birthing. With widening inequities in perinatal outcomes between Inuit and non-Indigenous in Quebec, there is a pressing need for culturally safe service re-design of childbirth evacuation, alongside support for continued local birthing in Nunavik.Objectives and methodsThis doctoral project engaged Inuit and their service providers in Montreal and Nunavik to support culturally safe Inuit birth in the context of evacuation and local birthing. Four objectives guided the thesis by publication:Objective 1: Assess the factors and outcomes associated Indigenous childbirth evacuation in Canada as the foundation for stakeholder mobilization and engagement in service re-design, using a scoping review of the literature (addressed in Publication 1).Objective 2: Collate the visions of Inuit evacuated for childbirth and their Montreal service providers about birth in a good way in the context of evacuation, using fuzzy cognitive mapping (FCM) (addressed in Publication 2).Objective 3: Develop a list of priority recommendations, implement, and evaluate these with service providers and Indigenous patient partners at the McGill University Health Centre (Publication 3).Objective 4: Examine Inuit and Nunavik service providers' perspectives on supporting perinatal wellness and birth in a good way in Nunavik, along with pathways for continued childbirth in the region, using FCM (Publication 4).ResultsCollating the research on Indigenous childbirth evacuation, the scoping review illustrated numerous emotional, social, and cultural harms. It highlighted a need to re-evaluate childbirth evacuation, considering knowledge gaps regarding its long-term impacts on Indigenous perinatal outcomes (Publication 1). A local application of FCM with 8 Inuit and 24 service providers in Montreal generated 17 recommendations for culturally safer childbirth evacuation. Operator independent weighting, based on Harris' discourse analysis helped collate stakeholder perspectives (Publication 2). A narrative description illustrated the implementation of four codesigned cultural safety interventions with Indigenous stakeholders and service providers. Tested against a modified theory of planned behaviour, an Indigenous-led cultural safety training demonstrated positive influence on service provider knowledge and actions (Publication 3). FCM with 16 Inuit and 9 service providers illustrated 13 protective factors of birth in a good way in Nunavik. Well-equipped medical facilities, local birth centres, and Inuit perinatal traditions had the strongest influence. For Inuit youth, instrumental and emotional support for mothers and families, along with health and self-care in pregnancy were the most influential factors for perinatal wellness. 21 Inuit and 7 providers identified 12 factors for continued community birthing in Nunavik, with local birth centres and well-equipped medical facilities being the most influential (Publication 4).ConclusionInuit and their service providers have detailed knowledge of culturally safe birth in the contexts of evacuation and local birthing. FCM collated Inuit and service provider visions, refining a method for stakeholder input and mobilisation in an area of shared concern.

English

ISBN: 9798304950329Subjects--Topical Terms:

641104
Medicine.
Subjects--Index Terms:

Fuzzy cognitive mapping

Giving Birth in a Good Way: Co-Designing Culturally Safe Birthing Services With Inuit From Nunavik and Their Service Providers /
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520 $a BackgroundIndigenous Peoples in remote regions of Canada are routinely transferred outside of their communities for birth - a practice known as childbirth evacuation. Recent evidence links childbirth evacuation with negative health and social impacts. Evacuation affects Inuit in Nunavik (Inuit territory in Northern Quebec), where at least 14% of people leave their communities for birth. Moreover, rapid population growth risks exceeding service capacity for local birthing in the region, recognized for its revitalization of Inuit midwifery and community birthing. With widening inequities in perinatal outcomes between Inuit and non-Indigenous in Quebec, there is a pressing need for culturally safe service re-design of childbirth evacuation, alongside support for continued local birthing in Nunavik.Objectives and methodsThis doctoral project engaged Inuit and their service providers in Montreal and Nunavik to support culturally safe Inuit birth in the context of evacuation and local birthing. Four objectives guided the thesis by publication:Objective 1: Assess the factors and outcomes associated Indigenous childbirth evacuation in Canada as the foundation for stakeholder mobilization and engagement in service re-design, using a scoping review of the literature (addressed in Publication 1).Objective 2: Collate the visions of Inuit evacuated for childbirth and their Montreal service providers about birth in a good way in the context of evacuation, using fuzzy cognitive mapping (FCM) (addressed in Publication 2).Objective 3: Develop a list of priority recommendations, implement, and evaluate these with service providers and Indigenous patient partners at the McGill University Health Centre (Publication 3).Objective 4: Examine Inuit and Nunavik service providers' perspectives on supporting perinatal wellness and birth in a good way in Nunavik, along with pathways for continued childbirth in the region, using FCM (Publication 4).ResultsCollating the research on Indigenous childbirth evacuation, the scoping review illustrated numerous emotional, social, and cultural harms. It highlighted a need to re-evaluate childbirth evacuation, considering knowledge gaps regarding its long-term impacts on Indigenous perinatal outcomes (Publication 1). A local application of FCM with 8 Inuit and 24 service providers in Montreal generated 17 recommendations for culturally safer childbirth evacuation. Operator independent weighting, based on Harris' discourse analysis helped collate stakeholder perspectives (Publication 2). A narrative description illustrated the implementation of four codesigned cultural safety interventions with Indigenous stakeholders and service providers. Tested against a modified theory of planned behaviour, an Indigenous-led cultural safety training demonstrated positive influence on service provider knowledge and actions (Publication 3). FCM with 16 Inuit and 9 service providers illustrated 13 protective factors of birth in a good way in Nunavik. Well-equipped medical facilities, local birth centres, and Inuit perinatal traditions had the strongest influence. For Inuit youth, instrumental and emotional support for mothers and families, along with health and self-care in pregnancy were the most influential factors for perinatal wellness. 21 Inuit and 7 providers identified 12 factors for continued community birthing in Nunavik, with local birth centres and well-equipped medical facilities being the most influential (Publication 4).ConclusionInuit and their service providers have detailed knowledge of culturally safe birth in the contexts of evacuation and local birthing. FCM collated Inuit and service provider visions, refining a method for stakeholder input and mobilisation in an area of shared concern.
520 $a ContexteLes Autochtones des regions eloignees du Canada sont regulierement transferees hors de leurs communautes pour accoucher - une pratique connue sous le nom d'evacuation pour l'accouchement. Des donnees recentes etablissent un lien entre l'evacuation pour accouchement et des repercussions negatives sur la sante et la vie sociale. L'evacuation affecte les Inuits du Nunavik (territoire inuit du nord du Quebec), ou au moins 14 % des personnes sont contraintes de quitter leur communaute pour accoucher. De plus, la croissance rapide de la population risque de depasser la capacite des services d'accouchement locaux dans la region, reconnue pour sa revitalisation de la profession de sage-femme inuite et de l'accouchement en milieu communautaire. Compte tenu des inegalites croissantes entre les Inuits et les allochtones du Quebec en matiere d'accouchement, il est urgent de repenser les services d'evacuation des naissances en tenant compte de la culture, tout en soutenant la poursuite des accouchements locaux au Nunavik.Objectifs et methodesCe projet de doctorat a implique les Inuits et leurs fournisseurs de services a Montreal et au Nunavik afin de soutenir l'accouchement inuit culturellement securitaire dans le contexte de l'evacuation et de l'accouchement local. Quatre objectifs ont guide la these par publication:Objectif 1: Evaluer, a l'aide d'une revue de la litterature, les facteurs et les resultats associes a l'evacuation des Autochtones pour accouchement ou pour la naissance au Canada comme base pour la mobilisation et l'engagement des parties prenantes dans la refonte des services (abordee dans la publication 1).Objectif 2: Rassembler les visions des Inuits evacues pour l'accouchement et de leurs fournisseurs de services montrealais sur la facon d'accoucher dans de bonnes conditions dans le contexte de l'evacuation, a l'aide de fuzzy cognitive mapping(FCM) (abordee dans la publication 2).Objectif 3: Elaborer une liste de recommandations prioritaires, les mettre en oeuvre et les evaluer avec les prestataires de services et les patients Autochtones partenaires du Centre universitaire de sante McGill (publication 3).Objectif 4: Examiner, a l'aide de la FCM, les points de vue des Inuits et leurs fournisseurs de services au Nunavik sur le soutien au bien-etre perinatal et a l'accouchement dans de bonnes conditions au Nunavik, ainsi que sur les voies a suivre pour poursuivre l'accouchement dans la region (publication 4).ResultatsEn rassemblant les recherches sur l'evacuation des Autochtones pour accouchement, l'etude exploratoire a mis en evidence de nombreux prejudices emotionnels, sociaux et culturels. Elle a fait ressortir la necessite de reevaluer l'evacuation pour accouchement, compte tenu des lacunes dans les connaissances concernant ses effets a long terme sur la sante de femmes et enfants Autochtones (publication 1). Une application locale de la FCM avec 8 Inuits et 24 prestataires de services a Montreal a permis de formuler 17 recommandations pour une experience d'evacuation culturellement securitaire. Une methode d'analyse basee sur l'analyse du discours de Harris, a permis de rassembler les points de vue des parties prenantes (publication 2). Une description narrative a mene a la mise en oeuvre de quatre interventions de securisation culturelle concues conjointement avec des Autochtones et des fournisseurs de services. Testee par rapport a une theorie modifiee du comportement planifie, une formation de securisation culturelle menee par des Autochtones a exerce une influence positive sur les connaissances et les actions des prestataires de services (publication 3). La FCM au Nunavik, a laquelle ont participe 16 Inuits et 9 prestataires de services, a mis en evidence 13 facteurs de protection favorisant une naissance dans de bonnes conditions au Nunavik. La presence d'installations medicales bien equipees, les centres de naissance locaux et les traditions perinatales inuites ont eu l'influence la plus forte. Pour les jeunes Inuits, le soutien instrumental et emotionnel aux meres et aux familles, ainsi que la sante et les autosoins pendant la grossesse etaient les facteurs les plus influents pour le bienetre perinatal. 21 Inuits et 7 prestataires ont identifie 12 facteurs pour le maintien de l'accouchement en milieu communautaire au Nunavik, les centres de naissance locaux et l'equipement adequat des es etablissements medicaux etant les plus influents (Publication 4).Conclusion Les Inuits et leurs fournisseurs de services ont une connaissance detaillee de l'accouchement culturellement securitaire dans les contextes d'evacuation et d'accouchement local. La FCM a rassemble les visions des Inuits et des prestataires de services, en affinant une methode de participation et de mobilisation des parties prenantes dans un domaine d'interet commun. La FCM a illustre une vision communautaire claire pour promouvoir la poursuite des accouchements au Nunavik.
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