Our team has been collaborating with four First Nations communities in Quebec and Saskatchewan. These communities have expressed urgent and critical needs for improved access to pediatric rehabilitation care. This project seeks to deepen our understanding of experiences of families accessing pediatric rehabilitation services.
Guided by principles of cultural humility, respect, equity, reciprocity, collaboration (Kovach 2021), and Two-Eyed Seeing (Bartlett 2012), we employed a Community-Based Participatory Action Research approach (Wallerstein 2010). This approach fosters collaboration between researchers and community members and adheres to the Principles of Ownership, Control, Access, and Possession (OCAP™) ensuring that data is handled in a manner that respects the rights, knowledge, and sovereignty of Indigenous Peoples. Using a qualitative multiple case study design and in partnership with communities, we examined and compared the impact of provincial policies, organizational structures, and community initiatives on pediatric rehabilitation services while preserving the uniqueness of data from each community. A community advisory board, including Elders, community members, and Knowledge Keepers, guided the development of the project. Data were collected through sharing circles and interviews. Questions explored participants' experiences and opinions regarding access to pediatric rehabilitation and healthcare services, travel for care, and virtual health experiences. We interviewed parents of children aged 0-18 with neurodevelopmental or orthopedic rehabilitation needs as well as community stakeholders involved in provision and planning of pediatric care. Data were analyzed using an iterative inductive thematic analysis approach.
In all communities, accessing care was described as a long and challenging journey. Families faced significant systemic barriers, legacies of colonial policies, including geographic isolation, lack of professionals, fear of not being heard, and experiences of racism. Despite these difficulties, parents showed remarkable resilience and advocacy for their children, consistently providing emotional support and encouraging their children's interests and development. The cultural and community context was vital, offering families opportunities to connect with their culture and community. When community stakeholders shared a common vision of holistic, culturally anchored care, it became a crucial factor in promoting self-determination of their services. Additionally, effective intersectoral collaboration emerged as a key ingredient in enhancing service delivery.
The results provide essential insights into the rehabilitation needs of First Nations children and will inform future projects aimed at improving access to services, including the use of telehealth for rural communities and the development of strategies and partnerships with local entities.
Physiotherapists play a crucial role in forming partnerships with Indigenous communities and collaboratively developing family-centered and culturally safe interventions.
Paediatrics
Access to care
