• Kristen M Jacklin, Rita I Henderson, Michael E Green, Leah M Walker, Betty Calam, and Lynden J Crowshoe.
• Northern Ontario School of Medicine (Jacklin), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Henderson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University, Kingston, Ont.; School of Population and Public Health, Faculty of Medicine (Walker), Department of Family Practice, Faculty of Medicine (Calam), University of British Columbia, Vancouver, BC; Department of Family Medicine (Crowshoe), Cumming School of Medicine, University of Calgary, Calgary, Alta. kjacklin@nosm.ca.
• CMAJ. 2017 Jan 23; 189 (3): E106-E112.

BackgroundIndigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. We sought to examine the health care experiences of Indigenous people with type 2 diabetes to understand how such determinants are embodied and enacted during clinical encounters.MethodsSequential focus groups and interviews were conducted in 5 Indigenous communities. Focus groups occurred over 5 sessions at 4 sites; 3 participants were interviewed at a 5th site. Participants self-identified as Indigenous, were more than 18 years of age, lived with type 2 diabetes, had received care from the same physician for the previous 12 months and spoke English. We used a phenomenological thematic analysis framework to categorize diabetes experiences.ResultsPatient experiences clustered into 4 themes: the colonial legacy of health care; the perpetuation of inequalities; structural barriers to care; and the role of the health care relationship in mitigating harm. There was consistency across the diverse sites concerning the root causes of mistrust of health care systems.InterpretationPatients' interactions and engagement with diabetes care were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. These experiences led to nondisclosure during health care interactions. Our findings show that health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and have a role in mitigating past harms.© 2017 Canadian Medical Association or its licensors.

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