Aligning Indigenous and Western Concepts of Health Resource Decision Making in a Western Canadian First Nations Context.

IF 3.3 4区 医学 Q1 ECONOMICS
Aidan Neill, Stephanie Montesanti, Lea Bill, Barbara S E Verstraeten, Rhonda C Bell, Richard T Oster, Arto Ohinmaa, Mike Paulden
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引用次数: 0

Abstract

Background: Western health economic evaluation tools often fail to reflect the relational, collective, and holistic perspectives that underpin Indigenous concepts of health. These limitations pose challenges when applying Western measures in Indigenous contexts. The individualistic foundation of the Western definition of health and the values that inform it are significantly different from the community-based values typically found in Canadian Indigenous communities. For health economics to effectively support Indigenous health decision making, a values-based approach should initially be undertaken to identify conceptual commonalities with Western perspectives.

Aims: This study aimed to develop a conceptual framework that identifies shared elements between Western and First Nations understandings of health resource decision making, with the goal of supporting the creation of culturally meaningful health outcome measures.

Methods: Through a Health Economics Technical Advisory Group (HE-TAG) in Alberta, Canada, co-led by Indigenous and non-Indigenous researchers, we conducted a conceptual exploration of health resource decision making. Fourteen HE-TAG sessions held between July 2021 and June 2023 were transcribed and analyzed using a hybrid approach-combining Q methodology, thematic analysis (Braun & Clarke), and Walker and Avant's concept analysis.

Data: Transcripts from 14 HE-TAG sessions provide the qualitative data upon which analysis was conducted. Sessions were held online using virtual meeting technology, and recordings were transcribed and analyzed.

Results: Indigenous and Western conceptual frameworks allow for a common understanding of health resourcing. Indigenous community and culture and Western economic evaluation and social determinants of health were the four main observed themes, each of which contained two subthemes which differentiated between concepts of 'health.' Five concepts were found to resonate between Indigenous and Western themes when exploring health resource thinking: values, holism, time, resources, and context. Concepts and themes were mapped to illustrate common approaches to understanding health resource decision making.

Conclusions: This Indigenous-informed research aligns concepts of resource decision making by showing the thematic backgrounds of First Nations and Western thinking, which are linked by the common concepts of values, holism, time, resources, and context. Centering future community engagement on these shared concepts while grounding them in community-generated health value sets can advance the development of novel, culturally relevant health outcome measures.

在加拿大西部第一民族背景下协调土著和西方卫生资源决策概念。
背景:西方卫生经济评估工具往往不能反映支撑土著健康概念的关系、集体和整体观点。这些限制给在土著环境中应用西方措施带来了挑战。西方健康定义的个人主义基础及其价值观与加拿大土著社区典型的以社区为基础的价值观有很大不同。为了使卫生经济学有效地支持土著居民的卫生决策,首先应采取一种基于价值观的方法,以确定与西方观点在概念上的共同之处。目的:本研究旨在建立一个概念框架,以确定西方和第一民族对卫生资源决策的共同理解,目的是支持创建具有文化意义的卫生结果测量。方法:通过加拿大艾伯塔省的卫生经济学技术咨询小组(HE-TAG),由土著和非土著研究人员共同领导,我们对卫生资源决策进行了概念性探索。在2021年7月至2023年6月期间举行的14次HE-TAG会议使用混合方法进行转录和分析-结合Q方法,主题分析(Braun & Clarke),以及Walker和Avant的概念分析。数据:14次HE-TAG会议的记录提供了进行分析的定性数据。会议使用虚拟会议技术在线举行,录音被转录和分析。结果:土著和西方的概念框架允许对卫生资源的共同理解。土著社区和文化以及西方经济评价和健康的社会决定因素是观察到的四个主要主题,每个主题都包含两个区分“健康”概念的次级主题。在探索卫生资源思维时,发现土著和西方主题之间有五个概念产生共鸣:价值观,整体主义,时间,资源和环境。绘制了概念和主题图,以说明理解卫生资源决策的常见方法。结论:这项土著知情的研究通过展示第一民族和西方思维的主题背景来协调资源决策的概念,这些主题背景由价值观、整体主义、时间、资源和环境等共同概念联系在一起。将未来的社区参与集中在这些共同的概念上,同时将其置于社区产生的健康价值观的基础上,可以促进新的、与文化相关的健康结果措施的发展。
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来源期刊
Applied Health Economics and Health Policy
Applied Health Economics and Health Policy Economics, Econometrics and Finance-Economics and Econometrics
CiteScore
6.10
自引率
2.80%
发文量
64
期刊介绍: Applied Health Economics and Health Policy provides timely publication of cutting-edge research and expert opinion from this increasingly important field, making it a vital resource for payers, providers and researchers alike. The journal includes high quality economic research and reviews of all aspects of healthcare from various perspectives and countries, designed to communicate the latest applied information in health economics and health policy. While emphasis is placed on information with practical applications, a strong basis of underlying scientific rigor is maintained.
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