Acceptability of Asking about Indigenous Identity in Health Care Settings

Abstract

Background: This case study assessed the acceptability and experience of being asked a single question about Indigenous self-identity when patients registered at a core neighborhood hospital in a western Canadian province. Registration clerks were trained and requested to ask all patients about their identity during the admission process and record the information in the registration system. The information was used to link patients to cultural support and navigation services. Methods: Two hundred and fifty-nine participants were interviewed to examine perceptions and experiences with being asked about their identity. Descriptive statistics including frequencies and percentages were used to summarize participant demographic characteristics and responses. Chi-squared or Fisher’s Exact tests were used to explore the relationship between demographic characteristics (age, gender, Indigenous identity) and domains of inquiry. A thematic analysis of participants’ responses was also done. Findings: Sixty (23.1%) participants self-identified as Indigenous and just over half (n=134) of all participants were female. Participants supported universally offering the opportunity to disclose their Indigenous identity. However, perceived importance of asking was associated with Indigenous identity (χ2 =16.52, p<0.001) and age (χ2=11.08, p=0.023). Elderly participants and those who did not identify as Indigenous assigned lower importance to asking about Indigenous identity. Among Indigenous participants who had prior negative experiences with the health care system, there were concerns about misuse of information and adverse effects on care. Preferences for how identity information should be collected were influenced by expectations about roles of health care providers and practical considerations. Conclusion: While acceptable, perceived value of collecting self-reported Indigenous identity at registration varies across patient groups. Priority should be given to targeted communication about the rationale for collection of identity information and how it will be used to improve the delivery of care.