Cultural Safety

Amuzgo traditional birth attendants discuss how to move forward with the Safe Birth in Cultural Safety initiative in Xochistlahuaca, Guerrero State, Mexico

The concept of cultural safety was first developed by Maori nurses in New Zealand to help improve the quality of health care in intercultural settings. Safe care affirms the cultural identity and well-being of patients, particularly from ethnic minorities, who should judge whether the care they receive is indeed culturally safe. The idea gradually expanded outside of health care to imply the protection of culture in research and social services.

For research to be culturally safe, researchers must act in ways that do not harm any culture involved. This entails more than being sensitive to practices and beliefs in other cultures and groups. Researchers must identify and challenge Western assumptions of superiority that might influence their work with culturally different groups. They must reflect on the impact of their theories, methods, and proposed interventions, not only on the evidence they generate and the way they present it (which could lead to stigmatizing disadvantaged groups), but also on other ways of life.

Culturally safe research challenges conventional power relations, engaging other types of knowledge and resources on an equal footing, and not as subordinates of Western science and scientists. In doing this, researchers and research participants explore potential articulations of different views and resources, while they acknowledge those areas that do not lend themselves to crossover.

Since it is often very difficult for persons of one culture to know what is harmful to another culture, community or participant group control over services and research is the best guarantor of cultural safety. Part of the cultural safety agenda, therefore, is to encourage participant involvement in research and to develop research and planning skills among vulnerable groups and communities.

CIET has adopted cultural safety as a core institutional strategy and takes a proactive stance that goes beyond avoiding harm, to promoting cultural resilience, intercultural dialogue, and knowledge exchange on equal terms. We do this in concrete ways. In Mexico, Safe Birth in Cultural Safety’s main concern is to improve maternal and newborn health among indigenous peoples without threatening their traditions. For this, we work with indigenous Nancue Ñomndaa communities in Guerrero state to assist well-established traditional midwives so they can pass on their knowledge and skills to a younger generation through apprenticeship.

Cultural safety is a concern in all of CIET’s recent work in Canada with First Nations, Métis and Inuit communities, and has been central to the design of the CIHR Centre for Intercultural Research on Prevention of Gender Violence. In all these partnerships, we recognize the expertise of research participants and we include the community’s protocols, aspirations, and needs into the research design. We also use methods (like cognitive mapping) that allow community members to frame the research problem on their own terms and help explore causal links from their point of view.

In Colombia, CIET collaborates with the Centro de Estudios Médicos Interculturales (CEMI) in support of their efforts to promote cultural safety for several indigenous groups in that country.

See our article in Pimatisiwin: a Journal of Aboriginal and Community Health for a detailed discussion on CIET’s approach to cultural safety at every stage of the research process, including the role of modern epidemiology and areas where scientific and indigenous interests may interface or diverge. A Spanish translation of this article is also available.