UCSF

AbstractBackground: Ethnic minority women, including Basque women, experience communication and language problems, as well as cultural discrimination during healthcare encounters compared to non-minority populations. Gender non-normative individuals who are members of Indigenous and ethnic minority communities also experience increase discrimination and violence that lead to poor health outcomes in healthcare compared to their non-minority counterparts. There are approximately 300-400 million Indigenous peoples in the world living in 90 countries. Europe is home to over 100 ethnic minority groups which form many of Europe´s stateless nations. The Basque Country is one of many examples of Europe´s stateless nations which is home to the Basque Indigenous/ethnic minority population. While several European countries have several official languages and the continent is home to a multitude of regional and ancestral languages and cultures, the number of studies regarding the impact of culture and language in healthcare is scarce. Objectives: The purpose of this dissertation was to explore the experiences of Basque Women and Gender Non-normative Individuals (BWNN) with healthcare in the Basque Country. The two aims of this dissertation were to map and summarize the available literature related to experiences with culturally safe care among Indigenous and ethnic minority women in Europe (Aim 1), and to explore the experiences of BWNN with healthcare and identify the barriers and facilitators to implement culturally safe practices in the Basque Country (Aim 2).

Methods: For Aim 1 a scoping review was conducted to synthesize the existing literature related to experiences with culturally safe care among Indigenous and ethnic minority women in Europe. For Aim 2 a critical ethnographic approach was used to conduct semi-structured interviews, health clinic observations, and focus groups to identify barriers and facilitators to implement culturally safe practices in the Basque Country.Results: A scoping review yielded four articles for inclusion. The review showed that Indigenous and ethnic minority populations in Europe experience discrimination and receive suboptimal healthcare services. This marginalization is related to power relations within the healthcare encounter and the healthcare system. Data regarding the implementation of cultural safety in Europe is limited, which can indicate a lack of awareness regarding the importance of cultural safety and the importance of culture, racism, and biases in healthcare related to ethnic minorities. The critical ethnographic study provided important insights into barriers and facilitators to culturally safe healthcare for BWNN. Euskalfobia (overall rejection to Basque culture) in the healthcare system and gender bias and discrimination during the healthcare encounter were identified as major themes. Invisibilizing Basque language and culture, normalization of euskarafobia, (negative attitude or rejection to the Basque language), and the devaluation of cultural healing practices were identified as barriers for culturally safe healthcare for BWNN while language and cultural concordance was considered a facilitator for the first major theme. For the second major theme, barriers to culturally safe healthcare are knowledge transmission gap regarding women’s health issues, discrimination based on sexual or gender identity, and obstetric/gynecological violence, while promoting autonomy over healthcare services is a facilitator. Conclusions: Overall, the findings of this dissertation present strong evidence of significant barriers to culturally safe healthcare experienced by BWNN. They also provide key insights to facilitate the implementation of culturally safe practice within the Basque context that can provide direction for further research, policy changes and clinical practice.