Implementing healthcare decolonisation for Indigenous people: a systematic review

Abstract

The Western biomedical system, rooted in colonialism, holds Western science as the only universally valid knowledge system. While it has been justified as an objective approach to improve health, it has failed to address health inequities for Indigenous communities. There is increasing recognition of the need to decolonise healthcare, but its practical application remains unclear. This study systematically reviewed global literature to explore what decolonising healthcare means in practice. A systematic search of published and grey literature was conducted across CINAHL, Embase, PubMed, Scopus, Google and reference lists for studies on decolonising health services for Indigenous peoples. Two reviewers independently screened and extracted data from eligible studies. Quality was appraised using the Joanna Briggs Institute's tool for systematic reviews and the Consolidated Criteria for health research involving Indigenous peoples. Data analysis and presentation followed an inductive thematic approach, refined through discussions with authors and external members who identify as Indigenous community members. Fifteen studies from Canada, Australia, Aotearoa (New Zealand), the United States, Chile, and South Africa met the inclusion criteria, all reporting qualitative data. Key elements of decolonising healthcare included community governance, holistic care, relationality and trust, storytelling, reflexive practice, and colonisation-informed care. These were underpinned by cultural, ontological, axiological, and epistemic equity, along with shared power, essential for their decolonial nature. Studies identified barriers and facilitators to decolonising healthcare, reflecting broader structural factors. Reported outcomes included increased patient satisfaction, empowerment, and trust in services. Decolonising healthcare requires acknowledging colonialism within healthcare systems and fostering medical encounters with equity between Western and Indigenous ways of knowing, being, and doing. Genuine community-informed partnerships and leadership from Indigenous communities are essential for developing and evaluating services aligned with Indigenous health, well-being, and healing paradigms. PROSPERO ID: CRD42024495407.