Health care through an Indigenous lens: insights from a university hospital photovoice study

Indigenous Peoples in Canada continue to experience profound health inequities rooted in colonialism, systemic racism, and structural barriers in health care systems. We sought to examine the experiences of Eeyou/Eenou patients receiving care and people supporting a patient at a university-affiliated hospital centre in Quebec, to inform culturally safe and equitable care delivery.

We employed a participatory qualitative design, using photovoice and semistructured interviews co-developed with the Cree Board of Health and Social Services of James Bay. Patients and support people contributed photographs, captions, and interviews between September 2023 and March 2024. We analyzed data using thematic and content analysis, following principles of relational accountability and reflexivity. We shared results with participants to confirm accuracy and meaning.

Twenty patients and 11 support people participated. Participants generated 102 images and narratives reflecting 3 interrelated themes: barriers to care - racialized neglect, poor communication, isolation, financial strain, and delays in care; healing experiences - respectful, empathetic care, and connection to culture, family, and community; and pathways for improvement - increased access to interpreters, Elders, spiritual services, and culturally inclusive hospital spaces.

We found that anti-Indigenous racism and systemic inequities persist in an academic hospital. Yet, moments of relational and culturally grounded care foster trust and healing, demonstrating that transformation is possible. Embedding Indigenous knowledge systems, family involvement, and community partnership within hospital structures can advance reconciliation in practice and fundamentally transform patient care experiences across health care systems.