INTRODUCTION

Despite Canada's commitment to primary healthcare and principles of social justice, health inequities remain a pressing national concern for Indigenous peoples.1 Healthcare for Indigenous peoples living in Canada, including First Nations, Inuit and Metis, is shared by the federal, provincial, and territorial levels of government. With a complex mix of policies, legislation, and relationships, the Canadian healthcare system includes Indigenous peoples in the per capita allocations of funding from the federal transfer who are entitled to access insured provincial and territorial health services as residents of a province or territory. Indigenous Services Canada funds or directly provides services for First Nations and Inuit that supplement those provided by provinces and territories. These funds or services include primary healthcare, health promotion, and supplementary health benefits.

Indigenous Services Canada also funds or directly provides certain healthcare services to First Nations communities and funds the provision of certain community health programs for Inuit peoples in addition to federal funding provided to territorial governments. Indigenous Services Canada similarly funds non-insured healthcare benefits to eligible First Nations and recognized Inuit regardless of where they live in Canada.

A coordinated approach to address the health needs of First Nations, Inuit, and Metis and healthcare delivery among all levels of government is an ongoing challenge. The inequities in access to healthcare and social determinants of health experienced by Indigenous peoples in Canada are known and documented; however, this relevant information and evidence has not been translated into improved health.2 The root causes of inequitable access to healthcare for Indigenous peoples are complex and need further assessment within the social, historical, and political contexts in order to develop solutions.

In June 2018, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched the Indigenous Wound, Ostomy and Continence Health Core Program to address the inequity of healthcare delivery. There was a commitment to gain a better understanding of the gaps in patient care delivery of wound, ostomy, and continence, looking at the unique perspectives in First Nations communities living in rural, remote, and urban areas. Healthcare delivery solutions that are equitable to non-Indigenous communities and supported cultural safety are at the forefront of the project.

One gap that was identified by this Core Program was the lack of a consistent process to deliver culturally safe information on the topic of wound, ostomy, and continence to First Nations medical practitioners, nurses, family caregivers, and patients. In January 2022, this Core Program put together a project team, which in addition to Catherine Harley, NSWOCC Chief Executive Officer, and Troy Curtis, NSWOCC Director of Operations, was made up of representatives who work on the front line with Indigenous, Metis, and Inuit people and also included 2 Indigenous patients (Box). This project team determined the need for a national communication tool in the form of a Web site, which would be an online informational and educational resource hub. The goal of this Web site was to enhance accessibility to information and ultimately improve healthcare for Indigenous peoples. To achieve this goal, the objectives were to create a Web site that would act as a single directory whereby hyperlinks to culturally safe Indigenous healthcare information and educational resources for patients, Nurses Specialized in Wound, Ostomy and Continence (NSWOCs), and other healthcare professionals could be found. The Web site also aimed to display hyperlinks to Indigenous Wound, Ostomy and Continence Health resources broken down by Province/Territory to help patients, NSWOCs, Skin Wellness Associate Nurses (SWANs), and other healthcare professionals disseminate pertinent information that exists elsewhere online for the respective region they live and work. In addition to these objectives, the Web site aimed to share news related to Indigenous Wound, Ostomy and Continence Health, welcome visitor-submitted suggestions for new links to resources to be added to the Web site, and support Web site visitors seeking to contact an NSWOC closest to their area using the NSWOCC "Find an NSWOC" tool. Further projective objectives are to provide information in multiple mediums including video, blog, external hyperlinks, and images; establish a common language by providing a glossary defining key ostomy-related terms adapted from the 2022 NSWOCC Ostomy Patient Teaching Guides for Ileostomy, Ileal Conduit, and Colostomy; and establish a glossary of terms, in the future, for wound care and continence.

The NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program project team met several times over the following 7 months to refine the design, content, and navigation of the Web site. The group collectively came up with the name of the "Sharing Circle" for this Web site to support that healthcare for Indigenous peoples must be shared by everyone. Sharing circles provide opportunities for each voice to be heard, respected, and valued. They are a traditional practice in some Indigenous communities in North America and are designed to ensure everyone has an equal opportunity to share their opinions and ideas.

On August 10, 2022, the NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program launched this new "Sharing Circle" Web site, helping patients, NSWOCs, SWANs, and other healthcare professionals access a directory of resources, education, training, and support related to Indigenous Wound, Ostomy and Continence Health. The "Sharing Circle" Web site was implemented through electronic communications, a social media campaign, posting on the NSWOCC Web site, and the Web sites of aligned organizations and through personal e-mails to colleagues.

The Sharing Circle can be accessed online at http://www.sharingcircle.online. It will continue to be updated as the NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program receives more feedback and resources to add to the site. The use of this Web site will be evaluated monthly with the Web site analytics.

We hope that by developing and launching the "Sharing Circle" Web site that we have provided an open, respectful way of providing wound, ostomy, and continence information and resources for healthcare providers and First Nations people in a culturally safe manner. By having access to this Web site, we strive to support better access to patient care in a more timely manner. This is one step toward supporting equitable healthcare for Indigenous peoples.

BOX. Indigenous WOC Health Core Program Sharing Circle Project Team Members

Beverly Smith, BScN, RN, NSWOC, Edmonton, Alberta (Core Program Leader)

Bruno Auger, Spinal Cord Injury Ontario, Thunder Bay, Ontario

Morgan Austin, Spinal Cord Injury Ontario, Thunder Bay, Ontario

Michelle Buffalo, RN, BScN, NSWOC, and WOCC (c), NSWOC, Wetaskiwin Home and Community Care, Alberta

Robin Cano, RN, First Nations and Inuit Home and Community Care/First Nations and Inuit Health Branch, Ontario

Jeremy Caul, BScN, MClSc-WH, RN, AHCP WH, CDE, Sioux Lookout First Nations Health Authority

Misty Corbiere, RPN, Maamwesying North Shore Health Services, Ontario

Sharon Gabison, PhD, MSc, BScPT, BSc, Hallisey Affiliate Scientist in Pressure Injury and Home Care Research University of Toronto

Billie-Jo Hardy, PhD, Assistant Professor, Waakebiness-Bryce Institute for Indigenous Health University of Toronto

Tamara Henry, Ottawa, Ontario

Melanie Jeffreys, PhD, Assistant Professor, Human Biology and Indigenous Studies University of Toronto

Audray Lafortune, BSc, Inf, IS. Infirmiere stomotherapeute CISSS de Lanaudiere

Denise Lalonde-Niccoli, BScN, RN, NSWOC, AAP, Saskatchewan

Tracy Locke, BScN, RN, NSWOC, First Nations Health Authority, British Columbia

Edith Mercieca, RN, Director of Home and Community Services at Mamwesying North Shore Tribal Council, Ontario

Sara Roach, RN, Fort Frances Tribal Area Health Services Inc

Anna Tumchewics, BScN, DipOPN, RN, NSWOC, Northwest Territories

Abbreviation: WOC, wound, ostomy, and continence.

REFERENCES