Cultural safety and telecare. A systematic scoping review and sector survey

Background: Telecare can play an important role in addressing existing mental health and addiction inequities affecting Indigenous peoples and racial and ethnic minorities. However, it is crucial first to assess whether it can deliver culturally and linguistically appropriate care. This is particularly important in contexts like Aotearoa New Zealand, where the healthcare system has explicitly recognized its commitment to providing culturally safe care, as defined by the communities it seeks to support.

Methods: Using the PRISMA extension for scoping reviews guideline, we conducted a systematic scoping review of the literature discussing cultural adaptations, barriers, opportunities, and facilitators for telecare services supporting minority groups. Informed by its findings, we developed an anonymous online survey to collect mental health and addiction service providers’ views on priorities for a research agenda focused on delivering culturally safe telecare. Participants were asked to rate the importance of potential research domains and items, and the mean values of each item were normalized to develop a priority index.

Results: A total of 1514 publications were screened, and 58 articles were included in the final review. Themes related to cultural adaptations of telecare services underscored the role of community involvement and quality service delivery. Various barriers, opportunities, and facilitators were also identified in the review. A total of 48 mental health and addiction service providers rated at least one of the survey’s listed potential items for a research agenda focused on culturally safe telecare. The highest-rated items included identifying strategies to improve access, co-developing e-mental health with the community, and developing a set of competencies required for delivering culturally safe care. ‘Standards and guidelines’ was the research domain with the highest priority index.

Conclusion: Telecare offers a significant opportunity to ensure access to quality care for under-served communities, albeit not without its challenges. Moving forward, it is imperative not only to acknowledge the unique needs of these communities but also to actively involve them in the development and implementation of telecare services. Such collaborative approach will enhance the cultural safety of these services, but also empower these communities to shape them so that they truly meet their needs.

Additional note: Both studies discussed in the abstract were published:

Rahman J, Cheung G, Lyndon MP, et al. Prioritising a culturally safe e-Mental Health research agenda in Aotearoa New Zealand: A sector survey report. Australasian Psychiatry. 2022;30(5):619-623. doi:10.1177/10398562221101794

Ruiz-Cosignani D, Chen Y, Cheung G, et al. Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic  scoping review. Journal of Telemedicine and Telecare. 2022;0(0). doi:10.1177/1357633X211069664