Educating for equity care framework

Lynden Crowshoe, Rita Henderson, Kristen Jacklin, Betty Calam, Leah Walker, Michael E. Green

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Objective To present a clinical framework for addressing critical social elements for Indigenous patients with type 2 diabetes. Sources of information The Educating for Equity (E4E) Care Framework was developed through a rigorous analysis of qualitative research that included the perspectives of Indigenous patients (n = 32), physicians (n = 28), and Indigenous health curriculum developers (n = 5) across Canada. A national advisory group of Indigenous health experts, educators, leaders, physicians, and community members provided feedback on integrating analysis from primary research into recommendations for physicians. Systematic literature reviews were conducted and a nominal group technique process helped forge research team consensus around the framework's themes and recommendations. Main message For Indigenous patients with type 2 diabetes, social factors arising from the legacy of colonization are often barriers to improved diabetes outcomes, while culture is often not recognized as a facilitator in diabetes management. Structural competency in balance with cultural safety should be central to the clinical process when negotiating diabetes management with Indigenous patients. The E4E Care Framework presented in this article provides recommendations to navigate this terrain. Conclusion A focus on social and cultural elements is fundamental to effective diabetes care among Indigenous patients. The E4E Care Framework is a resource that can help clinicians improve Indigenous patients' capacity for change in a way that acknowledges the social factors that affect the increasing diabetes rates, while using a cultural lens to facilitate improved outcomes.

Original languageEnglish (US)
Pages (from-to)25-33 and E19-E29
JournalCanadian Family Physician
Issue number1
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
This project was funded by the Canadian Institutes of Health Research.

Publisher Copyright:
© 2019 College of Family Physicians of Canada. All rights reserved.


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