Skip to main content


Log in

Barriers and facilitators for Indigenous students and staff in health and human services educational programs

Advances in Health Sciences Education Aims and scope Submit manuscript


Indigenous Peoples are underrepresented in many of the Health and Human Services Educational Programs (HHSEP, e.g.: Nursing, Social Work). As various studies have reported the benefits of diversifying HHSEP, the barriers and facilitators of increasing the number of Indigenous Peoples in these professions must be identified. The purpose of this exploratory study is to identify and understand the barriers and facilitators Indigenous Peoples face when entering, learning or working in HHSEP. A narrative approach was used in the facilitation of culturally safe sharing circles with Indigenous students and staff to collect perspectives based on their individual experiences in HHSEP. Inductive thematic analysis was used to identify emerging themes in participant experiences and the impact of those experiences on participation in learning and working at the university in these educational programs. Results from this exploratory study identified current academic structures and ideologies rooted in colonialism, that act as barriers for engagement and inclusion of Indigenous students, staff, and clinical and academic faculty. These findings shaped the main themes of this study including negotiation of identity in different spaces, negotiating colonial structures in HHSEP, and negotiating changes and transitions in HHSEP. We anticipate these preliminary results will act as a catalyst for uncovering further changes to be made regarding attitudes, procedures, and practices present in an academic environment that limit the inclusion of Indigenous Peoples in HHSEP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions


  • Ackerman-Barger, K., Bakerjian, D., & Latimore, D. (2015). How health professions educators can mitigate underrepresented students’ experiences of marginalization: Stereotype threat, internalized bias, and microaggressions. Journal of Best Practices in Health Professions Diversity, 8(2), 1060–1070

    Google Scholar 

  • Asmar, C., & Page, S. (2018). Pigeonholed, peripheral or pioneering? findings from a national study of indigenous Australian academics in the disciplines. Studies in Higher Education, 43, 1679–1691

    Article  Google Scholar 

  • Battiste, M., Bell, L., & Findlay, L. M. (2002). Decolonizing education in Canadian universities: an interdisciplinary, international, Indigenous research project. Canadian Journal of Native Education, 26, 82–95

    Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101

    Article  Google Scholar 

  • Brodt, E., Empey, A., Mayinger, P., Miller, M. F., Frutos, R., Bruegl, A. … Carney, P. A. (2019). Shifting the tide: innovative strategies to develop an American Indian/Alaska Native Physician Workforce. Hawai’i journal of health & social welfare, 78(12 Suppl 3), 21

    Google Scholar 

  • Bond, C., Brough, M., Willis, J., Stajic, J., Mukandi, B., Canuto, C. … Lewis, T. (2019). Beyond the pipeline: A critique of the discourse surrounding the development of an indigenous primary healthcare workforce in Australia. Australian Journal of Primary Health, 25(5), 389

    Article  Google Scholar 

  • Campbell, B. E. (2018). Educators must mind tone policing. School Library Journal, 64(9), 17

    Google Scholar 

  • Carpenter, C., & Suto, M. (2008). Qualitative research for occupational and physical therapists: A practical guide. Oxford, UK; Ames, Iowa;: Blackwell Pub

    Google Scholar 

  • Caxaj, C. S. (2015). Indigenous storytelling and participatory action research: Allies toward decolonization? Reflections from the Peoples’ International Health Tribunal. Global Qualitative Nursing Research, 1–12

  • Coulthard, G. (2014). Red skin, white masks: rejecting the colonial politics of recognition. Minneapolis: University of Minnesota Press

    Book  Google Scholar 

  • Davis, A. L. (2018). Experiences of underrepresented minority students in health professions programs, and their journeys to the programs. Available from ProQuest Dissertations & Theses Full Text: The Humanities and Social Sciences Collection. Retrieved from

  • Erasmus, G., & Dussault, R. (1996). Report of the Royal Commission on Aboriginal Peoples. The Royal Commission on Aboriginal Peoples

  • Gaudry, A., & Lorenz, D. (2018). Indigenization as inclusion, reconciliation, and decolonization: Navigating the different visions for indigenizing the Canadian academy. AlterNative:. An International Journal of Indigenous Peoples, 14(3), 218–227

    Article  Google Scholar 

  • Herrera, M. D. (2011). Red earth, brown earth: Walking in two worlds, the journey of indigenous women in academia (Order No. 3481819). Available from ProQuest Dissertations & Theses Global. (907247154). Retrieved from

  • Karani, R., Varpio, L., May, W., Horsley, T., Chenault, J., Miller, K. H., & O’Brien, B. (2017). Commentary: racism and bias in health professions education: how educators, faculty developers, and researchers can make a difference. Academic Medicine, 92(11S), S1–S6

    Article  Google Scholar 

  • Kovach, M. (2021). Indigenous methodologies: Characteristics, conversations, and contexts. University of Toronto press

  • Matthews, R. (2017). The cultural erosion of Indigenous people in health care. CMAJ, 189(2), E78–E79

    Article  Google Scholar 

  • Mayeda, D. T., Keil, M., Dutton, H. D., & Ofamo’Oni, I. F. H. (2014). “You’ve Gotta Set a Precedent”: Māori and Pacific voices on student success in higher education. AlterNative: An International Journal of Indigenous Peoples, 10(2), 165–179

    Article  Google Scholar 

  • Marmot, M., & Allen, J. (2014). Social determinants of health equity. American Journal of Public Health, 104(S4), S517–S519. doi:

    Article  Google Scholar 

  • Oliver, R., Rochecouste, J., Bennell, D., Anderson, R., Cooper, I., Forrest, S., & Exell, M. (2013). Understanding Australian Aboriginal Tertiary Student Needs. International Journal of Higher Education, 2(4), 52–64

    Article  Google Scholar 

  • Prescod-Weinstein, C. (2019, December 5). Tone Policing & the Sound of Equality in STEM [blog post]. Retrieved from

  • Roberts, D. (2011). Fatal invention: How science, politics, and big business re-create race in the twenty-first century. New Press/ORIM

  • Rodríguez, J. E., Campbell, K. M., & Pololi, L. H. (2015). Addressing disparities in academic medicine: what of the minority tax? BMC Medical Education, 15(1), 1–5

    Article  Google Scholar 

  • Rothe, J. P., Ozegovic, D., & Carroll, L. J. (2009). Innovation in qualitative interviews: “sharing circles” in a First Nations community. Inj Prev, 15, 334–340

    Article  Google Scholar 

  • Russel, D. J., Zhao, Y., Guthridge, S., Ramjan, M., Jones, M. P., Humphreys, J. S., & Wakerman, J. (2017). Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013–2015. Human Resources for Health, 15(1), 1–12

    Article  Google Scholar 

  • Sánchez, J. P., Peters, L., Lee-Rey, E., Strelnick, H., Garrison, G., Zhang, K. … Castillo-Page, L. (2013). Racial and ethnic minority medical students’ perceptions of and interest in careers in academic medicine. Academic Medicine, 88(9), 1299–1307

    Article  Google Scholar 

  • Simpson, A. (2014). Mohawk Interruptus: Political life across the borders of settler states. Durham, BC: Duke University Press

    Book  Google Scholar 

  • Statistics Canada (2018, July 07). National Indigenous Peoples Day… By the Numbers. Retrieved from

  • Statistics Canada (2019, May 02). Tables 14-10-0104-01 Employment by Aboriginal group and occupation (x 1,000). Retrieved from

  • Strickland, C. (1999). Conducting focus groups cross-culturally: experiences with Pacific Northwest Indian people. Public Health Nursing, 16(3), 190–197

    Article  Google Scholar 

  • Tachine, A. R., Bird, Y., E., & Cabrera, N. L. (2016). Sharing circles: an Indigenous methodological approach for research with groups of Indigenous Peoples. International Review of Qualitative Research, 9, 277–295

    Article  Google Scholar 

  • Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans – TCPS 2 (2018). Accessed on October 1, 2019

  • Truth and Reconciliation Commission of Canada. (2015). Truth and Reconcilliation Commission of Canada: Calls to Action. Truth and Reconcilliation Commission of Canada

  • Tuhiwai Smith, L. (2012). Decolonizing methodologies. Research and Indigenous Peoples. 2nd edition. Dunedin, New Zealand: Otago University Press

  • Turpel-Lanford, M. E. (2020). In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care.

  • US Department of Health and Human Services (2006). The rationale for diversity in the health professions: A review of the evidence.Health Resources and Services Administration, Bureau of Health Professions,

  • Usher, K., Miller, M., Turale, S., & Goold, S. (2005). Meeting the challenges of recruitment and retention of indigenous people into nursing: Outcomes of the indigenous nurse education working group. Collegian, 12(3), 27–31

    Article  Google Scholar 

  • Wakerman, J., Humphreys, J., Russell, D., Guthridge, S., Bourke, L., Dunbar, T. … Jones, M. P. (2019). Remote health workforce turnovver and retention: what are the policy and practice priorities?.Human Resources for Health, 17(1)

  • Weaver, H. N. (2001). Indigenous nurses and professional education: Friends or foes? The Journal of Nursing Education, 40(6), 252

    Article  Google Scholar 

  • Yeo, M., Haggarty, L., Wida, W., Ayoungman, K., Pearl, C. M., Stogre, T., & Waldie, A. (2019). Unsettling Faculty Minds: A Faculty Learning Community on Indigenization. Teaching and Learning, 2019: 27–41

  • Zhao, Y., Russell, D. J., Guthridge, S., Ramjan, M., Jones, M. P., Humphreys, J. S., & Wakerman, J. (2019). Costs and effects of higher turnover of nurses and aboriginal health practitioners and higher use of short-term nurses in remote australian primary care services: An observational cohort study. BMJ Open, 9(2), e023906. doi:

    Article  Google Scholar 

Download references


The success of cultural safety measures in lending to safe spaces for in-depth conversation could not have been done without the Indigenous members of our research team. Indigenous team members put in time and energy to educate non-Indigenous team members on appropriate land acknowledgements, how to share our vulnerabilities before asking the same of the participants, and how to word our questions in the most respectful way. The settler authors are grateful for the work and energy asked of Indigenous authors, they taught us the importance of a genuine expression of gratitude. We would like to acknowledge the contribution of all of the participants who so gracefully and generously gifted us with their stories to share in this paper. We would like to acknowledge Hannah Doyle’s help and support with revising the paper.

Author information

Authors and Affiliations



KJC and EN contributed substantially to the study design, acquisition, analysis, and interpretation of data for the work, drafting the paper and revising it critically for important intellectual content. HBM and HM contributed substantially to the study design, acquisition, analysis, and interpretation of data for the work, and revising it critically for important intellectual content. AQ, YM and TJ contributed substantially to the study design, analysis, and interpretation of data for the work, revising it critically for important intellectual content and supervising all aspects of the study. All the authors provided final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yael Mayer.

Ethics declarations

Conflict of interest

None of the authors has any relevant conflict of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joy-Correll, K., Nevill, E., Bird-Matheson, H. et al. Barriers and facilitators for Indigenous students and staff in health and human services educational programs. Adv in Health Sci Educ 27, 501–520 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: