First steps in the co-development of a virtual care prioritization tool for indigenous communities: community perspectives from a formative exploratory engagement process

Résumé fourni par la source

For many rural and remote Indigenous communities across Saskatchewan, accessing healthcare means navigating distance, limited resources, policies and systems shaped by colonialism. Virtual care offers promise in bridging some of these gaps, yet technology alone cannot create trust, cultural comfort, or lasting community adoption. Emerging evidence suggests that while readiness frameworks and prioritization checklists may help guide initial implementation, they cannot fully capture the relational, cultural, and lived realities that shape how care is experienced within communities. This initial exploratory engagement phase, conducted in a remote northern Saskatchewan Indigenous community, sought to understand community perspectives on virtual care and identify the conditions community members viewed as essential to informing implementation and co-development of a virtual care prioritization tool. This multi-phase exploratory engagement process involved 58 community listening conversations with Elders ( n = 12) and community members, including youth ( n = 46). Findings from the initial engagement informed a structured community feedback survey completed by Elders and other community members ( n = 27), as part of an ongoing formative planning process and to refine priorities for co-designing the virtual care prioritization tool. Data from both phases were organized in NVivo 14 and analyzed using Braun and Clarke’s thematic synthesis approach. Community members demonstrated highly variable levels of awareness, knowledge, attitudes, and beliefs regarding virtual care, ranging from limited familiarity and uncertainty to cautious optimism about its potential role in improving healthcare access. Longstanding healthcare access barriers further shaped perceptions of virtual care and intensified the perceived need for alternative forms of support. Technological limitations and privacy concerns significantly influenced community members’ beliefs about the feasibility, safety, and acceptability of virtual care. Relational, culturally grounded engagement was widely understood as foundational to fostering trust, comfort, and long-term adoption of virtual care within the community. Participants emphasized that meaningful attitudinal shifts toward virtual care cannot occur through education alone but must emerge through reciprocal relationship-building that creates culturally safe pathways for awareness, knowledge-sharing, and digital confidence. Sustainable virtual care in rural and remote Indigenous communities begins with understanding the unique landscape of each community through relationship-building, trust formation, cultural values, lived realities, and local approaches to healing and care. The Western approach to implementation, which utilizes ease-of-use checklists and readiness frameworks, may be potentially useful in initial higher-level planning but can sacrifice the required attention to Indigenous knowledges, systemic racism, and institutional barriers in Indigenous health contexts. Advancing virtual care in these communities requires a balanced use of the Two-Eyed Seeing approach, where Western systems of planning and technological readiness move in tandem with Indigenous ways of knowing, seeing, believing, and healing. Within this relational space, community voices, languages and local priorities become essential in shaping a virtual care prioritization tool and guiding ‘which forms of care and technology’ are most appropriate for the community.

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