Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review

Background: Māori (the Indigenous Peoples of New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity, and mortality rates, and are less likely to receive evidence-based CVD healthcare. Rural Māori experience additional barriers to treatment access, poorer health outcomes, and a greater burden of CVD risk factors, compared to Non-Māori and Māori living in urban areas.  Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD healthcare for rural Māori and other Indigenous Peoples in nations impacted by colonisation.
Methods: The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O’Malley’s (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre, and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted.  Literature based in any healthcare providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the United States of America were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting.
Results: A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 publications were included from the database search and 5 publications from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework Principles: Tino Rangatiratanga (Self-determination), Partnership, Active Protection, Equity, and Options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included: Input from rural Indigenous Peoples on healthcare service design and delivery; Adequate resourcing and support of indigenous and rural healthcare services; Addressing systemic racism and historical trauma; Provision of culturally appropriate healthcare; Rural Indigenous Peoples access to family and wellbeing support; Rural Indigenous Peoples differential access to the wider social determinants of health; Effective inter-service linkages and communication; and Equity driven and congruent data systems.  
Conclusions: The findings are consistent with other literature exploring access to healthcare for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity-and-rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.
Keywords: Indigenous Peoples; Indigenous Health Services; Rural Health Services; Rural Health; Cardiovascular Diseases; Health Services Accessibility; Health Care Quality, Access, and Evaluation.