MIXED METHODS AND CROSS-CUTTING APPROACHES
24 Cultural Safety
Loubna Belaid and Neil Andersson
Abstract
A concept originating from nursing sciences and here applied in an innovative way to evaluation, cultural safety refers to an approach aimed at ensuring that the evaluation takes place in a “safe” manner for the stakeholders, and in particular for the minority communities targeted by the intervention under study, i.e. that the evaluation process avoids reproducing mechanisms of domination (aggression, denial of identity, etc.) linked to structural inequalities. To this end, various participatory techniques are used at all stages of the evaluation. Cultural safety is compatible with all types of methods. It contributes to making the evaluation more relevant and useful for stakeholders and will likely increase their self-determination.
Keywords: Mixed methods, participation, indigenous evaluation, culturally responsive evaluation, inequalities, racism, decoloniality, fuzzy cognitive mapping
I. What does this approach consist of?
The cultural safety approach was developed in response to the observation that the evaluation process could reproduce mechanisms of domination linked to structural inequalities, particularly concerning indigenous peoples or in post-colonial contexts. For example, one study assessed the perception of three psychometric scales used to diagnose depression in the Inuit and Mohawk populations of Quebec. The study results showed that the three scales were not culturally safe. Participants disliked the numerical assessment, the self-report (as opposed to supportive interaction) and the focus on symptoms rather than supportive factors (Gomez Cardona et al. 2021).
Cultural safety aims to produce ‘an environment for people where there is no aggression, challenge or denial of who they are, what they need’ (Williams 1999). A Maori nurse originally developed the concept in response to the racism and discrimination faced by Maoris in healthcare settings (Papps and Ramsden 1996). Culturally safe evaluation aims for stakeholders to feel that their cultures are respected and strengthened by the evaluation.
Cultural safety goes beyond another approach more commonly promoted in evaluation based on cultural sensitivity and competence (culturally responsive evaluation). Indeed, beyond simply paying attention to cultural differences, cultural safety considers the power imbalances, institutional discrimination, racism and colonial relations that can interfere with the design and implementation of services and programmes (Curtis et al. 2019). The concept is thus situated within the spectrum of critical postcolonial theories and aims for social justice. The concept of cultural safety has been extended beyond Maori communities to any group that differs from its care or service providers regarding age, gender, socio-economic status, ethnicity, religion or disability (Smye and Browne 2002).
The concept has attracted the attention of research and eva