Patient Experience Survey: Indigenous Self-Identification (Self-ID)

Supported by the NH Evaluation Department

Introduction

You are invited to take part in a survey about your feedback on how we ask about Indigenous identity during your hospital visit. Your feedback helps us know what is working well, and what can be improved about the approach and ensure respectful, culturally safe care for all patients.

The survey will take 5 to 10 minutes to complete. Filling out the survey is voluntary and confidential. This means:

You decide whether you want to take the survey.
Your participation in the survey will not affect your care.
We will not share or report on individual responses –
our goal is to generally see people’s experiences,
needs and preferences.

If you have any questions or concerns regarding this survey, please contact Turgeon Taylor, Northern Health Regional Lead, Indigenous Patient Liaison, at Taylor.Turgeon@northernhealth.ca.

Thank you for your support!

Privacy Statement

Your feedback is being requested to help us improve our services. The survey has been designed to be anonymous and is not intended to collect any personal information. Should any personal information be discovered in survey responses, that information will be removed by authorized NH staff. Privacy statement | Northern Health

Please do not enter any personal or identifying information into the free form text questions of the survey.

Section 1: About Your Experience

Question Title

* 1. Did a staff member ask you about your Indigenous identity during your hospital visit?

Yes

I don't remember

Question Title

* 2. What is your Indigenous identity? (Please select the option that best describe you.)

First Nations

Métis

Inuit

Non-Indigenous

Prefer not to say

Question Title

* 3. How did you feel answering the Self-ID question? (Select ALL that apply)

Respected

Curious

Indifferent

Surprised

Uncomfortable

Offended

Other (please specify)

Question Title

* 4. Did the staff explain why the Self-ID question was being asked?

Yes, clearly

Yes, somewhat

I'm not sure

Question Title

* 5. Did you feel comfortable answering this Self-ID question?

Very comfortable

Somewhat comfortable

Neutral

Somewhat uncomfortable

Very uncomfortable

Question Title

* 6. Do you feel asking this question contributes to a better health care for Indigenous people?

Yes

Maybe

I don’t know

Section 2: Communication and Environment

Question Title

* 7. How clear was the explanation provided about the purpose of the Self-ID question?

Very clear

Somewhat clear

Neutral

Somewhat unclear

Very unclear

Question Title

* 8. Was the Self-ID question asked in a respectful manner?

Very respectful

Somewhat respectful

Neutral

Somewhat disrespectful

Very disrespectful

Question Title

* 9. Did the staff person give you time and space to respond without pressure?

Yes

Not applicable

Question Title

* 10. Did the hospital environment (e.g., signage, brochures, staff attitude) help you feel welcome and safe?

Yes

Somewhat

I’m not Indigenous

Section 3: Suggestions for Improvement

Question Title

* 1. Did a staff member ask you about your Indigenous identity during your hospital visit?

Question Title

* 2. What is your Indigenous identity? (Please select the option that best describe you.)

Question Title

* 3. How did you feel answering the Self-ID question? (Select ALL that apply)

Question Title

* 4. Did the staff explain why the Self-ID question was being asked?

Question Title

* 5. Did you feel comfortable answering this Self-ID question?

Question Title

* 6. Do you feel asking this question contributes to a better health care for Indigenous people?

Question Title

* 7. How clear was the explanation provided about the purpose of the Self-ID question?

Question Title

* 8. Was the Self-ID question asked in a respectful manner?

Question Title

* 9. Did the staff person give you time and space to respond without pressure?

Question Title

* 10. Did the hospital environment (e.g., signage, brochures, staff attitude) help you feel welcome and safe?

Question Title

* 11. Any additional feedback or reflections you would like to share?