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Enhancing health literacy can empower individuals and communities to take control over their health as well as improve safety and quality in healthcare. However, Indigenous health studies have repeatedly suggested that conceptualisations of health literacy are confined to Western knowledge, paradigms, and practices. The exploratory qualitative research design selected for this study used an inductive content analysis approach and systematic iterative analysis. Publicly available health literacy-related policy and practice documents originating from Australia, Canada, and New Zealand were analysed to explore the extent to which and the ways in which Indigenous knowledges are recognised, acknowledged, and promoted. Findings suggest that active promotion of Indigenous-specific health knowledges and approaches is limited and guidance to support recognition of such knowledges in practice is rare. Given that health services play a pivotal role in enhancing health literacy, policies and guidelines need to ensure that health services appropriately address and increase awareness of the diverse strengths and needs of Indigenous Peoples. The provision of constructive support, resources, and training opportunities is essential for Indigenous knowledges to be recognised and promoted within health services. Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. [ABSTRACT FROM AUTHOR]