Arts-based anti-colonial workshops in and from northern British Columbia: A summary of heartfelt lessons for future practice

Authors

Sarah de Leeuw (biography and disclosures), Lisa Striegler (biography and disclosures), Marion Erickson (biography and disclosures), Kelsey Chamberlin (biography and disclosures), Janet Ocloo (biography, no disclosures), Viviane Josewski (biography, no disclosures) and Laura McNab-Coombs (biography and disclosures)

Sarah de Leeuw’s disclosures: Research funded in part by SSHRC and CHIR. Mitigating Potential Bias: No authors were remunerated for any of this research.

Lisa Striegler’s disclosures: I received payment from the non-profit society, Nechako Healthy Community Alliance, for delivery of a video series on Active Witnessing. This is entirely unrelated to the workshops written about in the article. Mitigating Potential Bias: Treatments or recommendations in this article are unrelated to products/services/treatments involved in disclosure statements.

Marion Erickson’s disclosures: A member of British Columbia College of Oral Health Professionals (BCCOHP). BC Anti-Racism Data Committee. I am knowledgeable and influencing policies as a public member of BC. Has recived funding for IMPaCT Clinical Trials Fellowship and Health Systems Impact fellowship. I have been mentored to understand healthcare regulation and healthcare policy within these fellowships. Mitigating Potential Bias: Treatments or recommendations in this article are unrelated to products/services/treatments involved in disclosure statements.

Kelsey Chamberlin’s disclosures: I am employed by the non-profit society, Myriad Dance Projects, which has no bearing or relationship to this article. I have received research funding from CIHR & UNBC, both of which are unrelated to this article. Mitigating Potential Bias: Recommendations are consistent with current practice patterns.

Laura McNab-Coombs’ disclosures: My salary is paid by BC Cancer Clinical Trials as I am the ICS Lead for BC Cancer Clinical Trials. However, my work with BC Cancer CT’s is completely separate from the work outlined above. I am on the planning committee for the Urban Indigenous Wellbeing Conference. Although this conference is relevant to the health and wellbeing of Indigenous peoples, it is not related to the work outlined above. The work I do for the committee – which is, helping to plan the upcoming conference, review abstracts, ensure its both planned and executed in a culturally safe and accessible way – is separate from the work outlined above. Has received funding from 3CTN – through my role at BC Cancer CT’s. This funding is to support EDI and ICS projects within our organization and relevant to cancer clinical trials, not the work outlined above. Mitigating Potential Bias: Treatments or recommendations in this article are unrelated to products/services/treatments involved in disclosure statements.

What care gaps or frequently asked questions we have noticed

The Health Arts Research Centre (HARC), located within the Northern Medical Program in the Division of Medical Sciences at the University of Northern British Columbia (UNBC), attracts comments from numerous and diverse folx* wondering about the area in which we work: rural, northern, Indigenous-informed health humanities.

People offer feedback through our website, make observations during professional development workshops we offer, or write us reflective emails. As examples: “I don’t have time for an arts workshop. I need to learn what can help me save lives,” observed a physician back in 2024, after being invited to attend one of our workshops. “Isn’t anticolonial health care kind of prejudiced?” a website visitor once asked. On another occasion, a medical learner expressed, exasperatedly, “If I have to hear another word about DEI…”. Another time, an allied health professional who had worked for many years in southern urban geographies stated, “If you don’t like the health care where you live, move.”

These comments suggest a gap in knowledge. They reflect a lack of understanding about growing areas in medical scholarship and health-care practice^1-7 that act as preventative measures, improve health-care outcomes and mitigate provider burnout, especially in northern, rural and Indigenous geographies.^4-9

As is well-established by social determinants of health literatures, folx who face bias from health professionals experience poorer health outcomes than people who feel seen in health-care systems.^9,11 For those with intersecting positionalities, marginalization increases.¹¹ Implicit biases may negatively impact care offered to Indigenous patients, as well as to those who are queer, come from northern rural or remote geographies, are differently abled, fat, neurodivergent, or living in poverty.^4-9 Health-care providers’ implicit bias, then, can result in patients’ increased distrust of the health-care system.¹² Patients are not the only ones who suffer from implicit biases. In workplace environments where biases circulate, health professionals may experience lower job satisfaction and increased burnout.¹³

Implicit bias fosters anti-Indigenous racism. In November 2020, the Government of BC published the In Plain Sight report, unequivocally documenting a proliferation of anti-Indigenous racism across the province’s health-care ecosystem and describing “a picture … of a BC health care system with widespread systemic racism against Indigenous peoples. This racism results in a range of negative impacts, harm, and even death”.¹⁵ Prior to the report’s release, the Truth and Reconciliation Commission (TRC) had already confirmed Indigenous-specific racism throughout Canadian institutions, including in health-care locales. TRC’s Call to Action #23 emphasized the importance of providing cultural competency training to all health-care providers,¹⁶ while In Plain Sight’s recommendation #20 called for “a refreshed approach to anti-racism, cultural humility and trauma informed training for health workers [to] be developed and implemented”.¹⁵ The TRC call to action #23 and In Plain Sight recommendation #20 align with HARC’s core research question:

How might learning at the intersection of Indigenous knowledges, the arts and humanities and health unsettle implicit bias?

*Using ‘folx’ instead of ‘folks’ is a “conscious affirmation of respect for Black, Asian, Latine, Indigenous, Queer, Trans and other minoritized individuals”¹⁷

Data that answers these questions or gaps

Drawing on myriad well-established and still growing evidence (as above),^1-7 HARC focused on the transformative potential of integrating anticolonial, arts-anchored and heart-based learning to promote critical self-reflection and address implicit biases in health-care contexts. Of the myriad arts-based interventions developed at HARC, the Indigenous Voices, Stories, and Healthcare (IVSH) workshops proved to be an effective intervention. They provided a refreshed approach in tackling anti-Indigenous racism and other biases by using anticolonial, arts-based and humanities-informed methods, instead of following a didactic process. They were delivered by a diverse group of trainers, including northern, Indigenous, queer, neuro-diverse and racialized not-white folx, with a range of lived experiences. Elders’ knowledges were central to the learning.

The methods applied during the IVSH workshops encouraged activity and critical self-reflection. They included First Nations’ language lessons, Indigenous storytelling and arts-based activities such as colouring, writing, drawing, painting, singing, devised theatre and fabric arts. Participants were encouraged to get comfortable with experiencing discomfort, since many of them neither knew Indigenous languages nor engaged regularly in some of the arts activities we offered. The arc of a workshop often looked like this: Elder welcoming; reflective introductions using a colouring book; Indigenous language lesson through song; a skit; drawing and writing; creating something to take home (weaving, fabric arts, paintings); role-playing interventions; and storytelling.

Data gathered from the workshops were primarily qualitative and included facilitator-participant observations, informal feedback during and after the workshop and evaluation forms. Over six years, HARC delivered 32 IVSH workshops to more than 900 participants, both in-person and online. Most sessions were held in the Northern Health region, with additional workshops delivered to rural health practitioners at two BC Rural Health conferences. The online feedback response rate was 18% and the workshop format allowed ample time for discussion and feedback, resulting in data saturation and thus trustworthiness of the findings.

Generally, participants relayed their appreciation for the workshops’ innovative, interactive and experiential format and observed that they could apply similar methods in their own work. As one participant noted, “[this is] interactive education that I can incorporate in my regional role when I am educating–this type of participatory learning is fantastic!” (June 5, 2024). Furthermore, participants experienced how arts helped people explore challenging material, noting “learning some [local Indigenous language], […and engaging] with art and difficult questions [about racism] at the same time … softens the questions” (June 5, 2024). Additionally, the role-playing interventions in the skit activity allowed people to practise making change before confronting biases in the workplace: “I think the part where we interrupted the racism in HR scenario was especially powerful” (workshop participant, June 24, 2024). The workshops’ interactive and experiential components were relevant and supported making practical improvements in health-care settings.

Workshop participants noted how some of the learnings encouraged critical self-reflection and fostered a deeper understanding of how cultural safety might show up in health-care practice. One participant responded that they would be “giving extra time to people to communicate their needs and reach … out to them if they are shy or quiet as they may not be used to voicing their needs” (June 5, 2024), while another reflected, “I loved the secret pocket activity and the chance to reflect on how we could do things differently” (June 5, 2024). Across the 32 workshops, participants expressed broad and deep agreement about the value of the self-reflective, arts-based activities and the opportunity these workshops provided to deepen their understandings of and responses to anti-Indigenous racism in health care.

What we recommend

Creative arts and humanities-informed methods have a vital role to play in health care and medicine in BC and especially in professional training. Arts have the power to change hearts. Drawing on our experience delivering and analyzing humanities- and arts-based workshops, we offer some methods that provide the refreshed approach recommended by the In Plain Sight report for cultural competency training:

1. Offer content delivered by diverse trainers with lived experiences of the biases encountered in health care, including northern, Indigenous, queer, neuro-diverse and racialized not-white folx.
2. Employ humanities-informed methods: Elders’ knowledges, Indigenous storytelling, arts-based activities (e.g., theatre, singing, drawing, writing, fabric arts, colouring) and First Nations’ language lessons.
3. Provide varied and ample opportunities for participant feedback: formal feedback gathered through evaluation forms; informal feedback in the form of notes or naturally arising observations during each workshop; and opportunities to ask facilitators questions or share comments after the workshop.

Ideally, anticolonial arts-based methods will be integrated into health-care education so that new health-care providers will be better equipped to deliver care that sees patients who typically are marginalized in health care. Until then, however, incorporating anti-colonial, arts-based activities into cultural agility training and professional development in medicine and health care offers refreshed approaches and opportunities to mitigate negative bias in health-care practice.

Resources for health-care providers

• The Hearts-based Education and Anticolonial Learning (H.E.A.L.) Health Care website is a digital repository of arts-based, anticolonial curricula for addressing bias in health care. It includes 30 curricula developed by people with lived experiences of stigma and bias in health care. The curricula are free of charge, with suggested delivery methods for each, such as self-directed, lunch and learn and classroom formats.

References

1. Archibald L, Dewar J. Creative arts, culture, and healing: building an evidence base. J Indig Wellbeing. 2010;8(3). Accessed August 21, 2026. (View)  
2. Bleakley A. Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors. Routledge; 2015. (View with UBC) 
3. Kidd MG, Connor JT. Striving to do good things: teaching humanities in Canadian medical schools. J Med Humanit. 2008;29(1):45-54. doi:10.1007/s10912-007-9049-6 (View with UBC) 
4. Crampton P, Dowell A, Parkin C, Thompson C. Combating effects of racism through a cultural immersion medical education program. Acad Med. 2003;78(6):595-598. doi:10.1097/00001888-200306000-00008 (View with UBC) 
5. Aleshire ME, Ashford K, Fallin-Bennett A, Hatcher J. Primary care providers’ attitudes related to LGBTQ people: a narrative literature review. Health Promot Pract. 2019;20(2):173-187. doi:10.1177/1524839918778835 (View with UBC) 
6. Pratt-Chapman ML, Phillips S. Health professional student preparedness to care for sexual and gender minorities: efficacy of an elective interprofessional educational intervention. J Interprof Care. 2020;34(3):418-421. doi:10.1080/13561820.2019.1665502 (View) 
7. Symons AB, McGuigan D, Akl EA. A curriculum to teach medical students to care for people with disabilities: development and initial implementation. BMC Med Educ. 2009;9:78. doi:10.1186/1472-6920-9-78 (View) 
8. Donohoe MT. Stories and society: using literature to teach medical students about public health and social justice. 2010. Int J Creat Arts Interdiscip Pract. (View) 
9. Marshall M, Marshall A, Bartlett C. Two-Eyed Seeing in Medicine. In: Greenwood M, Lindsay NM, Reading C, eds. Determinants of Indigenous Peoples’ Health in Canada: Beyond the Social. Canadian Scholars’ Press; 2015: 44-53. (View with UBC) 
10. Gopal DP, Chetty U, O’Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J. 2021;8(1):40-48. doi:10.7861/fhj.2020-0233 (View) 
11. Hankivsky O, Christoffersen A. Intersectionality and the determinants of health: a Canadian perspective. Critical Public Health. 2008;18(3):271-283. doi:10.1080/09581590802294296 (View) 
12. Phillips-Beck W, Eni R, Lavoie JG, Avery Kinew K, Kyoon Achan G, Katz A. Confronting racism within the Canadian healthcare system: systemic exclusion of First Nations from quality and consistent care. Int J Environ Res Public Health. 2020;17(22):8343. doi:10.3390/ijerph17228343 (View)  
13. Di Marco D, López-Cabrera R, Arenas A, Giorgi G, Arcangeli G, Mucci N. Approaching the discriminatory work environment as stressor: the protective role of job satisfaction on health. Front Psychol. 2016;7:1313. doi:10.3389/fpsyg.2016.01313 (View) 
14. Turpel-Lafond, ME. In Plain Sight: Addressing Indigenous-Specific Racism and Discrimination in B.C. Health Care – Data Report. EngageBC, Government of British Columbia; 2020. Accessed May 7, 2025. (View) 
15. Turpel-Lafond, ME. In Plain Sight: Addressing Indigenous-Specific Racism and Discrimination in B.C. Health Care – Full Report. EngageBC, Government of British Columbia; 2020. (View) 
16. Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada: Calls to Action. Truth and Reconciliation Commission of Canada; 2015. (View)  
17. QUEERSPACE collective. Challenging the norms for radical Inclusivity: unpacking folks and folx from a queer intersectional lens. QUEERSPACE blog. February 15, 2024. Accessed August 21, 2026. (View)  

Vote