Stroke care in indigenous populations: A World Stroke Organization (WSO) scientific statement

Background: Indigenous Peoples have been reported to experience higher rates of stroke, poorer access to high-quality acute and rehabilitation stroke services, and worse post-stroke outcomes compared to dominant cultures residing in the same countries. The aim of this statement is to summarize available evidence on access barriers contributing to these inequities, effective solutions that have been deployed and tested, and present key recommendations to advance the field. Methods: We conducted a scoping review searching Medline, Embase, CINHAL, PubMed, Scopus, and Informit Indigenous Collection using the broad search terms “stroke” and “Indigenous” without date restriction until 1 August 2024. We screened 673 unique titles, 96 abstracts, and 80 full-text papers of which we retained 41. We added 10 additional key references known to authors. Articles were analyzed to identify key cross-cutting themes. Results: We identified five key themes: (1) Historical context, colonization and racism; (2) wholistic strength-based approaches to health, well-being, and recovery; (3) communication, health literacy, and cultural safety; (4) Indigenous knowledge systems, research principles, and community-led action; (5) achieving local acceptance versus wide generalizability. Recommendations: Key priority areas, detailed in the form of 11 specific recommendations and based on six core values, include improving stroke service responsiveness, Indigenous Peoples empowerment, and Indigenous research support to better meet the needs of Indigenous Populations globally. The statement has been reviewed and approved by the WSO Executive Committee.