Indigenous-Led and Culturally Safe Primary Healthcare Interventions for First Nations, Inuit, and Métis Peoples in Canada: A Narrative Literature Review

Background: First Nations, Inuit, and Métis peoples in Canada continue to experience inequities in access to primary healthcare. These inequities occur within diverse historical, geographic, cultural, organizational, and health-system contexts. Researchers have examined Indigenous-led, community-based, culturally safe, and equity-oriented approaches intended to improve healthcare access and delivery in Canada. Objective: This narrative literature review aimed to synthesize contemporary evidence on Indigenous-led, community-based, and culturally safe primary healthcare interventions involving First Nations, Inuit, and Métis peoples in Canada. It examined intervention characteristics and reported outcomes, recurring factors influencing implementation and sustainability, and implications for healthcare practice, policy, and future research. Methods: A structured literature search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Google Scholar was conducted for literature published between January 2010 and August 2026. Eligible studies reported original empirical research involving First Nations, Inuit, or Métis populations in Canada and examined interventions or models relevant to primary or community healthcare. Findings from eligible studies were synthesized using a narrative thematic approach to identify recurring patterns, differences, reported outcomes, and implementation considerations. Results: Five overlapping themes were identified: 1) Indigenous governance, community leadership, and co-design; 2) culturally safe, relational, and Indigenous-informed care; 3) community-based chronic disease prevention and management; 4) navigation, interdisciplinary care, and continuity; and 5) access innovations and conditions influencing implementation. Across the literature, Indigenous participation, culturally responsive relationships and organizational practices, coordination across services, local adaptation, and attention to workforce and infrastructure emerged as recurring considerations. However, substantial heterogeneity in populations, settings, intervention designs, implementation conditions, and outcomes limited direct comparison and generalization across communities. Conclusion: The evidence suggests that strengthening Indigenous primary healthcare requires more than increasing the availability of clinical services. Access also involves continuity, navigation, communication, cultural safety, relationships, and the capacity of healthcare systems to respond to local circumstances. First Nations, Inuit, and Métis peoples have distinct histories, cultures, governance structures, geographic circumstances, and relationships with healthcare systems; therefore, interventions should be locally responsive rather than assumed to be universally applicable across Indigenous communities. Future healthcare development and research should emphasize durable partnerships, meaningful Indigenous participation, locally responsive service design, culturally and linguistically appropriate communication, workforce and infrastructure capacity, and evaluation of clinical, access, implementation, sustainability, and patient- and community-centred outcomes.