Governance is a key issue in the struggle of Aboriginal people in Canada to survive historical and ongoing colonization. Yet, little attention has focused on the influence of governance on the quality and relevance of health care for Aboriginal people. The purpose of this study was to describe the influence of contextual factors on Aboriginal health care organizations’ experiences improving care for pregnant and parenting Aboriginal people. Participatory research principles were used in a comparative case study design with two Aboriginal health care organizations in British Columbia, Canada. Data were collected through exploratory interviews and small group discussions with purposefully selected leaders, providers, and community members; document review; and researcher field notes. Interpretive descriptive analysis was used to develop themes related to dimensions of governance that highlighted important similarities and differences between the two organizations’ experiences. Dimensions of governance identified included: the importance of a historically grounded vision; the extent to which Aboriginal community members had a voice in decision making; the autonomy of their organizations; their views of organizational accountability; and approaches to decision making. Findings suggest that greater attention to governance and use of models of governance that facilitate rather than thwart efforts to decolonize health care for Aboriginal people are needed.
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