**Background:** Family caregivers and care providers are essential to Canada's health and social care systems, yet their work is often invisible and unsupported. Family caregiver distress has risen from 16% in 2010 to 66% in 2022. Indigenous family caregivers face additional challenges due to colonialism, racism, and complex, siloed care systems. This study aimed to understand the experiences of First Nations family caregivers and providers in two Alberta Cree communities and to gather their recommendations for support.
**Methods:** This participatory action research (PAR) project was guided by Etuaptmumk (Two-Eyed Seeing) and involved community advisors from the Samson Cree Nation and Enoch Cree Nation. Participants were recruited via convenience snowball sampling. Semi-structured interviews were conducted by a First Nations registered nurse, either via Zoom, telephone, or in person, lasting 35 to 75 minutes. Participants included family caregivers (n=6), health and community providers (n=14), and healthcare/community leaders (n=6). All family caregivers identified as First Nations; providers and leaders identified as First Nations, Cree, Canadian, Caucasian, Filipino, or Black. Data were analyzed using Braun and Clarke's thematic analysis.
**Key Results:** Participants made eight overarching recommendations. For family caregivers: (1) Recognize family caregivers' role and work—participants noted that despite cultural valuing of care, there is no specific policy or department for family caregivers, and they are often peripheral to patient-focused care. (2) Enhance navigation and timely access to services—barriers included long waits (e.g., 8 years for a communication device, 20 years for an occupational therapist), lack of information, and limited appointment times (e.g., 7.5 minutes with a doctor). (3) Improve home care support and respite—participants reported inadequate home care staffing and funding, lack of 24-hour care, and that respite services often involve strangers, which is culturally inappropriate. (4) Provide culturally safe care—this includes revitalizing kinship connections, decolonizing Western perspectives, and integrating holistic Indigenous approaches. For providers: (1) Support providers' wellbeing—providers carry trauma home and need debriefing, recognition, and adequate financing. (2) Retain and recruit providers—there is a shortage of staff, especially from the community, and a need for well-equipped interdisciplinary teams. (3) Improve orientation for new providers—current orientation is insufficient; longer, more robust, and culturally immersive orientation is needed. (4) Offer comprehensive grounding in cultural awareness—this must be community-specific, ongoing, and address historical trauma, systemic racism, and the unique culture of each First Nation.
**Clinical Implications:** The findings highlight that First Nations family caregivers and providers are underrecognized and undersupported within a fragmented, multi-level policy system (Indigenous Services Canada, First Nations and Inuit Health Branch, Alberta Health Services, etc.). To improve care, systemic changes are needed: recognizing family caregivers as integral to care teams, co-designing programs with communities, ensuring equitable access to home care and respite, and providing culturally safe, community-specific care. For providers, investing in wellbeing, retention, and comprehensive cultural education is critical. These recommendations align with the Treaty Right to Health and the Truth and Reconciliation Commission's Calls to Action. A population-based, public health approach is necessary to address the root causes of caregiver invisibility and inequity.