Voices beyond the margins: a protocol for a qualitative systematic review and meta-synthesis of Indigenous patients' experiences accessing mainstream healthcare services in Canada.

introductionFirst Nations, Inuit and Métis Peoples in Canada continue to face significant disparities in healthcare access compared with non-Indigenous populations. Understanding their experiences in accessing healthcare is essential for addressing systemic barriers and promoting equitable, patient-centred care. Although existing studies have identified various barriers and facilitators to accessing healthcare, a lack of synthesised qualitative evidence delves into the intricacies of patients' experiences. This systematic review aims to investigate Indigenous patients' experiences with mainstream Canadian healthcare services and their recommendations for service improvement through a meta-synthesis of qualitative literature. METHODS AND ANALYSIS: Meta-aggregation will be used to conduct a systematic review of qualitative studies and qualitative components of mixed-methods studies exploring experiences of Indigenous patients accessing mainstream healthcare services in Canada. Papers published in English will be searched using electronic databases, including MEDLINE, APA PsycINFO, CINAHL, Global Health, the Bibliography of Indigenous Peoples in North America and Web of Science. A comprehensive list of non-indexed and grey literature will also be searched to ensure the inclusion of community-based and non-peer-reviewed evidence. Studies meeting the inclusion criteria will be assessed for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research and the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The review will involve the extraction of findings, categorisation into themes and synthesis into broader insights guided by the JBI meta-aggregation approach. An Indigenous advisory committee will guide the process, including interpretation of findings and ensuring alignment with Indigenous health research principles. ETHICS AND DISSEMINATION: Ethics approval is not required for this study as it is based on a secondary analysis of publicly available primary studies. The completed review will be published in a peer-reviewed manuscript. Findings will also be shared with relevant Indigenous organisations and community partners through plain-language summaries and community-engaged knowledge-sharing activities. PROSPERO REGISTRATION NUMBER: CRD420250656486.