Lowitja Institute Repository

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We are Australia’s only Aboriginal and Torres Strait Islander community controlled health research institute, named in honour of our namesake and co-patron, the late Dr Lowitja O’Donoghue AC CBE DSG. We deliver high-impact quality research, knowledge exchange, and by supporting a new generation of Aboriginal and Torres Strait Islander health researchers. This repository contains information on Lowitja research outputs.
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A critique of measures of emotion and empathy in First Peoples' cultural safety in nursing education: a systematic literature review.
(2022-04-04) Mills K.; Creedy D.K.; Sunderland N.; Allen J.; Corporal S.
Background: In Australia, undertaking cultural safety education often evokes strong emotional responses by health students. Despite the potential for emotion to drive transformative learning in this space, measures of emotion are uncommon. AIM: To review existing tools that intend to measure emotional components of learning in relation to cultural safety education. Methods: Articles published in English from January 2005 to January 2020; reported studies from Australia, New Zealand, Canada and United States of America; and measured an emotional construct/s after an education intervention offered to university students enrolled in a health programme were included. Studies were assessed for quality according to the Critical Appraisals Skills Programme criteria. Results: Eight articles were reviewed; five conducted in the United States of America, and three in Australia. Intervention type, measures, methodological rigour and outcomes varied. Studies predominately measured empathy, guilt and/or fear. Conclusions: Although students' emotional responses were measured, processes for students to reflect upon these reactions were not incorporated in the classroom. The review has implications for future research and curricula through developments in measuring and acting upon emotion in cultural safety education for nursing students in Australia.
A flow that comes when we're talking: water metaphors for exploring intercultural communication during early childhood assessment interactions in a Yolnu (First Nations Australian) community.
Armstrong E.; Maypilama L.; Bukulatjpi Y.; Gapany D.; Fasoli L.; Ireland S.; Baker R.D.; Hewat S.; Lowell A.; Yolnu
Culture mediates how all people think and communicate and intercultural communication skills are required for effective collaboration. This study (2017-2021) explored intercultural communication with 40 participants in one very remote First Nations Australian community in Northern Australia. We explored the perspectives of both Yolnu (First Nations Australian people from North-East Arnhem Land) and Balanda (non-Indigenous people, in this case Australian) on interactions during early childhood assessments of Yolnu children (0-6 years). Our intercultural research team used a culturally responsive form of video-reflexive ethnography, a Yolnu approach to in-depth discussion and collaborative analysis. In this article, we explore nine intercultural communication processes that were recognized and enacted by study participants. Each process is represented by a metaphor drawn from water traveling in North-East Arnhem Land. We share these processes so that others may consider exploring their relevance in other intercultural communication contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A framework to assess cultural safety in Australian public policy.
(2020-12-29) Mackean T.; Fisher M.; Friel S.; Baum F.
The concept of cultural safety (CS) has been developed as a critical perspective on healthcare provided to Indigenous service users in neo-colonial countries such as New Zealand, Australia and Canada. Unlike other frameworks for culturally competent healthcare, a CS approach recognizes impacts of colonization and power inequalities on Indigenous peoples and asks how these may manifest in healthcare settings. It has been argued that CS thinking is suited to critical analysis of public policy, but there has been limited work in this direction. Drawing on literature on CS in Australian healthcare, we defined a CS framework consisting of five concepts: reflexivity, dialogue, reducing power differences, decolonization and regardful care. Our research examined whether and in what terms this framework could be adapted as a tool for critical analysis of Australian public policy as it affects Aboriginal and Torres Strait Islander peoples. We used a collaborative inquiry process combining perspectives of an Aboriginal researcher and a non-Indigenous researcher. We developed a thematic analysis framework to examine how the five concepts might be reflected in contemporary writings on policy by leading Aboriginal or Torres Strait Islander thinkers. We found the framework is applicable as a tool for policy analysis; bringing together key concerns raised by Aboriginal and Torres Strait Islander leaders and critical concepts such as sovereignty and interface thinking. We concluded the framework is likely to be a useful tool for critical, systemic thinking about public policy as it affects Indigenous peoples and for specifying areas where performance can be improved to achieve culturally safe policy.Copyright © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
A postcolonial analysis of Indigenous cultural awareness training for health workers.
Downing R.; Kowal E.
Indigenous cultural training for health workers is an increasingly popular intervention designed to improve the health services provided to Indigenous peoples in Australia. The provision of this training is based on the recognition that the measured discrepancy between Indigenous and non-Indigenous health outcomes is in part influenced by cultural difference and a history of racism in Australian society. Indigenous cultural training in Australia predominantly draws on a 'cultural awareness' framework which seeks to educate health workers about 'Indigenous culture'. To date, evaluations of Indigenous cultural training programs have found them to have questionable efficacy, although most of these evaluations have been methodologically inadequate. This article draws on postcolonial theory to explore the limitations of Indigenous cultural training as it is commonly conceptualised. Issues of essentialising 'Indigenous culture', 'otherness' and the absence of systemic responsibility for culturally appropriate health service provision are discussed. Finally, we consider future directions for Indigenous cultural training that are useful to both Indigenous service users and the health workers charged with 'closing the gap' between Indigenous and non-Indigenous health outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
"Bridging two worlds?": Towards cultural safety within schools of nursing in Australian universities.
(2022-04-08) Petric S.; Hart B.; Mohamed J.
Background: Cultural safety has a stronghold within nursing practice and nursing education in Australia and is seen as a philosophy and practice that challenges and refutes previous concepts and frameworks of cultural awareness and cultural competence (Petric, 2019). Cultural safety practices are required for all members of the nursing profession, with a gaze now focused upon Australian Schools of Nursing to demonstrate their commitment and readiness towards cultural safety. AIM: This research study measures the commitment and readiness towards cultural safety within Schools of Nursing in Australian universities. Methods: This research study utilises a quantitative descriptive survey design, inviting the Deans of Schools of Nursing in Australia to respond to a modified Occupational Commitment and Health Professional Program Readiness Assessment Compass (DOH, 2014), that measures the current levels of commitment and readiness towards cultural safety. FINDINGS: This research study provides evidence of cultural safety strategies within Australian Schools of Nursing with leadership and commitment being the highest scoring factor (M = 34.81; SD 6.34). However, structures towards and support for the implementation of cultural safety strategies and practices were demonstrated as weaknesses (M = 21.18; SD 4.71). DISCUSSION: There is a valuable opportunity for leadership and knowledge sharing between Schools of Nursing in Australia. The research outcomes highlight the importance for Schools of Nursing to review, reflect upon, and fully implement the Nursing and Midwifery Curriculum Framework (CATSINaM, 2017) and to audit and report levels of cultural safety. Conclusions: There are cultural safety champions and their leadership is important to the continuing development of curricula, organisations and the profession. These individuals' actions must also be reflected within and supported by organisational cultures, as they fundamentally encourage or obstruct the development of cultural safety in nursing students and academics; material, cultural and human resources are fundamental to the transformations towards cultural safety and to the decolonising practices of the nursing profession (Petric, 2019).Copyright © 2021. Published by Elsevier Ltd.
Co-designing a health journey mapping resource for culturally safe health care with and for First Nations people.
(2024-06-13) Cormick A.; Graham A.; Stevenson T.; Owen K.; O'Donnell K.; Kelly J.
Background: Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method(s): Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Result(s): The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion(s): The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.Copyright © 2024 CSIRO. All rights reserved.
Communication, collaboration and care coordination: the three-point guide to cancer care provision for Aboriginal and Torres Strait Islander Australians.
(2020-06-17) de Witt A.; Matthews V.; Bailie R.; Garvey G.; Valery P.C.; Adams J.; Martin J.H.; Cunningham F.C.
Aim: To explore health professionals' perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland. Method(s): Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and non-Indigenous health professionals who had experience caring for Indigenous cancer patients in the PHC and hospital setting. The World Health Organisation integrated people-centred health services framework was used to analyse the interview data. Result(s): Seventeen health staff from six Aboriginal Community Controlled Services and nine health professionals from one tertiary hospital participated in this study. PHC sites were in urban, regional and rural settings and the hospital was in a major city. Analysis of the data suggests that timely communication and information exchange, collaborative approaches, streamlined processes, flexible care delivery, and patient-centred care and support were crucial in improving the continuity and coordination of care between the PHC service and the treating hospital. Conclusion(s): Communication, collaboration and care coordination are integral in the provision of quality cancer care for Indigenous Australians. It is recommended that health policy and funding be designed to incorporate these aspects across services and settings as a strategy to improve cancer outcomes for Indigenous people in Queensland. Copyright © 2020 The Author(s).
Community perspectives on delivering trauma-aware and culturally safe perinatal care for Aboriginal and Torres Strait Islander parents.
(2023-03-24) Fiolet R.; Woods C.; Moana A.H.; Reilly R.; Herrman H.; McLachlan H.; Fisher J.; Lynch J.; Chamberlain C.
Background: Since colonisation, Aboriginal and Torres Strait Islander peoples have experienced violence, loss of land, ongoing discrimination and increased exposure to traumatic events. These include adverse childhood experiences which can lead to complex trauma, and are associated with increased incidence of high-risk pregnancies, birth complications and emergence of post-traumatic symptoms during the perinatal period, potentially impacting parenting and leading to intergenerational trauma. The perinatal period offers unique opportunities for processing experiences of trauma and healing yet can also be a time when parents experience complex trauma-related distress. Therefore, it is essential that trauma-aware culturally safe perinatal care is accessible to Aboriginal and Torres Strait Islander parents. Aim(s): This study aimed to understand community perspectives of what 'trauma-aware culturally safe perinatal care' would look like for Aboriginal and Torres Strait Islander parents. Method(s): Data were collected during a workshop held with predominantly Aboriginal and Torres Strait Islander key stakeholders to co-design strategies to foster trauma-aware culturally safe perinatal care. Data were thematically analysed. Finding(s): Four overarching themes represent proposed goals for trauma-aware culturally safe care: Authentic partnerships that are nurtured and invested in to provide the foundations of care; a skilled workforce educated in trauma awareness; empowering and compassionate care for building trust; and safe and accessible environments to facilitate parent engagement. Conclusion(s): Provision of trauma-aware culturally safe care achieving these goals is likely to enable parents experiencing complex trauma to access appropriate support and care to foster healing in the critical perinatal period.Copyright © 2022 Australian College of Midwives
Culturally appropriate training for remote Australian Aboriginal health workers: evaluation of an early child development training intervention.
(2016-06-21) D'Aprano A.; Silburn S.; Johnston V.; Oberklaid F.; Tayler C.
Objective: This study aimed to design, implement, and evaluate training in early childhood development (ECD) and in the use of a culturally adapted developmental screening tool, for remote Australian Aboriginal Health Workers (AHWs) and other remote health practitioners. METHOD: A case-study evaluation framework was adopted. Two remote Australian Aboriginal health services were selected as case-study sites. Materials review, semistructured interviews, posttraining feedback surveys, and workplace observations contributed to the evaluation, guided by Guskey's 5-level education evaluation model. Results: Remote health practitioners (including AHWs and Remote Area Nurses) and early childhood staff from the sites participated in a customized 21/2 day training workshop focusing on the principles of ECD and the use of the culturally adapted Ages and Stages Questionnaire, third edition. Consistent with adult learning theories and recommendations from the literature regarding culturally appropriate professional development methods in this context, the workshop comprised interactive classroom training, role-plays, and practice coaching in the workplace, including booster training. The qualitative findings demonstrated that mode of delivery was effective and valued by participants. The workshop improved practitioners' skills, knowledge, competence, and confidence to identify and manage developmental difficulties and promote child development, evidenced on self-report and workplace clinical observation. Conclusion: The findings suggest that the practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners. This is an important finding that has implications in other Indigenous contexts, as effective training is a critical component of any practice improvement intervention. Further research examining factors influencing practice change is required.
Determining health professional students' self-perceived cultural capability following participation in clinical placement with Aboriginal and Torres Strait Islander Peoples: a systematic review.
(2024-12-20) Paisley K.; Sadler S.; West Wiradjuri M.; Gerrard J.; Wilson Wiradjuri R.; Searle A.; Chuter V.
Background: Collective evaluation of studies assessing students' self-perceived cultural capability following clinical placement is required to help inform future cultural capability training for both university and healthcare service environments. Therefore, the aim of this systematic review was to evaluate studies investigating health professional students' self-perceived cultural capability following participation in a clinical placement with First Nations Peoples. Methods: Electronic database searchers were conducted in MEDLINE, EMBASE, AMED, PsychINFO, Pubmed, CINAHL and Informit. Hand Searches of grey literature were conducted including Lowitja institute, Australian Indigenous HealthInfoNet, Menzies School of Health Research, Services for Australian Rural and Remote Allied Health, and the Australian Institute of Health and Welfare. Studies published in English that investigated health professional students' self-perceived cultural capability before and after clinical placement undertaken with First Nations people in Australia were eligible for inclusion. Two authors independently screened potentially eligible studies and performed quality appraisal and data extraction. Results: A total of 14 studies were included (n = 307 participants). Studies included undergraduate students from podiatry, medicine, nursing, pharmacy, and mixed health professions. The results of this systematic review suggest that clinical placements in health services or settings for Aboriginal and Torres Strait Islander Peoples that involve elements of co-design are effective in increasing aspects of health professional students' self-perceived cultural capability. This outcome was consistent across studies regardless of the location of clinical placements (urban or rural), type of clinical placement (health setting or Community), or length of placement. Conclusions: The findings from this systematic review suggest that clinical placement in health services or settings for Aboriginal and Torres Strait Islander Peoples may contribute to increased self-perceived cultural capability in health professions graduates. However, the impact of the placements on the cultural safety of student-led care, from a First Nations perspective, remains to be established.Copyright © 2024 The Author(s). Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.
Developing an ethics of relational responsibility-locating the researcher within the research and allowing connection, encounter and collective concern to shape the intercultural research space.
Hall L.
The choice to undertake a PhD is essentially the choice of an individual to complete an individual task that carries the name of the researcher as the cognitive authority and reinforces the place of their respective University within the western academy, with all of the structure of power and authority that comes along with that. But what happens when the research itself takes place in an intercultural space, and the rules and values of the academic space stand in contrast to the rules and values of the cultural space that is being inhabited? How does a PhD student fulfill their contract with the University while still embarking on morally responsible work with the research participants that has at its core existing relationships and a collective concern? How might an exploration of these issues open a window to new ways of doing research in culturally complex spaces? This article explores how one non-Indigenous PhD candidate working in an intercultural space with Indigenous research participants is unpacking and exploring these questions. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Evaluation of 'Ask the Specialist': a cultural education podcast to inspire improved healthcare for Aboriginal peoples in northern Australia.
(2022-07-12) Kerrigan V.; McGrath S.Y.; Herdman R.M.; Puruntatameri P.; Lee B.; Cass A.; Ralph A.P.; Hefler M.; Larrakia; Yolnu; Tiwi
In Australia's Northern Territory (NT) most people who access health services are Aboriginal and most healthcare providers are non-Indigenous; many providers struggle to deliver culturally competent care. Cultural awareness training is offered however, dissatisfaction exists with the limited scope of training and the face-to-face or online delivery format. Therefore, we developed and evaluated Ask the Specialist: Larrakia, Tiwi and Yolnu stories to inspire better healthcare, a cultural education podcast in which Aboriginal leaders of Larrakia, Tiwi and Yolnu nations, known as the Specialists, answer doctors' questions about working with Aboriginal patients. The Specialists offer 'counterstories' which encourage the development of critical consciousness thereby challenging racist narratives in healthcare. After listening to the podcast, doctors reported attitudinal and behavioural changes which led to stereotypes being overturned and more culturally competent care delivery. While the podcast was purposefully local, issues raised had applicability beyond the NT and outside of healthcare. Our approach was shaped by cultural safety, critical race theory and Freirean pedagogy. This pilot is embedded in a Participatory Action Research study which explores strategies to improve culturally safe communication at the main NT hospital Royal Darwin Hospital.
Evaluation of a first peoples-led, emotion-based pedagogical intervention to promote cultural safety in undergraduate non-Indigenous health professional students.
(2021-11-20) Mills K.; Creedy D.K.; Sunderland N.; Allen J.; Carter A.; Corporal S.
Background: Undergraduate health students learn cultural safety in complex and emotional ways. Pedagogies that account for these complexities must be developed and evaluated. Objective(s): To evaluate a First Peoples-led emotion-based pedagogical intervention on non-Indigenous health professional students' development towards cultural safety. Design(s): A pre-post mixed-methods intervention design. Setting and participants: All undergraduate health students undertaking a semester-long First Peoples cultural safety course (n = 395) were invited to participate. Method(s): The intervention involved students' written reflections and comfort (1 = very uncomfortable to 5 = very comfortable) with workshop content, using a gawugaa-gii-mara (head, heart, hands) form. The educator analysed student responses collected on the form, to prompt discussion in a series of four workshops. Students also completed the online 20-item Student Emotional Learning in Cultural Safety Education Instrument (SELCSI) which has two scales, Witnessing and Comfort. gawugaa-gii-mara responses were thematically coded. Paired sample t-tests examined differences over time. Eta squared determined effect size. Result(s): There were 102 matched pre-post-intervention surveys. Both SELCSI scales had excellent internal consistency (Witnessing alpha = 0.80, Comfort alpha = 0.92). A statistically significant difference was observed between students' mean scores on the Witnessing scale prior to the course (M = 47.10, SD = 6.51) compared to post-course (53.04, SD = 4.80), t(95) = 8.70, p < 0.001 (two-tailed) with a large effect size (d = 0.88). Most Comfort scale items increased but were not statistically significant. Data from the gawugaa-gii-mara intervention (n = 162 written responses) revealed students were challenged by self-reflexivity. There was a disconnect between what students had learnt (gawugaa), what they had felt (gii) and how this would be applied in professional practice (mara). Conclusion(s): The First Peoples-led, emotions-based pedagogical intervention was brief, meaningful and effective. As students grappled with their emotional connection to self-reflexivity as well as their ability to translate new knowledge into culturally safe practice, these offer important avenues for future research. Copyright © 2021
Examining the transformative potential of emotion in education: a new measure of nursing and midwifery students' emotional learning in first peoples' cultural safety.
(2021-03-13) Mills K.; Creedy D.K.; Sunderland N.; Allen J.
Background: There is growing evidence that non-Indigenous health students engage with cultural safety content in complex emotional ways. Identifying those emotions may contribute to transformative learning. Objective(s): To develop and test a measure of student emotion using an approach that centres relevant theory and First Peoples' perspectives, values and lived realities. Design(s): This study used a descriptive, cohort design. Participants and setting: All health professional students enrolled in an undergraduate Australian First Peoples health course (n = 616) were invited to complete an online survey. Method(s): A staged approach to tool development included: (1) item generation; (2) response selection; (3) expert review; (4) pilot testing, and (5) psychometric testing of the 20-item draft tool. Tests included item analysis, principal components analysis with varimax rotation, subscale analysis, and internal reliability. Result(s): One hundred and nine surveys were analysed (17.7% response rate) predominantly from nursing and midwifery students (n = 96, 88.1%). Testing resulted in the development of the two-scaled Student Emotional Learning in Cultural Safety Instrument (SELCSI). The 12-item Witnessing scale revealed three factors explaining 62.17% of variance, and the 8-item Comfort scale had two factors explaining 67.62% of the variance. Cronbach's alpha showed good internal consistency (Witnessing scale alpha = 0.78; Comfort scale alpha = 0.88). There was a correlation between mean Witnessing (M = 50.06, SD 5.66) and Comfort (M = 32.44, SD 5.01) scores (r = 0.47, p < 0.001, 95% CI [0.304-0.643]). Conclusion(s): The two scales of students' emotional learning were found to have preliminary validity and reliability. Use of the tool has important theoretical, pedagogical and methodological considerations for cultural safety in nursing and midwifery education. This tool may contribute to understanding how nursing and midwifery students learn to practice in culturally safe ways. Copyright © 2021 Elsevier Ltd
Experiences and outcomes of health professional students undertaking education on Indigenous health: a systematic integrative literature review.
(2018-08-06) Mills K.; Creedy D.K.; West R.
Objectives: To explore the experiences and outcomes of health professional students when undertaking education on Indigenous health. Design(s): An integrative systematic literature review. Data Sources: The search was undertaken from September 2017-November 2017. Six databases were searched: CINAHL, Scopus, Informit Health Collection, Informit Indigenous Collection, Proquest - Nursing and Allied Health Collection; and Proquest - Health and Medical Collection. Reference lists of all articles were scanned for further relevant articles. Review Methods: The search strategy was limited to English articles published in the previous decade. Articles were included if they focused on Indigenous health content provided to health professional university students, with a focus on Indigenous populations of Australia, New Zealand, Canada and the United States of America. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review. Studies were evaluated for methodological rigour using the CASP rating checklist. Both qualitative and quantitative data were coded using thematic qualitative analysis methods and presented as a meta-aggregation. Result(s): Twelve articles were included. Synthesis found significant variability in the ways Indigenous health issues were taught and integrated into health programs, particularly with regards to quality, methodological rigour of evaluation, pedagogical approaches and student experiences. Four themes were developed to describe student experiences and learning outcomes. These included: increasing knowledge of Indigenous health; emotional responses to content and teaching processes; perceived value of Indigenous health education; and cultural competence and critical thinking. Conclusion(s): Methodologically sound longitudinal studies are required to test if early changes in student knowledge and attitudes may be sustained. How students' 'increase in knowledge' translates to cultural capability is unclear, and there is a need for validated tools to measure this construct. A more sophisticated critique of how students emotionally engage with Indigenous health content, including understanding the relationships between 'discomfort' and transformative experiences is required. Copyright © 2018
Exploring satisfaction among women having a First Nations baby at one of three maternity hospitals offering culturally specific continuity of midwife care in Victoria, Australia: a cross-sectional survey.
(2023-07-11) McCalman P.; Forster D.; Springall T.; Newton M.; McLardie-Hore F.; McLachlan H.
Background: Continuity of midwife care is recommended to redress the inequitable perinatal outcomes experienced by Aboriginal and Torres Strait Islander (First Nations) mothers and babies, however more evidence is needed about First Nations women's views and experiences of their care. Aim(s): This study aimed to explore levels of satisfaction among women having a First Nations baby, who received maternity care at one of three maternity services, where new culturally specific midwife continuity models had been recently implemented. Method(s): Women having a First Nations baby who were booked for care at one of three study sites in Naarm (Melbourne), Victoria, were invited to complete one questionnaire during pregnancy and then a follow up questionnaire, 3 months after the birth. Result(s): Follow up questionnaires were completed by 213 women, of whom 186 had received continuity of midwife care. Most women rated their pregnancy (80 %) and labour and birth care (81 %) highly ('6 or '7' on a scale of 1-7). Women felt informed, that they had an active say in decisions, that their concerns were taken seriously, and that the midwives were kind, understanding and there when needed. Ratings of inpatient postnatal care were lower (62 %), than care at home (87 %). Conclusion(s): Women having a First Nations baby at one of three maternity services, where culturally specific, continuity of midwife care models were implemented reported high levels of satisfaction with care. It is recommended that these programs are upscaled, implemented and sustained.Copyright © 2023 Australian College of Midwives
Having a yarn about smoking: using action research to develop a 'no smoking' policy within an Aboriginal health organisation.
(2011-11-01) Fletcher G.; Fredericks B.; Adams K.; Finlay S.; Andy S.; Briggs L.; Hall R.
Objectives: This article reports on a culturally appropriate process of development of a smoke-free workplace policy within the peak Aboriginal Controlled Community Health Organisation in Victoria, Australia. Smoking is acknowledged as being responsible for at least 20% of all deaths in Aboriginal communities in Australia, and many Aboriginal health workers smoke. Method(s): The smoke-free workplace policy was developed using the iterative, discursive and experience-based methodology of Participatory Action Research, combined with the culturally embedded concept of 'having a yarn'. Result(s): Staff members initially identified smoking as a topic to be avoided within workplace discussions. This was due, in part, to grief (everyone had suffered a smoking-related bereavement). Further, there was anxiety that discussing smoking would result in culturally difficult conflict. The use of yarning opened up a safe space for discussion and debate, enabling development of a policy that was accepted across the organisation. Conclusion(s): Within Aboriginal organisations, it is not sufficient to focus on the outcomes of policy development. Rather, due attention must be paid to the process employed in development of policy, particularly when that policy is directly related to an emotionally and communally weighted topic such as smoking. © 2011 Elsevier Ireland Ltd.
Healing conversations: developing a practical framework for clinical communication between Aboriginal communities and healthcare practitioners.
(2019-05-03) McKivett A.; Paul D.; Hudson N.
In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner's own cultural identity and will be guided by collective Aboriginal worldviews in select Australian settings. Using a two-eyed seeing approach the framework will be developed and tested in health professional education. The aim of this research journey is to enable health practitioners to have more effective healthcare conversations with Aboriginal peoples, working toward more socially just and equitable healthcare interactions and outcomes.
Improving the service to Aboriginal and Torres Strait Islanders through innovative practices between Aboriginal hospital liaison officers and social workers in hospitals in Victoria, Australia.
Bnads H.; Orr E.; Clements J.C.
Aboriginal and Torres Strait Islanders have suffered violence and extreme prejudice in every walk of life as a result of the European colonisation of Australia. We acknowledge the ongoing colonial legacy to this suffering and discuss how cultural safety is a solution to overcoming some elements of the disadvantages that still beset Aboriginal and Torres Strait Islander people in terms of accessing health care. Accessible and culturally safe health services are critical in reducing health inequalities for First Nations' people because of the burden of ill-health they experience. 'Cultural safety' in this context refers to approaches that strengthen and respectfully engage with Aboriginal and Torres Strait Islander cultures in mainstream services. Alongside holistic Indigenous health and primary prevention approaches, a broad range of medical, socio-cultural and allied health support is needed to alleviate these inequalities. In this article, we describe how the working relationship between Aboriginal Hospital Liaison Officers and Social Workers in public hospitals in Victoria, Australia, contributes to cultural safety, and thereby improves the quality of care and a reduction in discharges against medical advice by Aboriginal patients. We conclude that elements of this model may be applicable to improving care for First Nation peoples in other countries. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Indigenous cultural training for health workers in Australia.
(20110526) Downing R.; Kowal E.; Paradies Y.
Purpose: Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to Indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia. Data sources: CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest. Study selection: The review focuses on the conceptual and empirical literature on Indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction: Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations. Results of data synthesis: Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian Indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect. Conclusion(s): This review shows that the evidence for the effectiveness of Indigenous cultural training programmes in Australia is poor. Critiques of cultural training from Indigenous and non-Indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for Indigenous Australians. ©The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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