Lowitja Associated Research

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The Lowitja Institute’s pioneering research projects and scholarship initiatives have significantly influenced health research worldwide. This collection includes research outputs that either reference publications by the Lowitja Institute or utilise our research tools.
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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)
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)
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.
'Maybe what I do know is wrong...': Reframing educator roles and professional development for teaching Indigenous health.
(2023-04-14) Francis-Cracknell A.; Truong M.; Adams K.
Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples' health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.Copyright © 2022 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.
Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary.
(2024-04-24) Tunnicliffe D.J.; Bateman S.; Arnold-Chamney M.; Dwyer K.M.; Howell M.; Gebadi A.; Jesudason S.; Kelly J.; Lambert K.; Majoni S.W.; Oliva D.; Owen K.J.; Pearson O.; Rix E.; Roberts I.; Taylor K.; Wittert G.A.; Widders K.; Yip A.; Craig J.; Phoon R.K.
Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age >= 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], <= 45 mL/min/1.73 m2, and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.Copyright © 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.
Tutor of resilience: a model for psychosocial care following experiences of adversity.
(2021-08-06) Giordano F.; Cipolla A.; Ungar M.
This article describes a model for training service providers to provide interventions that build resilience among individuals who have experienced adversity. The Tutor of Resilience model emphasizes two distinct dimensions to training: (1) transforming service providers' perceptions of intervention beneficiaries by highlighting their strengths and capacity for healing; and (2) flexibly building contextually and culturally specific interventions through a five-phase model of program development and implementation. Tutor of Resilience has been employed successfully with child and youth populations under stress in humanitarian settings where mental health and psychosocial support professionals are required to design and deliver interventions that enhance resilience among vulnerable children.© Copyright © 2021 Giordano, Cipolla and Ungar.
Weaving wayapa and cognitive behaviour therapy: applying research topic yarning to explore a cultural interface between western and Indigenous psychology practice in Australia.
O'Shea M.; Klas A.; Hardy T.; Stone J.; Frangos T.; Jacobs T.; Mitchell F.; Charles J.; Jones S.; Thomas J.; Ryan K.
Background: Indigenous Psychology within Australia reflects the traditional knowledges of Aboriginal and Torres Strait Islander Peoples and their understanding of the cultivation of relational social and emotional wellbeing (SEWB). However, these perspectives are poorly incorporated into dominant "Western" psychological theories and practice, such as Cognitive Behaviour Therapy (CBT). This represents a barrier to the cultural safety of current mental health practice and its decolonisation within Australia. Objectives: This study brought together CBT Practitioners and Practitioners of an Aboriginal Wellbeing practice ("Wayapa") to engage in a series of yarns (guided focus groups) to share perspectives, insights, and stories on their own and each other's practices. Method: Indigenous qualitative research approaches including Research Topic Yarning were engaged to decolonise the research environment and support dialogue at the cultural interface of the two practices. Results: Through experiencing Wayapa, CBT practitioners reflected on gaps in their own practice, with an enthusiasm for the opportunities that Wayapa provided to decolonise their practice. Wayapa practitioners were able to celebrate the holistic nature of their practice and the possibility for it to inform dominant "Western" psychological theories and practice, such as CBT, and encourage a more connected and culturally safe way of working with First Nations peoples. Conclusions: Creating safe cultural interfaces between "Western" and Indigenous Psychologies, and building awareness of the value of Aboriginal grounded wellbeing models, can help to promote and expand culturally safe practices within Australian psychological practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

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