Objectives: To identify factors limiting the effectiveness of communication between Aboriginal patients with end‐stage renal disease and healthcare workers, and to identify strategies for improving communication. Design: Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in‐depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication. Setting: A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001. Participants: Aboriginal patients from the Yolngu language group of north‐east Arnhem Land and their medical, nursing and allied professional carers. Main outcome measures: Factors influencing the quality of communication. Results: A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters. Conclusions: Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.

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This study demonstrates the potential impact of engagement in peer support services on some subjective aspects of mental health recovery. Namely, change mechanisms could be hypothesized to include identity transformation (from patient to peer). Future directions should continue to investigate potential mechanisms of change with larger samples in randomized studies. (PsycINFO Database Record

Consumers' reliance on formal therapeutic supports and support from peers and family suggests that education and support for dealing with individuals in despair and crisis should be targeted to the social networks of this high-risk population. The disparity between availability of formal mental health services and reliance on them when consumers are suicidal suggests that suicide prevention efforts should evaluate whether they are effectively engaging high-risk populations as they struggle to cope with despair.

A two‐terminal graph is an undirected graph with two specified target vertices. If each nontarget vertex of a two‐terminal graph fails independently with the same fixed probability (and edges and target vertices are perfectly reliable), the two‐terminal node reliability is the probability that the target vertices are in the same connected component in the induced subgraph of all operational nodes. A two‐terminal graph is uniformly most reliable if its node reliability polynomial is greater than or equal to that of all other two‐terminal graphs with the same fixed number of vertices, n, and edges, m. In this paper, we show that there is always a uniformly most reliable two‐terminal graph. Furthermore, with the additional restriction that the distance between the target vertices is at least three, we completely classify which values of n and m produce a uniformly most reliable graph and which do not.