A new clinic model for refugee health care: adaptation of cultural safety

Promoting healthy futures in a rural refugee resettlement location: A community-based participatory research intervention

“…Structural barriers include appointment availability and wait times, and the short duration of appointments, which can be insufficient given complex health needs and the time required for translation. Non-continuity of care can also impede the building of trust (Morris et al, 2009; Reavy et al, 2012; Riggs et al, 2017; Robertshaw et al, 2017).…”

“…It is not surprising, then, that language and communication are consistently cited as the most significant barriers to accessing and navigating healthcare for refugee-background populations in resettlement contexts, by both practitioners and people from refugee backgrounds (e.g. Morris et al, 2009; Reavy et al, 2012).…”

“…Lack of inclusive, culturally informed care is increasingly recognised as a significant issue in healthcare for refugee-background groups (Reavy et al, 2012; Robertshaw et al, 2017; Smith, Reynish et al, 2019), an issue that is further exacerbated by the lack of availability in rural and regional areas of healthcare practitioners with appropriate expertise in trauma-informed care. This is particularly critical in relation to the mental healthcare much needed by people with refugee backgrounds, but too often impeded by divergent cultural understandings and related stigma (Kokanovic et al, 2010; Morris et al, 2009).…”

“…Cultural safety goes beyond cultural competence – with its focus on learning aspects of a patient’s culture – to recognise both patients and healthcare workers as bearers of culture and to render visible the normative whiteness of the healthcare system and the unequal power relations that perpetuate it (DeSouza, 2008; Mayes, 2020; Nunesa and Louvisonb, 2020). Cultural safety seeks to confront and address entrenched inequalities through dialogue, collaboration, and reflexive practice (DeSouza, 2008; Reavy et al, 2012).…”

“…A cultural safety approach has significant transformative potential for healthcare for refugee-background communities in rural and regional settings, by providing a framework for engaging with the range of challenges outlined above, including divergent understandings of health and care, ineffective communication, lack of trust, and discrimination. Moreover, rather than creating ‘a checklist mentality that essentialises group members’, as cultural competency approaches risk doing (DeSouza, 2008: 129), cultural safety recognises culture as diverse and dynamic, accommodating different orientations to culture within and between refugee-background communities, including across life stages, and throughout the resettlement process (Reavy et al, 2012). It also has the potential to foster reflexive, inclusive care in rural and regional resettlement contexts where there is limited experience and skill in intercultural care (McKinnon, 2020), and where the prevalence of a white rural imaginary that centres Anglo-Australian people and culture often serves to marginalise and exclude those who are non-white and non-Western (Edgeworth, 2015).…”