Aboriginal patient and interpreter perspectives on the delivery of culturally safe hospital‐based care

Abstract

Issue addressed Improving equitable delivery of health care for Aboriginal people in northern Australia is a priority. This study sought to gauge patient experiences of hospitalisation and to identify strategies to improve equity in health care for Aboriginal patients. Aims were to validate an experience of care survey and document advice from Aboriginal interpreters. Methods Medical charts of Aboriginal patients were audited for documentation of language and interpreter use. Aboriginal inpatients were surveyed using an adapted Australian Hospital Patient Experience Question Set. Multiple‐choice responses were compared with free‐text comments to explore validity. Semi‐structured interviews were conducted with Aboriginal interpreter staff. Results In 68 charts audited, primary language was documented for only 30/68 (44%) people. Of 73 patient experience survey respondents, 49/73 (67%) indicated satisfaction with overall care; 64/73 (88%) indicated hospital staff communicated well in multiple‐choice responses. Respondents who gave positive multiple‐choice ratings nevertheless reported in free text responses concerns relating to social‐emotional support, loneliness, racism and food. Key themes from interviews included the benefits to patients from accessing interpreters, benefits of hospital‐based support for interpreters and the need for further service redesign. Conclusions Multiple‐choice questions in the survey were of limited utility; respondents' free comments were more informative. Social and emotional wellbeing must be addressed in future experience‐of‐care evaluations. Aboriginal patients' language and cultural needs can be better met by improved systems approaches. Aboriginal interpreters are uniquely placed to advise on this. So What? Improving health communication is critical to equitable and effective health care. Interventions must be driven by Aboriginal perspectives.

From “stuck” to satisfied: Aboriginal people’s experience of culturally safe care with interpreters in a Northern Territory hospital

“…This pilot study on Aboriginal interpreter-meditated communication at RDH is embedded in a larger Participatory Action Research (PAR) [ 29 – 31 ] project exploring the barriers and enablers to culturally safe communication at RDH [ 11 , 12 , 32 , 33 ]. This PAR project entailed researchers and participants collaborating through a cycle of action and reflection to identify and address areas requiring transformation [ 29 – 31 ].…”

“…It was chosen due to the high percentage of Aboriginal patients and support from nephrologists. Due to unreliable language documentation at RDH [ 12 , 45 ] the prevalence of Aboriginal languages spoken by renal patients was unknown. However, Djambarrpuyŋu, a dialect of Yolŋu Matha, is the most commonly spoken Aboriginal language in the region, with more than 4200 speakers from north-east Arnhem Land in the NT [ 1 , 46 ].…”

“…With no reliable mechanism to document Aboriginal languages spoken by RDH patients [ 12 , 45 ], participating doctors or NT AIS staff asked each patient: “what language do you speak at home?”. This was recorded on patient lists and shared with VK who entered de-identified data into an excel spreadsheet.…”

“…Instead, depending on interpreter availability, the NT AIS provided one Aboriginal language interpreter to work at the hospital for 4 h every weekday morning. The ‘rostered hospital interpreter’ was not attached to a team or division but instead waited to be paged by a health provider [ 12 ]. These interpreters were underused and felt undervalued [ 12 ].…”

“…The ‘rostered hospital interpreter’ was not attached to a team or division but instead waited to be paged by a health provider [ 12 ]. These interpreters were underused and felt undervalued [ 12 ]. Additionally, Aboriginal interpreters could be booked with 24-48 h’ notice.…”