Engaging Australian Aboriginal narratives to challenge attitudes and create empathy in health care: a methodological perspective

Abstract

BackgroundUnconscious bias and negative attitudes towards minority groups have detrimental effects on the way health care is, or is not, provided to these groups. Recognition of racist attitudes and behaviours as well as understanding clients’ experiences of health and health care are pivotal to developing better health care strategies to positively impact on the quality and safety of care provided to Indigenous people.Indigenous research demands inclusive research processes and the use of culturally appropriate methodologies. This paper presents a methodological account of collecting narratives which accurately and respectfully reflect Aboriginal Australians’ experiences with health care in Western Australia. The purpose of these narratives is to provide health students and professionals with an opportunity to ‘walk-in the shoes’ of Aboriginal people where face-to-face interaction is not feasible.MethodsWith the incorporation of Indigenous peoples’ voices being an important link in cultural safety, the project was led by an Indigenous Reference group, who encouraged active participation of Aboriginal people in all areas of the project. Using a phenomenological approach and guided by the Indigenous Reference group, yarning data collection was implemented to collect stories focusing on Aboriginal people’s experiences with health care services. An open-access, on-line website was established to host education resources developed from these “yarns”.ResultsYarning provided a rich source of information on personal experiences and encouraged the story provider to recognise their facilitative role in the research process. While the methodology used in this project was lengthy and labour-intensive it afforded a respectful manner for story collection and highlighted several innate flaws when Western methods are applied to an Indigenous context.ConclusionEngagement of an Indigenous Reference Group was pivotal to designing an appropriate methodology that incorporated the voices of Aboriginal people in a multimedia resource of Aboriginal narratives. However further research is warranted to understand how the resources are being used and integrated into curricula, and their impact on students and health care outcomes.

Recommended methodologies to determine Australian Indigenous community members' perceptions of their health needs: a literature review

“…Engagement of an Indigenous Reference Group (IRG) to guide the researchers in culturally appropriate protocols, behaviours, language and interpretation of data will strengthen the validity of the research process and findings. Wain et al (2016) found that the IRG provided an interface between the epistemological differences and created a foundation from which the Aboriginal narrative resources could be generated, guaranteeing they were true to, and respectful of, Indigenous cultures.…”

“…The reviewed literature indicates that yarning or storytelling is the single most recommended data collection method with Indigenous Australians (Gorman and Toombs 2009;Bessarab and Ng'andu 2010;Fredericks et al 2011;Lambert 2011;Geia et al 2013;Leeson et al 2016;Wain et al 2016;Doyle et al 2017;Ober 2017). The conversational method used to engage focus groups/talking circles is supported by Lambert (2011) and Braun et al (2014).…”

“…Yarning provides a culturally secure place and helps facilitate in-depth discussions that result in thick description (Geia et al 2013). Wain et al (2016) observed that yarning provided a rich source of information on personal experiences that encouraged the story provider to recognise their facilitative role in the research process. Yarning as a data collection tool constitutes a means through which Australian Indigenous ontology (the nature of being), epistemology (the nature, sources and limits of knowledge) and axiology (the nature of values and value judgements) can be prioritised in completing the research (Leeson et al 2016).…”

“…Yarning as a data collection tool constitutes a means through which Australian Indigenous ontology (the nature of being), epistemology (the nature, sources and limits of knowledge) and axiology (the nature of values and value judgements) can be prioritised in completing the research (Leeson et al 2016). An important aspect of yarning is to allow the participant's story to flow; where interruption by the researcher to bring the conversation 'back on track' can lead to missing highly pertinent information, as experienced by Bessarab and Ng'andu (2010) and Wain et al (2016).…”

Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action

“…Disparities in health care utilization and access by Aboriginal people are underscored by a history of negative health care experiences, mistrust and suspicion of the health care system and practitioners 30–32 . Cultural differences between Aboriginal people and non‐Aboriginal health care providers have been recognized since the 1970s 32 but little appears to have changed in terms of ensuring cultural safety, reducing racism or promoting better understanding by health providers over the ensuing five decades 27,33 . Aboriginal communities in Australia have long argued for the vital role that Aboriginal Community Controlled Health Services (ACCHS) play in improving the health of Aboriginal people 34 .…”