“The most culturally safe training I’ve ever had”: the co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia

Abstract

Background The Aboriginal health workforce provide responsive, culturally safe health care. We aimed to co-design a culturally safe course with and for the Aboriginal health workforce. We describe the factors which led to the successful co-design, delivery, and evaluation of the “Managing hepatitis B” course for the Aboriginal health workforce. Methods A Participatory Action Research approach was used, involving ongoing consultation to iteratively co-design and then develop course content, materials, and evaluation tools. An Aboriginal and Torres Strait Islander research and teaching team received education in chronic hepatitis B and teaching methodologies. Pilot courses were held, in remote communities of the Northern Territory, using two-way learning and teach-back methods to further develop the course and assess acceptability and learnings. Data collection involved focus group discussions, in-class observations, reflective analysis, and use of co-designed and assessed evaluation tools. Results Twenty-six participants attended the pilot courses. Aboriginal and Torres Strait Islander facilitators delivered a high proportion of the course. Evaluations demonstrated high course acceptability, cultural safety, and learnings. Key elements contributing to success and acceptability were acknowledging, respecting, and integrating cultural differences into education, delivering messaging and key concepts through an Aboriginal and Torres Strait Islander lens, using culturally appropriate approaches to learning including storytelling and visual teaching methodologies. Evaluation of culturally safe frameworks and findings from the co-design process led to the creation of a conceptual framework, underpinned by meeting people’s basic needs, and offering a safe and comfortable environment to enable productive learning with attention to the following: sustenance, financial security, cultural obligations, and gender and kinship relationships. Conclusions Co-designed education for the Aboriginal health workforce must embed principles of cultural safety and meaningful community consultation to enable an increase in knowledge and empowerment. The findings of this research can be used to guide the design of future health education for First Nations health professionals and to other non-dominant cultures. The course model has been successfully transferred to other health issues in the Northern Territory.

“Putting the power back into community”: A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia’s Northern Territory

“…We respectfully acknowledged difference, allowing flexibility for the participants and Aboriginal and Torres Strait Islander facilitators, including ensuring family and kinship needs were met so that the participants were able to fully engage in learning. We have previously described that before one can be empowered to learn they need to feel safe, secure and sustained [ 38 ]. The importance of these factors was emphasised by participants with non-content related themes emerging in the data.…”

“…Having Aboriginal and Torres Strait Islander facilitators was important to the participants, as role models and to re-invigorate enthusiasm for their professions. The co-design process included a focus to capacity build facilitators in CHB knowledge and teaching methodologies [ 38 ]. There is a sense of ownership, trust and respect that shone through and may have been a component to the success of the course, with the passion of facilitators mentioned by participants.…”

“…We used the Hep B story app [ 33 ], which was developed to improve CHB-specific health literacy among Aboriginal and Torres Strait Islander communities by providing culturally appropriate education in a person’s first language [ 33 ], currently available in nine NT Aboriginal languages [ 40 ]. The program has been designed to cater to the learning needs of the Aboriginal health workforce, modifying and adapting content considering context, group dynamics, cultural requirements, knowledge, experience, and capacity of the participants [ 38 , 50 ].…”

“…We evaluated the course and its utility using selected quantitative and qualitative methodologies and evaluation tools specifically designed for this purpose [ 38 ].…”

“…CHB-specific education exists for doctors and nurses. As there was no specific CHB-related education for the Aboriginal health workforce, we co-designed, developed and piloted the “Managing hepatitis B” training course using two-way learning and decolonising pedagogies [ 38 ], including Freirean pedagogy. Freirean pedagogy is a progressive educational approach rooted in the principles of critical thinking, social justice, and empowerment [ 39 ].…”