Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity

Abstract

BackgroundAboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface.MethodsThirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data.ResultsInterviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual).ConclusionsA health professional’s practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.

Assessing cultural safety in Aboriginal and Torres Strait Islander Health

“…However, the influence of organisational factors on the ability of the participants in this study to provide culturally safe care is further evidence for the need for change at the organisational level as well 30,35 . Barriers in an organisation have previously been shown to constrain the scope of practice of primary health care workers 28,30,36 . Specifically in relation to Aboriginal and Torres Strait Islander health, the lack of capacity within an organisation has previously adversely affected the delivery of primary health care interventions to Aboriginal and Torres Strait Islander people 37 .…”

“…Previous work has acknowledged that health professionals experience challenges when working in Aboriginal and Torres Strait Islander health, such as difficulty in responding to the needs of Aboriginal and Torres Strait Islander clients due to preconceived ideas about the role of health professionals 26 . Other work has demonstrated that working in Aboriginal and Torres Strait Islander health can raise issues such as discomfort and anxiety 24,27,28 . Previous work has investigated the approaches to cultural competence training, 29 but as yet there is limited exploration of whether or not health professionals exhibit cultural safety in their practice as a result of training.…”

“…26 Other work has demonstrated that working in Aboriginal and Torres Strait Islander health can raise issues such as discomfort and anxiety. 24,27,28 Previous work has investigated the approaches to cultural competence training, 29 but as yet there is limited exploration of whether or not health professionals exhibit cultural safety in their practice as a result of training. In this study, we use the self-reported demonstration of cultural safety principles as a measure for whether or not health professionals exhibit cultural safety in their practice.…”

Working together in Aboriginal health: a framework to guide health professional practice

“…Interview schedules were developed in conjunction with Aboriginal project mentors and had between eight to 13 items (depending on cultural and professional background and position) and have been included as supplementary files. The interview schedule used with non-Aboriginal health professionals has previously been published [38,39]. Participants were aware of the aims of the study and the interviewer's interest in the topic.…”

Exploring the role‐based challenges of providing culturally inclusive health care for maternal and child health nurses: Qualitative findings

“…Being responsive to health service users' needs must be informed by, include and require respect for the users' cultural location, their ways of seeing, living in, adapting to, experiencing and extracting meaning from the world (Kagawa Singer et al, ). This is a fundamental and essential part of providing safe, inclusive, quality and ultimately, effective health care (Coast, Jones, Lattof, & Portela, ; Desouza, ; Facente, ; Reiger & Keleher, ; Ruddock & Turner, ; Wilson, Kelly, Magarey, Jones, & Mackean, ). This is only possible to achieve when there is widespread recognition and deep reflection on the cultural location and practices of mainstream healthcare systems to which maternal and child health services belong.…”