Attitudes and characteristics of health professionals working in Aboriginal health

There is an unacceptable gap in health status between Aboriginal and non-Aboriginal people in Australia. Linked to social inequalities in health and political and historical marginalisation, this health gap must be urgently addressed. It is important that health professionals, the majority of whom in Australia are non-Aboriginal, are confident and equipped to work in Aboriginal health in order to contribute towards closing the health gap. The purpose of this study was to explore the attitudes and characteristics of non-Aboriginal health professionals working in Aboriginal health. Methods: The research was guided and informed by a social constructionist epistemology and a critical theoretical approach. It was set within a larger healthy eating and physical activity program delivered in one rural and one metropolitan community in South Australia from 2005 to 2010. Non-Aboriginal staff working in the health services where the program was delivered and who had some experience or an interest working in Aboriginal health were invited to participate in a semi-structured interview. Dietitians working across South Australia (rural and metropolitan locations) were also invited to participate in an interview. Data were coded into themes that recurred throughout the interview and this process was guided by critical social research. Results: Thirty-five non-Aboriginal health professionals participated in a semi-structured interview about their experiences working in Aboriginal health. The general attitudes and characteristics of non-Aboriginal health professionals were classified using four main groupings, ranging from a lack of practical knowledge (‘don’t know how’), a fear of practice (‘too scared’), the area of Aboriginal health perceived as too difficult (‘too hard’) and learning to practice regardless (‘barrier breaker’). Workers in each group had different characteristics including various levels of willingness to work in the area; various understandings of Australia’s historical relationship with Aboriginal peoples; varying awareness of their own cultural identity and influence on working with Aboriginal people; and different levels of (dis)comfort expressed in discussions about social, political and intercultural issues that impact on the healthcare encounter. Conclusions: These groupings can be used to assist non-Aboriginal health professionals to reflect on their own levels of confidence, attitudes, characteristics, experiences, approaches and assumptions to Aboriginal health, as an important precursor to further practice and development in Aboriginal health. By encouraging self-reflection of non-Aboriginal health professionals about where their experiences, characteristics and confidence lie, the groupings presented in this paper can be used to encourage non-Aboriginal health professionals, rather than Aboriginal clients or workers, to be the focus for change and deliver health care that is more acceptable to patients and clients, hence influencing health service delivery. The groupings presented can also begin to enable discussions between all health professionals about working together in Aboriginal health

Recognizing aboriginal oral tradition through blended learning: a success story

The Aboriginal Health and Community Administration Program (AHCAP) is a certificate program developed through the partnership of the Institute for Aboriginal Health and Continuing Studies at the University of British Columbia. This paper examines factors in the program’s blended design and development which have contributed to the exceptionally high completion rate and the strongly positive responses and outcomes for widely diverse learner cohorts. Factors which appear to contribute to the program success include: 1) a holistic approach compatible with traditional Aboriginal oral traditions of teaching and learning; 2) a university partnership that taps into unique networks and capacities; 3) incorporating the 4 R’s of Aboriginal education: relevance, reciprocity, respect and responsibility generated throughout the learning and teaching, both online and face-to-face; and 4) making the program accessible to geographically and technologically diverse communities of learners.\u

Aboriginal health and institutional reform within Australian federalism

This paper examines relationships between institutional reform within Australian federalism and Aboriginal health, both historically and in prospect. It begins with a brief historical analysis of government involvement in the general health arena within Australian federalism. It then provides a more extended historical account of government involvement in Aboriginal health and the emergence in the last 25 years of a group of important non-government players, the Aboriginal community-controlled health services. A more normative prescriptive analysis then follows, which identifies lessons from past experiences and enunciates principles for future action. These lessons and principles relate in particular to ideas about complexity and the need for greater role clarification and coordination in institutional arrangements for Aboriginal health. We argue for a view which in large part accepts this complexity and sees a need to draw organisations and their efforts into the Aboriginal health arena, rather than drive them out. We also, however, caution against drawing in all relevant organisations in related fields such as housing, education and infrastructure provision in the name of 'intersectoral collaboration'. A third argument suggests, perhaps counter intuitively, that measuring the success of institutional reform in Aboriginal health should to some extent be disarticulated from changes in substantive Aboriginal health status. A brief penultimate section of the paper looks at current general developments in the health arena. The conclusion of the paper identifies the key challenge and current opportunity for institutional reform within Australian federalism relating to Aboriginal health. This relates to the linking of responsibility sharing within Australian federalism and Aboriginal self-determination

Aboriginal Health Consumers Experiences of an Aboriginal Health Curriculum Framework

Introduction In settler colonised countries medical education is situated in colonist informed health systems. This form of colonisation is characterised by overt racism and contributes to the significant health inequities experienced by Indigenous peoples. Not surprisingly, medical accreditation bodies in these countries have mandated the curriculum include content relating to Indigenous peoples. However, what is absent is the Indigenous health consumer worldview of health care and their nuanced lived experience of the delivery of medical care. Methods Yarning methods, integral to Aboriginal peoples’ ways of understanding and learning, were utilised. A Yarning guide was constructed with Social Yarn and Research Topic Yarn questions to understand Aboriginal health consumer experiences of the five learning domains within the Aboriginal and Torres Strait Islander Health Curriculum Framework. Data were analysed using Framework Analysis. Results Seventeen Aboriginal adults from urban and rural areas participated in the Yarns during 2018 and 2019. Coding and mapping data identified medical practitioner enacting practices that either perpetuated racism and the settler colonial ideology or facilitated anti-racist health care. Unwanted care included three racism themes described as the practitioner perpetuating and being unresponsive to racism; assimilation and an inability to consider impacts of settler colonialism. Desired care included four anti-racist themes expressed as responsiveness to racism and settler colonialism; advocating within the settler colonial health system; engaging with diversity of Aboriginal ways of knowing, being and doing and lifelong learning and reflection. Conclusion Medical practitioners are promoting ill health through racist practices with Aboriginal health consumers. Aboriginal people’s experiences of racism via continued settler colonial processes and anti-racism in the Australian health system, are critical to meaningful curricula. However, there is a risk for tokenism if the academy continues its coloniality by privileging the biomedical model of illness and health over other models of health

"Got to build that trust" : the perspectives and experiences of Aboriginal health staff on maternal oral health

Background: In Australia, models of care have been developed to train antenatal care providers to promote oral health among pregnant women. However, these models are underpinned by Western values of maternity care that do not consider the cultural needs of Aboriginal and Torres Strait Islander women. This study aimed to explore the perceptions and experiences of Aboriginal health staff towards oral health care during pregnancy. It is part of a larger program of research to develop a new, culturally safe model of oral health care for Aboriginal women during pregnancy. Methods: A descriptive qualitative methodology informed the study. Focus groups were convened to yarn with Aboriginal Health Workers, Family Partnership Workers and Aboriginal management staff at two antenatal health services in Sydney, Australia. Results: A total of 14 people participated in the focus groups. There were four themes that were constructed. These focused on Aboriginal Health Workers and Family Partnership Workers identifying their role in promoting maternal oral health, where adequate training is provided and where trust has been developed with clients. Yet, because the Aboriginal health staff work in a system fundamentally driven by the legacy of colonisation, it has significantly contributed to the systemic barriers Aboriginal pregnant women continue to face in accessing health services, including dental care. The participants recommended that a priority dental referral pathway, that supported continuity of care, could provide increased accessibility to dental care. Conclusions: The Aboriginal health staff identified the potential role of Aboriginal Health Workers and Family Partnership Workers promoting oral health among Aboriginal pregnant women. To develop an effective oral health model of care among Aboriginal women during pregnancy, there is the need for training of Aboriginal Health Workers and Family Partnership Workers in oral health. Including Aboriginal staff at every stage of a dental referral pathway could reduce the fear of accessing mainstream health institutions and also promote continuity of care. Although broader oral health policies still need to be changed, this model could mitigate some of the barriers between Aboriginal women and both dental care providers and healthcare systems

Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia.

BACKGROUND:In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory's publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. METHODS:A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. RESULTS:39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, 'needs assessment' findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. CONCLUSION:This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems

First Nations, Inuit, Métis Health Core Competencies: A Curriculum Framework for Undergraduate Medical Education

The intent of these core competencies is to provide undergraduate medical educators with broad thematic domains around First Nations, Inuit, Métis (FN/I/M) health knowledge, skills and attitudes to engage in both patient and community-centered approaches to health care delivery with and for FN/I/M peoples

Setting and meeting priorities in Indigenous health research in Australia and its application in the Cooperative Research Centre for Aboriginal Health

Priority setting is about making decisions. Key issues faced during priority setting processes include identifying who makes these decisions, who sets the criteria, and who benefits. The paper reviews the literature and history around priority setting in research, particularly in Aboriginal health research. We explore these issues through a case study of the Cooperative Research Centre for Aboriginal Health (CRCAH)'s experience in setting and meeting priorities

Can my mechanic fix blue cars? A discussion of health clinician\u27s interactions with Aboriginal Australian clients

We expect our professional mechanics to ‘diagnose’ and \u27treat\u27 our cars irrespective of colour, but are we expecting less from our health professionals? There is an increasing focus in the literature on health practitioner decision-making and its influence on the nature and quality of health care. In this article we explore how the basic diagnostic and therapeutic skills that health care practitioners have should be utilised equitably for all clients and propose ways this might be realised. Could the development of Indigenous specific curricula be teaching our medical students to think that Aboriginal patients are different from the norm? We conclude that despite the gains in introducing more comprehensive Aboriginal health curricula there remains considerable work to be done before we can be confident that we are ensuring that health practitioners are no longer contributing to health disparities