Cultural safety and maternity care for Aboriginal and Torres Strait Islander Australians

PurposeTo discuss cultural safety and critique the provision of culturally appropriate maternity services to remote Aboriginal and Torres Strait Islander women in Australia.ProcedureThe literature and policies around ‘culture’ and ‘cultural safety’ are discussed and applied to the provision of maternity services to Aboriginal and Torres Strait Islander women in remote areas of Australia.FindingsThe current provision of maternity services to Aboriginal and Torres Strait Islander women, particularly those living in remote Australia, appears largely inadequate. The provision of culturally safe maternity care requires health system reform at all levels including: the individual practitioner response; the educational preparation of practitioners; the delivery of maternity services and the development of policy at local, state and national level. This paper considers the changes that can be made from the individual practitioner through to the design and implementation of maternity services.Principal conclusionsCultural safety provides a useful framework to improve the delivery of maternity services to remote Aboriginal and Torres Strait Islander women and their families

A participatory approach for assessing alternative climate change adaptation responses to cope with flooding risk in the upper Brahmaputra and Danube river basins

This article describes the research process used to develop and evaluate an Internet-based resource aimed at improving access by health professionals to Australian Aboriginal cultural knowledge specific to pregnancy and childbirth. As a result of the research, women's stories from Maningrida were recorded and presented on the `Birthing Business in the Bush Website' which provided a platform for Aboriginal Australian women from Maningrida to present cultural and other information to maternity care practitioners. In particular, this article describes the development of the participatory action research combined with an Aboriginal research process, and how this was guided by the Aboriginal co-researchers and participants

Bulldust, flat tyres and roadkill: a disorderly decolonising fieldwork journey through remote Aboriginal and Torres Strait Islander Australia

The purpose of this paper is to discuss the iterations and outcomes of a doctoral fieldwork experience where the Aboriginal and Torres Strait Islander participants challenged me to radically adapt my constructivist grounded theory methodology and commence decolonising data gathering and analysis while in the field. The starting point for the research was a discourse of defeatism in the literature around mature-age Aboriginal and Torres Strait Islander university graduates and students, which the participants, my doctoral supervisors and I perceived as unjust and unjustifiable. The aim of the ongoing research, therefore, is to explore and explicate an alternative discourse, beginning with the emic perspectives of mature- age Aboriginal and Torres Strait Islander university graduates. In the context of the remote Aboriginal and Torres Strait Islander field, I detail the early and some- what disorderly enactment of decolonising methodology — disorderly because I was unprepared for the extent to which the participants would take control of both the research agenda and methods. Disorder also partly characterised our collabora- tive methodological adaptation, in that it was initially more intuitive than deliber- ate. I discuss how the participants shifted the post-graduation narrative from one of personal and professional uplift to one they dubbed ‘the blessings and burdens of being an educated black’. This narrative unequivocally challenges the notion of Australia as a postcolonial society and positions the participants as activists in the fight for indigenous self-determination. I reflect on mistakes made and lessons learned, and articulate pragmatic and achievable fieldwork research methods that privilege participants as knowledge producers and custodians. The paper concludes by discussing the next stages of the decolonising constructivist grounded theory project, which necessitated a return to the field to test and refine the emerging conceptual categories with the participants, most of whom have remained active partners in the research

Understanding non-vaccinating parents\u27 views to inform and improve clinical encounters: A qualitative study in an Australian community

Objectives: To explain vaccination refusal in a sample of Australian parents. Design: Qualitative design, purposive sampling in a defined population. Setting: A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal. Participants: Semi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment: via local advertising then snowballing. Results: Thematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents\u27 accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for the real truth\u27; reactance to system inflexibilities and ongoing risk assessment. Conclusions: We suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group