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Tarpey-Brown G, Kirwan J, Wise S, Alisic E, Vaughan C, Block K. Domestic and Family Violence Affecting Children and Young People from Culturally and Racially Marginalized Migrant Backgrounds in Australia: A Scoping Review of Child Experiences and Service Responses. TRAUMA, VIOLENCE & ABUSE 2024; 25:3872-3886. [PMID: 39066616 PMCID: PMC11545364 DOI: 10.1177/15248380241265386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
In Australia, children and families from culturally and racially marginalized (CARM) migrant backgrounds experience a range of compounding structural and interpersonal factors that limit help-seeking and exacerbate the impacts of domestic and family violence (DFV). This scoping review examines the current state of knowledge on how children and young people from CARM migrant backgrounds experience DFV, and the services that respond to DFV including child protection services. A systematic search was conducted across PsycINFO, MEDLINE, and CINAHL databases and Google Scholar, alongside a complementary grey literature search. Articles were included in the review if participants were from CARM migrant backgrounds, and the article included information related to children and young people's experiences of DFV, and the DFV service system. The review found 19 articles that met selection criteria. Due to limited research on this topic in Australia, most articles focused on children and young people's experiences shared through parental, carer or service provider perspectives. To our knowledge, this is the first scoping review to examine how children and young people from CARM migrant backgrounds experience DFV. Findings demonstrate children and young people are victim-survivors of multiple forms of DFV. Children and young people's engagement with the DFV service system is often accompanied by feelings of fear and distrust. Findings suggest that to strengthen system responses to DFV, services must build their capability to implement intersectional approaches that simultaneously support the safety and well-being of both the child and the non-violent parent or carer.
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Affiliation(s)
| | - Jess Kirwan
- University of Melbourne, Carlton, VIC, Australia
| | - Sarah Wise
- University of Melbourne, Carlton, VIC, Australia
| | - Eva Alisic
- University of Melbourne, Carlton, VIC, Australia
| | | | - Karen Block
- University of Melbourne, Carlton, VIC, Australia
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Currie G, John G, Hewis J. Gender and ethnicity bias in generative artificial intelligence text-to-image depiction of pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024; 32:524-531. [PMID: 39228085 DOI: 10.1093/ijpp/riae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/15/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION In Australia, 64% of pharmacists are women but continue to be under-represented. Generative artificial intelligence (AI) is potentially transformative but also has the potential for errors, misrepresentations, and bias. Generative AI text-to-image production using DALL-E 3 (OpenAI) is readily accessible and user-friendly but may reinforce gender and ethnicity biases. METHODS In March 2024, DALL-E 3 was utilized to generate individual and group images of Australian pharmacists. Collectively, 40 images were produced with DALL-E 3 for evaluation of which 30 were individual characters and the remaining 10 images were comprised of multiple characters (N = 155). All images were independently analysed by two reviewers for apparent gender, age, ethnicity, skin tone, and body habitus. Discrepancies in responses were resolved by third-observer consensus. RESULTS Collectively for DALL-E 3, 69.7% of pharmacists were depicted as men, 29.7% as women, 93.5% as a light skin tone, 6.5% as mid skin tone, and 0% as dark skin tone. The gender distribution was a statistically significant variation from that of actual Australian pharmacists (P < .001). Among the images of individual pharmacists, DALL-E 3 generated 100% as men and 100% were light skin tone. CONCLUSIONS This evaluation reveals the gender and ethnicity bias associated with generative AI text-to-image generation using DALL-E 3 among Australian pharmacists. Generated images have a disproportionately high representation of white men as pharmacists which is not representative of the diversity of pharmacists in Australia today.
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Affiliation(s)
- Geoffrey Currie
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, Australia
- Department of Radiology, Baylor College of Medicine, Houston, United States
| | - George John
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Johnathan Hewis
- School of Dentistry and Medical Sciences, Charles Sturt University, Port Macquarie, Australia
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Hunter K, Ryder C, Coombes J, Clapham K, Mackean T, Holland AJA, Fraser S, Williams H, Griffin B, Möller H, Ivers RQ. Understanding burn injury among Aboriginal and Torres Strait Islander children - results of a two-year cohort study. Burns 2024; 50:1947-1956. [PMID: 39043514 DOI: 10.1016/j.burns.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 05/13/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Despite known inequalities, little is understood about the burden and healthcare experiences of Aboriginal and Torres Strait Islander children who sustain a burn injury and their families. METHODS The Coolamon Study recruited parents and carers whose children (aged <16 years) were Aboriginal and / or Torres Strait Islander children and had presented to burn units across four Australian states, New South Wales (Sydney), Northern Territory (Darwin), Queensland (Brisbane, Townsville) and South Australia (Adelaide), between 2015 and 2018. Consent was obtained and carers completed baseline and subsequent interviews at 3, 6, 12 and 24 months. Data were collected on the injury event, patient care and safety, sociodemographic factors, health related quality of life (PedsQual), and psychological distress (Kessler K-5). RESULTS Of the 208 participants, 64 % were male; 26 % were aged less than 2 years and 37 % aged 2-4 years. The most common burn mechanisms were scalds (37 %), contact (33 %) and flame burns (21 %), with more severe burns and flame burns occurring in rural and remote settings. Most carers rated their child's care as either excellent or very good (82 %). Family distress, measured by the K-5, lessened over the 24 months, however the changes were not statistically significant. While 77 % of carers reported that they received enough information, 18 % reported they would have liked more, and 3 % reported no information was provided before treatment. Parents described mixed access to information about the types of support available to them, such as accommodation, meals, travel or cultural support. CONCLUSION Data from this cohort provide rich new information about risk factors and care received from point of injury through to rehabilitation for Aboriginal and Torres Strait Islander children with burns, providing unique insights into what is needed for appropriate, culturally safe care.
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Affiliation(s)
- Kate Hunter
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Courtney Ryder
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia.
| | - Julieann Coombes
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Kathleen Clapham
- School of Medical, Indigenous and Health Sciences, University of Wollongong, NSW 2522, Australia
| | - Tamara Mackean
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
| | - Andrew J A Holland
- Sydney Medical School, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
| | - Sarah Fraser
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Hayley Williams
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia
| | - Holger Möller
- School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Rebecca Q Ivers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
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Rajkhowa A, Sharp M, Kelly B, Lang B, Rizzi A, Woodward-Kron R. Strategically communicating inclusion efforts at hospitals: Trust-signalling for community engagement. Int J Health Plann Manage 2024. [PMID: 39378159 DOI: 10.1002/hpm.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/15/2024] [Accepted: 09/18/2024] [Indexed: 10/10/2024] Open
Abstract
Trust is a challenging and complex concept and takes on particular significance in the context of community engagement and communication in healthcare. For the purpose of making health services more inclusive and of tackling discrimination where it occurs, there is a need to articulate a vision for inclusion that communities of historically disadvantaged or stigmatised patients can trust. This article considers examples of diversity and inclusion 'signals' on the public websites of two large public hospitals in Melbourne, Australia. We suggest that there is value in public communications reaffirming respect for diversity and a commitment to inclusion in health services. We also make the case for interdisciplinary research into how trust-signalling strategies, that is, rhetorical strategies employed to reassure or convince, are developed by and for health services for the purposes of community engagement, and the specific effects that they may engender. Websites' framing of messages that affirm institutional commitments to fostering an inclusive environment and addressing barriers can serve as a means of explicitly encouraging patients and healthcare workers from marginalised communities to overcome potential obstacles to fuller healthcare engagement and workforce participation respectively.
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Affiliation(s)
| | - Megan Sharp
- University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara Kelly
- University of Melbourne, Melbourne, Victoria, Australia
| | - Birgit Lang
- University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Rizzi
- University of Melbourne, Melbourne, Victoria, Australia
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Massey L, Gilroy J, Kowal E, Doolan D, Clough A. Aboriginal families living with MJD in remote Australia: questions of access and equity. Int J Equity Health 2024; 23:187. [PMID: 39294722 PMCID: PMC11409620 DOI: 10.1186/s12939-024-02228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/09/2024] [Indexed: 09/21/2024] Open
Abstract
Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups.Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice.Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care.
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Affiliation(s)
- Libby Massey
- Division of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia.
- MJD Foundation, Alyangula, NT, Australia.
| | - John Gilroy
- The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Emma Kowal
- Alfred Deakin Institute, Deakin University, Melbourne, Australia
| | - Denise Doolan
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Alan Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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Peek A, Hamilton S, Atchan M, Jojo N, Northam H. Unveiling injustice: Disrupting child removal policies and upholding breastfeeding: An emancipatory framework. Birth 2024. [PMID: 39149793 DOI: 10.1111/birt.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/30/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024]
Abstract
Before colonization, Aboriginal and Torres Strait Islander communities had nurturing, holistic, and communitarian approaches that promoted extended and healthy lives for their children. Colonization, marked by policies of genocide and assimilation, has resulted in an alarming overrepresentation of Aboriginal and Torres Strait Islander children under the care of child protection agencies, resulting in compromised health outcomes and reduced life expectancies. We are conducting a study designed to enhance positive developmental outcomes for Aboriginal and Torres Strait Islander children by articulating and enabling the rights of mothers and children to breastfeed in the context of a child protection intervention and child removal. To understand and address this problem, it is critical to implement culturally safe, de-colonized, emancipatory research that is guided by and benefits Aboriginal and Torres Strait Islander communities. This article presents an emancipatory framework that we are applying to our study using an Aboriginal participatory action research approach, that serves as a guide for non-Indigenous researchers seeking to conduct research with Indigenous communities. We emphasize the importance of incorporating an Aboriginal participatory action research framework, using community consultation and codesign; culturally secure data collection methods, and paying attention to Indigenous data sovereignty. Developing trusting respectful relationships is conducive to knowledge acquisition, exchange, and use, when research approaches deeply rooted in community involvement are applied. A call to action by the critical midwifery studies collective, urges non-Indigenous researchers to become accountable allies that demonstrates respect for community leadership while actively striving to ensure research does not perpetuate further harm, and produces effective change. This article provides an overview of ways to conduct ethical emancipatory research with Indigenous participants, that is, of benefit to midwifery practitioners and is applicable to many areas of research, policy, and practice.
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Affiliation(s)
- Amanda Peek
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Sharynne Hamilton
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Marjorie Atchan
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Natasha Jojo
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Holly Northam
- University of Canberra, Canberra, Australian Capital Territory, Australia
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Tarrago Wangkamahdla A, Veit-Prince E, Brolan CE. "Simply put: systems failed": lessons from the Coroner's inquest into the rheumatic heart disease Doomadgee cluster. Med J Aust 2024; 221:13-16. [PMID: 38946639 DOI: 10.5694/mja2.52350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024]
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Kerrigan V, McGrath SY, Doig C, Herdman RM, Daly S, Puruntatameri P, Lee B, Hefler M, Ralph AP. Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare. BMC Health Serv Res 2024; 24:119. [PMID: 38254093 PMCID: PMC10804863 DOI: 10.1186/s12913-024-10565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. METHODS Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. RESULTS Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. CONCLUSION The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Cassandra Doig
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Rarrtjiwuy Melanie Herdman
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Shannon Daly
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Pirrawayingi Puruntatameri
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Royal Darwin Hospital, Darwin, NT, 0811, Australia
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Welch S, Moles R, Viardot A, Deweerd P, Daly S, Lee K. Connecting the Dots of Care: A pilot study linking Aboriginal and/or Torres Strait Islander peoples with diabetes care in hospital, using hospital pharmacists. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100351. [PMID: 37965249 PMCID: PMC10641541 DOI: 10.1016/j.rcsop.2023.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Diabetes is common among Aboriginal and/or Torres Strait Islander peoples, yet often undetected in hospital. Objective To identify how urban hospital pharmacists can detect if Aboriginal and/or Torres Strait Islander patients have diabetes or a higher chance of getting diabetes. Methods A multi-methods study used data from patients, and researcher field notes. Aboriginal and/or Torres Strait Islander peoples admitted to hospital over 12-weeks (July-October 2021) were prospectively identified from admissions lists. A hospital pharmacist-researcher visited eligible patients. Consenting participants had their blood glucose and HbA1c checked. Participants with HbA1c > 6.5% (no known diabetes) or 7% (known diabetes) were referred for endocrinology review during their stay. Test results and resultant diabetes plan were shared with their general practitioner. Two days after discharge, participants were called to gauge views on their hospital-based diabetes care. Barcode technology recorded pharmacist time. Voice-recorded field notes were thematically analysed. Ethics approval was obtained. Results Seventy-two patients were eligible for inclusion, 67/72 (93%) consented to take part. Sixty-one (91%) patients returned a HbA1c < 6.5, of which, 4/61 (6.5%) returned a HbA1c, 6-6.4. They were contacted to yarn about diabetes prevention. Six of the 67 (9%) qualified for endocrine review, 5 had known diabetes, one newly diagnosed. None were known to endocrinology. All participants telephoned were satisfied with their hospital-based diabetes care. Pharmacist time for initial introductory yarn, consenting process, organisation of HbA1c and results discussion was 20 min or 40 min if referred for endocrine review. Field notes guided understanding of service implementation. Conclusion This novel pharmacist-led diabetes screening service for Aboriginal and/or Torres Strait Islander peoples appeared to provide a unique opportunity for screening and referral links in a holistic way. Future research is required to test this model by upscaling to include more pharmacists and other chronic disease screening and referral pathways.
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Affiliation(s)
- Susan Welch
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Sydney, N.S.W 2006, Australia
| | - Rebekah Moles
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Sydney, N.S.W 2006, Australia
| | - Alexander Viardot
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
- Garvan Institute, University of New South Wales, Randwick, Sydney, N.S.W. 2010, Australia
| | - Pauline Deweerd
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
| | - Scott Daly
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
| | - Kylie Lee
- University of Sydney, Addiction Medicine, Faculty of Medicine and Health, Camperdown, Sydney 2006, Australia
- The Edith Collins Centre, Camperdown, Sydney, 2006, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Vic 3083, Australia
- Burnet Institute, Melbourne, Vic 3004, Australia
- National Drug Research Institute, Curtin University, Perth, WA, 6045, Australia
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D'Costa I, Truong M, Russell L, Adams K. Employee perceptions of race and racism in an Australian hospital. Soc Sci Med 2023; 339:116364. [PMID: 37977016 DOI: 10.1016/j.socscimed.2023.116364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/09/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Racism contributes to health inequities faced by people of colour and marginalised groups. Despite widespread recognition of the impacts of racism, mitigating strategies and legislation have been largely unsuccessful. Research into racism in healthcare has mostly examined personal experiences of healthcare workers and patients, assuming that the definitions of racism and race are similarly understood by all. However, ethnicity and race are often conflated, and racism seen as primarily interpersonal and ahistorical. PURPOSE This paper explores hospital employee understandings of racism, its impacts and how to reduce it. METHODS Forty-nine staff within one Australian hospital participated in individual qualitative interviews regarding the definition, impact, and ways of reducing racism. Interviews were analysed with a reflexive thematic analytic approach using a Postcolonial framework. RESULTS Participants described racism as being experienced by marginalised groups of people in Australia. They identified that racism has detrimental effects on health and wellbeing. Not all were clear regarding what constituted racism: it was not described as an ideology created to justify colonial distribution of power and resources. Some thought that racism was individual prejudice while others noted it was also structural in nature. Participants commonly defined race as involving physical or cultural differences, suggesting that discredited historical and colonial concepts of race continue in Australian society. While many felt that education was the best way to reduce racism and its impacts, some participants noted that being educated did not necessarily change racist behaviour. CONCLUSIONS The lack of accurate understanding of the concept of race and racism likely contributes to the relatively poor effect of current strategies to combat racism. As an initial part of deeper systemic anti-racist reform, this research supports calls for anti-racist education to clarify the definition of racism as an ideology.
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Affiliation(s)
- Ieta D'Costa
- School of Medicine, Nursing and Health Science, Monash University, Clayton, Melbourne, Australia.
| | - Mandy Truong
- Monash Nursing and Midwifery, Adjunct Research Fellow, Monash University, Clayton, Melbourne, Australia.
| | - Lynette Russell
- Monash Indigenous Studies Centre, School of Philosophical, Historical, and International Studies, Monash University, Clayton, Melbourne, Australia.
| | - Karen Adams
- Indigenous Health Unit, School of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, Australia.
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Williams LT, Somerville M, Wright F, Atkins H, Rogany A, Bell KL, Vincze L. How Can We Find Out What Indigenous Children and Their Families Need to Manage Weight? Lessons from Formative Nutrition Intervention Research with First Australians. Nutrients 2023; 15:4982. [PMID: 38068840 PMCID: PMC10708399 DOI: 10.3390/nu15234982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
In Australia, Indigenous children have rates of overweight and obesity 1.5 times those of non-Indigenous children. Culturally safe and effective nutrition interventions are needed for this group. This paper aims to describe a Community-based Participatory Action Research (CPAR) approach to designing formative nutrition intervention research with First Australian children and their families and to reflect on the challenges arising from this process. After obtaining ethical approvals, a Steering Committee (SC), including nine Aboriginal and Torres Strait Islander people experienced in delivering or receiving health care, was established as a project governance body to develop culturally safe project materials and methods. The Indigenous research method of yarning circles was chosen by the SC for the community consultation, and the First Australian SC members were trained to collect the data. They liaised with community organizations to recruit yarning circle participants. Individual interviews conducted by an Aboriginal research assistant replaced yarning circles due to the COVID-19 pandemic lockdowns. While the CPAR approach to formative research was successful, the pandemic and other factors tripled the study duration. To authentically, ethically and safely engage First Australians in research, researchers need to decolonize their methodological approach, and funding bodies need to allow adequate time and resources for the process.
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Affiliation(s)
- Lauren T. Williams
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia;
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia; (M.S.); (F.W.)
| | - Mari Somerville
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia; (M.S.); (F.W.)
| | - Fiona Wright
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia; (M.S.); (F.W.)
- GUMURRII Student Success Unit, Griffith University, Gold Coast, QLD 4222, Australia
| | - Heidi Atkins
- Queensland Child and Youth Clinical Network, Clinical Excellence Queensland, Queensland Government, Brisbane, QLD 4006, Australia;
- Reform Office, Strategy, Policy and Reform Division, Queensland Government, Brisbane, QLD 4000, Australia
| | - Ayala Rogany
- Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD 4001, Australia; (A.R.); (K.L.B.)
| | - Kristie L. Bell
- Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD 4001, Australia; (A.R.); (K.L.B.)
| | - Lisa Vincze
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia;
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia; (M.S.); (F.W.)
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Chung H, Hyatt A, Crone E, Milne D, Aranda S, Gough K, Krishnasamy M. Clinical Utility Assessment of a Nursing Checklist Identifying Complex Care Needs Due to Inequities Among Ambulatory Patients With Cancer: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e48432. [PMID: 37943601 PMCID: PMC10667971 DOI: 10.2196/48432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Disparities in cancer incidence, complex care needs, and poor health outcomes are largely driven by structural inequities stemming from social determinants of health. To date, no evidence-based clinical tool has been developed to identify newly diagnosed patients at risk of poorer outcomes. Specialist cancer nurses are well-positioned to ameliorate inequity of opportunity for optimal care, treatment, and outcomes through timely screening, assessment, and intervention. We designed a nursing complexity checklist (the "Checklist") to support these activities, with the ultimate goal of improving equitable experiences and outcomes of care. This study aims to generate evidence regarding the clinical utility of the Checklist. OBJECTIVE The primary objectives of this study are to provide qualitative evidence regarding key aspects of the Checklist's clinical utility (appropriateness, acceptability, and practicability), informed by Smart's multidimensional model of clinical utility. Secondary objectives explore the predictive value of the Checklist and concordance between specific checklist items and patient-reported outcome measures. METHODS This prospective mixed methods case series study will recruit up to 60 newly diagnosed patients with cancer and 10 specialist nurses from a specialist cancer center. Nurses will complete the Checklist with patient participants. Within 2 weeks of Checklist completion, patients will complete 5 patient-reported outcome measures with established psychometric properties that correspond to specific checklist items and an individual semistructured interview to explore Checklist clinical utility. Interviews with nurses will occur 12 and 24 weeks after they first complete a checklist, exploring perceptions of the Checklist's clinical utility including barriers and facilitators to implementation. Data describing planned and unplanned patient service use will be collected from patient follow-up interviews at 12 weeks and the electronic medical record at 24 weeks after Checklist completion. Descriptive statistics will summarize operational, checklist, and electronic medical record data. The predictive value of the Checklist and the relationship between specific checklist items and relevant patient-reported outcome measures will be examined using descriptive statistics, contingency tables, measures of association, and plots as appropriate. Qualitative data will be analyzed using a content analysis approach. RESULTS This study was approved by the institution's ethics committee. The enrollment period commenced in May 2022 and ended in November 2022. In total, 37 patients with cancer and 7 specialist cancer nurses were recruited at this time. Data collection is scheduled for completion at the end of May 2023. CONCLUSIONS This study will evaluate key clinical utility dimensions of a nursing complexity checklist. It will also provide preliminary evidence on its predictive value and information to support its seamless implementation into everyday practice including, but not limited to, possible revisions to the Checklist, instructions, and training for relevant personnel. Future implementation of this Checklist may improve equity of opportunity of access to care for patients with cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48432.
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Affiliation(s)
- Holly Chung
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amelia Hyatt
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elizabeth Crone
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Donna Milne
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
- Skin and Melanoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sanchia Aranda
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Karla Gough
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Victoria, Australia
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da Silva FAJ, Peres AM, Lourenço RG, de Souza MAR, Figueiredo KC, de Camargo CL. Primary Healthcare of black immigrants during the COVID-19 pandemic. Rev Esc Enferm USP 2023; 57:e20220441. [PMID: 37738308 PMCID: PMC10634244 DOI: 10.1590/1980-220x-reeusp-2022-0441en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/16/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To analyze how the healthcare of black immigrants was conducted during the COVID-19 pandemic in Primary Healthcare. METHOD An exploratory-descriptive study with a qualitative approach, carried out through semi-structured interviews with professionals who worked in 10 Health Units in the city of Curitiba, Brazil, from October 2020 to January 2021. Structural racism was the conceptual framework. The statements were submitted to content analysis after using the MAXQDA program as support. RESULTS A total of 21 professionals from the multidisciplinary team participated and three categories emerged from the analyzes: Healthcare for black immigrants in PHC during the Covid-19 pandemic; Limits and potentialities of PHC for healthcare for black immigrants; Structural racism in PHC practices aimed at black immigrants. CONCLUSION Action in the pandemic was guided by protocols that did not expand healthcare to vulnerable populations, including black immigrants. The main barrier was communication, as most black immigrants in the surveyed locations were Haitians. Structural racism was identified in professional practice.
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Affiliation(s)
| | - Aida Maris Peres
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | | | | | | | - Climene Laura de Camargo
- Universidade Federal da Bahia, Escola de Enfermagem, Departamento de Enfermagem, Salvador, BA, Brazil
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Cama E, Beadman M, Beadman K, Hopwood M, Treloar C. Health workers' perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia. Harm Reduct J 2023; 20:116. [PMID: 37633903 PMCID: PMC10463284 DOI: 10.1186/s12954-023-00844-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma. METHODS Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia. RESULTS Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services. CONCLUSIONS Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Mitch Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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15
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Lokugamage AU, Rix EL, Fleming T, Khetan T, Meredith A, Hastie CR. Translating Cultural Safety to the UK. JOURNAL OF MEDICAL ETHICS 2023; 49:244-251. [PMID: 34282043 DOI: 10.1136/medethics-2020-107017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.
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Affiliation(s)
- Amali U Lokugamage
- Department of Clinical and Professional Practice, University College London Medical School, London, UK
- Department of Women's Health, Whittington Health NHS Trust, London, UK
| | - Elizabeth Liz Rix
- Faculty of Health, Southern Cross University, Gold Coast Campus, Bilinga, Queensland, Australia
| | - Tania Fleming
- School of Midwifery, Auckland University of Technology, Auckland, New Zealand
| | - Tanvi Khetan
- University College London Medical School Alumni, University College London, London, UK
| | - Alice Meredith
- University College London Medical School Alumni, University College London, London, UK
| | - Carolyn Ruth Hastie
- Department of Nursing and Midwifery, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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Wilson A, Cornett M, Delbridge R, Mackean T, Palermo C. A realist evaluation of a community of practice for dietitians and nutritionists working in Aboriginal and Torres Strait Islander health. J Hum Nutr Diet 2023; 36:277-287. [PMID: 35614859 PMCID: PMC10084382 DOI: 10.1111/jhn.13043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Communities of practice have been proposed as a workforce development strategy for developing dietitians, yet little is known about how they work and for whom, as well as under what circumstances. We aimed to understand the mechanisms by which dietitians working in Aboriginal and Torres Strait Islander health benefit from communities of practice. METHODS A realist evaluation of 29 interviews with non-Indigenous dietitians and nutritionists was employed, which was conducted over the course of two communities of practice (2013 and 2014) and follow-up interviews in 2019. Programme theory was developed from analysis of initial interviews and used to recode all interviews and test theory. The identification of patterns refined the programme theory. RESULTS Six refined theories were identified: (1) a community of practice fosters the relationships that support navigation of the many tasks required to become more responsive health professionals; (2) committed and open participants feel supported and guided to be reflexive; (3) sharing, reflexivity, feedback and support shift awareness to one's own practice to be able to manoeuvre in intercultural spaces; (4) through sharing, feedback, support and collaboration, participants feel assured and affirmed; (5) connection through feelings of understanding and being understood contributes to commitment to remain working in the area; and (6) through sharing, feedback, support and collaboration, participants with varied experience and roles see the value of and gain confidence in new perspectives, skills and practices. CONCLUSIONS Further research is required to test this model on a much larger scale, with communities of practice inclusive of Aboriginal and non-Aboriginal health professionals together, and across a diverse group of dietitians.
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Affiliation(s)
- Annabelle Wilson
- School of Health Sciences, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Marian Cornett
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Robyn Delbridge
- Swinburne University of Technology, Melbourne, VIC, Australia.,School of Allied Health, Human Services & Sport, La Trobe University Melbourne, Melbourne, VIC, Australia
| | - Tamara Mackean
- School of Health Sciences, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Hall K, Vervoort S, Del Fabbro L, Rowe Minniss F, Saunders V, Martin K, Bialocerkowski A, Milligan E, Syron M, West R. Evolving beyond antiracism: Reflections on the experience of developing a cultural safety curriculum in a tertiary education setting. Nurs Inq 2023; 30:e12524. [PMID: 36083828 PMCID: PMC10078494 DOI: 10.1111/nin.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023]
Abstract
There is an inextricable link between cultural and clinical safety. In Australia high-profile Aboriginal deaths in custody, publicised institutional racism in health services and the international Black Lives Matter movement have cemented momentum to ensure culturally safe care. However, racism within health professionals and health professional students remains a barrier to increasing the number of Aboriginal and Torres Strait Islander Health professionals. The Australian Health Practitioner Regulation Agency's Aboriginal and Torres Strait Islander Health Strategy's objective to 'eliminate racism from the health system', and the recent adoption of the Aboriginal and Torres Strait Islander peoples led cultural safety definition, has instigated systems level reflections on decolonising practice. This article explores cultural safety as the conceptual antithesis to racism, examining its origins, and contemporary evolution led by Aboriginal and Torres Strait Islander peoples in Australia, including its development in curriculum innovation. The application of cultural safety is explored using in-depth reflection, and the crucial development of integrating critical consciousness theory, as a precursor to culturally safe practice, is discussed. Novel approaches to university curriculum development are needed to facilitate culturally safe and decolonised learning and working environments, including the key considerations of non-Indigenous allyship and collaborative curriculum innovations and initiatives.
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Affiliation(s)
- Kerry Hall
- First Peoples Health UnitGriffith UniversitySouthportQueenslandAustralia
| | | | - Letitia Del Fabbro
- School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
- Nursing and Midwifery Education and Research UnitGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia
| | - Fiona Rowe Minniss
- School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
- Congress of Aboriginal and Torres Strait Islander Nurses and MidwivesAnnerleyQueenslandAustralia
| | - Vicki Saunders
- Centre for Health Equity Research, School of Health, Medical and Applied SciencesCentral Queensland UniversityCairnsQueenslandAustralia
| | - Karen Martin
- Mayim nayri Wingara Aboriginal and Torres Strait Islander Data Sovereignty CollectiveAustralia
| | - Andrea Bialocerkowski
- Micro‐credentialing and Professional Development, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
| | - Eleanor Milligan
- School of MedicineGriffith UniversitySouthportQueenslandAustralia
| | - Melanie Syron
- Black Wattle Professional ServicesBrisbaneQueenslandAustralia
| | - Roianne West
- First Peoples Health UnitGriffith UniversitySouthportQueenslandAustralia
- Congress of Aboriginal and Torres Strait Islander Nurses and MidwivesAnnerleyQueenslandAustralia
- School of Nursing and Midwifery, First Peoples Health UnitGriffith UniversitySouthportQueenslandAustralia
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18
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Topp SM, Tully J, Cummins R, Graham V, Yashadhana A, Elliott L, Taylor S. Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia. Int J Health Policy Manag 2022; 11:2951-2963. [PMID: 35569001 PMCID: PMC10105169 DOI: 10.34172/ijhpm.2022.6750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation. METHODS The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n=51), clinicians (n=19) community members (n=8) and administrators (n=5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it. RESULTS Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs. CONCLUSION Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role.
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Affiliation(s)
- Stephanie M. Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Josslyn Tully
- Torres and Cape Hospital and Health Services (TCHSS), Cairns, QLD, Australia
| | - Rachel Cummins
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Veronica Graham
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, UNSW, Sydney, NSW, Australia
- School of Social Sciences, UNSW, Sydney, NSW, Australia
| | - Lana Elliott
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Sean Taylor
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- NT Health, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
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Phan VTD. Institutional racism: a discursive paper. Contemp Nurse 2022; 58:388-392. [PMID: 35719105 DOI: 10.1080/10376178.2022.2092521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The purpose of this paper is to provide discourse regarding awareness of institutional racism, from a non-Indigenous, Australian nursing student's perspective. The discussion has a focus on the presence of institutional racism in the Australian healthcare system, its impact on the health of First Nation Peoples and a commitment to ensuring culturally safe practice. It will be argued that institutional racism is pervasive in healthcare as a consequence of three factors: exclusion of First Nations Peoples from governance roles, inherent racism impacting on socio-cultural treatment bias, and institutional racism influencing key relationships in healthcare delivery.
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Affiliation(s)
- Van Thanh Danh Phan
- Susan Wakil School of Nursing and Midwifery, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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20
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Jones DD. Examining the Unconscious Racial Biases and Attitudes of Physicians, Nurses, and the Public: Implications for Future Health Care Education and Practice. Health Equity 2022; 6:375-381. [PMID: 35651358 PMCID: PMC9148656 DOI: 10.1089/heq.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/12/2022] Open
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Perry C, Dimitropoulos Y, Skinner J, Bourke C, Miranda K, Cain E, Beaufils D, Christie V, Rambaldini B, Gwynne K. Availability of drinking water in rural and remote communities in New South Wales, Australia. Aust J Prim Health 2022; 28:125-130. [PMID: 35101161 DOI: 10.1071/py21119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
Many rural communities in New South Wales (NSW), Australia, have poor-quality water supplies. The lack of a palatable alternative increases the risk of the high consumption of sugar-sweetened beverages, a significant contributor to adverse health outcomes. This disproportionately effects Aboriginal people living in these towns, who are also profoundly affected by the social determinants of health. Therefore, examining health inequalities linked to water access is important. This study investigated the availability of drinking water fountains in rural and remote communities in NSW. Telephone interviewer-assisted surveys were conducted with 32 representatives from local government councils or Local Aboriginal Land Councils in NSW from communities with a population of <5000 and an Aboriginal population of at least 3%. The results were analysed descriptively. Towns and communities with a higher population of Aboriginal people and lower median weekly income were less likely to have access to free refrigerated and filtered water within the community or at local schools compared with towns and communities with a lower Aboriginal population and higher median weekly income. The availability of free, clean and refrigerated water in rural and remote communities is critical to reducing the consumption of sugar-sweetened beverages and the promotion of water as the preferred drink.
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Affiliation(s)
- Christina Perry
- Gallatin School of Individualized Study, New York University, New York, USA
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia; and Corresponding author
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia
| | - Chris Bourke
- Austrailan Healthcare and Hospitals Association, ACT 2600, Australia
| | - Kate Miranda
- Australian Dental Association, NSW 2065, Australia
| | - Elyse Cain
- New South Wales Council of Social Service, NSW 2011, Australia
| | | | - Vita Christie
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia
| | - Kylie Gwynne
- Garfield Barwick Chambers, NSW 2000, Australia; and Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
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Welch S, Patel B, Williams A, Moles R. Connecting the dots of care: survey of Australian hospital pharmacy departments regarding current initiatives in place to care for Aboriginal and/or Torres Strait Islander inpatients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Susan Welch
- Pharmacy Department St Vincent's Hospital, Sydney Darlinghurst Australia
- PhD Candidate University of Sydney Camperdown Australia
| | - Bhavini Patel
- Northern Territory Department of Health Charles Darwin University Darwin Australia
- Medicines Management Top End Health Service Darwin Australia
| | - Aleena Williams
- Public Health Directorate Department of Health Northern Territory Government Darwin Australia
| | - Rebekah Moles
- Faculty Medicine and Health School of Pharmacy University of Sydney Camperdown Australia
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23
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Enhancing Cultural Capabilities Amongst Health Professions Students: A Pilot Study of Interprofessional Tag Team Simulation. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Browne J, Gilmore M, Lock M, Backholer K. First Nations Peoples' Participation in the Development of Population-Wide Food and Nutrition Policy in Australia: A Political Economy and Cultural Safety Analysis. Int J Health Policy Manag 2021; 10:871-885. [PMID: 33008258 PMCID: PMC9309971 DOI: 10.34172/ijhpm.2020.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations' policy submissions, and (iii) the extent to which Aboriginal organisations' recommendations were addressed in final policy documents. METHODS Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents. RESULTS Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes. CONCLUSION This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples' right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.
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Affiliation(s)
- Jennifer Browne
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Michelle Gilmore
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Mark Lock
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Committix Pty Ltd., Newcastle, NSW, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Carvalho K, Kheyfets A, Maleki P, Miller B, Abouhala S, Anwar E, Amutah-Onukagha N. A Systematic Policy Review of Black Maternal Health-Related Policies Proposed Federally and in Massachusetts: 2010-2020. Front Public Health 2021; 9:664659. [PMID: 34746071 PMCID: PMC8566737 DOI: 10.3389/fpubh.2021.664659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3). Methods: Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed. Results: From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: N = 19, 61.3%, Massachusetts: N = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% (n = 17) of national policies and 68.8% (n = 11) of Massachusetts with positive impact on health equity. Conclusions: There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.
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Affiliation(s)
- Keri Carvalho
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Anna Kheyfets
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Pegah Maleki
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Brenna Miller
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Siwaar Abouhala
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Eimaan Anwar
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
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Bourke L, Mitchell O, Mohamed Shaburdin Z, Malatzky C, Anam M, Farmer J. Building readiness for inclusive practice in mainstream health services: A pre-inclusion framework to deconstruct exclusion. Soc Sci Med 2021; 289:114449. [PMID: 34626883 DOI: 10.1016/j.socscimed.2021.114449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/07/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective.
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Affiliation(s)
- Lisa Bourke
- Department of Rural Health, The University of Melbourne, 49 Graham St Shepparton, Vic, 3630, Australia.
| | - Olivia Mitchell
- Department of Rural Health, The University of Melbourne, 49 Graham St Shepparton, Vic, 3630, Australia.
| | | | - Christina Malatzky
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove Campus, Kelvin Grove, Brisbane, Qld, 4059, Australia.
| | - Mujibul Anam
- Department of Rural Health, The University of Melbourne, 49 Graham St Shepparton, Vic, 3630, Australia
| | - Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, John Street, Hawthorn, Vic, 3122, Australia.
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Bourke CJ, McAuliffe A, Jamieson LM. Addressing the oral health workforce needs of Aboriginal and Torres Strait Islander Australians. AUST HEALTH REV 2021; 45:407-410. [PMID: 34334157 DOI: 10.1071/ah20295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022]
Abstract
Tooth decay and gum disease, the main dental diseases affecting Australians, can cause pain and deformity as well as affecting eating and speech. Dental practitioners are efficient and effective in relieving dental pain, and they can effectively restore oral function. There is good evidence that better health care outcomes for Aboriginal and Torres Strait Islander patients are associated with care from Aboriginal and Torres Strait Islander health professionals. Unfortunately, the representation of Aboriginal and Torres Strait Islander people within the dental practitioner workforce is very low. We argue that a strategic approach, along with additional investment, is needed to increase the number of Aboriginal and Torres Strait Islander people qualified as dental practitioners.
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Affiliation(s)
- Christopher J Bourke
- Australian Healthcare and Hospitals Association, Deakin West, ACT, Australia. ; and Corresponding author.
| | - Andrew McAuliffe
- Australian Healthcare and Hospitals Association, Deakin West, ACT, Australia.
| | - Lisa M Jamieson
- Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia.
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Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. "The talking bit of medicine, that's the most important bit": doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care. Int J Equity Health 2021; 20:170. [PMID: 34301261 PMCID: PMC8299635 DOI: 10.1186/s12939-021-01507-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia's Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. METHODS This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. RESULTS Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. CONCLUSIONS Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
- Royal Darwin Hospital, Darwin, NT 0811 Australia
- Flinders University, Northern Territory Medical Program, Darwin, NT 0815 Australia
| | - Michelle Walker
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, NT 0801 Australia
| | - Mandy Ahmat
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, NT 0801 Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
- Royal Darwin Hospital, Darwin, NT 0811 Australia
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Exploration of My Aboriginal Heritage: An Autoethnography. HUMAN ARENAS 2021. [PMCID: PMC8249044 DOI: 10.1007/s42087-021-00234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This autoethnography tells the story of myself, a blonde haired blue-eyed Aboriginal woman exploring identity and belonging. It begins with a brief overview of the dark history that Aboriginal and Torres Strait Islander people have experienced as a result of colonisation and policy makers. An autoethnographic journal was kept over the course of several months, documenting affective responses to questions concerning the aboriginal identity of the author. These subjective responses informed a written personal narrative as well as creating the foundation for retrospective reflections on the journal that appears later in the autoethnography. A number of theories are then explored in an effort to explain the phenomena behind finding and belonging to two cultures, white Australian and Aboriginal.
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Bourke C, Lahn J, Gibbs C, Lennard N. Assessing the support of health leadership for increased Indigenous participation in the health workforce. AUST HEALTH REV 2021; 44:505-511. [PMID: 32600523 DOI: 10.1071/ah19262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/10/2020] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to assess the strength of leadership statements in Australian state and territory policy documents supporting increased representation of Indigenous people in the health workforce. Methods Document analysis of leadership statements, prefacing state and territory Indigenous health workforce plans, from a relevant Minister or Head of Department was undertaken to detect the presence and level of 'dependency messaging': did the leadership statement clearly state that an Indigenous health workforce was needed to improve Indigenous health outcomes? Results Australian health leaders do not routinely use dependency messaging in state and territory Indigenous health workforce plans. Conclusion Greater alignment of state and territory Indigenous health workforce plans with contemporary diversity management knowledge could improve recruitment and retention of Indigenous peoples and, ultimately, Indigenous health outcomes. What is known about the topic? The diversity management and change management literature highlights the importance of demonstrated leadership. Dependency messaging is the clear articulation of the benefit that members of minority and diversity groups bring to an organisation's performance; this is regarded as highly influential for diversity recruitment and retention. What does this paper add? Strong 'dependency messaging' in health policy leadership statements could increase the Indigenous health workforce, and ultimately improve health outcomes, but is currently not uniformly used across jurisdictions. State and territory Indigenous health workforce plans were analysed using the diverse literature of change management, diversity management and strength-based approaches to provide recommendations for policy improvement that could lead to better Indigenous healthcare outcomes. What are the implications for practitioners? The use of dependency messaging by health leaders could enhance recruitment of an Indigenous health workforce.
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Affiliation(s)
- Christopher Bourke
- Australian Healthcare and Hospitals Association, PO Box 78, Deakin West, ACT 2600, Australia; and Corresponding author.
| | - Julie Lahn
- Centre for Aboriginal Economic Policy Research, Copland Building #24, Australian National University, Canberra, ACT 2601, Australia. ;
| | - Colleen Gibbs
- Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Level 1, 15 Lancaster Place, Majura Park, Canberra, ACT 2609, Australia.
| | - Natasha Lennard
- Centre for Aboriginal Economic Policy Research, Copland Building #24, Australian National University, Canberra, ACT 2601, Australia. ;
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Lassemillante ACM, Delbridge R. Do we dare ask if this is racism? Nutr Diet 2021; 78:458-460. [PMID: 34109718 DOI: 10.1111/1747-0080.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Annie-Claude M Lassemillante
- Department of Nursing and Allied Health, School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Robyn Delbridge
- Department of Nursing and Allied Health, School of Health Science, Swinburne University of Technology, Melbourne, Australia
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Equity in clinical practice requires organisational and system-level change – The role of nurse leaders. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vincze L, Barnes K, Somerville M, Littlewood R, Atkins H, Rogany A, Williams LT. Cultural adaptation of health interventions including a nutrition component in Indigenous peoples: a systematic scoping review. Int J Equity Health 2021; 20:125. [PMID: 34022886 PMCID: PMC8140502 DOI: 10.1186/s12939-021-01462-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous populations throughout the world experience poorer health outcomes than non-indigenous people. The reasons for the health disparities are complex and due in part to historical treatment of Indigenous groups through colonisation. Evidence-based interventions aimed at improving health in this population need to be culturally safe. However, the extent to which cultural adaptation strategies are incorporated into the design and implementation of nutrition interventions designed for Indigenous peoples is unknown. The aim of this scoping review was to explore the cultural adaptation strategies used in the delivery of nutrition interventions for Indigenous populations worldwide. METHODS Five health and medical databases were searched to January 2020. Interventions that included a nutrition component aimed at improving health outcomes among Indigenous populations that described strategies to enhance cultural relevance were included. The level of each cultural adaptation was categorised as evidential, visual, linguistic, constituent involving and/or socio-cultural with further classification related to cultural sensitivity (surface or deep). RESULTS Of the 1745 unique records screened, 98 articles describing 66 unique interventions met the inclusion criteria, and were included in the synthesis. The majority of articles reported on interventions conducted in the USA, Canada and Australia, were conducted in the previous 10 years (n = 36) and focused on type 2 diabetes prevention (n = 19) or management (n = 7). Of the 66 interventions, the majority included more than one strategy to culturally tailor the intervention, combining surface and deep level adaptation approaches (n = 51), however, less than half involved Indigenous constituents at a deep level (n = 31). Visual adaptation strategies were the most commonly reported (n = 57). CONCLUSION This paper is the first to characterise cultural adaptation strategies used in health interventions with a nutrition component for Indigenous peoples. While the majority used multiple cultural adaptation strategies, few focused on involving Indigenous constituents at a deep level. Future research should evaluate the effectiveness of cultural adaptation strategies for specific health outcomes. This could be used to inform co-design planning and implementation, ensuring more culturally appropriate methods are employed.
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Affiliation(s)
- Lisa Vincze
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia.
- Menzies Health Institute Queensland, Griffith Health Centre, G40_8.86, Gold Coast, Queensland, 4222, Australia.
| | - Katelyn Barnes
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Academic Unit of General Practice, Medical School, College of Health & Medicine, The Australian National University, Canberra, Australian Capital Territory, 2601, Australia
| | - Mari Somerville
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Menzies Health Institute Queensland, Griffith Health Centre, G40_8.86, Gold Coast, Queensland, 4222, Australia
| | - Robyn Littlewood
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Health & Wellbeing Queensland, Queensland Government, Brisbane, Queensland, Australia
| | - Heidi Atkins
- Queensland Child and Youth Clinical Network, Clinical Excellence Queensland, Queensland Government, Brisbane, Queensland, Australia
| | - Ayala Rogany
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland Government, Brisbane, Queensland, Australia
| | - Lauren T Williams
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Menzies Health Institute Queensland, Griffith Health Centre, G40_8.86, Gold Coast, Queensland, 4222, Australia
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Haynes E, Walker R, Mitchell AG, Katzenellenbogen J, D'Antoine H, Bessarab D. Decolonizing Indigenous health: Generating a productive dialogue to eliminate Rheumatic Heart Disease in Australia. Soc Sci Med 2021; 277:113829. [PMID: 33895707 DOI: 10.1016/j.socscimed.2021.113829] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
In common with colonized Indigenous people worldwide, many Australian Aboriginal people experience inequitable health outcomes. While the commitment and advocacy of researchers and health practitioners has resulted in many notable improvements in policy and practice, systemic and structural impediments continue to restrain widespread gains in addressing Indigenous health injustices. We take Rheumatic Heart Disease (RHD), a potent marker of extreme health inequity, as a case study, and critically examine RHD practitioners' perspectives regarding the factors that need to be addressed to improve RHD prevention and care. This study is an important explanatory component of a broader study to inform new clinical practices, and health system strategies and policies to reduce RHD. A decolonising, critical medical anthropology (CMA) analysis of findings from 22 RHD practitioner in-depth interviews conducted in May 2016 revealed both practitioners' perceptions of health system shortcomings and a sense of hopelessness and powerlessness to transform existing health system inequities, the negative impacts of which were subsequently confirmed in a separate study of RHD patients' lived realities. We reveal how biomedical dominance, normalized deficit discourses and systemic racism influence the current policy and practice landscape, narrowing the intercultural space for productive dialogue and reinforcing the conditions that cause disease. To counter biomedical approaches that contribute to existing health inequities in health care, we recommend localized, strength-based, community-led research projects focused on actions that use critical decolonizing social science approaches to achieve system change. We demonstrate the importance of integrating biological and social sciences approaches in research, education/training, and practice to: 1) be guided by Indigenous strengths, knowledges and worldview, and 2) adopt a critical reflexive stance to examine systems, structures and practices. Such an approach facilitates productive cross-cultural dialogue and social transformation; providing direction and hope to practitioners, enhancing their knowledge, skills and capacity and improving Aboriginal health outcomes.
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Affiliation(s)
- Emma Haynes
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton St, Nedlands, Perth, Western Australia, 6009, Australia.
| | - Roz Walker
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton St, Nedlands, Perth, Western Australia, 6009, Australia.
| | - Alice G Mitchell
- Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, Northern Territory, 0811, Australia.
| | - Judy Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton St, Nedlands, Perth, Western Australia, 6009, Australia.
| | - Heather D'Antoine
- Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, Northern Territory, 0811, Australia.
| | - Dawn Bessarab
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton St, Nedlands, Perth, Western Australia, 6009, Australia.
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Gatwiri K, Rotumah D, Rix E. BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4399. [PMID: 33919080 PMCID: PMC8122304 DOI: 10.3390/ijerph18094399] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
Despite decades of evidence showing that institutional and interpersonal racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience 'epidemic' levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of 'doing' healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.
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Affiliation(s)
- Kathomi Gatwiri
- Center for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia
| | - Darlene Rotumah
- Gnibi College, Southern Cross University, Gold Coast, QLD 4225, Australia;
| | - Elizabeth Rix
- Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia;
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Marriott R, Reibel T, Barrett TL, Bowen A, Bradshaw S, Kendall S, Kotz J, Martin T, Monterosso L, Robinson M. Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women. Birth 2021; 48:132-138. [PMID: 33377233 DOI: 10.1111/birt.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.
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Affiliation(s)
- Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Tracy Reibel
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Terri-Lee Barrett
- WA Government Department of Health, Child and Adolescent Health Service, Community Health, Perth, Western Australia, Australia
| | - Angela Bowen
- College of Medicine, University of Saskatchewan, Saskatchewan, Saskatoon, Canada
| | - Sue Bradshaw
- Midwifery Services, St John of God, Murdoch Hospital, Murdoch, Western Australia, Australia
| | - Sally Kendall
- Community Nursing and Public Health, University of Kent, Kent, UK
| | - Jayne Kotz
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Tracy Martin
- Clinical Excellence Division, WA Government Department of Health, Perth, Western Australia, Australia
| | - Leanne Monterosso
- Notre Dame University, Fremantle, Western Australia, Australia
- St John of God, Murdoch Hospital, Murdoch, Western Australia, Australia
| | - Melanie Robinson
- WA Government Department of Health, Child and Adolescent Health Service, Community Health, Perth, Western Australia, Australia
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Elias A, Paradies Y. The Costs of Institutional Racism and its Ethical Implications for Healthcare. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:45-58. [PMID: 33387263 PMCID: PMC7778398 DOI: 10.1007/s11673-020-10073-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 11/30/2020] [Indexed: 05/13/2023]
Abstract
This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial minorities that impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research.
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Affiliation(s)
- Amanuel Elias
- Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Yin Paradies
- Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
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Quigley A, Hutton J, Phillips G, Dreise D, Mason T, Garvey G, Paradies Y. Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments. Emerg Med Australas 2021; 33:9-18. [PMID: 33248447 DOI: 10.1111/1742-6723.13691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/24/2022]
Abstract
Aboriginal and Torres Strait Islander peoples continue to suffer adverse experiences in healthcare, with inequitable care prevalent in emergency settings. Individual, institutional and systemic factors play a significant part in these persisting healthcare disparities, with biases remaining entrenched in healthcare institutions. This includes implicit racial bias which can result in stereotyping of racial minorities and premature diagnostic closure. Furthermore, it may contribute to distrust of medical professionals resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations. The aim of this review is to analyse the effect of implicit bias on patient outcomes in the ED in international literature and explore how these studies correlate to an Australian context.
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Affiliation(s)
- Alyssa Quigley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie Hutton
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Georgina Phillips
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darlene Dreise
- Reconciliation Action Plan (RAP) Steering Committee, St Vincent's Health Australia, Brisbane, Queensland, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
- Aboriginal Health, St Vincent's Health Australia, Brisbane, Queensland, Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
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Thackrah RD, Wood J, Thompson SC. Longitudinal Follow Up of Early Career Midwives: Insights Related to Racism Show the Need for Increased Commitment to Cultural Safety in Aboriginal Maternity Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1276. [PMID: 33572624 PMCID: PMC7908636 DOI: 10.3390/ijerph18031276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/04/2022]
Abstract
Racism in health care undermines equitable service delivery, contributes to poorer health outcomes and has a detrimental effect on the Aboriginal workforce. In maternity care settings, Aboriginal women's perceptions of discrimination are widespread, with the importance of cultural practices surrounding childbirth often not recognised. Efforts to build midwives' cultural capabilities and address health disparities have seen Aboriginal content included in training programs but little is known about its application to clinical practice. This study reinterviewed midwives who had previously completed university midwifery training that aimed to increase understanding of Aboriginal people and cultural safety in health care. Participants were 14 non-Indigenous midwives and two Aboriginal midwives. Interviews explored the legacy of program initiatives on cultural capabilities and observations and experiences of racism in maternity care settings. Methods followed qualitative approaches for research rigour, with thematic analysis of transcribed interviews. Findings revealed the positive impact of well-designed content and placements, with non-Indigenous participants cognisant and responsive to casual racism but largely not recognising institutional racism. The Aboriginal midwives had experienced and were attuned to racism in all its guises and suggested initiatives to heighten awareness and dispel stereotypes. It is evident that greater attention must be paid to institutional racism in educational programs to increase its recognition and appropriate actions within health care settings.
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Affiliation(s)
- Rosalie D. Thackrah
- Western Australian Centre for Rural Health, University of Western Australia, Nedlands 6009, Australia;
| | - Jennifer Wood
- Labour and Birth Suite, Maternal Fetal Assessment Unit, King Edward Memorial Hospital, Subiaco 6008, Australia;
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Nedlands 6009, Australia;
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Power T, Lucas C, Hayes C, Jackson D. 'With my heart and eyes open': Nursing students' reflections on placements in Australian, urban Aboriginal organisations. Nurse Educ Pract 2020; 49:102904. [PMID: 33069941 DOI: 10.1016/j.nepr.2020.102904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/19/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
Research has demonstrated that students who have immersive experiences in Indigenous settings emerge with a greater understanding of their own values and attitudes and increased appreciation for Indigenous Peoples and culture. Up to 80% of Indigenous people in Australia live in urban settings, yet research on nursing students' placements in urban Indigenous organisations is scarce. This manuscript presents qualitative findings from the analysis of eight third year nursing students' reflective essays, written iteratively across a three-week placement in urban Aboriginal organisations. Reflective journaling was employed as a pedagogical method. All the students reported experiencing profound personal and professional growth. Thematic analysis resulted in three themes 'Working with experience and uncertainty', 'Developing acceptance and understanding' and Becoming allies and advocates'. From the findings, it is evident that despite the logistical issues of a small Indigenous population and a vast nursing cohort, it is important to ensure that all nursing students have opportunities to engage authentically with Indigenous people, in places and spaces of Indigenous authority, and opportunities to reflect on their learnings in the context of their previous understandings.
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Affiliation(s)
- Tamara Power
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Cherie Lucas
- Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Carolyn Hayes
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
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Elvidge E, Paradies Y, Aldrich R, Holder C. Cultural safety in hospitals: validating an empirical measurement tool to capture the Aboriginal patient experience. AUST HEALTH REV 2020; 44:205-211. [PMID: 32213274 DOI: 10.1071/ah19227] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to develop a scale to measure cultural safety in hospitals from an Aboriginal patient perspective. Methods The Cultural Safety Survey was designed to measure five key characteristics of cultural safety that contribute to positive hospital experiences among Aboriginal hospital patients. Investigators developed a range of different methods to assess the validity and reliability of the scale using a sample of 316 participants who had attended a New South Wales hospital in the past 12 months. Targeted recruitment was conducted at two hospital sites. Opportunistic recruitment took place through a local health district, discharge follow-up service and online via social media. Results The Cultural Safety Survey Scale was a robust measurement tool that demonstrated a high level of content and construct validity. Conclusion The Cultural Safety Survey Scale could be a useful tool for measuring cultural safety in hospitals from the Aboriginal patient perspective. What is known about the topic? There are increasing calls by governments around the world for health institutions to enhance the cultural safety of their services as one way of removing access barriers and increasing health equity. However, currently there are no critical indicators or systematic methods of measuring cultural safety from the patient perspective. What does this paper add? The cultural safety scale, an Australian first, presents the first empirically validated tool that measures cultural safety from the Aboriginal patient perspective. What are the implications for practitioners? This measurement model will allow hospitals to measure the cultural safety of their services and ascertain whether current efforts aimed to improve cultural safety are resulting in Aboriginal patients reporting more culturally safe experiences. Over time it is hoped that the tool will be used to benchmark performance and eventually be adopted as a performance measure for hospitals across New South Wales.
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Affiliation(s)
- Elissa Elvidge
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; and Corresponding author.
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia.
| | - Rosemary Aldrich
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; and Ballarat Health Services, 1 Drummond Street North, Ballarat Central, Vic. 3350, Australia
| | - Carl Holder
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
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Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081326. [PMID: 31013860 PMCID: PMC6518110 DOI: 10.3390/ijerph16081326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/03/2022]
Abstract
Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.
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