‘I miss my family, it's been a while…’ A qualitative study of clinicians who live and work in rural/remote Australian Aboriginal communities

Embarking on a cultural journey: a qualitative study of new graduate physiotherapists' experiences of working in First Nations Australian health settings

INTRODUCTION

Internationally, there is growing momentum in the physiotherapy profession to improve the cultural safety and capabilities of physiotherapists. In Australia, this is essential given the important role physiotherapists play in the delivery of healthcare to First Nations Australians. Understanding the experiences of the newest members of the profession who work with First Nations Australians is an important step in exploring the broader professions' cultural safety journey.

OBJECTIVE

To explore new graduate physiotherapists' experiences working in First Nations Australian health settings.

METHODS

The study used an interpretative phenomenological approach through semi-structured interviews to explore the experiences of seven new graduate physiotherapists, in their first 2 years of practice. All participants worked within a First Nations Australian health setting for some or all of their experience as a new graduate physiotherapist.

RESULTS

Three themes were generated: 1) enrichment through connection; 2) navigating challenges; and 3) a catalyst for self-reflection.

CONCLUSION

New graduate physiotherapists reported positive experiences when working within a First Nations Australian health setting, underpinned by building a strong therapeutic relationship through rapport building; navigating challenges alongside their clients; and delving into critical self-reflection.

The Progress of the New South Wales Aboriginal Oral Health Plan 2014–2020: A Scoping Review

There are major disparities in oral health between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander people. The New South Wales (NSW) Aboriginal Oral Health Plan 2014–2020 was developed to improve the oral health of Aboriginal people. This scoping review describes programs that have been undertaken to implement the NSW Aboriginal Oral Health Plan 2014–2020. The methodology by Arksey and O’Malley was used to guide this review. Academic and grey literature were searched using a structured Medline, Lowitja and advanced Google searches. Articles were included if they aligned with the strategic directions of the Plan. Key information, including the aims of the study, methodology and results were recorded in a template on Microsoft Excel software. A total of 31 articles were included in this review. This included 25 articles from the academic literature and six initiatives from the grey literature. Included articles were categorised according to the six strategic directions in the NSW Aboriginal Oral Health Plan. Four studies were related to the first strategic direction, six related to strategic direction two, four related to strategic direction three, six initiatives related to strategic direction four, five related to strategic direction five, and eight related to strategic direction six. While there has been significant progress in achieving the strategic directions of the NSW Aboriginal Oral Health Plan, there is scope for continued collaboration between oral health service providers, universities and Aboriginal communities to improve oral health outcomes for Aboriginal people in NSW.

Strengthening Indigenous cultural competence in dentistry and oral health education: Academic perspectives

INTRODUCTION

Indigenous Australians continue to experience significant oral health disparities, despite numerous closing-the-gap initiatives. Higher education institutions and accrediting bodies recognise the need to incorporate Indigenous culture more widely into dentistry curricula to address these inequalities. This study aimed to define and explore current Indigenous cultural competence curricula, identify enablers and barriers for integration of Indigenous cultural competence curricula and ascertain innovative strategies to aid students in becoming culturally competent upon graduation, from academics' perspectives.

METHODS

Academics from the Doctor of Dental Medicine (DMD) and Bachelor of Oral Health (BOH) programmes at the University of Sydney, School of Dentistry participated in semi-structured interviews to define and explore current and future curricula practices to enable students to become competent in Indigenous culture. Thematic analysis was conducted to synthesise academics' responses.

RESULTS

Thirteen School of Dentistry academics participated in interviews. Following analysis of the data, six key themes emerged: Theme One: Transfer of Indigenous cultural knowledge, Theme Two: Barriers to developing Indigenous cultural curriculum. Theme Three: Importance of cultural immersion, Theme Four: Resources required for Indigenous cultural education, Theme Five: Proposed Indigenous cultural content, Theme Six: Strategies to incorporate Indigenous culture into curricula.

CONCLUSION

Improving Indigenous cultural competence amongst dentistry academics and students requires an educational and philosophical shift, incorporating the social determinants of health whilst maintaining the strengths of the biomedical foundations of dental care. It requires the inclusion of an informed history of Indigenous Australians, immersion within Indigenous communities and reflection upon these experiences, to facilitate culturally appropriate ways to improve the provision of dentistry and oral health for Indigenous peoples.

Novice occupational therapists: Navigating complex practice contexts in South Africa

BACKGROUND/AIM

The transition from student to occupational therapy practitioner is challenging. In South Africa, this transition is undertaken in rural and underserved areas, as graduate health professionals are deployed by the government for a year of compulsory Community Service. This study set out to establish the characteristics of these practice settings, the resources available for occupational therapy services, the availability and quality of supervision, and participants' perceived ability to communicate with their patients and negotiate cultural differences.

METHODS

A cross-sectional survey design was utilised and a questionnaire was sent to all occupational therapists completing Community Service in 2013 (N = 240). Data were analysed using Stata 12 and IBM SPSS Statistics 21.0. Frequencies and percentages were calculated for categorical variables and associations tested with Odds Ratios and the Pearson's Chi square test. Responses to open-ended questions were post-coded.

RESULTS

A 44.3% (n = 103) response rate was achieved. Practice settings often provided few resources. Although most participants had supervisors (89.6%), many did not find supervision satisfactory (65.9%). Communication difficulties featured strongly (73.9%), but the majority of participants felt they possessed basic cultural competence.

CONCLUSION

Participants worked within complex practice settings that were frequently resource-restricted with less than satisfactory supervision. Practice required cultural competence and an ability to work across language barriers. Undergraduate curricula need to be tailored to equip new graduates to navigate these contextual realities. Furthermore, human resourcing strategies need to be evaluated and effective supervision and support structures need to be developed.

A comparison of two models of dental care for Aboriginal communities in New South Wales

BACKGROUND

Aboriginal people, and particularly those in rural areas, continue to suffer very high levels of dental disease despite significant reductions in the wider Australian population in the past 30 years. Until recently, there has been a shortage of oral health clinicians and the majority have provided care in major cities. The NSW Government funded various models of care for rural and regional areas and vulnerable population groups including Aboriginal people. This study utilizes a comparative retrospective analysis to compare two models of oral health care for Aboriginal people including those living in rural NSW to inform future policy decisions.

METHODS

Two models (Model A - Fly in Fly out and Model B - Collective impact) of public oral health care for Aboriginal patients in NSW were examined using publicly available descriptive information. Two years of funding and Dental Weighted Activity Units (DWAUs) data were analysed for the two different models and regression analysis was used to compare the trends of monthly time series of DWAUs.

CONCLUSIONS

Based on the standardized national weighted pricing for public dentistry, model B offers significantly more services for less financial resources.