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Rusinga A, Setchell J, Jang S, Costa N. Exploring the Systemic Structures That Affect Access to Physical Therapist Services for Non-Indigenous Black People in Australia. Phys Ther 2024; 104:pzad139. [PMID: 37839057 DOI: 10.1093/ptj/pzad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Physical therapy is generally considered to be a white profession in Western nations. Australia's increasingly diverse population, driven largely by growth in immigration, invites Australian health systems to be responsive to factors that may impact on non-white Australian population's access to health care. Here, the authors sought to explore non-Indigenous Black people's perspectives of physical therapy in Australia. METHODS Eligible participants (n = 12) took part in semistructured, in-depth interviews and were prompted to discuss their experiences and perceptions of physical therapy. Interview data were analyzed using critical discourse analysis, underpinned by critical race theory. RESULTS Participants were on average 29.4 years (SD = 12.9) from diverse cultural and linguistic backgrounds. Participants described mostly positive experiences with physical therapists, but they noted that it was not widely accessed by their communities, with 2 key discourses underpinning these discussions. Discourse 1, "physiotherapy is a solution for white people," established physical therapy as primarily accessed by and welcoming of white people. "Whiteness" and the perpetuation of Western norms in physical therapy resulted in little consideration of other cultural practices. Participants' discussions also pointed to the intersections of systemic racism and social inequities such as low income and language barriers, impacting Black people's engagement with physical therapy. Discourse 2, "physiotherapists are white," was mostly concerned with how the perceived "whiteness" of professionals and lack of Black physical therapists impacts cultural safety and comfort when accessing physical therapy. CONCLUSION Our results suggest that Westernization and whiteness persist among discourses surrounding physical therapy. Such discourses are likely to inform Black people's perceptions and experiences of physical therapy. Our analyses suggest avenues to enhance the cultural diversity of the profession and improve physical therapy accessibility for Black people in Australia by providing culturally appropriate material, including critical reflexivity, epistemic and cultural humility in the curricula, recruiting staff from diverse backgrounds, and providing outreach services to underserved populations. IMPACT These findings highlight the need for increased cultural safety and diversity within the physical therapy profession to improve equity.
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Affiliation(s)
- Adelaide Rusinga
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Jenny Setchell
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Sarah Jang
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
- The University of Sydney, Sydney School of Health Sciences, Sydney, New South Wales, Australia
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Dawson AP, Warrior E, Pearson O, Boyd MA, Dwyer J, Morey K, Brodie T, Towers K, Waters S, Avila C, Hammond C, Lake KJ, Lampard ‘UF, Wanganeen ‘UF, Bennell O, Bromley D, Shearing T, Rigney N, Czygan S, Clinch N, Pitson A, Brown A, Howard NJ. Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study. Front Public Health 2023; 11:1206371. [PMID: 37809004 PMCID: PMC10556859 DOI: 10.3389/fpubh.2023.1206371] [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: 05/03/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing. Methods This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing. Results Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified. Conclusion Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.
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Affiliation(s)
- Anna P. Dawson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Eugene Warrior
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Mark A. Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Judith Dwyer
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Kurt Towers
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sonia Waters
- Aboriginal Services, AnglicareSA, Adelaide, SA, Australia
| | | | - Courtney Hammond
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Katherine J. Lake
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Indigenous Health Equity, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - ‘Uncle’ Frank Lampard
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - ‘Uncle’ Frank Wanganeen
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - Olive Bennell
- Executive Office, Nunga Mi:Minars Inc., Adelaide, SA, Australia
| | | | - Toni Shearing
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nathan Rigney
- Aboriginal Health Promotion, Wellbeing SA, Adelaide, SA, Australia
| | | | - Nikki Clinch
- Statewide Operations, South Australian Department for Corrections, Adelaide, SA, Australia
| | - Andrea Pitson
- Aboriginal Education Directorate, South Australian Department for Education, Adelaide, SA, Australia
| | - Alex Brown
- Indigenous Genomics, Telethon Kids Institute, Adelaide, South Australia, Australia
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
| | - Natasha J. Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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