Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers.
Med J Aust 2002;
176:466-70. [PMID:
12065009 DOI:
10.5694/j.1326-5377.2002.tb04517.x]
[Citation(s) in RCA: 170] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2001] [Accepted: 04/10/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVES
To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication.
DESIGN
Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication.
SETTING
A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001.
PARTICIPANTS
Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers.
MAIN OUTCOME MEASURES
Factors influencing the quality of communication.
RESULTS
A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.
CONCLUSIONS
Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.
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