4th August 2020

New Article Alert: Practitioner perceptions of the health of Australian First Nations’ Peoples: Preliminary findings

By DrMJLock

This is an interesting article because it is one way to assess the effectiveness of cultural awareness training which is supposed to increase the knowledge of health practitioners about the dimensions of Aboriginal wellbeing.

Crouch, AChew, B (Wadawurrung woman), Freeman, G (Yorta Yorta woman). Practitioner perceptions of the health of Australian First Nations’ Peoples: Preliminary findingsAust J Rural Health. 2020; 00: 1– 9.

Cultural Training Logic (by MJL): Increased cultural awareness promotes more knowledge about the determinants of Aboriginal wellbeing and better practice from health practitioners towards Aboriginal peoples and improved cultural appropriateness of health service planning and provision. How to test that logic?

Objective: ‘To probe health practitioner perceptions of Australian First Nations’ Peoples’ health and to compare these with reported burden of disease, social determinants and culturally safe health systems data.’

Method: Online survey of 21 questions to health discipline practitioners and students. Conducted in 2017-2018 or time period of 18 months. There were 131 respondents from across Australia.

Questions:

  1. ‘What, in your understanding, are the major health issues facing people in Australia who identify as Aboriginal or Torres Strait Islander? (Disease themed responses: Mental health/substance use Diabetes; Cardiovascular; Other chronic diseases; and Infections. Determinants themed responses: Access; Racism; Socio-economic status; Health literacy; Culture; and Other)
  2. ‘What do you imagine are the key health systems issues impacting on Aboriginal and Torres Strait Islander health? (Health system themed responses: Mistrust and unwelcoming spaces; Stigma, discrimination and racism; Culturally insensitive practice; Lack of Indigenous staff; and Service delivery and barriers to care).

Finding: ‘The most important national-level preliminary finding of this study is the disconnect between health practitioner knowledge of major health issues and key health systems issues, across the spectrum of allied health, nursing, pharmacy, psychology, social work and related disciplines, and the published evidence of disease burden, determinants of health and well-functioning health systems.’


High awareness about diseases, low awareness of social determinants of health, and low awareness of health system determinants of health.


Recommendation: ‘This further suggests that pre-service exposure to basic population health science and to well-functioning health systems theory should be embedded into the curricula of all genres of health practitioner undergraduate training in Australia.’

Results: ‘Survey respondent perceptions of key health systems issues were mapped against the elements of the Wellbeing Framework (Table 3). This analysis again identified the low levels of correspondence between survey respondent health practitioner perceptions with the key health systems parameters described by researchers who identified as Australian First Nation Peoples.’

Source: Crouch, A, Chew, B, Freeman, G. Practitioner perceptions of the health of Australian First Nations’ Peoples: Preliminary findings. Aust J Rural Health. 2020; 00: 1– 9.

Critique On the downside: Small number of responses (n=131); lack of Aboriginal reference group; poor transparency about the 21 survey questions and their design; reliance on literature (privileging Western knowledge); transforming a wellbeing framework into tool to assess the cultural safety of health systems (no criteria for selection, transformation, or validation); and no deep engagement with Australian cultural safety literature (cultural safety used as a buzzword). On the upside: Use of the phrase First Nations Peoples; two First Nations co-authors; continuing evidence of the limitations of cultural awareness training; and novel method of assessment.

Call for Action: Time to take cultural safety training rigorously! All Australian governments need to support the development of a cultural training authority, policy, and strategy through substantial funding and legislation so that cultural safety training is given the priority it deserves. #culturalsafety