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Table 1 Factors that influence patient-clinician engagement and the adverse consequences

From: Study Protocol: establishing good relationships between patients and health care providers while providing cardiac care. Exploring how patient-clinician engagement contributes to health disparities between indigenous and non-indigenous Australians in South Australia

Concept Features Adverse consequences
Cultural Safety · Health professional are self-aware of their ontology, epistemology and axiology. Actions that diminish, demean or disempower the cultural identity and well-being of an individual is unsafe clinical practice [3, 4].
  · An environment that facilitates and nurtures relationships Patients viewed the medical system as cold, indifferent and inflexible [2]
  · Health services do not comprise the patients legitimate cultural rights, views and values.” [1]  
  · High staff turnover [2]  
(Mis) Communication · Language (verbal and non-verbal), · May result in misdiagnosis; ineffective and inefficient clinical management; and marginalisation of the patient 6–8.
  · Rules, conventions and etiquette;  
  Communication between the community primary health care provider and the tertiary institution [5] · An inefficient model of care i.e. ‘no shows’ in patient travel and patient has limited understanding of their clinical care [5].
(Dis) Empowerment · A distressing patient journey [5] · Patients feel disempowered, discriminated by their race and clinicians show a lack of empathy toward them [2, 3, 5].
  · Financial burden  
  · Language barriers  
  · Lack of culturally appropriate resources  
  · Inadequate pre-operative preparation and post-operative follow-up.  
  · Lack of cognitive control [2, 3].  
(Mis) Trust · Informed by a whole of life experience; which included systemic oppression and discrimination with societal institutions (particularly justice and education settings). · In response to racist treatment people felt ashamed, humiliated, powerless and fearful; which in turn contributed to the lack of trust [3].
  · In an individual encounter.  
Biomedical Model · The dominance of medical language used to explain clinical diagnosis, management and long-term care. · Removes the opportunity to construct a shared understanding of health care [20].
  · Marginalisation of the patience preferred language or knowledge [2, 20]. · Patients feel alienated and less likely to participate with the recommended care [16]