Table 2 Alignment of course design with cultural safety principles, adapted from NAATSIHWP [24] & NHMRC [45]
Cultural safety principle | Demonstration of alignment | Evidence and practical examples | Self-reflection achievement met/not met |
|---|---|---|---|
Reciprocity Shared responsibility and obligation based on kinship networks. Shared mutual benefit. | Equitable and respectful engagement Ensuring Aboriginal and Torres Strait Islander Peoples and communities have the right to define benefits according to their own values and priorities. Linked to local, national health priorities. | Two-way learning providing a safe space for participants to discuss content, facilitated by male and female trained Aboriginal health staff. Confirming the appropriateness of course content prior to delivery with local staff based in community. Content of course modified in accordance with participant feedback and community needs e.g. “This course should be longer”, we changed to 1.5 days. “We should come together again and talk about hep b” we organised in-services, visited community and invited participants back to subsequent course. We enhance community capacity beyond the project, including transferable skills in chronic conditions management and transferrable model of education. Borne from community consultation for a need to improve CHB care on country and training for Aboriginal health workforce. The project was linked to community and national health priorities and strategies. | Met |
Respect | Respected decision processes of community Minimised difference blindness and engage with Aboriginal and Torres Strait Islander knowledge and experience. Respected cultural obligations and commitments. Respecting difference in education levels, professional expertise, and catering to all levels | Developing respectful relationships Use of metaphors and allowed time for and storytelling. Giving opportunity for facilitators and participants. Flexible and responsive, centring cultural priorities. “I felt very safe”. Course tailored to different education and literacy levels. Participants could break into groups of their choice. Verbal and storytelling used, and facilitators explained – not relying heavily on written text or answers | Met |
Equity and access Showing fairness and justice Benefits from research show flow mostly to the community, not the researchers. Integrating Aboriginal and Torres strait Islander worldviews into programs is critical to achieve culturally safe transformational change. Seeks to identify and redress historical, social, and political imbalances and inequities | Equitable partnerships Ensuring equality and equity to educational opportunities Actively engaging community in to and methods & considering first language and communication | Co-designed course. Ensuring equality and equity to educational opportunities. Delivering in remote/regional locations. Offered to broad range of Aboriginal and Torres Strait Islander workforce and ensuring course tailored to many educational and professional levels, respecting each other. Consciously considering factors including location, travel, accommodation, catering, and health clinic staffing, to remove barriers for attendance. Advocating for participant attendance by discussing the course with key stakeholders including Aboriginal health practitioner coordinators, district managers, clinic managers and other community health staff including doctors and nurses. Designed course content to suit a variety of learning styles, with a preference for visual, interactive, and kinaesthetic methods for a variety of educational and professional levels. Ability to make games, evaluation, knowledge sharing inclusive, so everyone has equal opportunity to contribute. | Met |
Cultural contextuality & cultural continuity A sense of strong, shared, and enduring individual and collective identities | Negotiated participation and awareness of cultural events (e.g., sacred sites; women’s business and men’s business). Establishing mechanisms that incorporate the balance between collective and individual identity. Establishing a community advisory group and respecting the community’s decisions. Considering the use of Aboriginal and Torres Strait Islander standpoints and methodologies when development | Acknowledging upfront that some concepts include culturally sensitive information. Before and during the course, acknowledge that some content (about transmission) will be talking about men’s and women’s business. Seeking permission and allowing participants to leave. Understanding kinship and ensuring gender balance of facilitators and participants. Working with community before selecting a training date to avoid dates of cultural significance. Understanding that the community are the experts in their culture and not being difference blind using strengths-based approaches. PAR and two-way approach. Aboriginal and Torres Strait Islander research team and participants informed development of the course. Reflecting, learning changing as required. “This is the most culturally safe training I’ve ever had”. | Met |
Responsibility and advocacy Caring for country, kinship, bonds, maintenance of cultural and spiritual awareness. To do no harm, including avoiding having an adverse impact on the ability of others to comply with their responsibilities | Treating people with respect as adult learners Responsibility to ensure basic needs are met (accommodation, food etc) Responsibility to support ongoing learning and development - ongoing follow up of participants, mentorship. Responsibility to ensure quality training materials to pass on knowledge. | We understood that people have other family and cultural responsibilities and allowed for this. Enabling and facilitated opportunities to do other things and meet obligations in “town”. Sharing responsibility of imparting knowledge to assist in critical thinking. Advocated with managers for travel allowance to be paid upfront to avoid financal stress. All food and accommodation provided. Provided on-going training opportunities, including assisting liver clinics, and provided mentors and support (i.e., AHP coordinator, nurse in clinic, where possible) Provided with education booklet, Hep B Story app, presentation with key messages. Manager informed before and after of learning outcomes and provided with information of how to support staff to consolidate learnings. | Met |
Sustainability Sustained commitment to improving healthcare services to Aboriginal and Torres Strait Islander Peoples and educational opportunities for the Aboriginal health workforce. | Sustain partnerships and relationships with Aboriginal and Torres Strait Islander Peoples and communities that are based on trust, mutual responsibility, and ethics. Sustain education opportunity. Initiating research translation strategy | Developing trusted relationships through the design and delivery of the course, researchers and community developed relationships which has vast beneficial implications beyond the delivery of this course. “Building relationships is crucial particularly in the NT where most clinics are in remote settings”. Endorsement from NAATSIHWP. Presented findings to organisations and community. Successful advocacy and investment from NTG to fund future courses. Working with managers to support attendance in trainings. Initiating research translation strategy, using model for other health conditions. Successfully transferred model to COVID-19 training. Broader model of care, Aboriginal health workforce part of the core clinical care group. Improvements in the cascade of care for people living with CHB. | Met |