'Believe in me and I will believe in myself', a rural Australian health service learns how to mangan dunguludja ngatan (build strong employment) for Aboriginal and Torres Strait Islander people: a qualitative study.

BACKGROUND: Australian Aboriginal people have higher rates of unemployment and poorer health than non-Aboriginal Australians. Historical segregation policies that spanned 60 years negatively impacted workforce inclusion. A Victorian regional health service recently developed an Aboriginal Employment Plan (AEP) targeted to reach 2% employment of Aboriginal people by 2020. This study aimed to identify strategies that will build strong Aboriginal employment. METHODOLOGY: A qualitative research protocol was designed. Purposive recruitment of people with a vested interest in the growth of Aboriginal employment at the health service participated in focus groups and individual interviews. RESULTS: Twenty-four people including local Elders, past and present Aboriginal employees, key community stakeholders and health service executives participated. Learnings from the past, the present and strategies for the future emerged from two important stories: (1) the story of a strong group of local Aboriginal people who successfully approached the matron of the hospital in the early 1960s for employment. (2) The story of the 'verandah babies'. DISCUSSION: The history of the health service in question demonstrated the power of the possible with a self-determined group of Aboriginal people, who, in the face of cultural inequity, achieved employment at the health service. The opportunity for healing and a new start was illustrated by the story of women who gave birth on the verandahs due to their exclusion from the main hospital. Today, the 'verandahs' have been replaced with a modern hospital decorated with Aboriginal art, expressing cultural safety and inclusion, presenting fertile ground for strengthening and sustaining Aboriginal employment. CONCLUSION: Eleven strategies have emerged from three themes; safety, equity and pathway, offering mainstream health services insight into how to mangan dunguludja ngatan (build strong employment). Cultural safety can be achieved through acknowledging the past and reconciling that through engaging, partnering and collaborating with the Aboriginal community. Visual representations of culture and participation in celebratory activities engender awareness and understanding. The development of local, flexible career development pathways for Aboriginal people facilitates a 'sense of belonging' to the health service and a dual 'sense of pride' within the community: whereby the Aboriginal person feels proud to represent their community and the community is proud to be represented. Cultural equity is facilitated through mutual learning and reciprocal understanding of difference.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

BACKGROUND: The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. OBJECTIVE: The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. DESIGN: This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. RESULTS: The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. CONCLUSION: The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated.

Understanding cultural inclusion in alcohol and other drug services in New South Wales, Australia and assessing the acceptability of a cultural inclusion audit.

INTRODUCTION: Cultural inclusion and competence are understood at the most basic level to be the practice of considering culture so as to provide effective services to people of different cultural backgrounds. In order to work better with clients from diverse backgrounds, alcohol and other drug (AOD) services need to offer a service that is designed to be accessible to all people, where systems in place operate in a way that considers different cultural needs. This research aimed to assess the extent to which non-government AOD services in New South Wales are positioned to support cultural inclusion as well as to evaluate the acceptability of a cultural inclusion audit across four AOD sites. METHODS: The research adopted a mixed methods approach comprising of a pre-audit online survey (n = 85) designed to assess AOD services' attitudes and practices towards cultural inclusion, and in-depth interviews that were conducted with nine AOD service staff and four cultural auditors to explore the acceptability of a cultural inclusion audit process. RESULTS: Findings from the survey indicate cultural inclusion practices are limited. Interview data highlight that while staff are not fully aware of what appropriate cultural inclusions entails, they are receptive to and want a cultural inclusion program. DISCUSSION AND CONCLUSIONS: The study illustrates the benefits of implementing a cultural inclusion audit process aimed at raising awareness of what cultural inclusion entails. Including a cultural inclusion service audit is likely to enhance AOD service provision to culturally and linguistically diverse groups and thereby improve treatment outcomes.

Evaluation of online text-based information resources of gynaecological cancer symptoms.

BACKGROUND: Gynaecological cancer symptoms are often vague and non-specific. Quality health information is central to timely cancer diagnosis and treatment. The aim of this study was to identify and evaluate the quality of online text-based patient information resources regarding gynaecological cancer symptoms. METHODS: A targeted website search and Google search were conducted to identify health information resources published by the Australian government and non-government health organisations. Resources were classified by topic (gynaecological health, gynaecological cancers, cancer, general health); assessed for reading level (Simple Measure of Gobbledygook, SMOG) and difficulty (Flesch Reading Ease, FRE); understandability and actionability (Patient Education Materials Assessment Tool, PEMAT, 0-100), whereby higher scores indicate better understandability/actionability. Seven criteria were used to assess cultural inclusivity specific for Aboriginal and Torres Strait Islander people; resources which met 3-5 items were deemed to be moderately inclusive and 6+ items as inclusive. RESULTS: A total of 109 resources were identified and 76% provided information on symptoms in the context of gynaecological cancers. The average readability was equivalent to a grade 10 reading level on the SMOG and classified as 'difficult to read' on the FRE. The mean PEMAT scores were 95% (range 58-100) for understandability and 13% (range 0-80) for actionability. Five resources were evaluated as being moderately culturally inclusive. No resource met all the benchmarks. CONCLUSIONS: This study highlights the inadequate quality of online resources available on pre-diagnosis gynaecological cancer symptom information. Resources should be revised in line with the recommended standards for readability, understandability and actionability and to meet the needs of a culturally diverse population.

Culture and Language Inclusion in the Practice of Applied Behavior Analysis: Next Steps for Improving Outcomes for Autistic Clients.

As applied behavior analysis (ABA) is widely prescribed as an intervention for autistic children, ABA practitioners must have a thorough understanding of the impact of language and culture on the individuals and families they serve. The twin purposes of this article are to discuss cultural humility in ASD service delivery, and to provide an overview of practice parameters for the expansion of equity and inclusion. These efforts are guided by the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Readers will be provided with recommendations for incorporating culturally and linguistically appropriate services into training, practice, and supervision in ABA settings.

The Development of the Measure of Adolescent Relationship Harassment and Abuse (MARSHA): Input From Black and Multiracial, Latinx, Native American, and LGBTQ+ Youth.

This formative research study was designed to collect opinion data from adolescents historically underrepresented in adolescent dating abuse (ADA) research measure development. Eight in-person focus groups and 7 telephone-based one-on-one interviews were conducted with U.S. youth aged from 11 to 20 years (N=48). We conducted two focus groups with Black, Multiracial, Latinx, Native American, and LGBTQ+ youth. Seven LGBTQ+ youth participated in one-on-one telephone-based interviews. Focus group participants and interview subjects were asked the same 11 questions from a semi-structured focus group question guide. Five questions were on the topic of dating behaviors in general. In addition, six questions were asked for reactions to a paper-based list of 75 abusive acts. Youth generated ideas for 10 new possible cyber-ADA items and 14 emotionally abusive items for inclusion on the ADA measurement instrument. They did not generate any new physical or sexual ADA items. Youth identified 14 acts that they felt should not be on the measure, either because the acts were not abusive and too common, because they could not understand the item, or because it seemed unrealistic as an act of ADA. The study faced several limitations and was a good first step toward enriching the cultural inclusivity of ADA measurement instrument. Continued attention to inclusionary research that seeks to understand the cultural milieux of diverse participants is essential for violence prevention scholarship and subsequent health programming and policy that derive from it.

Building HCA Bridges.

Description On June 28, 2021, the incoming residents reported for their first day of orientation at HCA Florida Westside Hospital (HFWH). This GME program is a joint venture and requires the same level of commitment from HCA Florida Northwest Hospital (HFNWH). As a new employee, I was immediately impressed with the residents, leadership, and staff. Everyone was relaxed, excited, attentive, and cooperative. I met people from all over the world, from different religions, and of different sexual orientations. The following day the same group of residents attended orientation at HFNWH and the leadership and staff were equally impressive. I went home feeling energized by this extraordinary residency program where diversity, equity and inclusion were not just words but were embodied in both the residency program, and both hospitals. I created "Building HCA Bridges" as an abstract expression with feelings, movement, textures, and symbolic colors. When I stepped back, I realized that the painting was missing something. The next day, I spoke with the GME and hospital leadership and with their support, the painting was subsequently passed throughout both hospitals, and everyone was invited to sign. This small gesture created a sense of community, pride, and validation for all who participated in creating this incredible residency program and ultimately, unique piece of artwork. I am submitting the traveling painting, "Building HCA Bridges" on behalf of the inaugural GME programs at HFWH and HFNWH and for those who support the programs every day. We are blessed.

The (Biological or Cultural) Essence of Essentialism: Implications for Policy Support among Dominant and Subordinated Groups.

Most research links (racial) essentialism to negative intergroup outcomes. We propose that this conclusion reflects both a narrow conceptual focus on biological/genetic essence and a narrow research focus from the perspective of racially dominant groups. We distinguished between beliefs in biological and cultural essences, and we investigated the implications of this distinction for support of social justice policies (e.g., affirmative action) among people with dominant (White) and subordinated (e.g., Black, Latino) racial identities in the United States. Whereas, endorsement of biological essentialism may have similarly negative implications for social justice policies across racial categories, we investigated the hypothesis that endorsement of cultural essentialism would have different implications across racial categories. In Studies 1a and 1b, we assessed the properties of a cultural essentialism measure we developed using two samples with different racial/ethnic compositions. In Study 2, we collected data from 170 participants using an online questionnaire to test the implications of essentialist beliefs for policy support. Consistent with previous research, we found that belief in biological essentialism was negatively related to policy support for participants from both dominant and subordinated categories. In contrast, the relationship between cultural essentialism and policy support varied across identity categories in the hypothesized way: negative for participants from the dominant category but positive for participants from subordinated categories. Results suggest that cultural essentialism may provide a way of identification that subordinated communities use to mobilize support for social justice.