Codesigning informative resources for families of Aboriginal and Torres Strait Islander children who sustained a burn injury: a protocol for a participatory action research study.

INTRODUCTION: Parents of children hospitalised in a burn unit experience psychological trauma and later post-traumatic stress. Aboriginal and Torres Strait Islander families whose child has been admitted to a burn unit encounter additional burdens through a culturally unsafe healthcare system. Psychosocial interventions can help reduce anxiety, distress and trauma among children and parents. There remains a lack of interventions or resources that reflect Aboriginal and Torres Strait Islander people's perspective of health. The objective of this study is to codevelop a culturally appropriate informative resource to assist Aboriginal and Torres Strait Islander parents whose child has been hospitalised in a burn unit. METHODS: In this participatory research study, the development of a culturally safe resource will build on Aboriginal and Torres Strait Islander families' experiences and voices, complemented by the knowledge and expertise of an Aboriginal Health Worker (AHW) and burn care experts. Data will be collected through recorded yarning sessions with families whose child has been admitted to a burn unit, the AHW and burn care experts. Audiotapes will be transcribed and data will be analysed thematically. Analysis of yarning sessions and resource development will follow a cyclical approach. ETHICS AND DISSEMINATION: This study has been approved by the Aboriginal Health and Medical Research Council (AH&MRC) (1690/20) and the Sydney Children's Hospitals Network ethics committee (2020/ETH02103). Findings will be reported to all participants and will be disseminated with the broader community, the funding body and health workers at the hospital. Dissemination with the academic community will be through peer-reviewed publications and presentations in relevant conferences.

Discharge Interventions for First Nations People with Injury or Chronic Conditions: A Protocol for a Systematic Review.

Severe injury and chronic conditions require long-term management by multidisciplinary teams. Appropriate discharge planning ensures ongoing care to mitigate the long-term impact of injuries and chronic conditions. However, First Nations peoples in Australia face ongoing barriers to aftercare. This systematic review will locate and analyse global evidence of discharge interventions that have been implemented to improve aftercare and enhance health outcomes among First Nations people with an injury or chronic condition. A systematic search will be conducted using five databases, Google, and Google scholar. Global studies published in English will be included. We will analyse aftercare interventions implemented and the health outcomes associated. Two independent reviewers will screen and select studies and then extract and analyse the data. Quality appraisal of the included studies will be conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. The proposed study will analyse global evidence on discharge interventions that have been implemented for First Nations people with an injury or chronic conditions and their associated health outcomes. Our findings will guide healthcare quality improvement to ensure Aboriginal and Torres Strait Islander peoples have ongoing access to culturally safe aftercare services.

A co-designed curriculum for cultural safety training of Colombian health professionals: sequential-consensual qualitative study.

Background: Although traditional and cultural health practices are widely used in Colombia, physicians are not trained to address intercultural tensions that arise in clinical practice. Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients' culture. It requires inviting patients of non-dominant cultures to co-design culturally safe health care. We co-designed a curriculum for cultural safety training of Colombian health professionals. Methods: A sequential-consensual qualitative study defined the learning objectives of the curriculum. Semi-structured questionnaires and focus groups explored the opinions of traditional medicine users, medical students, and intercultural health experts to inform the content of the curriculum. Deliberative dialogue between key intercultural health experts settled the academic content of the curriculum. A member-checking strategy modified and approved the final version. Results: Seven traditional medicine users, six medical students, and four intercultural health experts participated in the study. The stakeholders defined five learning objectives: (a) culturally unsafe practices: acknowledge the intercultural tensions and its consequences; (b) cultural awareness: examine their attitudes, beliefs, and values, and how they shape their professional practice; (c) cultural humility: listen and learn from the patients' traditional practices; (d) cultural competence: describe current pedagogical approaches to address intercultural tensions; and (e) cultural safety: discuss with patients to reach an agreement on their treatment. Conclusion: This study integrated the perspectives of different stakeholders and proposed new applications of cultural safety that are relevant to other countries. Researchers and educators can use these results to inform future cultural safety initiatives.

Contexte: Bien que les pratiques traditionnelles et culturelles en matière de santé soient largement utilisées en Colombie, les médecins ne sont pas formés pour faire face aux tensions interculturelles qui peuvent surgir dans le contexte clinique. La sécurité culturelle encourage les praticiens à s'interroger sur les façons dont leur propre culture influence leur pratique clinique et à respecter la culture de leurs patients. Elle exige qu'ils invitent leurs patients de cultures non dominantes à co-concevoir des soins de santé culturellement sûrs. Nous avons co-conçu un programme de formation en sécurité culturelle pour les professionnels de santé colombiens. Méthodes: Les objectifs d'apprentissage du programme ont été définis sur la base d'une étude qualitative séquentielle-consensuelle. Par le biais de questionnaires semi-structurés et de groupes de discussion, nous avons exploré les opinions d'utilisateurs de la médecine traditionnelle, d'étudiants en médecine et d'experts en santé interculturelle dans le but de définir le contenu du cursus de façon éclairée. Son contenu académique a été finalisé à la suite d'un dialogue délibératif entre les principaux experts en santé interculturelle. Une vérification par les membres a permis de modifier et d'approuver la version finale. Résultats: Sept utilisateurs de la médecine traditionnelle, six étudiants en médecine et quatre experts en santé interculturelle ont participé à l'étude. Les parties prenantes ont défini cinq objectifs d'apprentissage : (a) pratiques culturellement non sécuritaires : reconnaître les tensions interculturelles et leurs conséquences; (b) prise de conscience culturelle : examiner leurs attitudes, croyances et valeurs, et la manière dont elles façonnent s pratiques professionnelles; (c) humilité culturelle : écouter et apprendre des pratiques traditionnelles des patients; (d) compétence culturelle : décrire les approches pédagogiques actuelles sur la question des tensions interculturelles; et (e) sécurité culturelle : discuter avec les patients pour parvenir à un terrain d'entente sur leur traitement. Conclusion: Cette étude intègre les perspectives de différentes parties prenantes et propose de nouvelles applications de la sécurité culturelle qui seraient également pertinentes dans d'autres pays. Les chercheurs et les enseignants peuvent utiliser ces résultats pour alimenter des initiatives futures en matière de sécurité culturelle.

Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review.

BACKGROUND: Racism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples. METHODS: A systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary. RESULTS: Of total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism. CONCLUSION: Racism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.

The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique.

Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.

Impact of racism and discrimination on the physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: a protocol for a scoping review.

BACKGROUND: Racism is increasingly recognised internationally as a key factor contributing to health disparities. A comprehensive body of strong research from international authors has reported negative associations between racism and health outcomes. In Australia, although the literature is more limited, available findings follow global trends. Australia has an identified health gap between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians, and despite efforts to bridge this gap, health inequities continue to exist. This scoping review aims to assess, analyse and synthesise the relationship between racism and discrimination on the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. METHOD: This is the study protocol for a scoping review. A systematic search will be conducted using five electronic databases: PubMed, CINAHL, Embase, Web of Science and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. The database search will include studies published between 2000 and 2020. Reference lists of the included articles will be searched. Outcome measures will include physical and mental health components including chronic conditions, depression and anxiety, psychological distress, social and emotional difficulties, suicide and health-related outcomes such as wellbeing and life satisfaction. Duplications will be removed, and titles and abstracts will be reviewed to select studies. Full-text screening of preselected studies will be performed by four reviewers independently, to select studies according to inclusion criteria. Included studies will be appraised for quality using appropriate tools tailored for each study design. Data will be extracted, and study findings and characteristics synthesised in a narrative summary. DISCUSSION: Our scoping review will synthesise the evidence on the impacts of racism and discrimination in relation to the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. These findings could guide future health interventions by addressing the exposure of racism and racial discrimination in order to reduce health disparity. It is anticipated the findings to be of interest to policymakers, researchers, Aboriginal and Torres Strait Islander communities and community health organisations and other stakeholders interested in optimising public health interventions for and in partnership with Aboriginal and Strait Torres Islander communities of Australia. SCOPING REVIEW REGISTRATION: The protocol for this review has been registered on the international prospective register of systematic reviews (PROSPERO). The registration ID is CRD42020186193 .