Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review.

Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare practices, ensuring accountability and sustainability of changes, necessitates robust mechanisms for auditing and monitoring progress. This study examined existing cultural safety audit tools, and facilitators and barriers to implementation, in the context of providing culturally safe and responsive healthcare services with Aboriginal and Torres Strait Islander people. This will assist organisations, interested in developing tools, to assess culturally responsive practice. A scoping review was undertaken using Medline, Scopus, CINAHL, Informit and PsychInfo databases. Articles were included if they described an audit tool used for healthcare practices with Aboriginal and Torres Strait Islander people. Selected tools were evaluated based on alignment with the six capabilities of the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness in Action Framework. Implementation barriers and facilitators were identified. 15 papers were included. Audit tools varied in length, terminology, domains assessed and whether they had been validated or evaluated. Seven papers reported strong reliability and validity of the tools, and one reported tool evaluation. Implementation facilitators included: tool comprehensiveness and structure; effective communication; clear organisational responsibility for implementation; commitment to prioritising cultural competence; and established accountability mechanisms. Barriers included: the tool being time-consuming and inflexible; responsibility for implementation falling on a small team or single staff member; deprioritising tool use; and lack of accountability for implementation. Two of the six IAHA capabilities (respect for the centrality of cultures and inclusive engagement) were strongly reflected in the tools. The limited tool evaluation highlights the need for further research to determine implementation effectiveness and sustainability. Action-oriented tools, which comprehensively reflect all cultural responsiveness capabilities, are lacking and further research is needed to progress meaningful change within the healthcare system.

Reflections on an evaluation of the 'Remote Health Experience' - an interprofessional learning, cultural immersion program.

INTRODUCTION: Cultural immersion can be an effective method of health professional student cultural learning, and part of interprofessional learning. This evaluation aimed to report the views of staff and Aboriginal and Torres Strait Islander contributors about a cultural immersion program, as well as the student perspective. METHODS: Semi-structured interviews with staff (11 non-Aboriginal, 3 Aboriginal) and Aboriginal contributors (n=3) were conducted after the 2020 immersion program. Data were collected from 138 student participants following the 2018 (n=45), 2019 (n=33) and 2020 (n=60) remote health experience immersion weekends in Katherine, in the Northern Territory of Australia. Seven staff of the 2020 weekend provided written feedback about their experiences. Qualitative data were analysed thematically, and quantitative results scored from ratings on a five-point scale were presented as means, standard deviations and percentage of respondents agreeing or strongly agreeing with evaluative statements. RESULTS: Results are presented under the four themes that were identified: (1) understanding remote practice, (2) Aboriginal culture, (3) working together and learning from each other, and (4) ongoing opportunities. Feedback from students and staff was overwhelmingly positive, with learning occurring in each of the intended areas. Relationship building and embedding Aboriginal and Torres Strait Islander culture and knowledge throughout the weekend were seen as invaluable components. CONCLUSION: The Katherine Remote Health Experience is a valuable, immersive introduction to remote health practice for students from multiple disciplines. As a standalone event it has developed positive relationships, improved knowledge, and encouraged students to consider practising outside of metropolitan areas. There is scope to further develop pathways into remote practice for interested students.

Co-creation of a student-implemented allied health service in a First Nations remote community of East Arnhem Land, Australia.

OBJECTIVES: To co-create a culturally responsive student-implemented allied health service in a First Nations remote community and to determine the feasibility and acceptability of the service. DESIGN: Co-creation involved a pragmatic iterative process, based on participatory action research approaches. Feasibility and acceptability were determined using a mixed-method pre/postdesign. SETTING: The service was in Nhulunbuy, Yirrkala and surrounding remote First Nations communities of East Arnhem Land, Northern Territory, Australia. PARTICIPANTS: Co-creation of the service was facilitated by the Northern Australia Research Network, guided by Indigenous Allied Health Australia leadership, with East Arnhem local community organisations and community members. Co-creation of the day-to-day service model involved local cultural consultants, service users and their families, staff of community organisations, students, supervisors, placement coordinators and a site administrator. FINDINGS: A reciprocal learning service model was co-created in which culturally responsive practice was embedded. The service was feasible and acceptable: it was delivered as intended; resources were adequate; the service management system was workable; and the service was acceptable. Health outcome measures, however, were not appropriate to demonstrate impact, particularly through the lens of the people of East Arnhem. Recommendations for the service included: continuing the reciprocal learning service model in the long term; expanding to include all age groups; and connecting with visiting and community-based services. CONCLUSION: The co-created service was feasible and acceptable. To demonstrate the impact of the service, measures of health service impact that are important to First Nations people living in remote communities of northern Australia are required.