Cultural respect in general practice: a cluster randomised controlled trial

Siaw‐Teng Liaw · Vicki Wade · John Furler · Iqbal Hasan · Phyllis Min-Yu Lau · Margaret Kelaher +2 more

24 citations0/0 files storedThe Medical Journal of Australia

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Indigenous Health, Education, and Rights Primary Care and Health Outcomes Cultural Competency in Health Care

Abstract

OBJECTIVE: To examine whether the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect framework improves clinically appropriate anticipatory care in general practice and the cultural respect levels of medical practice staff. DESIGN: Mixed methods, cluster randomised controlled trial with a participatory action research approach. SETTING, PARTICIPANTS: Fifty-six general practices in Sydney and Melbourne, 2014-2017. INTERVENTION: WoTWoD encompasses a toolkit (ten scenarios illustrating cross-cultural behaviour in clinical practice), one half-day workshop, cultural mentor support for practices, and a local care partnership between participating Medicare locals/primary health networks and local Aboriginal Community Controlled Health Services for guiding the program and facilitating community engagement. The intervention lasted 12 months at each practice. MAJOR OUTCOMES: Rates of claims for MBS item 715 (health assessment for Aboriginal and Torres Strait Islander People) and recording of chronic disease risk factors; changes in cultural quotient (CQ) scores of practice staff. RESULTS: Complete results were available for 28 intervention (135 GPs, 807 Indigenous patients) and 25 control practices (210 GPs, 1554 Indigenous patients). 12-Month rates of MBS item 715 claims and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in CQ scores, regardless of staff category and practice attributes. CONCLUSION: The WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect scores in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12614000797673.

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References

2009Handbook of cultural intelligence: theory, measurement, and applications 2007Social Determinants of Indigenous Health 2014Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities 2009Aboriginal and Torres Strait Islander Health Performance Framework 2008 report: detailed analyses 2011Successful chronic disease care for Aboriginal Australians requires cultural competence 2011A postcolonial analysis of Indigenous cultural awareness training for health workers 2007Improving organisational systems for diabetes care in Australian Indigenous communities 2004Factors That Prevent Equitable Access to Rehabilitation for Aboriginal Australians With Disabilities: The Need for Culturally Safe Rehabilitation.

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