Communicating medical information with Aboriginal patients: lessons learned from GPs and GP registrars in Aboriginal primary health care

Wissam Ghamrawi; Jill Benson; Emma Kennedy

doi:10.1071/PY23128

RESEARCH ARTICLE (Open Access)

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Communicating medical information with Aboriginal patients: lessons learned from GPs and GP registrars in Aboriginal primary health care

Wissam Ghamrawi ^A ^B ^* , Jill Benson ^A ^B and Emma Kennedy ^A

+ Author Affiliations

- Author Affiliations

^A Flinders University, College of Medicine and Public Health, Bedford Park, NT 41326, Australia.

^B GPEx, Research Department, Unley, SA 5061, Australia.

^* Correspondence to: w.ghamrawi@protonmail.com

Australian Journal of Primary Health 30, PY23128 https://doi.org/10.1071/PY23128

Submitted: 7 December 2022 Accepted: 21 August 2023 Published: 15 September 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Aboriginal culture stands as the oldest continuous culture in the world. It gives paramount importance to a harmonious balance between personal connections to the body, spirit, and mind, as well as collective relationships with family, land, and community, integral to the wellbeing of Aboriginal people. However, obstacles can emerge for patients due to language barriers, cultural differences, or a historical lack of trust in the healthcare system. The establishment of Aboriginal Community Controlled Health Organisations (ACCHOs) has undoubtedly improved the healthcare experience for Aboriginal patients, yet there is limited research on the specific approaches utilised by general practitioners (GPs) working in these clinics.

Methods

Twelve semi-structured interviews were conducted with two groups of GPs working in Aboriginal health. Each GP was presented with three scenarios and asked questions related to each scenario. Braun and Clarke’s method of thematic analysis was applied to transcribed interviews.

Results

Patient-doctor relationship, health literacy, and engagement with the health system emerged as key factors influencing communication with Aboriginal patients. Experienced GPs, despite differing clinical backgrounds, shared concise yet similar ideas to their less experienced counterparts. Notably, experienced GPs prioritised non-medical conversations and mindful body language, emphasising the importance of building strong patient relationships over other consultation aspects.

Conclusions

This research provides initial insights for GPs in Aboriginal health, comparing experienced GPs with more than 10 years experience to novices. However, further research involving Aboriginal patients is needed to validate GP strategies and understand their significance from the patients’ perspective.

Keywords: Aboriginal community-controlled primary health care, Aboriginal culture, Aboriginal health, consultation skills, general practice, GP training, health literacy, Indigenous, patient-doctor relationship, patient engagement, primary health care.

References

ACSQHC (2019) Health literacy. Australian Commission on Safety and Quality in Health Care. Available at https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard/health-literacy

AHCSA (n.d.) About AHCSA. Available at https://ahcsa.org.au/about-ahcsa/about-ahcsa. [Retrieved 10 July 2023]

AHRC (2014) Face the facts: cultural diversity. Australian Human Rights Commission. Available at https://humanrights.gov.au/our-work/education/face-facts-cultural-diversity

AIHW (2015) Cultural competency in the delivery of health services for Indigenous people. Australian Institute of Health and Welfare. Available at https://www.aihw.gov.au/uploadedfiles/closingthegap/content/our_publications/2015/ctgc-ip13.pdf

AIHW (2023) 1.23 Leading causes of mortality – AIHW Aboriginal and Torres Strait Islander Health Performance Framework: Summary report. Australian Institute of Health and Welfare. Available at https://www.indigenoushpf.gov.au/measures/1-23-leading-causes-mortality

AMA (2022) AMA position statement – cultural safety. Australian Medical Association. Available at https://www.ama.com.au/articles/ama-position-statement-cultural-safety-0

Bessarab D, Ng’andu B (2010) Yarning about yarning as a legitimate method in indigenous research. International Journal of Critical Indigenous Studies 3(1), 37-50.
| Crossref | Google Scholar |

Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.
| Crossref | Google Scholar |

Campbell MA, Hunt J, Scrimgeour DJ, Davey M, Jones V (2018) Contribution of aboriginal community-controlled health services to improving aboriginal health: an evidence review. Australian Health Review: A Publication of the Australian Hospital Association 42(2), 218-226.
| Crossref | Google Scholar | PubMed |

Canuto K, Harfield S, Wittert G, Brown A (2019) Listen, understand, collaborate: developing innovative strategies to improve health service utilisation by Aboriginal and Torres Strait Islander men. Australian and New Zealand Journal of Public Health 43(4), 307-309.
| Crossref | Google Scholar | PubMed |

Charlton JI (1998) ‘Nothing about us without us: disability oppression and empowerment.’ (University of California Press)

Davy C, Cass A, Brady J, DeVries J, Fewquandie B, Ingram S, Mentha R, Simon P, Rickards B, Togni S, Liu H, Peiris D, Askew D, Kite E, Sivak L, Hackett M, Lavoie J, Brown A (2016) Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples. Australian and New Zealand Journal of Public Health 40(6), 535-541.
| Crossref | Google Scholar | PubMed |

Diversity of language – Australia’s cultural diversity (2021) Diversity of language. Racism. No Way! Available at https://racismnoway.com.au/about-racism/australias-cultural-diversity/diversity-of-language/

Gomersall JS, Gibson O, Dwyer J, O’Donnell K, Stephenson M, Carter D, Canuto K, Munn Z, Aromataris E, Brown A (2017) What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Australian and New Zealand Journal of Public Health 41(4), 417-423.
| Crossref | Google Scholar | PubMed |

Janca A, Bullen C (2003) The Aboriginal concept of time and its mental health implications. Australasian Psychiatry: Bulletin of The Royal Australian and New Zealand College of Psychiatrists 11(1_suppl), S40-S44.
| Crossref | Google Scholar |

Lin I, Green C, Bessarab D (2016) ‘Yarn with me’: applying clinical yarning to improve clinician-patient communication in Aboriginal health care. Australian Journal of Primary Health 22(5), 377-382.
| Crossref | Google Scholar | PubMed |

Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, Ju X, Zhang X (2020) What is the meaning of health literacy? A systematic review and qualitative synthesis. Family Medicine and Community Health 8(2), e000351.
| Crossref | Google Scholar | PubMed |

McKivett A, Paul D, Hudson N (2019) Healing conversations: developing a practical framework for clinical communication between aboriginal communities and healthcare practitioners. Journal of Immigrant and Minority Health 21(3), 596-605.
| Crossref | Google Scholar | PubMed |

Rheault H, Coyer F, Jones L, Bonner A (2019) Health literacy in Indigenous people with chronic disease living in remote Australia. BMC Health Services Research 19(1), 523.
| Crossref | Google Scholar | PubMed |

WHO (2023) Constitution of the World Health Organization. Available at https://www.who.int/about/governance/constitution