Cultural safety in hospitals: validating an empirical measurement tool to capture the Aboriginal patient experience
Elissa Elvidge A E , Yin Paradies B , Rosemary Aldrich A C and Carl Holder D
+ Author Affiliations
- Author Affiliations
A School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. Email: Rosemary.Aldrich@newcastle.edu.au
B Faculty of Arts and Education, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: Yin.Paradies@deakin.edu.au
C Ballarat Health Services, 1 Drummond Street North, Ballarat Central, Vic. 3350, Australia.
D Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Email: Carl.Holder@HMRI.org.au
E Corresponding author. Email: elissa.elvidge@uon.edu.au
Australian Health Review 44(2) 205-211 https://doi.org/10.1071/AH19227
Submitted: 8 October 2019 Accepted: 9 December 2019 Published: 27 March 2020
Abstract
Objective The aim of the present study was to develop a scale to measure cultural safety in hospitals from an Aboriginal patient perspective.
Methods The Cultural Safety Survey was designed to measure five key characteristics of cultural safety that contribute to positive hospital experiences among Aboriginal hospital patients. Investigators developed a range of different methods to assess the validity and reliability of the scale using a sample of 316 participants who had attended a New South Wales hospital in the past 12 months. Targeted recruitment was conducted at two hospital sites. Opportunistic recruitment took place through a local health district, discharge follow-up service and online via social media.
Results The Cultural Safety Survey Scale was a robust measurement tool that demonstrated a high level of content and construct validity.
Conclusion The Cultural Safety Survey Scale could be a useful tool for measuring cultural safety in hospitals from the Aboriginal patient perspective.
What is known about the topic? There are increasing calls by governments around the world for health institutions to enhance the cultural safety of their services as one way of removing access barriers and increasing health equity. However, currently there are no critical indicators or systematic methods of measuring cultural safety from the patient perspective.
What does this paper add? The cultural safety scale, an Australian first, presents the first empirically validated tool that measures cultural safety from the Aboriginal patient perspective.
What are the implications for practitioners? This measurement model will allow hospitals to measure the cultural safety of their services and ascertain whether current efforts aimed to improve cultural safety are resulting in Aboriginal patients reporting more culturally safe experiences. Over time it is hoped that the tool will be used to benchmark performance and eventually be adopted as a performance measure for hospitals across New South Wales.
References
[1] NSW Health. Policy directive. Preferred terminology to be used when referring to Aboriginal and Torres Strait Islander Peoples. 2005. Available at: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2005_319.pdf [verified 27 January 2020].[2] Department of the Prime Minister and Cabinet. Closing the gap report 2019. 2019. Available at: https://www.niaa.gov.au/sites/default/files/reports/closing-the-gap-2019/sites/default/files/ctg-report-20193872.pdf?a=1 [verified 12 March 2020].
[3] Mbuzi V, Fulbrook P, Jessup M. Indigenous peoples’ experiences and perceptions of hospitalisation for acute care: a metasynthesis of qualitative studies. Int J Nurs Stud 2017; 71 39–49.
| Indigenous peoples’ experiences and perceptions of hospitalisation for acute care: a metasynthesis of qualitative studies.Crossref | GoogleScholarGoogle Scholar | 28301800PubMed |
[4] Bourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Aust Health Rev 2018; 43 611–618.
| Transforming institutional racism at an Australian hospital.Crossref | GoogleScholarGoogle Scholar |
[5] Australian Health Ministers’ Advisory Council. Cultural respect framework for Aboriginal and Torres Strait Islander health 2004–2009. Adelaide: Department of Health South Australia; 2004.
[6] Gwynne K, Jeffries T, Lincoln M. Improving the efficacy of healthcare services for Aboriginal Australians. Aust Health Rev 2018; 43 314–322.
| Improving the efficacy of healthcare services for Aboriginal Australians.Crossref | GoogleScholarGoogle Scholar |
[7] Johnstone M, Kanitsaki O. Cultural racism, language prejudice and discrimination in hospital contexts: an Australian study. Diversity in Health and Social Care 2008; 5 19–30.
[8] Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health 2015; 105 e60–76.
| Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review.Crossref | GoogleScholarGoogle Scholar | 26469668PubMed |
[9] Australian Government. National Aboriginal and Torres Strait Islander health plan 2013–2023. Canberra: Department of Health; 2013.
[10] Australian Health Ministers’ Advisory Council’s National Aboriginal and Torres Strait Islander Health Standing Committee. Cultural respect framework 2016–2026 for Aboriginal and Torres Strait Islander health: a national approach for building a culturally respectful health system. 2016. Available at: https://nacchocommunique.files.wordpress.com/2016/12/cultural_respect_framework_1december2016_1.pdf [verified 27 January 2020].
[11] Ramsden I. Kawa Whakaruruhau: cultural safety in nursing education in Aotearoa. Nurs Prax N Z 1993; 8 4–10.
| 8298296PubMed |
[12] Phillips G. CDAMS Indigenous health curriculum framework. Melbourne: CDAMS (Committee of Deans of Australian Medical Schools); 2004. Available at: https://www.limenetwork.net.au/wp-content/uploads/2017/10/cdamsframeworkreport.pdf [verified 12 March 2020].
[13] AHPRA & National Boards. Have your say: how should we define ‘cultural safety’? 2019. Available at: https://www.ahpra.gov.au/News/2019-04-03-cultural-safety.aspx [verified 12 March 2020].
[14] Eckermann A-K, Dowd T, Chong E, Nixon L, Gray R, Johnson SM. Binan goonj: bridging cultures in Aboriginal health. 3rd edn. Sydney: Churchill Livingstone; 2010.
[15] Ramsden I. Cultural safety and nursing education in Aotearoa and Te Waipounamu. PhD thesis, Victoria University of Wellington, Wellington; 2002.
[16] Wepa D. Cultural safety in Aotearoa New Zealand. 2nd edn. Cambridge: Cambridge University Press; 2015.
[17] Nursing Council of New Zealand. Guidelines for cultural safety, the treaty of Waitangi, and Maori health in nursing and midwifery education and practice. 2011. Available at: http://pro.healthmentoronline.com/assets/Uploads/refract/pdf/Nursing_Council_cultural-safety11.pdf [verified 27 January 2020].
[18] Accreditation Canada. Accreditation Agreement Canada Qmentum: Standards Aboriginal Community Health and Wellness. Ottawa: Accreditation Canada; 2015.
[19] Mackean T, Fisher M, Friel S, Baum F. A framework to assess cultural safety in Australian public policy. Health Promot Int 2019;
| A framework to assess cultural safety in Australian public policy.Crossref | GoogleScholarGoogle Scholar | 30796455PubMed |
[20] Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM). A framework for promoting cultural safety in the Australian healthcare system. Canberra: CATSINaM; 2017.
[21] Taylor K, Guerin P. Health care and Indigenous Australians: cultural safety in practice. 3rd edn. Melbourne: Palgrave Macmillan; 2014.
[22] Milne T, Creedy DK, West R. Development of the awareness of Cultural Safety Scale: a pilot study with midwifery and nursing academics. Nurse Educ Today 2016; 44 20–5.
| Development of the awareness of Cultural Safety Scale: a pilot study with midwifery and nursing academics.Crossref | GoogleScholarGoogle Scholar | 27429325PubMed |
[23] Australian Government. Implementation plan for the National Aboriginal and Torres Strait Islander health plan 2013–2023. Canberra: Department of Health; 2015. Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/AC51639D3C8CD4ECCA257E8B00007AC5/$File/DOH_ImplementationPlan_v3.pdf [verified 12 March 2020].
[24] Gadsden T, Wilson G, Totterdell J, Willis J, Gupta A, Chong A, Clarke A, Winters M, Donahue K, Posenelli S, Maher L, Stewart J, Gardiner H, Passmore E, Cashmore A, Milat A. Can a continuous quality improvement program create culturally safe emergency departments for Aboriginal people in Australia? A multiple baseline study. BMC Health Serv Res 2019; 19 222
| 30975155PubMed |
[25] Weech-Maldonado R, Dreachslin JL, Dansky KH, De Souza G, Gatto M. Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals. J Healthc Manag 2002; 47 111–24.
| Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals.Crossref | GoogleScholarGoogle Scholar | 11933599PubMed |
[26] Weech-Maldonado R, Dreachslin JL, Brown J, Pradhan R, Rubin KL, Schiller C, Hays RD. Cultural competency assessment tool for hospitals: evaluating hospitals’ adherence to the culturally and linguistically appropriate services standards. Health Care Manage Rev 2012; 37 54–66.
| Cultural competency assessment tool for hospitals: evaluating hospitals’ adherence to the culturally and linguistically appropriate services standards.Crossref | GoogleScholarGoogle Scholar | 21934511PubMed |
[27] Weech-Maldonado R, Dreachslin JL, Epané JP, Gail J, Gupta S, Wainio JA. Hospital cultural competency as a systematic organizational intervention: key findings from the National Center for Healthcare Leadership Diversity Demonstration Project. Health Care Manage Rev 2018; 43 30–41.
| Hospital cultural competency as a systematic organizational intervention: key findings from the National Center for Healthcare Leadership Diversity Demonstration Project.Crossref | GoogleScholarGoogle Scholar | 27782970PubMed |
[28] Bainbridge R, Tsey K, McCalman J, Kinchin I, Saunders V, Lui FW, Cadet-James Y, Miller A, Lawson K. No one’s discussing the elephant in the room: contemplating questions of research impact and benefit in Aboriginal and Torres Strait Islander Australian health research. BMC Public Health 2015; 15 696
| No one’s discussing the elephant in the room: contemplating questions of research impact and benefit in Aboriginal and Torres Strait Islander Australian health research.Crossref | GoogleScholarGoogle Scholar | 26202429PubMed |
[29] Hess JL, Strobel J, Rui P, Wachter Morris CA. Practicing engineers’ perceptions of empathy and care: derived exploratory factor structure from a 37-item survey. Paper presented at the ASEE Annual Conference & Exposition; 15–18 June 2014; Indianapolis, IN, USA. 2014. Available at: https://peer.asee.org/22924 [verified 27 January 2020].
[30] Thomson AM, Perry JL, Miller TK. Conceptualizing and measuring collaboration. J Public Adm Res Theory 2009; 19 23–56.
| Conceptualizing and measuring collaboration.Crossref | GoogleScholarGoogle Scholar |
[31] Çokluk Ö, Koçak D. Using Horn’s parallel analysis method in exploratory factor analysis for determining the number of factors. Educ Sci Theor Pract 2016; 16 537–51.
[32] Watkins D. The role of confirmatory factor analysis in cross-cultural research. Int J Psychol 1989; 24 685–701.
| The role of confirmatory factor analysis in cross-cultural research.Crossref | GoogleScholarGoogle Scholar |
[33] Conte KP, Schure MB, Goins RT. Correlates of social support in older American Indians: the Native Elder Care Study. Aging Ment Health 2015; 19 835–43.
| Correlates of social support in older American Indians: the Native Elder Care Study.Crossref | GoogleScholarGoogle Scholar | 25322933PubMed |
[34] Gabriel EH, Hoch MC, Cramer RJ. Health belief model scale and theory of planned behavior scale to assess attitudes and perceptions of injury prevention program participation: an exploratory factor analysis. J Sci Med Sport 2019; 22 544–9.
| Health belief model scale and theory of planned behavior scale to assess attitudes and perceptions of injury prevention program participation: an exploratory factor analysis.Crossref | GoogleScholarGoogle Scholar | 30501955PubMed |
[35] Kedem LE, Evans EM, Chapman-Novakofski K. Psychometric evaluation of dietary self-efficacy and outcome expectation scales in female college freshmen. Behav Modif 2014; 38 852–77.
| Psychometric evaluation of dietary self-efficacy and outcome expectation scales in female college freshmen.Crossref | GoogleScholarGoogle Scholar | 25034078PubMed |
[36] Ham C-D, Lee J, Hayes JL, Bae YH. Exploring sharing behaviors across social media platforms. Int J Mark Res 2019; 61 157–77.
| Exploring sharing behaviors across social media platforms.Crossref | GoogleScholarGoogle Scholar |
[37] Chapman R, Smith T, Martin C. Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian emergency department. Contemp Nurse 2014; 48 48–58.
| Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian emergency department.Crossref | GoogleScholarGoogle Scholar | 25410195PubMed |
[38] Anderson K, Devitt J, Cunningham J, Preece C, Cass A. ‘All they said was my kidneys were dead’: Indigenous Australian patients’ understanding of their chronic kidney disease. Med J Aust 2008; 189 499–503.
| ‘All they said was my kidneys were dead’: Indigenous Australian patients’ understanding of their chronic kidney disease.Crossref | GoogleScholarGoogle Scholar | 18976191PubMed |
[39] Jennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Aust J Prim Health 2018; 24 109–15.
| The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication.Crossref | GoogleScholarGoogle Scholar | 29490869PubMed |
[40] DeVellis RF. Guidelines in scale development. In: Bickman L, Rog DJ, editors. Scale development: theory and applications. 4th edn. Thousand Oaks, CA: Sage Publishing; 2017. pp. 105–51.
[41] Abbott P, Gordon E, Davison J. Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition. Contemp Nurse 2007; 27 157–64.
[42] Taylor KP, Thompson SC, Smith JS, Dimer L, Ali M, Wood MM. Exploring the impact of an Aboriginal health worker on hospitalised Aboriginal experiences: lessons from cardiology. Aust Health Rev 2009; 33 549–57.
| Exploring the impact of an Aboriginal health worker on hospitalised Aboriginal experiences: lessons from cardiology.Crossref | GoogleScholarGoogle Scholar | 20166903PubMed |
[43] NSW Health. Good health – great jobs: Aboriginal health worker guidelines for NSW Health. Sydney: NSW Ministry of Health; 2018.
[44] Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. 2nd edn. Sydney: ACSQHC; 2017.
