Principles for the development of Aboriginal health interventions: culturally appropriate methods through systemic empathy

Abstract

Objective. To increase Aboriginal participation in mainstream health services, it is necessary to understand the factors that influence health service usage. This knowledge can contribute to the development of culturally appropriate health services that respect Aboriginal ways of being.

Design. We used a community-based participatory approach to examine the reasons for underutilization of health services by Aboriginal Australians.

Results. Based on three focus groups and 18 interviews with Aboriginal health professionals, leaders, and community members in rural, regional, and urban settings, we identified five factors that influenced usage, including (1) negative historical experiences, (2) cultural incompetence, (3) inappropriate communication, (4) a collective approach to health, and (5) a more holistic approach to health.

Conclusion. Given that these factors have shaped negative Aboriginal responses to health interventions, they are likely to be principles by which more appropriate solutions are generated. Although intuitively sensible and well known, these principles remain poorly understood by non-Aboriginal health systems and even less well implemented. We have conceptualized these principles as the foundation of an empathic health system. Without empathy, health systems in Australia, and internationally, will continue to face the challenge of building effective services to improve the state of health for all minority populations.

Keywords:

• Australian Aboriginal health
• cultural competence
• Murri health
• empathy
• health reform

Notes

1. The term ‘Murri’ is a locally accepted term used to refer to Aboriginal Australians originating from Queensland.

2. Within the Australian Aboriginal population, the concept of ‘shame’ is commonly understood and encompasses feelings of discomfort, uncertainty, clumsiness, or feeling out of place. For example, an Aboriginal person may feel ‘shame’ when being singled out and praised for an achievement or when entering unfamiliar surrounds, e.g., a crowded function room (Stockwell and Scott 2000).

3. The colloquial term ‘blackfella’ is often used by Aboriginal and Torres Strait Islander people to refer to other members of the Aboriginal and Torres Strait Islander community. The term ‘blackfella’ usually denotes solidarity among fellow Aboriginal community members, but can be offensive if used by nonindigenous people.

4. ‘Gin’ is a derogatory Australian slang term for an Aboriginal woman which is no longer in use.