Understanding the role of Australian Aboriginal maternal infant care workers: bringing a cultural dimension to a critique of the ideal worker concept

ABSTRACT

Models of care that include a prominent role for Aboriginal workers are fundamental to improving the health of Aboriginal Australians. However, tension arises when these models co-exist with mainstream models, contributing to difficulties sustaining an Aboriginal workforce. The ‘ideal worker’ theory is drawn on to explore whether historical workplace norms undermine the roles of Aboriginal workers in an Australian hospital setting. In-depth interviews were conducted with 30 staff and clients of an innovative maternity service, featuring Aboriginal Maternal Infant Care (AMIC) workers caring for Aboriginal women in partnership with midwives. A phenomenological methodology highlighted that unrealistic and inappropriate assumptions embedded in the ideal worker notion underpin many challenges facing AMIC workers. These workers have deep ties to their communities, with extensive responsibilities beyond the workplace. Although the hospital system relies on these ties to engage clients, this time commitment and the unbounded ways in which AMIC workers provide care are not acknowledged. Findings illustrate how the ideal worker concept has a cultural and gender dimension, which undermines AMIC workers and does not value culturally relevant care. This work has implications for ingraining cultural competence into health care, suggesting the wide-ranging contributions of Aboriginal workers must be recognised to achieve sustainable reform.

RESUMEN

Los modelos de atención que incluyen un papel prominente para los trabajadores aborígenes son fundamentales para mejorar la salud de los aborígenes australianos. Sin embargo, cuando estos modelos coexisten con los modelos convencionales surge tensión, lo cual contribuye a las dificultades para mantener una fuerza de trabajo aborigen. La teoría del ‘trabajador ideal’ se basa en explorar si las normas históricas del lugar de trabajo socavan el papel de los trabajadores aborígenes en un hospital australiano. Se llevaron a cabo entrevistas en profundidad con 30 empleados y clientes de un innovador servicio de maternidad, en el que se contó con trabajadores aborígenes de cuidado materno infantil (AMIC) que cuidan a mujeres aborígenes en asociación con parteras. Una metodología fenomenológica puso de relieve que los supuestos irrealistas e inapropiados incluidos en la noción de trabajador ideal sustentan muchos desafíos que enfrentan los trabajadores de AMIC. Estos trabajadores tienen profundos vínculos con sus comunidades, con amplias responsabilidades más allá del lugar de trabajo. Aunque el sistema hospitalario se basa en estos lazos para involucrar a los clientes, el tiempo comprometido y las formas ilimitadas en las que los trabajadores de AMIC proporcionan atención no son reconocidos. Los hallazgos ilustran cómo el concepto de trabajador ideal tiene una dimensión cultural y de género, lo que socava a los trabajadores de AMIC y no valora la atención culturalmente relevante. Este trabajo tiene implicaciones para el enraizamiento de la competencia cultural en la atencionde salud, lo que sugiere que las contribuciones de los trabajadores aborígenes deben ser reconocidas para lograr una reforma sostenible.

KEYWORDS:

• Aboriginal
• maternal health
• ideal worker
• cultural competence
• Aboriginal workforce

PALABRAS CLAVE:

• Aborigen
• salud materna
• Trabajador ideal
• Competencia cultural
• Fuerza laboral aborigen

Acknowledgements

We thank the University of Adelaide's Spencer Gulf Rural Health School and School of Population Health for their support of this PhD. This article is based on the first author’s doctoral work, which was supervised by the other authors. We thank the participants who contributed to this study, particularly the Aboriginal women who gave insight into challenging aspects of their lives; the Aboriginal Reference Group provided invaluable guidance throughout the project; and, the Aboriginal Family Birthing Program’s Steering Committee and local health services who supported this project throughout its entirety.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Renae Kirkham is a Postdoctoral Research Fellow at Menzies School of Health Research. She is passionate about the health and well-being of Aboriginal women and their families, and employs qualitative methodologies to better understand the facilitators and barriers to improved health outcomes.

Elizabeth Hoon is a research fellow working in Public Health with a particular interest in the use of qualitative methodologies to explore and understand community experiences of health.

Alice Rumbold is a Senior Research Fellow with the Robinson Research Institute at the University of Adelaide. Her primary research interests are in the determinants of reproductive and perinatal health inequality. For over 10 years, she has undertaken a range of projects collaboratively with remote Aboriginal communities. These projects have drawn attention to the impact of common sexually transmitted infections (e.g. chlamydia, human papillomavirus) in these communities, and identified key areas to improve the quality of maternity care provided to Aboriginal women.

Vivienne Moore is a Professor in the School of Public Health and co-director of the Life Course and Intergenerational Health Research Group at the University of Adelaide, South Australia and Fay Gale Centre for Research on Gender at the University of Adelaide. Her research investigates the social and behavioural influences on women’s and children’s health within a life course perspective, and gender inequalities in health.

Notes

1 The use of the word Aboriginal refers to people who identify as being of Aboriginal and/or Torres Strait Islander descent.