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Objectives To examine associations between community cultural connectedness indicators and suicide mortality rates for young Aboriginal and Torres Strait Islander people. Study design Retrospective mortality study. Setting, participants Suicide deaths of people aged 10‒19 years recorded by the Queensland Suicide Register, 2001‒2015. Main outcome measures Age‐standardised suicide death rates, by Indigenous status, sex, and age group; age‐standardised suicide death rates for young First Nations people by area level remoteness and Index of Relative Socioeconomic Advantage and Disadvantage, and by cultural connectedness indicators (at statistical area level 2): cultural social capital index score, community Indigenous language use, and reported discrimination. Results The age‐specific suicide rate was 21.1 deaths per 100 000 persons/year for First Nations young people and 5.0 deaths per 100 000 persons/year for non‐Indigenous young people (rate ratio [RR], 4.3; 95% CI, 3.5‒5.1). The rate for Aboriginal and Torres Strait Islander young people was higher in areas with low levels of cultural social capital (greater participation of community members in cultural events, ceremonies, organisations, and community activities) than in areas classified as having high levels (RR, 1.8; 95% CI, 1.2‒2.7), and also in communities with high levels of reported discrimination (RR, 2.7; 95% CI, 1.7‒4.3). Associations with proportions of Indigenous language speakers and area level socio‐economic resource levels were not statistically significant. Conclusion We found that suicide mortality rates for Aboriginal and Torres Strait Islander young people in Queensland were influenced by community level culturally specific risk and protective factors. Our findings suggest that strategies for increasing community cultural connectedness at the community level and reducing institutional and personal discrimination could reduce suicide rates.

ast and present colonisation in Australia has resulted in injustice against First Peoples through forced removal of communities from traditional homelands and children from their families, as well as genocide, dispossession, subjugation and discrimination. [1][2][3] Discriminatory legislation, paradoxically titled 'Protection Acts' , provided state governments, or 'Chief Protectors', the authority to remove children without evidence of neglect, take property and deny access to lands, displace people, control wages (if wages were received), control who people could marry and dictate where people could reside. 1,[4][5][6] Many regulations existed until the 1970s, and some components of these policies still exist today. 7 The systemic and widespread oppression of Aboriginal and Torres Strait Islander peoples in Australia has resulted in profound inequalities across multiple domains, including employment, housing, income, education, incarceration, infant mortality and life expectancy. 1,8 Aboriginal and Torres Strait Islander communities also bear disproportionately higher burden of psychotic and mood disorders, involuntary hospital admissions and substance use disorders than non-Indigenous communities in Australia. 8,9 Throughout the paper the phrase 'Aboriginal and Torres Strait Islander people' is used to represent the First Peoples/First Nations peoples in the lands now referred to as Australia, while references pertaining to international First Nations or First Peoples populations are reported as such.Of immense importance, First Peoples die by suicide at more than twice the rate of other people in Australia, with young people particularly overrepresented. 10,11 In the state of Queensland specifically, the suicide rate for Aboriginal and Torres Strait Islander young people is four times higher than the non-Indigenous rate. 12,13 Moreover, Aboriginal and Torres Strait Islander young people are more likely to reside in communities that experience known risk factors for youth suicide generally, including

Background Assessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognizant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. From this, we aim to develop a tool to assess whether GP registrars are conducting a culturally safe consultation, where cultural safety is determined by Aboriginal and Torres Strait Islander peoples. Methods This protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. We aim to recruit approximately 40 patient and 20 GP participants for interviews, conduct one to five nominal groups (seven to 35 participants) and recruit fifteen participants for the Delphi process. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars. Discussion This study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area.

BackgroundAs The Royal Australian College of General Practitioners (RACGP) introduces alternatives to the Objective Structured Clinical Examination, it is imperative that standards are continually set for a culturally safe general practice workforce. Assessments have many functions and should be continually reviewed to ensure that they require general practitioners (GPs) to demonstrate genuine cultural safety.

This scoping review aims to explore how cultural safety is defined in the Australian literature with health professional learners in clinical interactions. It maps how the components of the Australian Health Practitioner Regulation Agency definition of cultural safety align with this evidence. Databases were systematically searched for original, peer-reviewed research that included Australian Aboriginal and Torres Strait Islander peoples, health professional learners who were eligible for registration in Australia, teaching and assessment. Many elements of cultural safety lacked Indigenous input and had no patient involvement. General consultation and communications skills were key components of culturally safe interactions. The Australian Health Practitioner Regulation Agency consensus statement on cultural safety provides a consistent definition for teaching and learning cultural safety within health professions in Australia. The findings suggest that developing an approach for cultural safety requires incorporation of Indigenous voices, patient-centred care metrics, patient feedback, learner self-assessment and attitude measures.

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Assessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognisant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. Methods: This protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars. Discussion: This study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area.