Building cultural responsiveness in a mainstream health organisation with ‘8 Aboriginal Ways of Learning’: a participatory action research study

Abstract

Objective: Despite much effort and goodwill, the gap in health status between Aboriginal and non‐Aboriginal Australians persists. Bringing Aboriginal cultural protocols and teaching strategies into healthcare could improve the fit between healthcare services provided and Aboriginal peoples. This approach to making healthcare more accessible has not been tested in mainstream health settings. This study aimed to introduce ‘8 Aboriginal Ways of Learning’ to a mainstream health organisation and observe how learning about Aboriginal perspectives and processes shaped work‐related project or program design. Methods: Program and network coordinators (n=18) employed in a state‐wide health organisation joined in‐person workshops and virtual sessions. Participatory Action Research methods guided the process and framework analysis transformed data. Results: Introducing ‘8 Ways’ generated conversations which went beyond deficits in Aboriginal health. Learning about cultural processes provided scaffolding to show how services and models of care can change. Conclusions: This strategy demonstrated potential to improve approachability, acceptability and appropriateness of mainstream healthcare for Aboriginal peoples. Implications for public health: Introduction of Aboriginal pedagogies were welcomed by mainstream healthcare workers as they provided scaffolding and support to plan and work in new ways. Future studies could examine outcomes on program design and access to services for Aboriginal peoples.

Aboriginal people’s perceptions of patient-reported outcome measures in the assessment of diabetes health-related quality of life†

“…Given the health disparity in Aboriginal populations (Australian Institute of Health and Welfare 2020; Lowitja Institute 2022), the current study further supports the need for culturally sensitive HRQOL survey content that is tailored to Aboriginal people's broader understanding of wellbeing, and health knowledge beyond current biomedical and individual models (NSW Ministry of Health 2012; Brooks et al 2019). Cultural responsiveness has been a key enabler in this study and will be vital in the future translation of the research findings (Wilson et al 2018;Webster et al 2022). HRQOL survey content revision, dissemination and survey administration approaches used by health professionals and services should be inclusive of genuine co-design and consultation with Aboriginal communities and Aboriginal subject matter experts (Sherwood et al 2015;Wilson et al 2018;Aboriginal Health and Medical Research Council Ethics Committee 2020).…”

A mixed methods study of Aboriginal health workers’ and exercise physiologists’ experiences of co-designing chronic lung disease ‘yarning’ education resources

“…Sessions commenced with an Acknowledgment of Country and introductions. Each session was designed to incorporate 8 Ways of learning [20,21] and co-design principles [36]. For each topic, the facilitator prepared and presented brief PowerPoint slides of the main topic points and, depending on the topic, sessions would include story sharing between participants stimulated by videos of patients with lung disease or demonstrations of the correct use of inhalers.…”

“…The online education sessions were designed to be participantcentred, responding to AHWs' and EPs' training needs and placed value on the use of co-design and 8 Ways of learning. The value of incorporating an Aboriginal pedagogy framework to improve culturally safe and accessible mainstream services is being realised within the NSW public health sector, with the first study published focusing on introducing 8 Ways of learning guided by participatory action research to shape project and program design [20]. Variations were made to the format and structure of the online education sessions to align with AHWs' and EPs' socio-cultural, professional and the contexts of each of the four ACCHS.…”

“…The '8 Ways of learning' is an Aboriginal pedagogy framework and was an initiative of the NSW Department of Education that engaged Aboriginal knowledge holders in its development. 8 Ways of learning incorporates cultural protocols and Aboriginal perspectives to realign teaching techniques and approaches, and to strengthen engagement and outcomes for Aboriginal learners [20]. Fundamental to this framework is prioritising people and relationships and integrating Aboriginal ways of knowing, being and doing [20][21][22].…”

“…8 Ways of learning incorporates cultural protocols and Aboriginal perspectives to realign teaching techniques and approaches, and to strengthen engagement and outcomes for Aboriginal learners [20]. Fundamental to this framework is prioritising people and relationships and integrating Aboriginal ways of knowing, being and doing [20][21][22]. The cultural protocols include the following 8 ways: Deconstruct/reconstruct (dismantling and reassembling approaches using local Aboriginal world views); Community Links (identification of key community stakeholders to be consulted about projects); Learning maps (exploring and visualising concepts and strategies); Story Sharing (clarifying and sharing content verbally); Symbols and images (explaining concepts using artwork and visual methods); Land links (relating learning to spaces, places and the living landscape); Non-verbal (using hands-on activities and body language, including silence); and Non-linear (non-consequential and indirect orientation of learning) [20,21].…”