The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication

Abstract

The study aimed to explore Indigenous narrative accounts of healthcare access within qualitative research papers, to better understand Indigenous views on culturally safe healthcare and health communication represented in that literature. A systematic literature review of peer-reviewed academic qualitative studies identified 65 papers containing Indigenous respondents' views on accessing healthcare. Analysis included all Indigenous voice (primary quotations) and author findings describing healthcare access across these studies. Healthcare communication, or 'talk', emerged as a key theme. Indigenous clients valued talk within healthcare interactions; it was essential to their experience of care, having the power to foster relationships of trust, strengthen engagement and produce positive outcomes. By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client's level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system.

Exploring the incidence of culturally responsive communication in Australian healthcare: the first rapid review on this concept

“…The perceptions of the service users indicated that healthcare practitioners style of communication was not culturally responsive [27,30,34,35,38,42,49,50]. Service users felt that healthcare practitioners presented as sceptical, authoritarian and patronising [27,42,43,49] using complicated explanation with excessive jargon [27,42,44].…”

“…The characteristics that a healthcare practitioner must display to achieve culturally responsive communication include: self-reflection and reflexivity [12, 27, 28, 36-41, 44, 45, 50], flexibility [28,37,41,44,45], self-and otherawareness [28,36,37,40], being respectful [12,34,35, 38,40,42,44,48], being trustworthy [12,27,34,44], being honest and transparent [34,37,38,42,44], being non-judgmental [27,35,37,38] and have a willingness to learn [12,32,40,41,44,46].…”

Voices behind the Statistics: A Systematic Literature Review of the Lived Experience of Rheumatic Heart Disease

“…Additionally, reflecting cultural safety principles of prioritising direct Indigenous voices over authors' synthesis [24], a sociolinguistic analysis was undertaken of the combined research participants' quotes extracted from all publications. This method addresses concerns "that participants' voices become diluted through the sequential filters of selection, interview, analysis, publication and meta-synthesis" [24], particularly when academic authors are drawing conclusions from disenfranchised voices.…”

“…Changing health care delivery and empowering Indigenous people will require changes that can cause discomfort as a result of shifting the current hierarchies of power and disrupting the dominant white privilege norm. This will require implementing findings regarding the need for culturally responsive care based on analysis of the culture of the healthcare system and healthcare practitioners themselves [24]. Change will never be possible without discussions about power and inequity [54].…”

“…Poverty was described as a significant barrier to making health-enhancing choices, including food choices [8,9,27,28]. As stated in Gruen, there is no "escape from the hardship of daily existence and few opportunities to improve their situation" [24] in settings of poverty.…”