TY - JOUR
T1 - Building patient trust in health systems
T2 - A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia
AU - Topp, Stephanie M.
AU - Tully, Josslyn
AU - Cummins, Rachel
AU - Graham, Veronica
AU - Yashadhana, Aryati
AU - Elliott, Lana
AU - Taylor, Sean
N1 - Funding Information:
This research was supported by a Career Development Fellowship (SMT) funded by the National Health and Medical Research Council and Hot North Collaboration, GNT1131932; and in-kind support from the Torres and Cape Hospital and Health Service. SMT holds a NHMRC Investigator Award (2020?24) GNT1173004.We thank all study participants but particularly the 51 A&TSIHW who helped shape this research from inception and without whose contributions and trust this work would not have happened. We thank Venessa Curnow for her support throughout including helping share findings widely within and outside Queensland Health. Alex Edelman provided assistance to this study through the production of several data synthesis reports. SMT would like to acknowledge Marta Schaaf and other colleagues present at the ?Think-in? on Community Health Worker Voice, Power and Citizens' Right to Health workshop co-hosted by the Averting Maternal Death and Disability (AMDD) Program at the Mailman School of Public Health, Columbia University and the Accountability Research Centre (ARC) at American University, as a catalyst for conversations that led to this study.
Publisher Copyright:
© 2022 The Authors
PY - 2022/6
Y1 - 2022/6
N2 - Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not ‘cultureless,’ but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.
AB - Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not ‘cultureless,’ but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.
KW - Aboriginal and Torre Strait Islander Health Worker
KW - Community health workers
KW - Governance
KW - Health system
KW - Human resources for health
KW - Indigenous
KW - Trust
UR - http://www.scopus.com/inward/record.url?scp=85129302398&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2022.114984
DO - 10.1016/j.socscimed.2022.114984
M3 - Article
C2 - 35523107
AN - SCOPUS:85129302398
VL - 302
SP - 1
EP - 10
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
M1 - 114984
ER -