Batji-gum dilba (Good talk medicine)
: Improving culturally safe communication between doctors and Aboriginal patients in the Northern Territory of Australia

Student thesis: Doctor of Philosophy (PhD) - CDU


In Australia’s Northern Territory (NT) the repercussions of colonisation on Aboriginal peoples, the oldest continuous cultures on earth, are evident in healthcare. Most people who access NT hospitals are Aboriginal and most doctors are White. Many doctors struggle to communicate effectively and respectfully with patients. Poor communication is a common way patients experience racism and has resulted in patients dying. Miscommunication is also a major stressor for doctors, who often feel unprepared to work in the NT.

Conducted on Larrakia country, this Participatory Action Research is based on qualitative data from White and Aboriginal doctors, Aboriginal patients, and Aboriginal language interpreters regarding culturally safe communication at Royal Darwin Hospital (RDH). Cultural safety aims to dismantle the power imbalance present in clinical interactions; it places the onus for change onto the health professionals who hold power. To be a culturally safe practitioner
doctors must develop their critical consciousness, which may be fostered by listening to Aboriginal people’s stories outside power-laden clinical interactions. The concept of critical consciousness and the power of stories to address racism links cultural safety with Freirean pedagogy and Critical Race Theory. These three decolonising philosophies provide the research framework.

Australian governments have committed to addressing racism in health care by endorsing culturally safe care. However, a policy-practice gap exists. The purpose of this thesis is to provide evidence regarding the challenges and opportunities to improve culturally safe communication in the NT.

A baseline evaluation of more than 600 cultural awareness training feedback forms from NT healthcare providers informed two interventions. The evaluation revealed that training was considered an invaluable entry point and the personal stories shared by Aboriginal educators was a highlight. Healthcare providers wanted more opportunities to improve their communication skills and critically reflect on their own bias.

The first intervention aimed to improve culturally safe communication by embedding a Yolŋu Matha and Tiwi interpreter in an RDH medical team for 4 weeks. After having consistent access to trusted interpreters, patients who had felt “stuck” became satisfied with care. Aboriginal interpreters who previously felt unwelcome at RDH reported feeling valued as skilled professionals. Doctors developed critical consciousness, which led to them adapting work routines to better suit patient needs and ensure collaborative relationships with interpreters.

The second intervention built on and extended the baseline cultural awareness training. I created and evaluated a podcast: Ask the Specialist: Larrakia, Tiwi and Yolŋu stories to inspire better healthcare in which Aboriginal leaders answer doctors’ questions about working with Aboriginal patients. After listening to the podcast, doctors changed their communication style with patients and were better equipped to recognise system failures. This cultural education, which addressed issues specific to the local context and delivered “counterstories” from Aboriginal peoples, encouraged critical consciousness.

Date of Award5 May 2022
Original languageEnglish
SupervisorBilawara Lee (Supervisor), Anna Ralph (Supervisor), Marita Hefler (Supervisor) & Alan Cass (Supervisor)

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