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JCPSLP
Volume 19, Number 1 2017
Journal of Clinical Practice in Speech-Language Pathology
cultural and ethical suitability (AH&MRC, 2013), and
procedures and interview questions were reviewed by
health professionals working with Aboriginal people and an
Aboriginal caregiver to ensure they were culturally
appropriate. All documentation for the research provided to
prospective participants identified the support and
collaboration with the Aboriginal Health Unit (e.g., Aboriginal
Health Unit logo and artwork).
The principles of appreciative inquiry (Cooperrider &
Whitney, 2005) were adopted in developing the interview
questions, whereby participants were encouraged to
identify positive experiences (e.g., “what’s worked well?”) of
their engagement with the SLP service, and also to identify
what would motivate them to continue to engage with the
service. This contrasted with existing studies into health
care access and SLP experience (not specifically focused
on Aboriginal peoples) which have focused on barriers to
service use. Appreciative inquiry has been found to be a
culturally safe methodology with Aboriginal communities
(Murphy, Kordyl, & Thorne, 2004), and health research
(Fowler et al., 2012). The decision to use interviews was
based on the observation by Form, Bourchier, Cvetkovski,
and Stewart (2012) that they are less prone to bias
when compared to other methods (e.g., written surveys)
and doing so is endorsed by Aboriginal community
organisations. Sharing information via interviews also aligns
with the strong oral culture of Aboriginal people (Gorman &
Toombs, 2009), and alleviates embarrassment surrounding
potential literacy issues (SCRGSP, 2009).
Study setting
The study was conducted with the support of clients,
caregivers, and staff at a paediatric speech pathology
service provided in one of the seven community health
centres in the Greater Newcastle area. According to the
Australian Bureau of Statistics (2011), the Aboriginal
population in Greater Newcastle is approximately 2.8% of
the total and a review of service data at the time of the
study indicated that 10.4% of clients referred to the SLP
service identified as Aboriginal. The SLP service had
instituted a number of initiatives directed at improving
engagement with Aboriginal clients (e.g., contacting the
caregiver via telephone at the first point of contact,
maintaining the same clinician, encouraging support people
to attend appointments, and allowing extra appointment
time). Despite these initiatives, speech-language
pathologists reported that attendance and engagement of
Aboriginal families at the service remained lower than that
of non-Aboriginal families. None of the speech-language
pathologists in the service identified as Aboriginal and both
of the authors had completed specific Aboriginal cultural
respect training.
Participants
Twenty-four participants were invited by speech-language
pathologists to participate in the study over a 6-month
period, and 12 consent forms were returned to the first
author, indicating a response rate of 50 per cent. The
participants were caregivers of children currently attending
regular speech-language pathology services, as they could
indicate the factors that assisted families to attend. The
inclusion criteria for the participants were that the clients
(children) were Aboriginal and were currently attending
therapy. The participants’ demographics are presented in
Table 1. Ten interviews were conducted in total, as two
individuals who initially responded were unable to be
contacted.
Communication between Aboriginal clients and non-
Aboriginal clinicians is important for effective engagement
with health services, including non-Aboriginal clinicians
having respect for cultural differences (McBain-Rigg &
Veitch, 2011) and an understanding of historical events and
their impact on Aboriginal health and well-being today (Cox,
2007). It has been identified that some Aboriginal peoples’
access to health services has been negatively impacted
upon by their feelings of being treated differently by staff
or organisations based on perceptions related to their
race (DiGiacomo et al., 2013; Martin & DiRienzo, 2012).
If Aboriginal families feel safe and welcomed, they will be
more likely to engage with services (HNELHD, 2014).
Presence of Aboriginal staff
The presence of Aboriginal staff (Martin & DiRienzo, 2012;
Wylie et al., 2013) or employment of Aboriginal people as
liaison officers (DiGiacomo et al., 2013; Nelson & Allison,
2004) to assist communication between the client and
non-Aboriginal clinician has been reported to facilitate
Aboriginal people accessing mainstream health services.
Unfortunately, Aboriginal people are underrepresented in
the health workforce (Pink & Allbon, 2008). While there has
been a small increase in the number of Aboriginal speech-
language pathologists in recent years (Byrne, 2015), they
make up only 0.2% of the SLP workforce (Health Workforce
Australia, 2014). However, it is likely that additional factors
also need to be addressed, and asking families may shed
light on what they see as the issues influencing access to SLP
services and ultimately lead to finding appropriate solutions.
Facilitating culturally appropriate
mainstream services
A survey by McBain-Rigg and Veitch (2011) reported that
Aboriginal peoples’ perceptions of health services were
negatively impacted by feelings that their specific cultural
differences and needs were not taken into account. This
includes understanding that family commitments, such as
caring for family members or attending funerals, will often
take precedence over health care appointments (Nelson &
Allison, 2004; Williams, 2012). Increasing awareness of
Aboriginal culture among non-Aboriginal staff, through
initiatives such as cultural education to address individual
racism, has been cited as a way to make health care
services more culturally appropriate (Martin & DiRienzo,
2012).
This pilot study aimed to explore caregiver experiences
within an urban paediatric SLP service, and to identify
(a) factors that facilitate Aboriginal families accessing the
services, (b) ways to increase engagement of Aboriginal
families with the service, and (c) ways to make the service
more culturally appropriate.
Method
Approval to conduct this research was granted by the
Hunter New England Human Research Ethics Committee
(reference # 13/08/21/4.04) and the Aboriginal Health and
Medical Research Council Ethics Committee (reference #
954/13).
Research design
A qualitative research methodology via telephone interview
was employed to allow exploration of an area in which there
is limited pre-existing knowledge (Bowling, 2002). The
methodology was developed in consultation with the
Hunter New England Aboriginal Health Unit to ensure