25 March 2019

Cultural respect program fails to make difference

General practice

A cultural respect program for GPs has made no difference to the rates of Indigenous people seeking health checks, after one year of operation.

A cluster randomised controlled trial reported in the latest MJA set out to measure whether a program of workshops and mentoring would increase Indigenous consultations, chronic disease risk factors documented, and cultural respect levels of clinical staff.

“The gap in life expectancy between Indigenous and non-Indigenous Australians remains large,” the paper says. “Urban Indigenous Australian-controlled health services are under-resourced, and … Indigenous Australians frequently encounter cultural disrespect in mainstream primary care services.” They cite two surveys in which 16% and 29% of respondents reported experiencing racism in health settings.

The team of eight researchers, led by Siaw-Teng Liaw from the University of NSW’s Centre for Primary Health Care and Equity, recruited 56 general practices in Sydney and Melbourne. Half of the practices received the Ways of Thinking and Ways of Doing (WoTWoD) intervention, which “translates the systemic, organisational, and clinical elements of the Australian Health Ministers’ Advisory Council Cultural Competency Framework into routine clinical practice”, the paper says.

“Cultural respect reflects the attitudes and behaviour of the entire medical practice, from reception to consulting room.”

The intervention comprised a toolkit of 10 scenarios that illustrate cross-cultural behaviour in clinical practice, a half-day workshop, cultural mentor support, and guidance involving local Aboriginal-Controlled Community Health Services.

The researchers measured the numbers of Aboriginal and Torres Strait Islander health assessments (MBS item 715) claimed, and the chronic disease risk factors documented for Indigenous patients, in the year before and the year after the intervention.

Staff were also given a cultural quotient (CQ) assessment at baseline and follow-up, which “measured the capacity of the practice staff to deal with four dimensions of cultural diversity: metacognition (strategy), cognition, motivation, and behaviour”, and the mean results were compared.

The researchers found no significant differences between intervention and control practices in any of these three outcome measures.

The authors write that while the intervention was delivered with fidelity at the practice level, the high levels of staff turnover during the restructuring from Medicare Locals to PHNs at the time may have influenced the results.

They say the length of the trial may have not been sufficient to detect any significant changes, and that the numbers of Indigenous patients was small.

They intend to analyse qualitative data collected during the trial to better understand the effects of the program on their chosen outcome measures. 

MJA 2019, 25 March