Rural Clinical School - Research Publications
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ItemSocial interaction and social inclusion in international rural health research(Springer International Publishing, 2022-05-14)There are particular attributes of rural communities that shape inclusion and exclusion in these settings. Social inclusion, or the opportunity for participation and access, together with its opposite, social exclusion, are central issues in rural contexts due to lower levels of income, education, and health outcomes as well as less access to health services. Adapting Wilkinson's interactional perspective of rural communities, this chapter focuses on how social interactions, or the ways local people talk, undertake activities and organize their daily lives, play a central role in understanding inclusion and exclusion within rural communities. This perspective underpins three case studies of inclusion research, one investigating the inclusion of socially and culturally diverse consumers in local health services in regional Australia, one working with a rural Australian health service to increase inclusion for local consumers, and a traditional healing approach to men's sexual health in rural Bangladesh. Key lessons from these case studies include the importance of developing genuine relationships and partnerships, working with local systems and "ways of doing things," progressing change slowly, and adopting pluralistic approaches to inclusion. Successful inclusion research was found to involve effective engagement, working with local networks, conducting long-term projects, and employing local researchers. The case studies highlight the need for more inclusive practices in rural health which can be assisted by research that challenges exclusionary interactions in rural communities.
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Item'It's a cultural thing': excuses used by health service providers on providing inclusive care(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2022-01-02)Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.