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.
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ItemBuilding readiness for inclusive practice in mainstream health services: A pre-inclusion framework to deconstruct exclusion(PERGAMON-ELSEVIER SCIENCE LTD, 2021-11)Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective.
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ItemA qualitative evaluation of the implementation of a cultural competence project in rural Victoria(ELSEVIER SCIENCE INC, 2021-06)OBJECTIVE: To explore the complex factors influencing the implementation of cultural competency frameworks for Aboriginal and Torres Strait Islander peoples within rural, Victorian, mainstream health and community service organisations. METHODS: Semi-structured telephone interviews were conducted with key individuals from 20 public health and community services in rural Victoria who had participated in the Koolin Balit Aboriginal Health Cultural Competence Project (KB-AHCC project). Interviews were recorded and transcribed verbatim and a content analysis was undertaken. The findings informed the selection of six case study sites for more in-depth analysis. Following this, an expert reference group provided feedback on the findings. Findings from the different data were triangulated to identify eight factors. RESULTS: Key factors acting as barriers and/or enablers to implementing cultural competence frameworks were: comprehensive, structured tools; project workers; communication; organisational responsibility for implementation; prioritising organisational cultural competence resourcing; resistance to focussing on one group of people; and accountability. CONCLUSIONS: Embedding cultural competence frameworks within rural, mainstream health and community services requires sustained government resourcing, prioritisation and formal accountability structures. Implications for public health: Findings will inform and guide the future development, implementation and evaluation of organisational cultural competence projects for rural public health and community services.