Students' experiences of placements in urban indigenous health contexts: developing a culturally responsive workforce.
A culturally responsive health workforce is essential to ensure the delivery of culturally safe health services that meet Aboriginal and Torres Strait Islander Peoples needs. In partnership with universities, placement providers play an essential role in creating opportunities for immersive experiences that enable students to develop their cultural responsiveness. This study evaluated students' experiences of an innovative student placement model embedded within an urban Aboriginal and Torres Strait Islander Community-Controlled Health Organisation.
Students completed pre and post placement surveys administered using a web-based interface. The surveys involved five-point Likert and open-ended response items exploring students' perceptions of their knowledge, skills development, awareness and self-development, and overall placement experience. Frequencies were calculated for the variables of interest and compared between pre and post surveys. The sign test for matched pairs was used to calculate differences between pre and post surveys, and a one-sided hypothesis test was utilised to determine if the level of agreement increased from pre to post survey. Qualitative data obtained for seven questions were thematically analysed using Groundwater Method, an Indigenous data analysis technique.
Between January 1, 2017, and June 30, 2019, 938 students from 32 disciplines were placed within the organisation and its Member services. Survey responses were received from 338 participants pre-placement, and 158 participants post-placement. The matched pre-post group contained 81 students. The results indicate significant positive changes in cultural responsiveness, skills development, awareness, and self-development when comparing pre- and post-placement responses. Students' overall satisfaction with the quality of their placement was positively associated with their intention to work in Aboriginal and Torres Strait Islander health contexts in the future. Key pre-placement themes included competence, cultural skills, support and fear, and key post-placement themes included expertise, cultural responsiveness, learning environment and challenges.
Indigenous-led, regionally coordinated placements in urban Indigenous health contexts can support transformative learning and the development of a culturally responsive workforce. Universities should aim to develop reciprocal relationships with Indigenous-led organisations to support students to develop their cultural responsiveness and improve the provision of culturally safe care for Aboriginal and Torres Strait Islander Peoples. Future research should explore the longer-term impacts of student placements on cultural responsiveness, attitudes, values, and behaviours, as well as the experiences of Aboriginal and Torres Strait Islander Peoples interfacing with university students on placement in urban settings. NOTE: We will predominantly use the term 'Aboriginal and Torres Strait Islander Peoples', as opposed to 'Indigenous' or 'First Nations'. When the term 'Indigenous' is used, it largely relates to government policy - except when referring to Indigenisation of curriculum and Indigenous Knowledges - and where 'First Nations' is used, it is in a global context. In addition, we use the term 'Peoples' to signify that Aboriginal and Torres Strait Islander Peoples are not one People or Nation, but a collective of Peoples and Nations.
Odgers-Jewell K
，Nelson A
，Brown R
，Hunter N
，Atkins T
，Menzel K
... -
《BMC Medical Education》
Australia in 2030: what is our path to health for all?
CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.
Backholer K
，Baum F
，Finlay SM
，Friel S
，Giles-Corti B
，Jones A
，Patrick R
，Shill J
，Townsend B
，Armstrong F
，Baker P
，Bowen K
，Browne J
，Büsst C
，Butt A
，Canuto K
，Canuto K
，Capon A
，Corben K
，Daube M
，Goldfeld S
，Grenfell R
，Gunn L
，Harris P
，Horton K
，Keane L
，Lacy-Nichols J
，Lo SN
，Lovett RW
，Lowe M
，Martin JE
，Neal N
，Peeters A
，Pettman T
，Thoms A
，Thow AMT
，Timperio A
，Williams C
，Wright A
，Zapata-Diomedi B
，Demaio S
... -
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ResearchGate
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钛学术
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