Developing Pictorial Conceptual Metaphors as a means of understanding and changing the Australian Health System for Indigenous People (original) (raw)
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BMC Medical Education, 2016
Background: Unconscious bias and negative attitudes towards minority groups have detrimental effects on the way health care is, or is not, provided to these groups. Recognition of racist attitudes and behaviours as well as understanding clients' experiences of health and health care are pivotal to developing better health care strategies to positively impact on the quality and safety of care provided to Indigenous people. Indigenous research demands inclusive research processes and the use of culturally appropriate methodologies. This paper presents a methodological account of collecting narratives which accurately and respectfully reflect Aboriginal Australians' experiences with health care in Western Australia. The purpose of these narratives is to provide health students and professionals with an opportunity to 'walk-in the shoes' of Aboriginal people where face-to-face interaction is not feasible. Methods: With the incorporation of Indigenous peoples' voices being an important link in cultural safety, the project was led by an Indigenous Reference group, who encouraged active participation of Aboriginal people in all areas of the project. Using a phenomenological approach and guided by the Indigenous Reference group, yarning data collection was implemented to collect stories focusing on Aboriginal people's experiences with health care services. An open-access, on-line website was established to host education resources developed from these "yarns". Results: Yarning provided a rich source of information on personal experiences and encouraged the story provider to recognise their facilitative role in the research process. While the methodology used in this project was lengthy and labour-intensive it afforded a respectful manner for story collection and highlighted several innate flaws when Western methods are applied to an Indigenous context. Conclusion: Engagement of an Indigenous Reference Group was pivotal to designing an appropriate methodology that incorporated the voices of Aboriginal people in a multimedia resource of Aboriginal narratives. However further research is warranted to understand how the resources are being used and integrated into curricula, and their impact on students and health care outcomes.
2009
is a co-investigator and provided research training for co-researchers. Ann developed the material for the introductory chapter and produced the stimulus questions for the second round of community consultation. Sarah Barter-Godfrey, Deakin University. Sarah is a co-investigator and acted as liaison between the three parts of the project. Sarah provided research training for co-researchers and supervised the Deakin students. Sarah carried out the third stage of the policy analysis, including the 'heat mapping' and development of the policy chapter. Sarah developed material for the report and, together with Samantha Furneaux, provided the administrative support for the project. Researchers (in alphabetical order) Sandy Barber, community researcher. Sandy took part in the research training and facilitated focus groups discussions at the community forums. Neil Bo Barney, community researcher. Neil took part in the research training and facilitated focus groups discussions at the community forums. Troy Blow, community researcher. Troy took part in the research training and facilitated focus groups discussions at the community forums. Troy also assisted in the second round of community consultation and provided feedback on the interim report. Andrea Gough, Deakin University student. Andrea carried out an initial scoping of health policy during her undergraduate health promotion placement, producing a report that informed the full policy analysis. Peta Farquhar, Wesley Mission Melbourne. Peta identified, sourced and collated the policies used in the policy review. Peta produced the policy summaries for the first stage of the policy analysis and mapped the relationships between them in the second stage of the analysis, producing the materials presented in the document 'Mapping relationships between parties' avaiable in the full report. Samantha Furneaux, Deakin University. Samantha was the research assistant for the project and provided administrative support for the production of the report and discussion materials. Samantha carried out the literature review, and produced the diagrams used in the policy review to summarise the relationships between the policies, and the map to illustrate participants' countries in the focus group study. Samantha completed the meta-synthesis analysis and diagrams presented in the introductory chapter. Chris Halacas, Wesley Mission Melbourne. Chris took part in the research training and facilitated focus groups discussions at the community forums. Chris also assisted in the successful grant application. Mary Hassall, Artist. Mary produced the artwork for the Talking it Up project. Mary also transcribed the group discussions, providing a careful record of the focus groups that was used to guide the analysis. Danielle Thomson, Deakin University student. Danielle took part in the research training and assisted with the community forums. Artwork The artwork for Talking it Up was produced by Mary Hassall, and copyright remains with her. The artwork cannot be reproduced elsewhere without her permission. Artist statement: "I am an Australian artist, in my 50s, born and brought up in various locations around Victoria, currently living
Ethnicity & Health, 2014
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Gema Online Journal of Language Studies , 2017
Diverse methods and approaches have been utilised in researching the cultural bases of health, illness and wellbeing. Understanding the cultural representation of health and illness of particular communities becomes urgent especially when the community concerned is underserved in healthcare. In this project, we sought to examine the representations of health and illness by members of the Semai indigenous community through the use of metaphor analysis, a qualitative method in applied linguistics that attend to how people use language in real-world discourses to understand their conceptualisations of abstract ideas and emotions. From semi-structured interviews with the indigenous Semai people in a village in Malaysia, metaphors of health and illness were identified from the oral stories told by participants. Metaphors were identified and analysed following Lakoff and Johnson's (1980) conceptual metaphor theory that explains how people understand one idea in a conceptual domain through accessing resources in another conceptual domain. The results show that universal metaphors are dominant in representing embodied experiences while culturally influenced metaphors are important as vehicles of expression derived from their environment and folk beliefs. We argue that while culturally influenced metaphors may mark the participants as strange in their ways of thinking, a closer look at their underlying frameworks finds that they connect with universal bases that are intrinsic to all human experience. Understanding conceptual metaphors can contribute to the expansion of the locus of shared understanding between healthcare providers and the communities they serve.
Sage Open, 2019
Health promotion within Aboriginal communities has typically come from a top-down approach with government-funded health research directing the nature in which health information is disseminated. Previous literature has argued for two- way interaction that requires an equivalent bottom-up approach to integrate community beliefs and perceptions. Good hygiene has been the focus of many health promotion campaigns to reduce the presence of a wide variety of pathogens, but to date, there have been few attempts to incorporate traditional knowledge into such campaigns. This article proposes that visual ethnography, specifically community video, provides a good method for understanding community beliefs while simultaneously creating health promotion materials within the local culture.
Lowitja Institute and National Centre for Indigenous Studies, 2018
This report explores ‘deficit discourse’ in Aboriginal and Torres Strait Islander health policy. ‘Discourse’, in this context, encompasses thought represented in written and spoken communication and/or expressed through practices. The term draws attention to the circulation of ideas, the processes by which these ideas shape conceptual and material realities, and the power inequalities that contribute to and result from these processes. ‘Deficit discourse’ refers to discourse that represents people or groups in terms of deficiency – absence, lack or failure. It particularly denotes discourse that narrowly situates responsibility for problems with the affected individuals or communities, overlooking the larger socio-economic structures in which they are embedded. It is implicated with race-based stereotypes and there is evidence that it is a barrier to improving health outcomes.
Although successful communication is at the heart of the clinical consultation, communication between Aboriginal patients and practitioners such as doctors, nurses and allied health professionals, continues to be problematic and is arguably the biggest barrier to the delivery of successful health care to Aboriginal people. This paper presents an overarching framework for practitioners to help them reorientate their communication with Aboriginal patients using 'clinical yarning'. Clinical yarning is a patient-centred approach that marries Aboriginal cultural communication preferences with biomedical understandings of health and disease. Clinical yarning consists of three interrelated areas: the social yarn, in which the practitioner aims to find common ground and develop the interpersonal relationship; the diagnostic yarn, in which the practitioner facilitates the patient's health story while interpreting it through a biomedical or scientific lens; and the management yarn, that employs stories and metaphors as tools for patients to help them understand a health issue so a collaborative management approach can be adopted. There is cultural and research evidence that supports this approach. Clinical yarning has the potential to improve outcomes for patients and practitioners.
Health Policy, 2011
This paper discusses the technique of 'yarning' as an action research process relevant for policy development work with Aboriginal peoples. Through a case study of an Aboriginal community-based smoking project in the Australian State of Victoria, the paper demonstrates how the Aboriginal concept of 'yarning' can be used to empower people to create policy change that not only impacts on their own health, but also impacts on the health of others and the Aboriginal organisation for which they work. The paper presents yarning within the context of models of empowerment and a methodological approach of participatory action research. The method is based on respect and inclusivity, with the final policy developed by staff for staff. Yarning is likely to be successful for action researchers working within a variety of Indigenous contexts.
2011
This report was made possible by contributions from many people. Firstly and most importantly, we thank the participants for taking part in the focus group discussions, attending community forums and providing feedback in later phases of consultation, without which this research would not have been possible. Participation was confidential, so we are not naming all of the participants here, but to everyone who took part we say: Thank you. Your ideas, stories and suggestions were sincerely appreciated and highly valued. We hope you like the final report. The research was funded by the VicHealth Discovery grant program (Grant Number 2008-0077), and we thank them for funding research into Aboriginal health in Victoria. The research was carried out by: Co-investigators Aunty Shirley Firebrace, community Elder and co-investigator. Aunty Shirley conceptualised the original idea for the project and facilitated the first round of community consultation, as well as providing editorial insight for the report. Uncle Reg Blow, community Elder and co-investigator. Uncle Reg facilitated the second round of consultation and provided vital editorial input for the report.
2020
In Australia, an evidence gap exists for governments and policymakers about what it means when the cultures of Aboriginal and Torres Strait Islander people are included in public policies. Specifically, when the cultures of Indigenous Australians have been incorporated in a public health policy like the Australian Government's National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (Health Plan), how do policymakers implement - enable, embed, and enact - cultures? More disturbing is the non-recognition of Indigenous culture's innate relationship to the knowledges held by Indigenous Australians. In recognition of the importance of Indigenous cultures to the health and wellbeing of Indigenous Australians, the centrality of culture in the Health Plan represents the first national Indigenous public policy that reflects its relevance. This research protocol describes a public policy qualitative research study that aims to address this evidence gap by using the He...