A call for culture-centred care: Exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia

Abstract Background Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants’ second birthday. It explores health workers’ perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health. Methods Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed. Results Three key themes emerged: the system takes priority, culture is not central in approaches to care, and ‘we’ve got to be allowed to do it in a different way’. Conclusions This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants’ first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.

摘要 背景：与非原住民群体相比，澳大利亚原住民女性及其婴儿的健康结局显著处于劣势。及时获取有效且适宜的母婴保健服务，有助于缩小此类现存健康差距。本研究旨在探究南澳大都会地区原住民女性及其婴儿的护理持续性（continuity of care）相关影响因素。本文报告了从产前阶段至婴儿两周岁末期间，主流医疗服务机构中医护人员的相关视角，探讨了医护人员认为哪些因素可提升原住民女性及其婴儿在主流医疗服务中的就医体验与护理满意度。

方法：本研究开展8组焦点小组访谈，共纳入52名医疗专业人员作为参与者，包括原住民儿童与家庭支持文化顾问（Aboriginal Cultural Child and Family Support Consultants，n=7）、原住民母婴护理专员（Aboriginal Maternal Infant Care Workers，n=3）、助产士（Midwives，n=3）以及儿童与家庭护士（Child and Family Nurses，n=39）。数据采用归纳式编码法开展主题分析。

结果：共提炼出三大核心主题：其一为“系统优先于一切”，其二为“文化未成为护理实践的核心导向”，其三为“我们必须被允许以不同方式开展工作”。

结论：本研究表明，原住民家庭在从产前阶段至婴儿出生后前1000天期间，获取主流医疗服务时的护理持续性不足。本研究对社区具有实践指导意义，呼吁制定相关策略以强化护理持续性，并推动医疗服务机构提供适宜且具有文化安全性的照护（culturally safe care）。研究结果将为未来改善原住民家庭与婴儿在出生后前1000天内的护理持续性提供参考与指引。