Culturally competent communication in Indigenous disability assessment: a qualitative study

Abstract Background Indigenous people tend to exhibit a higher burden of disability than their non-Indigenous counterparts, and are often underserved by disability services. Engaging appropriately with Indigenous communities, families and individuals in the initial stages of disability assessment and planning is crucial in order to build trust and understanding of disability service models and ensure that Indigenous people receive support that is tailored to their needs and cultural realities. This article aims to identify key elements of culturally competent communication in Indigenous disability assessment and planning, and provide recommendations for strengthening capacity in this area. Methods This qualitative research was designed to involve Aboriginal and Torres Strait Islander people at all stages and to reflect the views of Aboriginal and Torres Strait Islander researchers, people and families affected by disability and the community-controlled health sector. Semi-structured individual interviews were undertaken with staff implementing the National Disability Insurance Scheme (NDIS) (n = 4), NDIS participants (n = 24), disability support providers and organisational partners (n = 19) and Community Connectors (n = 8) in Queensland and the Northern Territory of Australia. Key themes derived from thematic analysis included appropriate and adequate engagement of individuals with disability and their families, the role of trusted relationships, and culturally safe and appropriate communication during planning meetings. Results Overall, the research findings highlight that a low level of cultural competence in the initial stages of the disability assessment and planning process exacerbated participant confusion and distrust towards assessment staff and the NDIS. Given difficulties in communication, participant understanding of the NDIS was generally limited. The necessity of culturally safe and appropriate use of interpreters was stressed, as was the role of trusted individuals, including existing service providers, Community Connectors and family members in providing a solid base for participant understanding of the NDIS. Conclusions Cultural competence in disability assessment and planning can be strengthened through multi-level engagement with the Aboriginal community-controlled sector and community leaders. Implementing mechanisms to enable the involvement of families, trusted service providers and Community Connectors can support a more meaningful understanding of individuals’ needs within their cultural context and in relation to their cultural roles.摘要 ## 背景 原住民（Indigenous people）的残疾负担往往高于非原住民群体，且残疾服务的供给常存在不足。在残疾评估与规划的初始阶段，与原住民社区、家庭及个体开展恰当互动，对于建立对残疾服务模式的信任与认知，确保原住民获得适配其需求与文化现实的支持至关重要。本文旨在明确原住民残疾评估与规划中具备文化胜任力的沟通核心要素，并就提升该领域的服务能力提出建议。 ## 方法 本项质性研究旨在让原住民与托雷斯海峡岛民（Aboriginal and Torres Strait Islander people）参与全流程，并体现原住民与托雷斯海峡岛民研究者、受残疾影响的个体与家庭、社区自主管理的医疗部门的观点。研究在澳大利亚昆士兰州与北领地开展，对参与国家残疾保险计划（National Disability Insurance Scheme, NDIS）的工作人员（n=4）、NDIS服务参与者（n=24）、残疾支持服务提供商与机构合作伙伴（n=19）以及社区联络官（Community Connectors）（n=8）开展半结构化个人访谈。主题分析得出的核心主题包括：残疾个体及其家庭的恰当充分互动、信任关系的作用，以及规划会议期间具备文化安全性与适配性的沟通方式。 ## 结果 总体而言，研究结果显示，残疾评估与规划流程初始阶段的文化胜任力不足，加剧了服务参与者对评估人员及NDIS的困惑与不信任。受沟通障碍影响，参与者对NDIS的认知普遍有限。研究强调了安全且恰当地使用口译人员的必要性，同时指出，现有服务提供商、社区联络官及家庭成员等可信赖个体，可为服务参与者理解NDIS提供坚实的认知基础。 ## 结论 可通过与原住民社区自主管理的部门及社区领袖开展多层次互动，提升残疾评估与规划中的文化胜任力。建立相关机制以推动家庭、可信赖服务提供商及社区联络官的参与，能够帮助更深入地理解个体在其文化语境及文化角色中的需求。