Indigenous health: Overview

Elvidge E, Taylor SL, Harvey K, Thompson Y, Armao J, Rogers GB, et al. Empirical assessment of cultural safety within Australian hospitals highlights the impact of access to Aboriginal hospital liaison officers on the experiences of Aboriginal patients. First Nations Health and Wellbeing - The Lowitja Journal [Internet]. 2025;3:100061. Available from: http://dx.doi.org/10.1016/j.fnhli.2025.100061

Abstract
Purpose
Ensuring access to hospital services that are culturally safe is imperative for improving Aboriginal and Torres Strait Islander health outcomes. Addressing failings within existing services relies on the ability to prioritise areas for improvement in a methodologically robust manner that reflects the experiences of Indigenous service users. The construct and content validity of the Cultural Safety Survey, a mixed-methods questionnaire-based tool that captures the lived experiences of First Nations peoples attending hospital, was previously established. This study aimed to identify hospital and participant characteristics associated with positive or negative experiences of care.
Methods
Study sites included 49 hospitals in New South Wales, either through direct engagement with the hospital or opportunistic participant recruitment. A total of 413 participants took part in the study; 307 completed the whole survey and 298 of them had complete hospital and demographic data for analysis. Multivariable ordinal logistic regression was used to identify contributors to composite and domain-specific cultural safety scores. Assessed variables included respondent age, gender, distance travelled, attendance capacity (patient or visitor), hospital size, remoteness and socioeconomic status of location. Additional analysis assessing reported interaction with an Aboriginal hospital liaison officer (AHLO) on cultural safety scores was also performed.
Main findings
Of 413 participants, 298 provided complete demographic and hospital data, and confirmed informed consent. Responses related to 49 separate hospitals in New South Wales. Participant age and level of interaction with an AHLO showed a consistently positive association with cultural safety score. A unit increase in age was associated with 51.3% increased odds of a higher overall cultural safety score (P = .0012). Similarly, each unit increase in AHLO interaction was associated with 89.3% greater likelihood of a higher cultural safety score (P = .0031). Other variables – including higher socioeconomic advantage, female gender, and a shorter distance travelled – were positively associated with specific cultural safety domains. Respondent comments captured in the free text component of the questionnaire were consistent with quantitative findings.
Principal conclusions
The findings highlight the importance of access to an AHLO when visiting hospital. More generally, the ability to quantify the performance of hospital services based on the experiences of Indigenous end-users, and to identify factors that contribute to the nature of those interactions, provides a potential guide for impactful service reform.

Abstract
Objective: To explore the values of Aboriginal people in the Northern Territory during their perioperative journey.

Design: A community-based participatory action research approach was used, integrating yarning, deep listening and reflection methods to gather qualitative data in culturally appropriate ways. Data collection involved two yarning circles followed by interpretation and triangulation sessions with co-researchers.

Setting: Conducted in non-health care settings in Garramilla (Darwin) between May 2023 and September 2024, the study included participants from urban, regional and remote NT Aboriginal communities.

Participants: Purposive and snowball sampling were used to engage 18 participants with lived experience of surgery, who share expertise in renal health journeys and have kinship ties spanning from Saltwater Country to Desert Country, with diverse age, language and gender representation.

Main outcome measures: Thematic insights into what First Nations peoples in the NT value during the perioperative journey, to inform culturally safe models of care.

Results: Respect emerged as the core principle in the perioperative journey, with family involvement, cultural practices and effective communication identified as key elements. Respect was evident in honouring cultural protocols, integrating traditional healing practices and recognising patient autonomy. Family involvement was highlighted as essential, with kinship ties influencing shared decision-making processes and support throughout the perioperative experience. Culturally competent communication, including the use of interpreters and clear explanations, played a critical role in bridging cultural differences and ensuring shared understanding. Together, these elements fostered a sense of safety, belonging and empowerment. Ultimately, trust was identified as an overarching outcome that unified these interconnected values, enhancing patient comfort, engagement and overall satisfaction in the perioperative journey.

Conclusion: Respect is integral to Aboriginal people in the perioperative journey, and they value family, culture and communication when navigating surgery. When these values coalesce, trust is generated. These findings highlight the need to integrate culturally informed, patient-centred care models that prioritise respect and trust building to improve accessibility, experience and surgical outcomes.

Keywords: Indigenous health; Social determinants of health.

Abstract
Eliminating Indigenous and ethnic health inequities requires culturally-competent and culturally-safe health workforces and systems. Health professional training institutions and regulatory bodies are increasingly including cultural competency and cultural safety in health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. In 2019, we published a review of international understandings of these terms, and proposed an Indigenous-led definition for cultural safety that we believed to be more fit for purpose in achieving health equity. We also clarified essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The aim of this paper is to share our expert reflections upon the experience over the six years since 2019, of implementing this definition in an Aotearoa New Zealand (NZ) context. Recent work undertaken with health regulatory bodies in NZ to refine the understandings of cultural competency, cultural safety and Indigenous health has extended our positioning on these important concepts. A practical example of how these related but distinct concepts apply to Indigenous health is presented.