MJA
MJA

Sharing the true stories: improving communication between Aboriginal patients and healthcare workers

Med J Aust 2002; 176 (10): 466-470.

Summary

Objectives: To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication.

Design: Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication.

Setting: A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001.

Participants: Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers.

Main outcome measures: Factors influencing the quality of communication.

Results: A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.

Conclusions: Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.

Please login with your free MJA account to view this article in full

  • Alan Cass1
  • Anne Lowell2
  • Michael Christie3
  • Paul L Snelling4
  • Melinda Flack5
  • Betty Marrnganyin6
  • Isaac Brown7

  • Cooperative Research Centre for Aboriginal and Tropical Health, NT.

Correspondence: alancass@menzies.edu.au

Acknowledgements: 

Our study was supported by a grant from the Cooperative Research Centre for Aboriginal and Tropical Health. We would like to thank Dr Peter Arnold for his critical reading of the manuscript.

Competing interests:

None declared.

  • 1. Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor–patient communication: a review of the literature. Soc Sci Med 1995; 40: 903-918.
  • 2. Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ 1995; 152: 1423-1433.
  • 3. Putsch RW. Cross-cultural communication. The special case of interpreters in health care. JAMA 1985; 254: 3344-3348.
  • 4. Dollis N. Removing cultural and language barriers to health. Melbourne: National Health Strategy, 1993.
  • 5. Lowell A. Communication and cultural knowledge in Aboriginal health care. Darwin: Cooperative Research Centre for Aboriginal and Tropical Health, 2001.
  • 6. Australian Royal Commission into Aboriginal Deaths in Custody (Commissioner E Johnston). National report: overview and recommendations. Canberra: AGPS, 1991.
  • 7. Humphery K, Weeramanthri T, Fitz J. Forgetting compliance: Aboriginal health and medical culture. Darwin: Northern Territory University Press in conjunction with the Cooperative Research Centre for Aboriginal and Tropical Health, 2001.
  • 8. Devitt J, McMasters A. Living on medicine: a cultural study of end-stage renal disease among Aboriginal people. Alice Springs: IAD Press, 1998.
  • 9. Mobbs R. But I do care! Communication difficulties affecting the quality of care delivered to Aborigines. Med J Aust 1986; 144(Suppl): S3-S5.
  • 10. Edis F. "Just scratching the surface": miscommunication in Aboriginal health care. MEd thesis, Northern Territory University, 1998.
  • 11. Trudgen R. Why warriors lie down and die. Darwin: Aboriginal Resource and Development Services Inc., 2000.
  • 12. Cooke M. Anglo/Yolngu communication in the criminal justice system. PhD thesis, University of New England, 1998.
  • 13. Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ 2000; 320: 114-116.
  • 14. Meyer J. Qualitative research in health care. Using qualitative methods in health related action research. BMJ 2000; 320: 178-181.
  • 15. QSR NVivo [computer program]. Version 1.2.42. Melbourne: QSR International Pty Ltd, 1999–2000.
  • 16. Higginbotham N, Albrecht G, Connor L. Health social science: a transdisciplinary and complexity perspective. Melbourne: Oxford University Press, 2001.
  • 17. Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ 2000; 320: 50-52.
  • 18. Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 2001; 322: 1115-1117.
  • 19. Eades D. Communicative strategies in Aboriginal English. In: Romaine S, editor. Language in Australia. Cambridge: Cambridge University Press, 1991.
  • 20. Campbell DA. Hope and harm: a delicate balance [commentary]. Med J Aust 2001; 175: 540-541.
  • 21. Steffensen MS, Colker L. Intercultural misunderstandings about health care. Recall of descriptions of illness and treatment. Soc Sci Med 1982; 16: 1949-1954.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article