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  1. Article ; Online: Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare.

    Kerrigan, Vicki / McGrath, Stuart Yiwarr / Doig, Cassandra / Herdman, Rarrtjiwuy Melanie / Daly, Shannon / Puruntatameri, Pirrawayingi / Lee, Bilawara / Hefler, Marita / Ralph, Anna P

    BMC health services research

    2024  Volume 24, Issue 1, Page(s) 119

    Abstract: Background: First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver ... ...

    Abstract Background: First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants.
    Methods: Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model.
    Results: Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences.
    Conclusion: The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.
    MeSH term(s) Humans ; Health Facilities ; Hospitals ; Communication ; Learning ; Students
    Language English
    Publishing date 2024-01-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-024-10565-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Evaluation of 'Ask the Specialist': a cultural education podcast to inspire improved healthcare for Aboriginal peoples in Northern Australia.

    Kerrigan, Vicki / McGrath, Stuart Yiwarr / Herdman, Rarrtjiwuy Melanie / Puruntatameri, Pirrawayingi / Lee, Bilawara / Cass, Alan / Ralph, Anna P / Hefler, Marita

    Health sociology review : the journal of the Health Section of the Australian Sociological Association

    2022  Volume 31, Issue 2, Page(s) 139–157

    Abstract: In Australia's Northern Territory (NT) most people who access health services are Aboriginal and most healthcare providers are non-Indigenous; many providers struggle to deliver culturally competent care. Cultural awareness training is offered however, ... ...

    Abstract In Australia's Northern Territory (NT) most people who access health services are Aboriginal and most healthcare providers are non-Indigenous; many providers struggle to deliver culturally competent care. Cultural awareness training is offered however, dissatisfaction exists with the limited scope of training and the face-to-face or online delivery format. Therefore, we developed and evaluated
    MeSH term(s) Culturally Competent Care ; Delivery of Health Care ; Humans ; Indigenous Peoples ; Native Hawaiian or Other Pacific Islander ; Northern Territory
    Language English
    Publishing date 2022-04-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2146435-2
    ISSN 1839-3551 ; 1446-1242
    ISSN (online) 1839-3551
    ISSN 1446-1242
    DOI 10.1080/14461242.2022.2055484
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Improving outcomes for hospitalised First Nations peoples though greater cultural safety and better communication: the Communicate Study Partnership study protocol.

    Ralph, Anna P / McGrath, Stuart Yiwarr / Armstrong, Emily / Herdman, Rarrtjiwuy Melanie / Ginnivan, Leah / Lowell, Anne / Lee, Bilawara / Gorham, Gillian / Taylor, Sean / Hefler, Marita / Kerrigan, Vicki

    Implementation science : IS

    2023  Volume 18, Issue 1, Page(s) 23

    Abstract: Background: The Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results ... ...

    Abstract Background: The Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results in First Nations peoples experiencing adverse outcomes of hospitalisation in Australia's Northern Territory. In this setting, the majority of healthcare users are First Nations peoples, but the majority of healthcare providers are not. Our hypotheses are that strategies to ensure cultural safety can be effectively taught, systems can become culturally safe and that the provision of culturally safe healthcare in first languages will improve experiences and outcomes of hospitalisation.
    Methods: We will implement a multicomponent intervention at three hospitals over 4 years. The main intervention components are as follows: cultural safety training called 'Ask the Specialist Plus' which incorporates a locally developed, purpose-built podcast, developing a community of practice in cultural safety and improving access to and uptake of Aboriginal language interpreters. Intervention components are informed by the 'behaviour change wheel' and address a supply-demand model for interpreters. The philosophical underpinnings are critical race theory, Freirean pedagogy and cultural safety. There are co-primary qualitative and quantitative outcome measures: cultural safety, as experienced by First Nations peoples at participating hospitals, and proportion of admitted First Nations patients who self-discharge. Qualitative measures of patient and provider experience, and patient-provider interactions, will be examined through interviews and observational data. Quantitative outcomes (documentation of language, uptake of interpreters (booked and completed), proportion of admissions ending in self-discharge, unplanned readmission, hospital length of stay, costs and cost benefits of interpreter use) will be measured using time-series analysis. Continuous quality improvement will use data in a participatory way to motivate change. Programme evaluation will assess Reach, Effectiveness, Adoption, Implementation and Maintenance ('RE-AIM').
    Discussion: The intervention components are innovative, sustainable and have been successfully piloted. Refinement and scale-up through this project have the potential to transform First Nations patients' experiences of care and health outcomes.
    Trial registration: Registered with ClinicalTrials.gov Protocol Record 2008644.
    MeSH term(s) Humans ; Allied Health Personnel ; Communication ; Delivery of Health Care ; Health Personnel ; Hospitals ; Multicenter Studies as Topic
    Language English
    Publishing date 2023-06-22
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2225822-X
    ISSN 1748-5908 ; 1748-5908
    ISSN (online) 1748-5908
    ISSN 1748-5908
    DOI 10.1186/s13012-023-01276-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: From "stuck" to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital.

    Kerrigan, Vicki / McGrath, Stuart Yiwarr / Majoni, Sandawana William / Walker, Michelle / Ahmat, Mandy / Lee, Bilawara / Cass, Alan / Hefler, Marita / Ralph, Anna P

    BMC health services research

    2021  Volume 21, Issue 1, Page(s) 548

    Abstract: Background: Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are ... ...

    Abstract Background: Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019.
    Methods: This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient's language or English, researcher field notes from shadowing doctors, doctors' reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted.
    Results: The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling "stuck" and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates.
    Conclusions: A culturally unsafe system which restricted people's ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.
    MeSH term(s) Allied Health Personnel ; Communication Barriers ; Hospitals ; Humans ; Language ; Northern Territory
    Language English
    Publishing date 2021-06-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-021-06564-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: "The talking bit of medicine, that's the most important bit": doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care.

    Kerrigan, Vicki / McGrath, Stuart Yiwarr / Majoni, Sandawana William / Walker, Michelle / Ahmat, Mandy / Lee, Bilawara / Cass, Alan / Hefler, Marita / Ralph, Anna P

    International journal for equity in health

    2021  Volume 20, Issue 1, Page(s) 170

    Abstract: Background: In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter- ... ...

    Abstract Background: In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia's Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot.
    Methods: This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted.
    Results: Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team.
    Conclusions: Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.
    MeSH term(s) Allied Health Personnel/psychology ; Australia ; Communication Barriers ; Cooperative Behavior ; Culturally Competent Care/organization & administration ; Hospitals ; Humans ; Oceanic Ancestry Group/psychology ; Physician-Patient Relations ; Physicians/psychology ; Translating
    Language English
    Publishing date 2021-07-23
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1475-9276
    ISSN (online) 1475-9276
    DOI 10.1186/s12939-021-01507-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Extended Versus Standard Antibiotic Course Duration in Children <5 Years of Age Hospitalized With Community-acquired Pneumonia in High-risk Settings: Four-week Outcomes of a Multicenter, Double-blind, Parallel, Superiority Randomized Controlled Trial.

    McCallum, Gabrielle B / Fong, Siew M / Grimwood, Keith / Nathan, Anna M / Byrnes, Catherine A / Ooi, Mong H / Nachiappan, Nachal / Saari, Noorazlina / Morris, Peter S / Yeo, Tsin W / Ware, Robert S / Elogius, Blueren W / Oguoma, Victor M / Yerkovich, Stephanie T / de Bruyne, Jessie / Lawrence, Katrina A / Lee, Bilawara / Upham, John W / Torzillo, Paul J /
    Chang, Anne B

    The Pediatric infectious disease journal

    2022  Volume 41, Issue 7, Page(s) 549–555

    Abstract: Background: High-level evidence is limited for antibiotic duration in children hospitalized with community-acquired pneumonia (CAP) from First Nations and other at-risk populations of chronic respiratory disorders. As part of a larger study, we ... ...

    Abstract Background: High-level evidence is limited for antibiotic duration in children hospitalized with community-acquired pneumonia (CAP) from First Nations and other at-risk populations of chronic respiratory disorders. As part of a larger study, we determined whether an extended antibiotic course is superior to a standard course for achieving clinical cure at 4 weeks in children 3 months to ≤5 years old hospitalized with CAP.
    Methods: In our multinational (Australia, New Zealand, Malaysia), double-blind, superiority randomized controlled trial, children hospitalized with uncomplicated, radiographic-confirmed, CAP received 1-3 days of intravenous antibiotics followed by 3 days of oral amoxicillin-clavulanate (80 mg/kg, amoxicillin component, divided twice daily) and then randomized to extended (13-14 days duration) or standard (5-6 days) antibiotics. The primary outcome was clinical cure (complete resolution of respiratory symptoms/signs) 4 weeks postenrollment. Secondary outcomes included adverse events, nasopharyngeal bacterial pathogens and antimicrobial resistance at 4 weeks.
    Results: Of 372 children enrolled, 324 fulfilled the inclusion criteria and were randomized. Using intention-to-treat analysis, between-group clinical cure rates were similar (extended course: n = 127/163, 77.9%; standard course: n = 131/161, 81.3%; relative risk = 0.96, 95% confidence interval = 0.86-1.07). There were no significant between-group differences for adverse events (extended course: n = 43/163, 26.4%; standard course, n = 32/161, 19.9%) or nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus or antimicrobial resistance.
    Conclusions: Among children hospitalized with pneumonia and at-risk of chronic respiratory illnesses, an extended antibiotic course was not superior to a standard course at achieving clinical cure at 4 weeks. Additional research will identify if an extended course provides longer-term benefits.
    MeSH term(s) Amoxicillin/therapeutic use ; Amoxicillin-Potassium Clavulanate Combination/adverse effects ; Anti-Bacterial Agents ; Child ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/microbiology ; Double-Blind Method ; Humans ; Infant ; Pneumonia/drug therapy
    Chemical Substances Anti-Bacterial Agents ; Amoxicillin-Potassium Clavulanate Combination (74469-00-4) ; Amoxicillin (804826J2HU)
    Language English
    Publishing date 2022-06-07
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 392481-6
    ISSN 1532-0987 ; 0891-3668
    ISSN (online) 1532-0987
    ISSN 0891-3668
    DOI 10.1097/INF.0000000000003558
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial.

    Chang, Anne B / Fong, Siew Moy / Yeo, Tsin Wen / Ware, Robert S / McCallum, Gabrielle B / Nathan, Anna M / Ooi, Mong H / de Bruyne, Jessie / Byrnes, Catherine A / Lee, Bilawara / Nachiappan, Nachal / Saari, Noorazlina / Torzillo, Paul / Smith-Vaughan, Heidi / Morris, Peter S / Upham, John W / Grimwood, Keith

    BMJ open

    2019  Volume 9, Issue 4, Page(s) e026411

    Abstract: Introduction: Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young ... ...

    Abstract Introduction: Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually <2 weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms/signs or bronchiectasis 24 months after the original pneumonia episode.
    Methods and analysis: This multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand Māori/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg/kg/day (maximum 980 mg of amoxicillin) in two-divided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom/signs of bronchiectasis at 24 months. The main secondary outcomes are 'clinical cure' at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria.
    Ethics and dissemination: The Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research; Auckland: Starship Children's and KidsFirst Hospitals; East Malaysia: Likas Hospital and Sarawak General Hospital; Kuala Lumpur: University of Malaya Research Ethics Committee; and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication.
    Trial registration: ACTRN12616000046404.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Australia/epidemiology ; Child, Preschool ; Double-Blind Method ; Female ; Follow-Up Studies ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Infant ; Malaysia/epidemiology ; Male ; New Zealand/epidemiology ; Pneumonia/drug therapy ; Pneumonia/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2019-04-24
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2018-026411
    Database MEDical Literature Analysis and Retrieval System OnLINE

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