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Element 1: Wellbeing is supported by locally defined, culturally safe primary healthcare services.

Locally defined, culturally safe primary healthcare services can be achieved by creating culturally welcoming space(s) as defined by Aboriginal and Torres Strait Islander communities; by developing trusting relationships between healthcare providers, clients and communities; by understanding and accepting diversity within and between communities; and by offering flexible approaches to the delivery of primary healthcare services that can address the complex needs and accommodate the competing demands experienced by many Aboriginal and Torres Strait Islander people with chronic diseases.

PRINCIPLES

Principle 1a: Creating culturally welcoming places

Culturally welcoming places include physical spaces as well as staff within the facility actively working towards ensuring that Aboriginal and Torres Strait Islander community members feel safe and comfortable [14]. Welcoming spaces are free from discrimination on the basis of differences, including those of race, gender and disability [15], and are reflective of dynamic local community contexts [15, 16].

Principle 1b: Developing trusting relationships with clients and communities

Trusting relationships encourage confidence in primary healthcare services [17-19]. Fundamental to developing trusting relationships is communicating responsively and responsibly and ensuring that people feel respected, valued and cared for when accessing primary healthcare services [14, 19-22].

Principle 1c: Understanding and accepting cultural diversity within communities

Primary healthcare staff should become aware of the diversity both within and between Aboriginal and Torres Strait Islander communities in order to ensure that a wide range of healthcare needs are attended to [13]. Different communities and groups within communities have distinct laws, governance arrangements, kinship structures and ways in which they view and maintain cultural identities [23], which are often overlooked when providing primary healthcare services to Aboriginal and Torres Strait Islander peoples.

Principle 1d: Delivering flexible primary healthcare services both within and outside of healthcare facilities

In order to adequately meet the complex needs and competing demands experienced by some Aboriginal and Torres Strait Islander communities, the provision of primary healthcare services should extend beyond the geographical and temporal constraints frequently applied in conventional primary healthcare settings [24-28].

APPLICATIONS

Applications associated with Principle 1a: Creating culturally welcoming places

Culturally welcoming places may be created by:

  • Engaging with Aboriginal and Torres Strait Islander communities to determine what constitutes safe and welcoming healthcare spaces within the local context [13, 14, 16, 19, 45, 47-49]
  • Developing resources that assist people to access primary healthcare services [13]
  • Ensuring that primary healthcare facilities can be identified as culturally appropriate and welcoming to Aboriginal and Torres Strait Islander people [13], for example by displaying culturally appropriate posters, paintings and artefacts [18, 19, 47]
  • Ensuring that protocols acknowledging Country are in place [15]
  • Ensuring local Aboriginal and Torres Strait Islander staff are the first point of contact within primary healthcare services [13, 18, 19, 50]
  • Ensuring staffing within primary healthcare services reflects an appropriate gender balance [15]
  • Being responsive to peoples’ diverse understandings and uses of English [13, 36, 44]
  • Using interpreters when and where appropriate [13, 44]
  • Ensuring that health promotion and information materials within facilities are designed to meet the needs of local Aboriginal and Torres Strait Islander peoples [19]
  • Ensuring that healthcare providers are aware of Aboriginal ways
Applications associated with Principle 1b: Developing trusting relationships with clients and communities

Trusting relationships between healthcare providers and clients and their communities may be developed by:

  • Ensuring that healthcare providers are aware of Aboriginal and Torres Strait Islander ways of knowing and doing
  • Creating opportunities for two-way learning between healthcare professionals and communities [13]
  • Scheduling appointments so that there is sufficient time to allow for the development of adequate relationships between clients and healthcare providers [13, 17, 31]
  • Allocating appropriate case-loads in order to ensure staff have sufficient time to build relationships with clients [13, 17, 31]
  • Developing procedures which ensure that client confidentiality is maintained [14, 45]
Applications associated with Principle 1c: Understanding and accepting cultural diversity within communities

Understanding and acceptance of cultural diversity may be promoted by:

  • Involving local communities in the development of culturally safe practices [13, 16, 19, 47-49]
  • Seeking the opinions of a variety of locally identified community members to guide the delivery of primary healthcare services [6, 13]
  • Encouraging significant input from Aboriginal and Torres Strait Islander peoples into the development of primary healthcare services and resources [6, 13]
Applications associated with Principle 1d: Delivering flexible primary healthcare services both within and outside of healthcare facilities

Flexible service delivery may include:

  • Delivering services outside of primary healthcare facilities, including within homes, schools, cultural venues or parklands [13, 20, 24, 25, 33, 44, 45, 51-55]
  • Providing services to populations who may be experiencing complex needs, including itinerant, homeless or prison populations [13, 48]
  • Using cultural ambassadors or local sporting groups to connect with young people about healthcare and health promotion [13]
  • Communicating health messages more broadly through appropriate media [13]
  • Identifying and utilising appropriate healthcare electronic applications (apps) [13]
  • Offering after-hours phone services [13, 45]
  • Providing after-hours clinical services [13, 45]
  • Promoting Aboriginal and Torres Strait Islander healthcare through various media, including radio, television, social media and electronic applications [29]