Building patient trust in health systems: a qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia

Topp, Steph, Tully, Josslyn, Cummins, Rachel, Graham, Veronica, Yashadhana, Aryiati, Elliott, Lana, and Taylor, Sean (2022) Building patient trust in health systems: a qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia. Social Science and Medicine, 302. 114984.

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Abstract

Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not ‘cultureless,’ but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.

Item ID: 73680
Item Type: Article (Research - C1)
ISSN: 1873-5347
Keywords: Trust, Health system, Community health workers, Aboriginal and Torre Strait Islander Health, Worker, Indigenous, Governance, Human resources for health
Copyright Information: © 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/bync/4.0/).
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC GNT1131932, NHMRC GNT1173004
Date Deposited: 27 May 2022 00:06
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 40%
42 HEALTH SCIENCES > 4203 Health services and systems > 420306 Health care administration @ 20%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 40%
SEO Codes: 21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210303 Aboriginal and Torres Strait Islander health system performance @ 40%
20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs) @ 40%
23 LAW, POLITICS AND COMMUNITY SERVICES > 2302 Government and politics > 230204 Public services policy advice and analysis @ 20%
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