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Title: 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.
Authors: Topp, Stephanie M
Tully, Josslyn
Cummins, Rachel
Graham, Veronica
Yashadhana, Aryati
Elliott, Lana
Taylor, Sean
Citation: Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Soc Sci Med. 2022 Jun;302:114984. doi: 10.1016/j.socscimed.2022.114984. Epub 2022 Apr 19.
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.
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Journal title: Social science & medicine (1982)
Volume: 302
Pages: 114984
Publication Date: 2022-06-01
Type: Journal Article
DOI: 10.1016/j.socscimed.2022.114984
Appears in Collections:(a) NT Health Research Collection

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