Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners

This is the accepted version of the following article: [Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. and Francis, T. (2014), Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38: 355–361. ], which has been published in final form at doi: 10.1111/1753-6405.12231. This item was under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Objective. There is little literature on health service level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies: , one Aboriginal community controlled, and one state government managed primary health care service to examine cultural respect strategies, client experiences, and barriers to cultural respect. Methods. Data were drawn from 22 interviews with staff from both services, and four community assessment workshops, with a total of 21 clients. Results. Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included being grounded in a social view of health, including advocacy and addressing social determinants, employing Aboriginal staff, creating a welcoming service, supporting access through transport, outreach, and walk-in centres, and integrating cultural protocol. Barriers included communication difficulties, racism and discrimination, and externally developed programs. Conclusions. Service level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing. Implications. Primary health care’s social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system