The experiences of Aboriginal health workers and non-Aboriginal health professionals working collaboratively in the delivery of health care to Aboriginal Australians: a systematic review

Background: Effective partnership between Aboriginal health workers and non-Aboriginal health care providers is critical in reducing the health inequity facing Aboriginal Australians. Many factors can obstruct successful workplace partnerships causing them to be damaging and unproductive. Understanding the elements of best practice in forming and maintaining successful working partnerships between Aboriginal health workers and non-Aboriginal health professionals is essential. Objectives: To systematically review the qualitative evidence on the lived experience of interprofessional collaboration between Aboriginal health workers and health professionals delivering care to Aboriginal Australians, with a view to identifying the perceived skills, knowledge, attitudes, management practices and institutional policies that enable successful interprofessional partnership. Inclusion criteria: Types of participants: The review considered qualitative studies that included Aboriginal health workers, Aboriginal liaison officers, Aboriginal community health workers and health professionals working collaboratively to deliver clinical care to Aboriginal Australians across a variety of Australian health care settings. These studies were conducted across a variety of rural, remote and urban Australian health care settings and included both Aboriginal community controlled and mainstream health organisations. Types of intervention(s)/phenomena of interest: The review considered studies that described the experiences of delivering/receiving care from Aboriginal health workers and non-Aboriginal health care providers in collaborative work practices, told from the perspectives of non-Aboriginal health care providers, Aboriginal health workers and the Aboriginal clients receiving care. Types of studies: Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included in this review. There was adequate evidence in the qualitative studies included in this review, so text and opinion papers were not considered. Types of outcomes: The review focussed on qualitative research findings reported as themes/categories in the included studies that related to the perspectives of the Aboriginal health workers, non-Aboriginal health care providers and Aboriginal clients regarding their experiences receiving/delivering care as a result of a clinical collaboration between an Aboriginal health workers and non-Aboriginal health care providers. It was also concerned with the experiences within the workplace, to identify those elements that support or obstruct collaboration between Aboriginal health workers and non-Aboriginal health care providers in order to enable the provision of culturally safe care. Search strategy: Using a three-step search strategy, databases of CINAHL, Pub Med, Scopus, Embase, Mednar, TROVE, ProQuest dissertation and Thesis, NHMRC, Department of Health and Ageing, Australian Indigenous Health Infonet and Conference proceedings and Australian Digital Theses where searched for published and unpublished studies in English from 1995 to2012. Hand-searching the Aboriginal and Islander Health Worker Journal was also included in the searching process. Methodological quality: Qualitative papers were assessed by two independent reviewers for methodological validity prior to inclusion in this review using standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data collection: Qualitative data was extracted from papers included in this review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Data synthesis: Qualitative research findings where pooled using QARI The process of meta-synthesis involved the extraction of qualitative findings of significance to the review question, which were grouped into categories, then analysed to generate synthesised findings. Results: Thirteen qualitative papers met the inclusion criteria for this review. From these studies, 429 findings were extracted and aggregated to from 39 categories. Seven meta-syntheses were derived from the categories with key themes relating to the benefits of effective partnership for the practitioner, the health service and the Aboriginal community, negative experiences as a result of a disabling work environment, and empowering factors at the organisational, workforce and interpersonal/practitioner level which enable successful partnership. Conclusions: Workplace culture and environments impact on the experiences of Aboriginal health workers and non-Aboriginal health care providers working in collaborative clinical arrangements. When Aboriginal health workers and non-Aboriginal health care providers are empowered to work in a successful clinical partnership, through an enabling workplace, there is a great benefit for both the health professional and Aboriginal health worker, the Aboriginal community and the health service. When the workplace is a disabling environment to successful interprofessional partnership, this undermines the capacity of the Aboriginal health worker and non-Aboriginal health care provider to perform their roles within a partnership, resulting in negative experiences for the Non Aboriginal health care provider, Aboriginal health worker and Aboriginal client. © the authors 2014.Carmel Anne Mercer, Jacinta Byrth, Zoe Jorda