Empirical assessment of cultural safety within Australian hospitals highlights the impact of access to Aboriginal hospital liaison officers on the experiences of Aboriginal patients

Abstract

Purpose

Ensuring access to hospital services that are culturally safe is imperative for improving Aboriginal and Torres Strait Islander health outcomes. Addressing failings within existing services relies on the ability to prioritise areas for improvement in a methodologically robust manner that reflects the experiences of Indigenous service users. The construct and content validity of the Cultural Safety Survey, a mixed-methods questionnaire-based tool that captures the lived experiences of First Nations peoples attending hospital, was previously established. This study aimed to identify hospital and participant characteristics associated with positive or negative experiences of care.

Methods

Study sites included 49 hospitals in New South Wales, either through direct engagement with the hospital or opportunistic participant recruitment. A total of 413 participants took part in the study; 307 completed the whole survey and 298 of them had complete hospital and demographic data for analysis. Multivariable ordinal logistic regression was used to identify contributors to composite and domain-specific cultural safety scores. Assessed variables included respondent age, gender, distance travelled, attendance capacity (patient or visitor), hospital size, remoteness and socioeconomic status of location. Additional analysis assessing reported interaction with an Aboriginal hospital liaison officer (AHLO) on cultural safety scores was also performed.

Main findings

Of 413 participants, 298 provided complete demographic and hospital data, and confirmed informed consent. Responses related to 49 separate hospitals in New South Wales. Participant age and level of interaction with an AHLO showed a consistently positive association with cultural safety score. A unit increase in age was associated with 51.3% increased odds of a higher overall cultural safety score (P = .0012). Similarly, each unit increase in AHLO interaction was associated with 89.3% greater likelihood of a higher cultural safety score (P = .0031). Other variables – including higher socioeconomic advantage, female gender, and a shorter distance travelled – were positively associated with specific cultural safety domains. Respondent comments captured in the free text component of the questionnaire were consistent with quantitative findings.

Principal conclusions

The findings highlight the importance of access to an AHLO when visiting hospital. More generally, the ability to quantify the performance of hospital services based on the experiences of Indigenous end-users, and to identify factors that contribute to the nature of those interactions, provides a potential guide for impactful service reform.