Understanding cultural safety in mainstream health services for Aboriginal and Torres Strait Islander children, young people and their families: A rapid review and thematic synthesis

Abstract

Purpose

As in all colonised nations, Aboriginal and Torres Strait Islander children and young people face higher rates of mental health challenges and medical conditions than non-Indigenous youth. Strengthening cultural safety in healthcare services is increasingly being recognised as essential to addressing these disparities and improving service delivery. This rapid review sought to synthesise existing evidence on the components of culturally safe healthcare for Aboriginal and Torres Strait Islander children and young people aged 0 to 25 years.

Methods

PubMed, Web of Science, Embase, PsycINFO, CINAHL and ATSIHEALTH were searched to identify peer-reviewed articles published up to November 2024. Eligible studies explored characteristics of culturally safe health services from the perspectives of service users (Aboriginal and Torres Strait Islander children and young people aged 0 to 25 years), their families and Indigenous staff within these services. The quality of included studies was assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool, and thematic synthesis was used to develop themes.

Main findings

Twenty studies were included in the review. Six themes were identified. Cultural safety in healthcare requires culturally responsive communication and a capable, well-supported workforce that includes Aboriginal and Torres Strait Islander staff at all levels. Care must centre families and communities, acknowledging and embedding kinship systems and cultural values. Strong Indigenous governance and service-led community engagement are essential. While representations of culture in service environments are essential, true cultural safety requires integrating Aboriginal and Torres Strait Islander knowledges and healing practices throughout care.

Principal conclusions

The findings highlight the critical role of a capable and culturally responsive workforce and visible representations of culture in healthcare settings to foster safety. These efforts must be complemented by broader service-level and system-level reforms that formalise cultural governance, embed Aboriginal and Torres Strait Islander cultural values, and deliver care that is responsive to the strengths and needs of families.