Improving Clinician-Patient Communication in Aboriginal Health Care: Barriers and Enablers to Implementing Culturally Informed Communication Training (Clinical Yarning)

Abstract

Objective

This study examines barriers and enablers to implementing Clinical Yarning into health care from the perspective of health care staff.

Setting

The Midwest Region (> 60,000 km²), Western Australia (WA).

Design

Semi-structured interviews with health care practitioners across four regional, rural and remote centers. Interview schedule was drawn from the Theoretical Domains Framework (TDF). Interviews were transcribed verbatim and analysed using inductive and framework analysis, informed by the TDF and Mechanisms of Action.

Results

Interviews with 53 health care practitioners (17% Aboriginal, 83% non-Aboriginal) ranged from 14 to 60 min in length. Barriers and enablers coalesced around three main themes: knowledge/perceptions of Clinical Yarning, training practices in general and Clinical Yarning specifically, and environmental conditions including general cultural safety and executive support. The barriers and enablers found in each of the domains lead to implementation strategies which use program champions and executive support, build on the positivity towards Clinical Yarning, pay attention to training delivery modes like including local cultural experts where able and acknowledge the larger cultural safety/security barriers within the health service. The barriers presented by workforce challenges are important key variables in any success of the Clinical Yarning intervention.

Conclusion

The documented enablers and barriers to implementing Clinical Yarning in the Midwest when viewed through a TDF/MoA framework provide a way to create a systematic implementation strategy to address the identified barriers and enablers. The findings have implications for other health services wishing to implement Clinical Yarning as well as culturally secure health care more broadly.