Building patient trust in health systems: A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia

Stephanie M Topp; Josslyn Tully; Rachel Cummins; Veronica Graham; Aryati Yashadhana; Lana Elliott; Sean Taylor

doi:10.1016/j.socscimed.2022.114984

Building patient trust in health systems: A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia

Soc Sci Med. 2022 Jun:302:114984. doi: 10.1016/j.socscimed.2022.114984. Epub 2022 Apr 19.

Authors

Stephanie M Topp¹, Josslyn Tully², Rachel Cummins³, Veronica Graham³, Aryati Yashadhana⁴, Lana Elliott⁵, Sean Taylor⁶

Affiliations

¹ College of Public Health Medical and Vet Sciences, James Cook University, Australia; Nossal Institute for Global Health, University of Melbourne, Australia. Electronic address: globalstopp@gmail.com.
² Torres and Cape Hospital and Health Service, Queensland, Australia.
³ College of Public Health Medical and Vet Sciences, James Cook University, Australia.
⁴ Centre for Primary Health Care, University of New South Wales, Australia; School of Population Health, University of New South Wales, Australia; School of Social Sciences, University of New South Wales, Australia.
⁵ College of Public Health Medical and Vet Sciences, James Cook University, Australia; School of Public Health and Social Work, Queensland University of Technology, Australia.
⁶ NT Health, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.

PMID: 35523107
DOI: 10.1016/j.socscimed.2022.114984

Abstract

Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not 'cultureless,' but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.

Keywords: Aboriginal and Torre Strait Islander Health Worker; Community health workers; Governance; Health system; Human resources for health; Indigenous; Trust.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Health Services, Indigenous*
Humans
Native Hawaiian or Other Pacific Islander
Queensland
Trust