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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

Author

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  • Topp, Stephanie M.
  • Tully, Josslyn
  • Cummins, Rachel
  • Graham, Veronica
  • Yashadhana, Aryati
  • Elliott, Lana
  • Taylor, Sean

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.

Suggested Citation

  • Topp, Stephanie M. & Tully, Josslyn & Cummins, Rachel & Graham, Veronica & Yashadhana, Aryati & Elliott, Lana & Taylor, Sean, 2022. "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," Social Science & Medicine, Elsevier, vol. 302(C).
    • Handle: RePEc:eee:socmed:v:302:y:2022:i:c:s0277953622002908
    DOI: 10.1016/j.socscimed.2022.114984
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    References listed on IDEAS

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