Aboriginal patient and interpreter perspectives on the delivery of culturally safe hospital-based care

Issue addressed: Improving equitable delivery of health care for Aboriginal people in northern Australia is a priority. This study sought to gauge patient experiences of hospitalisation and to identify strategies to improve equity in health care for Aboriginal patients. Aims were to validate an experience of care survey and document advice from Aboriginal interpreters.

Methods: Medical charts of Aboriginal patients were audited for documentation of language and interpreter use. Aboriginal inpatients were surveyed using an adapted Australian Hospital Patient Experience Question Set. Multiple-choice responses were compared with free-text comments to explore validity. Semi-structured interviews were conducted with Aboriginal interpreter staff.

Results: In 68 charts audited, primary language was documented for only 30/68 (44%) people. Of 73 patient experience survey respondents, 49/73 (67%) indicated satisfaction with overall care; 64/73 (88%) indicated hospital staff communicated well in multiple-choice responses. Respondents who gave positive multiple-choice ratings nevertheless reported in free text responses concerns relating to social-emotional support, loneliness, racism and food. Key themes from interviews included the benefits to patients from accessing interpreters, benefits of hospital-based support for interpreters and the need for further service redesign.

Conclusions: Multiple-choice questions in the survey were of limited utility; respondents' free comments were more informative. Social and emotional wellbeing must be addressed in future experience-of-care evaluations. Aboriginal patients' language and cultural needs can be better met by improved systems approaches. Aboriginal interpreters are uniquely placed to advise on this. SO WHAT?: Improving health communication is critical to equitable and effective health care. Interventions must be driven by Aboriginal perspectives.