Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-11T03:52:07.720Z Has data issue: false hasContentIssue false
  • English
  • Français

Development and Validation of a Questionnaire to Measure Attitude change in Health Professionals after Completion of an Aboriginal Health and Cultural Safety Training Programme

Published online by Cambridge University Press:  11 December 2017

Courtney Ryder ,
Tamara Mackean ,
Shahid Ullah ,
Heather Burton ,
Heather Halls ,
Dennis McDermott  and
Wendy Edmondson
Courtney Ryder*
Affiliation:
Southgate Institute for Health, Society and Equity, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
Tamara Mackean
Affiliation:
Southgate Institute for Health, Society and Equity, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
Shahid Ullah
Affiliation:
South Australian Health & Medical Research Institute, ANZDATA & ANZOD Registry Adelaide, South Australia 5000, Australia
Heather Burton
Affiliation:
Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
Heather Halls
Affiliation:
Flinders Rural Health South Australia, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
Dennis McDermott
Affiliation:
The Poche Centre for Indigenous Health and Well-Being, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
Wendy Edmondson
Affiliation:
Rural Clinical School, The Office of the Medical Dean, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland 4350, Australia
*
address for correspondence: Courtney Ryder, Southgate Institute for Health, Society and Equity, Medicine, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia. Email: courtney.ryder@flinders.edu.au
Get access

Abstract

Socially accountable health curricula, designed to decrease Aboriginal health inequities through the transformation of health professional students into culturally safe practitioners, has become a focal point for health professional programmes. Despite this inclusion in health curricula there remains the question of how to best assess students in this area in relation to the concept, of cultural safety and transformative unlearning, to facilitate attitudinal change. To address this question, this study developed a research questionnaire to measure thematic areas of transformative unlearning, cultural safety and critical thinking in Aboriginal Health for application on undergraduate and postgraduate students and faculty staff. The Likert-scale questionnaire was developed and validated through face and content validity. Test–retest methodology was utilised to determine stability and reliability of the questionnaire with 40 participants. The extent of agreement and reliability were determined through weighted kappa and intraclass correlation coefficient. Exploratory factor analysis was calculated to determine construct validity for questionnaire items. For the overall population subset the tool met good standards of reliability and validity, with 11 of the 15 items reaching moderate agreement (κ > 0.6) and an intraclass correlation coefficient of 0.72, suggesting substantial agreement. Cronbach's alpha was calculated above 0.7 for the thematic areas. The majority of items provided high factor loadings, low loading items will be reviewed to strengthen the tool, where validations of the revised tool with a larger cohort will allow future use to compare and determine effective teaching methodologies in Aboriginal health and cultural safety curricula.

Keywords

Aboriginal peoplecritical thinkingcultural safetyhealth curriculumtool validationtransformative learning
Type
Research Article
Information
The Australian Journal of Indigenous Education , Volume 48 , Issue 1 , August 2019 , pp. 24 - 38
Copyright
Copyright © The Author(s) 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Almeida, S.R.G. (2016). A story told in a whisper, or the impossibility of atonement. Ilha do Desterro, 69 (2), 57–62.Google Scholar
Anderson, J., Perry, J., Blue, C., Browne, A. Henderson, A., Khan, K., Kirkham, S., Lynam, J., Semeniuk, P., & Smye, V. (2003). “Rewriting” cultural safety within the postcolonial and postnational feminist project toward new epistemologies of healing. Advances in Nursing Science, 26 (3), 196–214.Google Scholar
Australian Medical Council. (2010). Assessment and accreditation of medical schools: Standards and procedures. Retrieved December 10, 2013 from http://www.amc.org.au/Google Scholar
Australian Nursing and Midwifery Accreditation Council. (2012). Registered nurse accreditation standards 2012. Retrieved January 30, 2014 from http://www.anmac.org.au/Google Scholar
Beavis, A., Hojjati, A., Kassam, A., Choudhury, D., Fraser, M., Masching, R., & Nixon, S. (2015). What all students in healthcare training programs should learn to increase health equity: perspectives on postcolonialism and the health of Aboriginal peoples in Canada. BMC Medical Education, 15, 155.Google Scholar
Benham, S. (2001). Cultural safety values difference. Nursing New Zealand (Wellington, NZ: 1995), 7 (1), 28.Google Scholar
Berger, J. (2004). Dancing on the threshold of meaning recognising and understanding the growing edge. Journal of Transformative Education, 2 (4), 336–351.Google Scholar
Best, O. (2014). The cultural safety journey: An Australian nursing context. In Best, O. & Fredericks, B. (Eds.), Yatdjuligin aboriginal and Torres strait islander nursing and midwifery care (pp. 51–73). Melbourne: Cambridge University Press.Google Scholar
Blair, I., Steiner, J., & Havranek, E. (2011). Unconscious (Implicit) bias and health disparities: Where do we go from here?. The Permanente Journal, 15 (2), 71–78.Google Scholar
Branch, W. (2010). The road to professionalism: Reflective practice and reflective learning. Patient Education and Counselling, 80, 327–332.Google Scholar
Brascoupé, S., & Waters, C. (2009). Cultural safety exploring the applicability of the concept of cultural safety to aboriginal health and community wellness. Journal of Aboriginal Health, 5 (2), 6–41.Google Scholar
Browne, A., Smye, V., & Varcoe, C. (2005). The relevance of postcolonial theoretical perspectives to research in aboriginal health. Canadian Journal of Nursing Research, 37 (4), 17–37.Google Scholar
Carr, S.E., Paul, D., & Bazen, J. (2011). Integrated undergraduate Aboriginal health curricula: Validating a program evaluation survey tool. Focus on Health Professional Education, 12 (3), 34–40.Google Scholar
Cohen, J. (1968). Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychological Bulletin, 70, 213–220.Google Scholar
Cooper, L. (2011). Activists within the academy: The role of prior experience in adult learners’ acquisition of postgraduate literacies in a postapartheid South African university. Adult Education Quarterly, 61 (1), 40–56.Google Scholar
Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334.Google Scholar
DeVon, H., Block, M., Moyle-Wright, P., Ernst, D., Hayden, S., Lazzara, D., Savoy, S., & Kostas-Polston, E. (2009). A psychometric toolbox for testing validity and reliability. Journal of Nursing Scholarship, 39 (2), 155–164.Google Scholar
Dietitians Association of Australia. (2009). National competency standards for entry level dietitians in Australia. Retrieved January 30, 2014 from http://daa.asn.au/Google Scholar
Durey, A. (2010). Reducing racism in Aboriginal health care in Australia: Where does cultural education fit?. Australian and New Zealand Journal of Public Health, 34 (S1), S87–S92.Google Scholar
Durey, A., & Thompson, S. (2012). Reducing the health disparities of Indigenous Australians: Time to change focus. BMC Health Services Research, 12, 151.Google Scholar
Efron, B. (1986). Bootstrap methods for standard errors, confidence intervals and other measures of statistical accuracy. Statistical Science, 1, 54–57.Google Scholar
Fleiss, J. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76 (5), 378–382.Google Scholar
Gerlach, A.J. (2012). A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79 (3), 151–158.Google Scholar
Hislop, D., Bosley, S., Coombs, C.R., & Holland, J. (2013). The process of individuals unlearning: A neglected topic in an under-researched field, Management Learning, 45 (5), 540–560.Google Scholar
Hume, C., Ball, K., & Salmon, J. (2006). Development and reliability of a self-report questionnaire to examine children's perceptions of the physical activity environment at home and in the neighbourhood. International Journal of Behavioural Nutritional and Physical Activity, 17, 3–16.Google Scholar
Jungersen, K. (2002). Cultural safety: Kawa Whakaruruhau: An occupational therapy perspective. New Zealand Journal of Occupational Therapy, 49, 4–9.Google Scholar
Kelaher, M., Ferdinand, A., & Paradies, Y. (2014). Experiencing racism in health care: The mental health impacts for victorian aboriginal communities. Medical Journal of Australia, 200, 1–4.Google Scholar
Larson, A., Gillies, M., Howard, P., & Coffin, J. (2007). It's enough to make you sick: the impact of racism on the health of Aboriginal Australians. Australian & New Zealand Journal of Public Health, 31 (4), 322–329.Google Scholar
Lynn, M. (1985). Determination and quantification of content validity. Nursing Research, 35 (6), 382–386.Google Scholar
Macdonald, G. (2002). Transformative unlearning: Safety, discernment and communities of learning. Nursing Inquiry, 9, 170–178.Google Scholar
McCleland, A. (2011). Culturally safe nursing research: exploring the use of an indigenous research methodology from an indigenous researcher's perspective. Journal of Transcultural Nursing, 22 (4), 362–367.Google Scholar
McDermott, D. (2012). Can we educate out of racism?. Medical Journal of Australia, 197 (1), 15.Google Scholar
McDermott, D., & Sjoberg, D. (2012). Managing a diverse student discomfort with an Indigenous health curriculum. LIME Good Practice Case Studies Volume 1, 26. Retrieved December 10, 2013 from http://www.limenetwork.net.au/resources/good-practice-case-studiesGoogle Scholar
McGough, S., Wynaden, D., & Wright, M. (2017). Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study. International Journal of Mental Health Nursing, doi: 10.1111/inm.12310.Google Scholar
Miville, M., Gelso, C., Pannu, R., Liu, W., Touradji, P., Holloway, P., & Fuertes, J. (1999). Appreciating similarities and valuing differences: The Miville-Guzman universaility diversity scale. Journal of Counselling Psychology, 43 (6), 291–307.Google Scholar
Moreton-Robinson, A. (2004). Whitening race: Essays in social and cultural criticism. Canberra: Aboriginal Studies Press.Google Scholar
Mulnix, J. (2012). Thinking critically about critical thinking, Educational Philosophy Theory, 44 (5), 464–479.Google Scholar
Newman, P., & Peile, E. (2002). Valuing learners’ experience and supporting further growth: Educational models to help experienced adult learners in medicine. British Medical Journal, 325, 200–202.Google Scholar
Nichols-English, G., & Guion, W. (2008). Evaluation of the perception of cultural competency assessment instrument for allied health students. Journal of Allied Health, 37 (4), 244–254.Google Scholar
Nursing Council of New Zealand. (2005). Guidelines for cultural safety, the Treaty of Waitangi and Māori health in nursing education and practice. Retrieved September 5, 2012 from http://www.nursingcouncil.org.nz/download/97/cultural-safety11.pdfGoogle Scholar
Occupational Therapy Council (OTC) (Australia & New Zealand). (2013). Accreditation standards for entry-level occupational therapy education programs. Retrieved January 30, 2014 from http://otcouncil.com.au/Google Scholar
Paradies, Y., Harris, R., & Anderson, I. (2008). The impact of Racism on indigenous health in Australia and Aotearoa: Towards a research agenda. Discussion paper no. 4. Darwin: Cooperative Research Centre for Aboriginal Health.Google Scholar
Paul, D., Ewen, S., & Jones, R. (2014). Cultural competence in medical education: Aligning the formal, informal and hidden curricula. Advances in Health Science Education, 19, 751–758.Google Scholar
Pedersen, A., Beven, J., Walker, I., & Griffiths, B. (2004). Attitudes toward indigenous Australians: The role of empathy and guilt. Journal of Community & Applied Social Psychology, 14, 233–249.Google Scholar
Phillips, G. (2015). Dancing with power: Aboriginal health, cultural safety and medical education. Unpublished PhD Thesis. Monash University, Melbourne.Google Scholar
Ramsden, I. (2002). Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Unpublished PhD Thesis. Victoria University, Melbourne.Google Scholar
Rasmussen, L. (2001). Towards reconciliation in aboriginal health: Initiatives for teaching medical students about aboriginal issues. Melbourne: The University of Melbourne.Google Scholar
Rew, L., Becker, H., Cookston, J., Khosropour, S., & Martinez, S. (2003). Measuring cultural awareness in nursing. Journal of Nursing Education, 42 (6), 249–257.Google Scholar
StataCorp. (2011). Stata statistical software: Release 12. College Station, TX: StataCorp.Google Scholar
Strasser, R., Hogenbirk, J., Minore, B., March, D., Berry, S., Mccready, W., & Graves, L. (2013). Transforming health professional education through social accountability: Canada's Northern Ontario school of medicine. Medical Teacher, 35 (6), 490–496.Google Scholar
Streiner, D., & Norman, G. (2008). Health measurement scales — A practical guide to their development and use. New York: Oxford University Press.Google Scholar
Tabachnick, B., & Fidell, L. (2007). Using multivariate statistics. Boston: Pearson Education.Google Scholar
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53–55.Google Scholar
Thackrah, R., & Thompson, S. (2013). Confronting uncomfortable truths: Receptivity and resistance to Aboriginal content in midwifery education. Contemporary Nurse, 46 (1), 113–122.Google Scholar
Tlostanova, Madina V., & Mignolo, Walter D. (2012). Learning to unlearn: Decolonial reflections from Eurasia and the Americas. Columbus, OH: Ohio State University Press.Google Scholar
Trees, K., & Nyoongah, M. (1993). Postcolonialism: Yet another colonial strategy? Journal of the South Pacific Association for Commonwealth Literature and Language Studies, 36. Retrieved May 11, 2017 from http://researchrepository.murdoch.edu.au/id/eprint/11925/Google Scholar
Walton, J. (2011). Can a one-hour presentation make an impact on cultural awareness?. Nephrology Nursing Journal, 38 (1), 21–31.Google Scholar
Weir, J. (2005). Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. Journal of Strength and Conditioning Research, 19 (1), 231–240.Google Scholar
Westwood, B., & Westwood, G. (2010). Aboriginal cultural awareness training: Policy v. accountability failure in reality. Australian Health Review, 34, 423–429.Google Scholar
Williams, B., Brown, T., & Onsman, A. (2012). Exploratory factor analysis: A five-step guide for novices. Australasian Journal of Paramedicine, 8 (3), 1–13.Google Scholar
Wilson, A. (2014). Addressing uncomfortable issues: reflexivity as a tool for culturally safe practice in Aboriginal and Torres Strait Islander health. The Australian Journal of Indigenous Education, 43, 218–230.Google Scholar
Woloschuk, W., Harasym, P., & Temple, W. (2004). Attitude change during medical school: A cohort study. Medical Education, 38, 522–534.Google Scholar