Addressing “Non-Compliance” in Aboriginal & Torres Strait Islander (ATSI) Patients

A strengths-based, culturally safe approach to improving treatment and follow-up adherence in general practice

Traditional lens	Culturally safe lens
“Non-compliance” implies patient fault.	“Sub-optimal adherence” is a shared system gap stemming from cultural, structural, social and historical factors.

Key principle: Shift from blaming individuals to adapting care so it fits patients’ realities and values.

Level	Barrier (examples)
System / Structural	• Distance to services, transport costs • Complex booking systems • Short, rigid consult times
Cultural & Historical	• Past discriminatory experiences → mistrust • Communication mismatch (medical jargon, indirect questioning)
Socio-economic	• Housing crowding, carer duties, food insecurity • Medication cost despite PBS co-payment relief
Health-system literacy	• Limited understanding of chronic disease or “silent” conditions (e.g. hypertension)
Treatment factors	• Painful injections (BPG), polypharmacy, complex dosing

Strategy	Practical Tips
Yarning & family-inclusive dialogue	Begin with open narrative (“What’s been happening for you?”); invite family/Elders.
Plain-language + culturally relevant metaphors	Use body charts, everyday analogies; avoid negatives (“bad kidneys”) → use positive framing (“keep kidneys strong”).
Teach-back	Ask patient to explain back the plan; clarifies misunderstandings in safe manner.
Motivational interviewing & strengths focus	Highlight resilience and previous successes; collaboratively set small goals.

Strategy	Action Items
Culturally safe environment	Aboriginal artwork, flags, Indigenous staff at front desk; zero-tolerance racism policy.
Flexible & longer appointments	Reserve untimed ATSI slots; walk-in capacity; outreach nurse visits.
Recall & reminder systems	SMS in plain language; phone calls from known staff; home visits for high-risk patients.
Use of Aboriginal Health Workers (AHWs)	AHW prepares patient, attends consult, explains meds in language/dialect.
Dose administration aids / blister packs	Fund through QUMAX or Closing the Gap (CtG) co-payment; explain icons not numbers.

Condition	Targeted Enablers	Illustrative Initiatives
RHD secondary prophylaxis	• Minimise injection pain (buffered BPG, EMLA cream) • Culturally meaningful schedules (e.g. “full-moon strategy”) • RHD registers with community dashboards	RHD Action, NT stepped-wedge trial, Rheumatic Fever Strategy evaluations.
Diabetes	• Group education led by local champions • On-Country physical-activity programs • Food-security partnerships	Community-driven “Got Sugar” program (Townsville ACCHO).

Map your ATSI cohort (use CTG & 715 registers).
Co-design solutions with local Elders & AHWs (ask “What works for our mob?”).
Audit missed appointments & incomplete scripts quarterly; look for system gaps.
Bundle care – align script renewals, pathology, and recall visits on the same day.
Case-manage the complex – create GPMP/TCA with clear roles and up to 5 allied-health visits.
Evaluate pain points – survey patients after injections or new medication starts.
Celebrate wins – share positive stories (with permission) to reinforce adherence norms.

✔ Language & trust trump directives – culturally adjusted communication halves misunderstanding and improves engagement.
✔ Non-adherence signals a system failure – redesign the care model, don’t blame the patient.
✔ AHWs and ACCHSs are adherence accelerators – integrate them early, fund their roles.
✔ Condition-specific tweaks matter – painless BPG techniques and meaningful timing boost RHD prophylaxis completion.
✔ Social determinants must be tackled – transport vouchers, meal programs, housing referrals prevent drop-outs.