Communicating effectively with Aboriginal and Torres Strait Islander people

Recognize Historical Trauma: Understand that experiences of marginalization, including forced displacement, segregation, and the Stolen Generations, have led to a mistrust in government institutions and healthcare systems. Many Aboriginal and Torres Strait Islander individuals may still carry memories or stories of mistreatment, which may influence their willingness to engage with healthcare services.
Acknowledge Inequality: Awareness of ongoing disparities in health, education, housing, and employment can help in empathizing with challenges patients may face. This awareness fosters a respectful and informed approach, especially as some patients may have previously faced or witnessed instances of discrimination.
Reflect Without Judgment: Reflect on your biases and assumptions during interactions. Cultural values and beliefs in Aboriginal and Torres Strait Islander communities may vary significantly from Western norms, impacting decisions and interactions. Engage without imposing judgments to foster respect and understanding.

Start with Personal Connections: Begin consultations by introducing yourself warmly and sharing a bit about yourself. Showing genuine interest in where the patient is from or discussing common interests builds rapport and makes the individual feel valued beyond their clinical needs.
Adopt a “Person-First” Approach: Aboriginal and Torres Strait Islander cultures often prioritize relationships over tasks. Engage in meaningful conversation before diving into clinical matters, which can help in establishing a trust-based relationship.

Use Plain Language: Avoid medical jargon and complex terminology, as these can create barriers to understanding. Be clear and concise in explaining conditions, procedures, and treatment options.
Check for Understanding: Clarify and confirm understanding, particularly for critical terms. Rephrase or use visual aids (like diagrams, models, or videos) to make complex concepts more accessible.
Be Mindful with Dialects: Aboriginal English, Kriol, and Torres Strait Creole are common and have unique grammatical structures and vocabulary. Avoid mimicking these unless you’re fluent, as improper use can come off as disrespectful.

Flexible Time Allocation: Many Aboriginal and Torres Strait Islander people view time with a focus on family and community over rigid schedules. Allow for flexible appointment lengths and avoid rushing, as this can affect rapport and understanding.
Prioritize Relationship Over Efficiency: Avoid signaling impatience, as valuing relationships over strict schedules is a sign of respect in many Indigenous cultures.

Body Language Awareness: Be cautious of your body language, as feelings of frustration or impatience may be readily noticed. Maintain relaxed and open gestures to create a welcoming atmosphere.
Respect Personal Space: Respectful distance is important, especially between individuals of different genders. Ask for permission before touching, and consider the cultural sensitivities around physical contact.
Silence as a Positive: Silence can be a sign of respect, active listening, or contemplation, rather than discomfort or lack of understanding. Allow for pauses and do not rush to fill gaps in conversation.

Avoid Direct Eye Contact: Direct eye contact, especially with elders or individuals of the opposite gender, can be seen as disrespectful or aggressive. Follow the patient’s cues, averting or lowering your gaze if they seem uncomfortable with sustained eye contact.
Gender-Specific Eye Contact: Some individuals may prefer less eye contact with healthcare providers of a different gender. Respect these cues to avoid causing discomfort.

Using ‘Aunty’ or ‘Uncle’ Respectfully: These titles convey respect for elders in the community but should only be used with permission or if the individual initiates this approach.
Approaching ‘Shame’ Sensitively: Personal or sensitive topics may cause “shame,” or intense embarrassment. Avoid discussing personal information in public areas, and establish a private and secure setting for conversations.

Listen Actively and Avoid Assumptions: Listen without forming premature conclusions. Reflective listening, such as paraphrasing back what the patient said, ensures clarity and reinforces that their words are valued.
Indirect Questioning: Indirect approaches often help patients feel comfortable sharing. Frame questions in statements and avoid double-barreled questions, which can be confusing. Single, straightforward questions are often most effective.

Interpret “Yes” with Caution: Some individuals may say “yes” out of politeness or discomfort, not out of agreement or understanding. To confirm comprehension, ask patients to summarize what was discussed or to explain in their own words.
Set Expectations on Appointment Length: At the beginning, explain how long the consultation will last and provide opportunities to ask questions. This can help alleviate feelings of wanting to rush through the consultation.

Avoid Ambiguity in Instructions: Simple instructions like “take until finished” might be interpreted differently (e.g., stopping medication when symptoms improve). Clarify expectations with detailed explanations to ensure adherence.
Offer Choices for Self-Management: Present realistic options to increase the likelihood of treatment compliance. Empower patients by offering choices that align with their preferences and lifestyle, which may improve outcomes.

Understand Kinship Roles: Decisions are often influenced by extended family, so respect the role of family in decision-making processes. Allow time for discussions with family members, and provide private space if family consultation is needed.
Honor Privacy Requests: If a patient asks you to step out for a private discussion, respect this request as it demonstrates cultural sensitivity and trust.

Engage Local Indigenous Staff: Aboriginal and Torres Strait Islander staff or community liaison officers can provide cultural guidance and language support. This assistance may enhance communication, particularly when discussing complex health issues.
Community-Based Information Dissemination: Indigenous staff can advise on effective ways to distribute information in the community, helping ensure that it is well received and respected.