Prompt

Culturally safe care: disengagement is data — reading the consultation, the recall system and the maternity pathway

KFP 1 (10 marks)

A 48-year-old Aboriginal man transferred to your practice 8 months ago after his previous GP retired. He has type 2 diabetes (HbA1c 8.9%) and hypertension, and his notes show three missed reviews and one presentation where he left before being seen. He has attended today for a work certificate. ^[55] ^[22]

Interpret his attendance pattern using the documented drivers of disengagement, rather than as non-adherence. (4) ^[55] ^[22]
What does the evidence identify as the key enablers of culturally safe general practice care you should build into his next contact? (3) ^[55]
How could an Aboriginal Community Controlled Health Service fit his care, and which patients prefer them most strongly? (3) ^[56]

Model answers

Missed reviews, leaving before being seen, and disengagement after a change of doctor are signals of unmet needs — information, confidence in quality of care, respectful treatment, basic comforts and peace of mind — which for Indigenous patients are compounded by racist and discriminatory treatment experiences. Self-discharge studies identify these five unmet needs as the tipping point; for Aboriginal participants the impact was compounded by racist and discriminatory behaviours. Treat the pattern as data about the service relationship, not the patient. ^[22] ^[55]
Qualitative work with Aboriginal and Torres Strait Islander general practice patients names: trusting and caring relationships, effective communication, respect for diverse Indigenous identities, individualised care, clinical competence and the GP's attitude. Enablers include adequate time, continuity of care, genuine engagement, informed consent, confidentiality, privacy and a physically welcoming environment. ^[55]
ACCHOs provide culturally safe, trusted, affordable, holistic care mainstream services often cannot. Nationally 34% of Indigenous adults use one as usual care but 47% prefer it; preference rises with financial stress (aOR 1.60), access to cultural knowledge (aOR 1.40), family-removal history (aOR 1.70) and past-year discrimination (aOR 1.68). Offer a referral and dual care pathway. ^[56]

References13Show

[5]Bailie J, Schierhout GH, Kelaher MA et al. Follow-up of Indigenous-specific health assessments - a socioecological analysis. Med J Aust, 2014.PMID 24938347
[11]McAullay D, McAuley K, Bailie R et al. Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children. J Paediatr Child Health, 2018.PMID 28833811
[15]O'Donnell M, Taplin S, Marriott R et al. Infant removals: The need to address the over-representation of Aboriginal infants and community concerns of another 'stolen generation'. Child Abuse Negl, 2019.PMID 30769191
[16]Liaw ST, Wade V, Furler JS et al. Cultural respect in general practice: a cluster randomised controlled trial. Med J Aust, 2019.PMID 30802313
[17]Harris BM, Harris ML, Rae K et al. Barriers and facilitators to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women: An integrative review. Midwifery, 2019.PMID 30878900
[22]Askew DA, Foley W, Kirk C et al. 'I'm outta here!': a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital. BMC Health Serv Res, 2021.PMID 34479571
[25]Dawson J, Laccos-Barrett K, Hammond C et al. Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature. Int J Environ Res Public Health, 2022.PMID 35682275
[33]Hardy BJ, Filipenko S, Smylie D et al. Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States. BMJ Open, 2023.PMID 37793931
[51]Williams K, Hamilton SL, Bacon R et al. First Nations families' maternity care experiences in the Australian Capital Territory: Kapati Time Yarning, intergenerational trauma and the case for Birthing with Country. Women Birth, 2026.PMID 41679160
[52]Kennedy M, Booth K, Bryant J et al. Effectiveness and implementation of an indigenous-led mailed smoking cessation intervention for aboriginal and torres strait islander people: outcomes of a hybrid type 1 trial. Nicotine Tob Res, 2026.PMID 41689484
[55]Brumpton K, Evans R, Sen Gupta T et al. Exploring cultural safety and person- and patient-centred care in general practice: voices of Aboriginal and Torres Strait Islander peoples. BMC Med Educ, 2026.PMID 41904486
[56]Astawesegn FH, Thapa S, Aychiluhm SB et al. The usual and preferred sources of healthcare for Aboriginal and Torres Strait Islander Australians: a multilevel analysis. BMC Health Serv Res, 2026.PMID 41981551
[61]Forster DA, Shafiei T, McLardie-Hore FE et al. The effect of culturally tailored continuity of midwifery care on perinatal outcomes for women having a first Nations baby in Victoria, Australia: a prospective non-randomised translational study. EClinicalMedicine, 2026.PMID 42534669

KFP 1 (10 marks)

Interpret his attendance pattern using the documented drivers of disengagement, rather than as non-adherence. (4) ^[55] ^[22]

What does the evidence identify as the key enablers of culturally safe general practice care you should build into his next contact? (3) ^[55]

How could an Aboriginal Community Controlled Health Service fit his care, and which patients prefer them most strongly? (3) ^[56]

Model answers

Missed reviews, leaving before being seen, and disengagement after a change of doctor are signals of unmet needs — information, confidence in quality of care, respectful treatment, basic comforts and peace of mind — which for Indigenous patients are compounded by racist and discriminatory treatment experiences. Self-discharge studies identify these five unmet needs as the tipping point; for Aboriginal participants the impact was compounded by racist and discriminatory behaviours. Treat the pattern as data about the service relationship, not the patient. ^[22] ^[55]

Qualitative work with Aboriginal and Torres Strait Islander general practice patients names: trusting and caring relationships, effective communication, respect for diverse Indigenous identities, individualised care, clinical competence and the GP's attitude. Enablers include adequate time, continuity of care, genuine engagement, informed consent, confidentiality, privacy and a physically welcoming environment. ^[55]

ACCHOs provide culturally safe, trusted, affordable, holistic care mainstream services often cannot. Nationally 34% of Indigenous adults use one as usual care but 47% prefer it; preference rises with financial stress (aOR 1.60), access to cultural knowledge (aOR 1.40), family-removal history (aOR 1.70) and past-year discrimination (aOR 1.68). Offer a referral and dual care pathway. ^[56]

References13Show

[5]Bailie J, Schierhout GH, Kelaher MA et al. Follow-up of Indigenous-specific health assessments - a socioecological analysis. Med J Aust, 2014.PMID 24938347
[11]McAullay D, McAuley K, Bailie R et al. Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children. J Paediatr Child Health, 2018.PMID 28833811
[15]O'Donnell M, Taplin S, Marriott R et al. Infant removals: The need to address the over-representation of Aboriginal infants and community concerns of another 'stolen generation'. Child Abuse Negl, 2019.PMID 30769191
[16]Liaw ST, Wade V, Furler JS et al. Cultural respect in general practice: a cluster randomised controlled trial. Med J Aust, 2019.PMID 30802313
[17]Harris BM, Harris ML, Rae K et al. Barriers and facilitators to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women: An integrative review. Midwifery, 2019.PMID 30878900
[22]Askew DA, Foley W, Kirk C et al. 'I'm outta here!': a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital. BMC Health Serv Res, 2021.PMID 34479571
[25]Dawson J, Laccos-Barrett K, Hammond C et al. Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature. Int J Environ Res Public Health, 2022.PMID 35682275
[33]Hardy BJ, Filipenko S, Smylie D et al. Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States. BMJ Open, 2023.PMID 37793931
[51]Williams K, Hamilton SL, Bacon R et al. First Nations families' maternity care experiences in the Australian Capital Territory: Kapati Time Yarning, intergenerational trauma and the case for Birthing with Country. Women Birth, 2026.PMID 41679160
[52]Kennedy M, Booth K, Bryant J et al. Effectiveness and implementation of an indigenous-led mailed smoking cessation intervention for aboriginal and torres strait islander people: outcomes of a hybrid type 1 trial. Nicotine Tob Res, 2026.PMID 41689484
[55]Brumpton K, Evans R, Sen Gupta T et al. Exploring cultural safety and person- and patient-centred care in general practice: voices of Aboriginal and Torres Strait Islander peoples. BMC Med Educ, 2026.PMID 41904486
[56]Astawesegn FH, Thapa S, Aychiluhm SB et al. The usual and preferred sources of healthcare for Aboriginal and Torres Strait Islander Australians: a multilevel analysis. BMC Health Serv Res, 2026.PMID 41981551
[61]Forster DA, Shafiei T, McLardie-Hore FE et al. The effect of culturally tailored continuity of midwifery care on perinatal outcomes for women having a first Nations baby in Victoria, Australia: a prospective non-randomised translational study. EClinicalMedicine, 2026.PMID 42534669

Culturally safe care — KFP-style written assessment

KFP 1 (10 marks)

Model answers

Culturally safe care — KFP-style written assessment

KFP 1 (10 marks)

Model answers