Table 2 Summary and Key Data Extracted from Review Articles
Author (date) | Title | Journal/publication | Study type & methods | Focus location & organisational setting | Key themes relating to AHWs’ accountability relationships in the four domains |
|---|---|---|---|---|---|
Tregenza, J. & Abbott, K. 1995 [41] | Rhetoric and reality: Perceptions of the roles of Aboriginal Health Workers in Central Australia | Monograph | Empirical: intersectional lens using mixed methods; semi-structured interviews;. 294 AHWs from 26 communities. | 26 Remote and Regional communities in Central Australia (Northern Territory) | Social • AHWs ‘agents’ to improve health status and agents of social change in the community • Being Aboriginal and part of the community gives strength in role Provider • AHWs seen as main providers of healthcare in the community Political/Organisational • Clear power differentials with non-Aboriginal colleagues, with AHWs are ‘bottom of the rung’ • Perception that further education could enhance power and status • Non-Indigenous co-workers’ & supervisors’ perceptions of role frequently divergent with their own and a source of tension |
McMasters, A., 1996 [39] | Research from an Aboriginal health worker’s point of view | Australian & New Zealand Journal of Public Health | Non-empirical: experiential/opinion | Central Australia | Political • High expectations of AHW by mainstream health system Political/Organisational • Demanding responsibilities of the role, compounded for AHWs from remote communities, at odds with levels of knowledge and power • Tensions between Western and Indigenous models of health promotion |
Hecker, R. (1997) [52] | Participatory action research as a strategy for empowering aboriginal health workers | Australia New Zealand Journal of Public Health | Empirical: empowerment lens using participatory action research | ACCHO in Pitjantjatjara Lands, remote South Australia | Political • Access to practical training ad hoc Organisational • Perception that opinions not valued and no representation on key health service committees |
Jackson, D. et al., 1999 [40] | Towards (re)conciliation: (re)constructing relationships between Indigenous health workers and nurses | Journal of Advanced Nursing | Empirical: feminist lens, qualitative descriptive; in-depth interviews | Undisclosed Australian health service settings | Political • Role confusion involving inconsistent definitions of role and scope Organisational/Political • Power dynamics interfere with capacity for cross-professional collaboration • Cultural advocacy role key but un- or under-recognised by other professions Provider • Complex lines of responsibility to local community, family and bio-medically oriented health services |
Dollard, J.S. et al., 2001 [51] | Aboriginal Health Worker Status in South Australia | Aboriginal and Islander Health Worker Journal | Empirical: qualitative descriptive; questionnaire (n = 74), in depth interviews (10), and 4 focus group discussions (n = 35) | Various health service settings in South Australia | Political/Organisational • Lack of satisfaction with status compared to other staff linked to lack of professional and role recognition; inequality compared to other professionals (e.g. pay and qualifications required for appointments) • Limited capacity to voice concerns at high levels due to vertical power structures Organisational • Perception of being ‘jack of all trades but master of none’ |
Williams, C. 2003 [46] | Aboriginal health workers, emotional labour, obligatory community labour and occupational health and safety | Journal of Occupational Health and Safety Australia and New Zealand | Empirical: Sociological lens placing AHWs within institutional context; qualitative descriptive; interviews of 29 AHWs | Variety of health service settings, South Australia | Social • Experience of strong sense of obligation to care for family and kin of patient as well as patient • Community advocacy and cultural brokerage role crucial to AHWs Organisational • AHWs seen as point of contact for all Aboriginal patients regardless of health problem - causing tensions due to conflicting understandings of role Political/Organisational • Experiences of racism from non-Aboriginal co-workers |
Genat, B. (2006) [7] | Aboriginal Health workers: Primary Health Care at the Margins. | Book | Empirical: Ethnographic based on 6 AHWs experiences & interviews with colleagues and community clients in late 1990s | Urban Aboriginal Community Controlled Service in Western Australia | Social • AHWs experience strong sense of obligation to Aboriginal clients but tensions around perception that they should be available 24/7 Political/Organisational • AHWs lack voice and status within organisation and sector, that undermines professional capacity Provider • Professional identity of AHWs is tenuous, undermined by weak understanding of the role by colleagues and even clients |
Mitchell, M. et al., 2006 [38] | The Aboriginal health worker | Medical Journal of Australia | Non-empirical: experiential/opinion | Aboriginal Community Controlled Organisation, Townsville, Queensland | Political • Challenges in cross-jurisdictional variation in definitions of role, competencies and skills recognition Organisational • Different scope of work for AHWs in ACCHO setting compared with mainstream health service setting - reflecting a ‘social model of health’ versus a ‘disease model of health’ Social • Experience of being ‘everything to everyone’, incorporating community demand and expectation for after work hours Organisational • Perceptions of co-workers limited understanding of AHW role and impact on teamwork Provider/Organisational • Reflections on intersection of cultural and social norms relating to age and clan/family groups with workplace dynamics and their impact on patient relationships |
Harris, A. et al. (2007) [42] | The Aboriginal Mental Health Worker Program: The challenge of supporting Aboriginal involvement in mental health care in the remote community context | Australian e-journal for the Advancement of Mental Health | Empirical: qualitative descriptive; audits of client records, participant observation, and semi-structured interviews | Remote community health centres, Northern Territory | Political • Lack of consensus on AHWs role in clinical settings Organisational • Role confusion and varied expectations of AHWs • GPs resisting responsibility for proactive mentoring role • Assumption that AHWs are universally culturally skilled, not requiring formal support or development Provider • Role ambiguity and unclear cultural legitimacy source of individual strain and ‘burnout’ |
Hooper, K. et al., 2007 [43] | Health professional partnerships and their impact on Aboriginal health: an occupational therapist’s and Aboriginal health worker’s perspective | Australian Journal of Rural Health | Empirical: qualitative descriptive; in-depth interviews | Aboriginal and mainstream health and human service organisations in rural and remote North Queensland | Political • Lack of role clarity a barrier to communication and service planning Provider • Cultural advocacy and brokerage role central to efficacy of AHWs • Not having an AHW trained in OT undermines continuity of care |
Abbott, P. et al., 2008 [6] | Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition | Contemporary Nurse | Non-empirical: commentary with mini-cases | Australia-wide, with mini-cases focused on an AMS in Western Sydney | Social • Central nature of Cultural brokerage to role Provider • Rarely ‘off duty’ Political • Lack of recognition and limited career opportunities Organisational • Experience more autonomy within community controlled health services |
Stamp, G.E. et al., 2008 [50] | Aboriginal maternal and infant care workers: partners in caring for Aboriginal mothers and babies | Rural and Remote Health | Empirical: qualitative descriptive; semi-structured interviews with 5 AMIC workers and 4 midwives | Regional South Australia | Social • Community advocacy perceived to be crucial part of AHW role Organisational • Two-way partnership model with midwives emphasising mutual equivalence and valuing cultural knowledge of AHWs builds community trust in service Political/Organisational • Overcoming initial staff resistance to new AHW roles and agency |
Taylor, K.et al., 2009 [47] | Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology | Australian Health Review | Empirical: qualitative descriptive; open-ended interviews with 4 cardiology nurses, 3 nurses, 2 doctors, 2 social workers, 2 AHWs, 12 recent Aboriginal clients | Cardiology department in a tertiary hospital, Western Australia | Social • Community advocacy and brokerage work crucial to helping Aboriginal patients Provider • AHWs seen as point of contact for all sociocultural needs of Indigenous patients Organisational • Other staff tend to understand AHW role purely in terms of social and education functions despite clinical training, capacity and interest |
Lloyd, J. et al., 2009 [45] | The influence of professional values on the implementation of Aboriginal health policy | J Health Serv Res Policy | Empirical: qualitative descriptive; semi-structured interviews with 35 frontline health professionals | All sectors of the health system in Darwin, Alice Springs and remote Aboriginal communities, Northern Territory | Political/Organisational • Diverging views between AHWs and other professionals on scope of health care role including responsibility towards addressing social determinants of health |
Peiris, D. et al., 2012 [37] | Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment | BMC Health Services Research | Empirical: theory-driven (‘Candidacy’) health system assessment involving group interviews with 37 health staff | 7 health services (6 community-controlled and 1 government): two urban, one inner regional, two outer regional, and two remote, Queensland. | Social • Extension of AHW work beyond official hours Provider/Organisational • AHWs embody a community governance model and cultural brokerage role important but family obligations and kinship relations can sometime affect capacity to deliver health care |
Dawson, A.P. et al., 2012a [13] | Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study | International Journal for Equity in Health | Empirical: social-ecological lens using qualitative descriptive methods; in-depth interviews and focus groups | Urban, rural and remote health services in South Australia | Social • Widespread social acceptance and normalisation of tobacco use in the community Provider • Sense of professional responsibility for promoting smoking-cessation Organisational • Tacit acceptability of smoking in the workplace despite guidelines to the contrary Provider • Smoking as way to cope with stress of being ‘everything to everyone’ |
Dawson, A.P. et al., 2012b [54] | ‘I know it’s bad for me and yet I do it’: Exploring the factors that perpetuate smoking in Aboriginal health workers - a qualitative study | BMC Health Services Research | Empirical: qualitative descriptive; in-depth interviews and focus groups | Urban, rural and remote health services in South Australia | Provider • Conflict between professional responsibility to promote smoking cessation and social norms around tobacco use. • High value placed on community relationships and trust Organisational/Provider • Smoking as a coping mechanism for stresses caused by job and financial insecurity including salary disparities and short term contracts, high staff turnover, lack of value and recognition by local and broader health system |
Browne, J. et al., 2013 [55] | A qualitative evaluation of a mentoring program for Aboriginal health workers and allied health professionals | Australian and New Zealand Journal of Public Health | Empirical: qualitative evaluative; interviews (phone / face to face) | ACCHOs and state health services in Victoria | Political & Organisational • Uneven power dynamics with other health care providers |
King, M. et al., 2013 [44] | Issues that impact on Aboriginal health workers’ and registered nurses’ provision of diabetes health care in rural and remote health settings | Australian Journal of Rural Health | Empirical: qualitative descriptive; ‘discussion schedule’ with 17 participants from nine health services (5 of whom were AHWs) | Two Aboriginal community controlled and seven mainstream health services in Far Western New South Wales | Political/Organisational • Non-recognition of qualifications and lack of incentives to develop and use new skills • Tension between Western models of health promotion work and culturally appropriate engagement with community Organisational • Perception of being ‘glorified taxi drivers’ transporting patients, with limited time available to apply expertise • Poor communication with health service managers perpetuates role confusion Provider • Cultural advocacy and brokerage work source of pride and sense of uniqueness |
Rose, M. 2014 [36] | ‘Knowledge is power’: Aboriginal Healthworkers’ perspectives on their practice, education and communities | Doctor of Education Thesis - University of Technology, Sydney | Empirical: Social ecological lens; qualitative descriptive; in-depth, semi-structured interviews with 9 health workers in diverse roles | A variety of communities (rural, regional, urban), New South Wales | Social • Being Aboriginal and part of the community gives strength in role Provider • Community advocacy and brokerage work key component of role Political/Organisational • Clear power differentials with non-Aboriginal colleagues, where AHWs are ‘bottom of the rung’ • Perception that further education could enhance power and status Provider • Co-workers’ and community perceptions of role sometimes divergent and a source of tension |
Deshmukh, T. et al., 2014 [52] | ‘It’s got to be another approach’: an Aboriginal health worker perspective on cardiovascular risk screening and education | Australian Family Physician | Empirical: qualitative descriptive; in-depth interviews | AMS in Western Sydney, New South Wales | Social • AHWs’ strong sense of connectedness and embeddedness in community Political/Organisational • Perceptions of being undervalued by health system and other health professionals |
Jennings, W. et al., 2014 [34] | Yarning about health checks: barriers and enablers in an urban Aboriginal medical service | Aust J Prim Health | Empirical: qualitative descriptive; semi-structured interviews with clinical staff - 8 AHWs and 3 Aboriginal nurses | Urban community controlled AMS, Brisbane, Queensland | Organisational • Doctors perceived to have more authority by community members and also by other staff within health service Provider/Social • Cultural brokerage component of AHW role engenders community trust • Co-ownership approach to health between AHWs and community, and advocacy activity, key to role Provider • Cultural and social norms relating to gender, age & family background are in tension with some of AHWs’ professional obligations |
Hengel, B. et al., 2015 [48] | Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study | Sexual Health | Empirical: qualitative descriptive; in-depth interviews | Pirmary health centres in Queensland and Northern Territory | Social • Community connectedness promotes trust and improves access to clients. Provider/Social • Gendered cultural norms and cultural relationships influence appropriateness and ability to deliver care depending on gender and family connections of AHW staff |
Lowell, A. et al., 2015 [47] | Supporting Aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program | BMC Pregnancy & Childbirth | Empirical: program evaluation; semi-structured interviews with 76 participants (incl 15 Strong Women Workers)’ analysis of reports | Five remote communities, Northern Territory | Provider/Political • Smoking ceremony for new babies and use of traditional medicine seen by AHWs as an important part of a broad and continuous process of promoting health and wellbeing that occurs throughout life - but this type of work and approach is under-recognised by broader health system and is sometimes at odds with policy. Political/Social • Under-recognition of cultural dimensions of health care increases community dependence on mainstream services under a biomedical model of service delivery, to the detriment of both AHWs and community members |
Cosgrave, C. et al., 2016 [11] | Factors affecting job satisfaction of Aboriginal mental health workers working in community mental health in rural and remote New South Wales | Australian Health Review | Empirical: grounded theory study; semi-structured interviews | Rural and remote local health districts and community mental health services (NSW Health), New South Wales | Organisational • Role clarity difficulties impacting cross-professional collaboration • Perception among some non-Indigenous providers that AHWs are responsible for ‘anything Aboriginal’ • Perception among some non-Indigenous providers that Aboriginal clients always want to see Aboriginal health worker Political • Inequity in career pathways and remuneration as against qualifications and nature of work Social • Perception of being ‘everything for everybody’ • Tensions relating to service provision to clients with whom there may be family business or personal issues. |
Kirkham, R. et al., 2017 [34] | Emotional labour and aboriginal maternal infant care workers: the invisible load | Women & Birth: Journal of the Australian College of Midwives | Empirical: phenomenological qualitative study; 30 in-depth interviews with staff and clients | Anangu Bibi Birthing Program, run at Port Augusta Hospital and involving Country Health, South Australia | Social • Connection with community enhances trust in AHW but simultaneously exposes them to emotional stress Provider • Experiences of tension between cultural and community obligations, and health service (clinical/institutional expectations. • Personal and professional roles blurred Organisational • Perceptions of other professionals’ lack of respect for, and misunderstanding of, AHW role and capacity Political • Institutional barriers to greater agency and professional aspirations of AHW |
Conway, J. et al., 2017 [17] | The barriers and facilitators that Indigenous health workers experience in their workplace and communities in providing self-management support: a multiple case study | BMC Health Services Research | Empirical: multiple case studies; in-depth interviews | Rural and urban health centres including AMSs in five Australian states | Provider • Managing ‘dual relationships’ with health service managers and members of the community • Challenge of maintaining professional boundaries Social • Tensions regarding smoking - social pressure to smoke versus undermining role model capacity |