I recently gave a presentation at the 8th Rural and Remote Health Scientific Symposium (online, 6th October 2021). Here’s a link to the blog post and my full presentation (link), which is based on the concept of cultural rigour.
1. Cultural Rigour Definition—So What?
Yep, another definition, and definitions are something that I love examining, as when I did my Master of Public Health research on holistic health (Lutschini, 2005—that’s my birth name).
“We propose an initial definition of cultural rigour as the detailed attention to protocols of engaging with First Nations peoples in all research processes to ensure the cultural validity of the results. As a result, First Nations peoples’ diverse cultural knowledge is epitomised in research design, governance, and evidence-based recommendations.” (Lock, Walker & Browne 2021)
So what? Yes, I am determined to practice what I research! Hence the presentation.
2. Quality Appraisal Tools
My colleagues and I have been thinking about cultural rigour in our research practice (see the three references, below). When Jennifer, Troy, and I (Browne et al. 2020) worked on systematic reviews of nutrition, we used a “tool” to assess the quality of engagement between researchers and First Nations Australians. I get a lot of enjoyment from doing these technical research activities😊 We used that Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSIQAT—Harfield et al. 2020), and I participated in its development.
So, I wanted to bring the ATSIQAT into my governance practice with the Aboriginal Working Group, Patient Reported Measures, NSW Agency for Clinical Innovation. I wanted to join research with health program development. I know very well that researchers are criticised for being disconnected from the realities of program development.
3. Reflective Practice in Governance
I made some simple changes to the ATSIQAT, such as from “research” to “project” and “researchers” to “project leaders”, but I kept all the questions. It meant that I, as co-chair of the working group, and with the responsibility for ensuring that cultural safety is embedded in the development of the Aboriginal Patient Reported Outcomes Measures (APROMS), could undertake reflective practice.
I examined all the documents that the Working Group had amassed in two years or operation. At the end of it all I generated a list of 10 items that I reckon showed cultural rigour (but I’m a biased, in research it’s called confirmation bias, because self-examination is likely to be more positive than is an external, independent examination).
4. Culturally Rigorous Governance
The cultural rigour definition says things like cultural protocols, cultural validity, and cultural knowledge. These are fancy smancy terms and I wanted to show that I walk the talk in my governance practice. The ten items show that cultural rigour is clear at:
- beginning of the project and throughout its governance (philosophy of cultural safety, lots of First Nations people, diverse perspectives, yarning methodology),
- open to involvement of different stakeholders (government, researchers, primary health networks, different state agencies, and Aboriginal community advocates),
- assessing different PROMs tools (lots of these! For example, PROMIS-29, which we assessed through our cultural safety lens – did they include the worldviews of First Nations peoples?),
- policy support for cultural wellbeing (lots of policy statements about the importance of culture to health and wellbeing),
- heuristic, diagrammatic, program logic (cultures are difficult to describe, so drawing diagrams is one way to tease-out how cultures influence programs),
- patient and community engagement activities (For us, we used Community of Interest forums that involved over 100 people from across Australia. There are also three Proof of Concept sites where ACI project officers are working directly with First Nations patients to adapt the PROMIS-29),
- use of reflective quality appraisal tools (adapting the Aboriginal and Torres Strait Islander Quality Appraisal Tool),
- partnering with What Matters Wellbeing mob (This mob is developing a Quality of Life Tool for measuring wellbeing, but it’s not ready yet),
- developing an evaluation plan and activities (the three Proof of Concept sites will undergo realist evaluation), and
- an upcoming workshop on data sovereignty (First Nations people are asked to provide information to health professionals, so how is the data collected, used, and protected?).
I like to blab on about cultural safety being relevant at different levels, points, and pathways of the healthcare system. Here’s what my reflective practice on cultural rigour shows: cultural wellbeing at levels of governance, policy, practice, and program development. It’s shown at different points in the heuristic, program logic, proof of concepts, and community engagement activities. It’s also infusing different pathways because of the diverse stakeholders, the broad meaning of cultural wellbeing, and the nature of the PROM where First Nations patients’ needs trigger the health provider to access different social services (not just clinical health needs). But it’s my assessment only, and if there are any budding governance researchers out there who are willing to research this process, then give me a yell. I just hope that when I look back on this process, in ten years’ time, that First Nations patients are getting culturally safe services.
Christidis, R., Lock, M., Walker, T., Egan, M., & Browne, J. (2021). Concerns and priorities of Aboriginal and Torres Strait Islander peoples regarding food and nutrition: a systematic review of qualitative evidence. International Journal for Equity in Health, 20(1). https://doi.org/10.1186/s12939-021-01551-x
Lock, M. J., Walker, T., & Browne, J. (2021). Promoting cultural rigour through critical appraisal tools in First Nations peoples’ research. Australian and New Zealand Journal of Public Health, n/a(n/a). https://doi.org/https://doi.org/10.1111/1753-6405.13097
Browne, J., Lock, M., Walker, T., Egan, M., & Backholer, K. (2020). Effects of food policy actions on Indigenous Peoples’ nutrition-related outcomes: a systematic review. BMJ Global Health, 5(8), e002442. https://doi.org/10.1136/bmjgh-2020-002442
Harfield, S., Pearson, O., Morey, K., Kite, E., Canuto, K., Glover, K., Gomersall, J. S., Carter, D., Davy, C., Aromataris, E., & Braunack-Mayer, A. (2020, Apr 10). Assessing the quality of health research from an Indigenous perspective: the Aboriginal and Torres Strait Islander quality appraisal tool. BMC Med Res Methodol, 20(1), 79. https://doi.org/10.1186/s12874-020-00959-3
Lutschini, M. (2005). Engaging with holism in Australian Aboriginal health policy – a review. Aust New Zealand Health Policy, 2(1), 15. https://doi.org/0.1186/1743-8462-2-15