Aboriginal health research is not black and white – lessons from the field

Brief report

Published in the HealthBulletin

Posted on:

15 August, 2014

Issue

Vol 14 No 3, July 2014 – September 2014

Introduction

Having embarked on a journey in Aboriginal and Torres Strait Islander health research, other researchers have asked about our experiences. There are several points to share with other non-Aboriginal researchers. These are brief lessons from the field from an Aboriginal cultural consultant and a non-Aboriginal researcher, where working together has been a two-way learning experience. As a consultant, there has been greater insight into the research arena and as a non-Aboriginal researcher, valuable cultural lessons into the values, beliefs and protocols of an Aboriginal community.

Relationships

Before commencing any research, it is imperative to build trust and relationships with the community. In Aboriginal culture the overarching glue of life, work and community is relationships. On opposing ends of the cultural spectrum are individualistic (Western) and collectivist cultures (1). Aboriginal cultures value social cohesion, obligation and perseverance, and are more collective (2), loyal and interdependent (1). Relationships require time to develop, and in our time-poor society we need to shift the way we overvalue time and undervalue relationships.

Relationships with Aboriginal mentors and community reference group members are important not only for professional networks, but integral to personal growth, understanding and continuous reflection – a process of informal reconciliation. Having an Aboriginal supervisor or consultant from the formal beginning of the research is recommended. This person’s contribution and guidance will enrich the journey. Vicary and Bishop describe the process of establishing an Aboriginal reference or steering group, and their role to provide advice and to vouch for researchers (3).

Reciprocity and mutual benefit

Australian Aboriginal people are regarded as some of the most researched groups in the world (4). There has been a recent trend in Aboriginal research to be strength-based rather than deficit-focussed, as has often been the case of much past research in Aboriginal health. Early research studies have been criticised as being biased and disempowering with a focus on the gaps between Aboriginal and non-Aboriginal groups (5). There is shift towards strength-based research, as well as internal cohorts within Aboriginal groups, rather than between Aboriginal and non-Aboriginal. Many communities welcome research if there are benefits for the community and the process is undertaken with cultural security (6). Consider about how your research will benefit the community and build the capacity of community members. Work with Aboriginal elders or mentors to refine a research question that is meaningful in an area of priority and concern to the community.

Time and meetings

The concept of time in Aboriginal culture is constructed in a different manner to that in Western society. Aboriginal people perceive time in a more circular pattern rather than a non-Aboriginal linear way of past, present and future (7). A circular pattern or time-circle implies that events are placed according to their importance to both the individual and the community. Don’t be impatient; it takes time to work with the community.

Meetings with Aboriginal reference group members and mentors require a different approach to Western systems and social expectations. Some Aboriginal consultants, formal or informal, will support your research outside of their normal job description, therefore structured time is often less relevant. If possible, it may be useful to avoid scheduling other appointments shortly after meetings with Aboriginal mentors and colleagues as many of the deeper conversations occur at the end of meetings, usually after formalities end. Social yarning (8) is the conversations wherein rapport and trust develop. Like most new working relationships, initial introductions are most effective face-to-face, via an introduction by a mutually known party. Regardless of the culture or colour of a person, face-to-face interactions allow a more open mode of communication.

Language and methodology

There are a number of research methods for Aboriginal populations developed by Aboriginal researchers – with use of appropriate language in interview schedules and questionnaires impacting the effectiveness of the research (8-11). Research instruments must be developed or selected in consultation with Aboriginal representatives (12). As all good researchers know, asking the wrong questions will lead you in the wrong direction. Asking the right questions, and in the right way, is imperative. The National Health and Medical Research Council (NHMRC) Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research include the values of reciprocity, respect, equality, survival and protection; and responsibility (13). Putt (9) discusses the benefits of participatory and community based research as sharing ownership between participants and researchers. Putt also describes considerations when adapting research instruments (9).

Snowballing and purposive sampling are common methods of recruitment in Aboriginal research – both methods used in our research (14). Invitations are generally most effective when introduction is made by a mutually known individual, who can vouch on behalf of the researchers. This can be via colleagues, peers, family members and staff. Being involved in a volunteer capacity in Aboriginal community agencies and events is also a practical way of engaging within the values of reciprocity, respect and responsibility. Another point of recommended practice is to seize opportunities and remain flexible. If individuals are interested, maintaining momentum can be difficult as peoples’ interests’ peak and fall, as their personal and professional demands fluctuate.

The language we use in daily contexts shapes our social constructs and affirms cultural values (15, 16). Terms such as ‘give back’, ‘our’ or ‘my’ (e.g. my cultural consultant), ‘their’ (e.g. their problem) implies disproportional power, ownership and a deficit view. Even terms like ‘problem’ and ‘difficulties’ have underlying implications of social constructs of position and power, which perpetuate a culture of inequality. Although one does not have to be continuously uncertain of saying the wrong thing, it is necessary to be aware of how language subconsciously impacts schemas (17). In addition to language considerations, many Aboriginal people speak a variety of both Aboriginal English and Standard Australian English. Eades (18) describes the use of English in Aboriginal culture and how Aboriginal English reflects the grammatical structure of traditional Aboriginal languages. Language must always be interpreted in context.

Aboriginal cultures are predominately collective cultures, and often use indirect ways of communication (2, 19, 20). For example, if a person intends to gain an understanding about another individual, they may speak about themselves in that context or situation, with the anticipation that the individual will then disclose information, rather than asking explicitly. Indirect communication in collectivist cultures places more emphasis on the recipient and their listening and interpreting skills (19). Another general point to note is that in your emails, conversations, information sheets and other documents, suggestions, rather than prescriptions and bold directions, are sometimes received better by indirect communicators. Be mindful of the word you use – avoid long words or high English.

Preconceptions and self-reflection

One of the first questions asked by an Aboriginal colleague was ‘why are you doing this research?’ which is a pertinent starting point of reflection. There is no prescribed way of self-reflection, only that is it an active and continual process. With each encounter, whether it is a meeting or in yarning circles (informal, semi-structured interview); there are always lessons to be learnt. Ask yourself what prejudices may have come into play. Note your differing emotions of contentment, pride, fulfilment, frustration or disillusionment that may have come prior, during or after the event. For non-Aboriginal researchers, it may be useful to pen a few paragraphs of reflection after data collection. To note, it is also imperative for researchers not to misinterpret data and what participants are saying – understanding your position will help eliminate faulty interpretations. Ongoing self-reflection assists not only in the area of personal and professional growth, but aids in the later phases of data analysis. McIntosh’s and Rix and colleagues’ articles on white privilege and reflective practice, respectively, are essential starting points of self-reflection (21). In simple terms, treat everyone with respect and don’t look down on anybody.

What does it mean to be Australian? Think about your circle of friends or colleagues. Australia has a diversity of cultures with 18% of the population being born in non-English speaking countries (22). What does it mean to be Aboriginal? Aboriginality, in general terms, is the identification of a person with their culture, language, way of life, family and land – in a way that non-Aboriginal people will seldom understand. An Aboriginal or Torres Strait Islander person may look black, brown, pink, white or even yellow. As with every person; there is uniqueness in colour, height, experience, socioeconomic status, education attainment and more. Never assume how an Aboriginal person looks, dresses, speaks and behaves, and discard your preconceptions.

History and diversity

Linked to the idea of disposing of preconceptions is the emphasis on understanding Aboriginal history and diversity within the culture. Gaining an understanding of Aboriginal history will give insight into what Aboriginal people face daily. Aboriginal health research is widely recognised as linked to colonising practices and critiqued for denigrating and distorting the cultures of the oppressed (23, 24). Understanding the impact colonisation has on both the past and present culture of Aboriginal Australians is necessary. The social environments of communities contain both constraints and opportunities. Their personal accounts are rooted in history, linked to historical events and the consequences of massive disruptions to the lives following colonisation (25). The impact of child removal policies, massacres and separations from land and culture on individuals and their extended families are strongly associated with current emotional struggles and loss of spiritual knowledge (26, 27).

Although many tribes share a common history of struggles, there is wide diversity of the nuances of culture between different mobs. What is acceptable and the experience of one tribe may not be translatable or generalizable to another. For example, the term ‘yarning circle’ may be acceptable within the Noongar community, while other regions in WA may consider the term to mean gossiping, with a negative connotation. Furthermore, any cultural knowledge shared by Aboriginal peers must be received with reverence and respect. It is a culture rich in wisdom and spirituality.

Other cultural considerations – age and gender

Within face-to-face qualitative research, the dynamics between genders can impact on the openness of stories shared. In our experience working with youths, we found that within existing relationships, such as that between friends or siblings, participants were far more open to contributing. As expected, when individuals did not know each other well, participants were often more reserved. Mixed gender groups in adolescent aged groups also had some barriers of openness in our research. Throughout the process note your position in terms of age, gender and cultural values. These and other factors subtly impact the dynamics between you as the researcher and your colleagues, peers and participants.

Specific research areas may have some gender boundaries; however this would differ between metropolitan and regional areas. For instance, areas such as maternal health may be considered strictly women’s business in some communities but not in others. When working with individuals of the opposite gender, consider how you dress and what is appropriate within that community. Also noteworthy is the process of decision making, which is made in context of other people in collective cultures (e.g. what choice is best for the community), rather than ‘what do I want as an individual’ (e.g. what are my needs). The importance of remaining within the cultural boundaries of that community should never be overlooked.

Summary

For epidemiologists and researchers, figures, trends and odd ratios often become familiar statistics and numbers – which obscure the fact that these figures represent peoples’ fathers, mothers, children and cousins. Health determinants, and social issues such as low birth weight, access to health services, poverty, domestic violence, suicide and housing issues are many Aboriginal people’s daily lived experiences. The resilience and perseverance demonstrated by many Aboriginal friends and colleagues are some of the greatest stories shared. The path of Aboriginal research requires relationships, time, continuous self-reflection, perseverance, openness to correction and re-education – and the journey is rarely black and white.

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