Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Co-designing a Health Journey Mapping resource for culturally safe health care with and for First Nations people

Alyssa Cormick A * , Amy Graham A , Tahlee Stevenson A , Kelli Owen A , Kim O’Donnell A B and Janet Kelly A
+ Author Affiliations
- Author Affiliations

A Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia.

B College of Medicine and Public Health, Flinders University, Kaurna Yarta, Bedford Park, SA 2100, Australia.

* Correspondence to: alyssa.cormick@adelaide.edu.au

Australian Journal of Primary Health 30, PY23172 https://doi.org/10.1071/PY23172
Submitted: 12 September 2023  Accepted: 13 March 2024  Published: 15 April 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Many healthcare professionals and services strive to improve cultural safety of care for Australia’s First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals’ perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources.

Method

Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus.

Results

The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings.

Conclusion

The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.

Keywords: Aboriginal and/or Torres Strait Islander health care, co-design in participatory action research, continuous quality and improvement, cultural safety, decolonising First Nations health care, Health Journey Mapping, patient centred care, Patient Journey Mapping.

References

Armstrong E, Coffin J, Hersh D, Katzenellenbogen JM, Thompson SC, Ciccone N, Flicker L, Woods D, Hayward C, Dowell C, McAllister M (2021) “You felt like a prisoner in your own self, trapped”: the experiences of Aboriginal people with acquired communication disorders. Disability and Rehabilitation 43(13), 1903-1916.
| Crossref | Google Scholar | PubMed |

Australian Commission on Safety and Quality Health Care (ACSQHC) (2022) The NSQHS standards. Available at https://www.safetyandquality.gov.au/standards/nsqhs-standards

Australian Health Practitioner Regulation Agency (AHPRA) (2020) National scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy. Available at https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/health-and-cultural-safety-strategy.aspx

Belton S, Kruske S, Jackson Pulver L, Sherwood J, Tune K, Carapetis J, Vaughan G, Peek M, McLintock C, Sullivan E (2018) Rheumatic heart disease in pregnancy: how can health services adapt to the needs of Indigenous women? A qualitative study. Australian and New Zealand Journal of Obstetrics and Gynaecology 58(4), 425-431.
| Crossref | Google Scholar | PubMed |

Butler T, Gall A, Garvey G, Ngampromwongse K, Hector D, Turnbull S, Lucas K, Nehill C, Boltong A, Keefe D, Anderson K (2022) A comprehensive review of optimal approaches to co-design in health with First Nations Australians. International Journal of Environmental Research and Public Health 19(23), 16166.
| Crossref | Google Scholar | PubMed |

Chamberlain C, Gee G, Brown SJ, Atkinson J, Herrman H, Gartland D, Glover K, Clark Y, Campbell S, Mensah FK, Atkinson C, Brennan SE, McLachlan H, Hirvonen T, Dyall D, Ralph N, Hokke S, Nicholson J (2019) Healing the past by nurturing the future – co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study. BMJ Open 9(6), e028397.
| Crossref | Google Scholar | PubMed |

Cormick A, Owen K, Turnbull D, Kelly J, O’Donnell K (2022) Renal healthcare: voicing recommendations from the journey of an Aboriginal woman with chronic kidney disease. Renal Society of Australasia Journal 18(3), 88-100.
| Crossref | Google Scholar |

Davies EL, Pollock D, Graham A, Laing RE, Langton V, Bulto L, Kelly J (2022) Reporting of patient journey mapping in current literature: a scoping review protocol. JBI Evidence Synthesis 20(5), 1361-1368.
| Crossref | Google Scholar | PubMed |

Fisher M, Mackean T, George E, Friel S, Baum F (2021) Stakeholder perceptions of policy implementation for Indigenous health and cultural safety: a study of Australia’s ‘Closing the Gap’ policies. Australian Journal of Public Administration 80(2), 239-260.
| Crossref | Google Scholar |

Fraser S (2019) A disjuncture of World views: manifestation in burns care for Aboriginal and Torres Strait Islander children in Australia. PhD Thesis, Flinders University, Adelaide, SA, Australia. Available at https://flex.flinders.edu.au/file/594bbe6b-d5c2-4581-9118-72352a933314/1/ThesisFraser2019OA.pdf

Fraser S, Mackean T, Grant J, Hunter K, Ryder C, Kelly J, Holland A, Griffin B, Clapham K, Teague WJ, Darton A, Ivers RQ (2021) Patient journey mapping to investigate quality and cultural safety in burn care for Aboriginal and Torres Strait Islander children and families – development, application and implications. BMC Health Services Research 22(1), 1428.
| Crossref | Google Scholar |

Freeman A (2020) Navigating early pregnancy loss within Ontario’s healthcare system: a qualitative exploratory study of the experiences of midwifery clients and midwives. Master’s Thesis, University of Waterloo, Ontario, Canada. Available at http://hdl.handle.net/10012/16288

Gatwiri K, Rotumah D, Rix E (2021) BlackLivesMatter in healthcare: racism and implications for health inequity among Aboriginal and Torres Strait Islander peoples in Australia. International Journal of Environmental Research and Public Health 18(9), 4399.
| Crossref | Google Scholar | PubMed |

Gollan S, Stacey K (2021) First Nations cultural safety framework. Australian Evaluation Society, Melbourne. Available at https://www.aes.asn.au/images/AES_FirstNations_Cultural_Framework_finalWEB_final.pdf

Ivers RQ, Hunter K, Clapham K, Coombes J, Fraser S, Lo S, Gabbe B, Hendrie D, Read D, Kimble R, Sparnon A, Stockton K, Simpson R, Quinn L, Towers K, Potokar T, Mackean T, Grant J, Lyons RA, Jones L, Eades S, Daniels J, Holland AJA (2015) Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study. BMJ Open 5(10), e009826.
| Crossref | Google Scholar | PubMed |

Joseph AL, Kushniruk AW, Borycki EM (2020) Patient journey mapping: current practices, challenges and future opportunities in healthcare. Knowledge Management & E-Learning: An International Journal 12(4), 387-404.
| Crossref | Google Scholar |

Kelly J (2008) Moving forward together in Aboriginal women’s health: a participatory action research exploring knowledge sharing, working together and addressing issues collaboratively in urban primary health care settings. Doctoral Dissertation, Flinders University, Adelaide, SA, Australia. Available at https://flex.flinders.edu.au/file/00b93d55-fa65-4e01-af67-11aad0479eab/1/Thesis-Kelly-2009.pdf

Kelly J (2017) Using mapping tools to improve Aboriginal patient journeys. Australian Nursing & Midwifery Journal 24(9), 43.
| Google Scholar | PubMed |

Kelly J, Dwyer J, Mackean T, O Donnell K, Willis E (2017) Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care. Australian Journal of Primary Health 23(6), 536-542.
| Crossref | Google Scholar | PubMed |

Mackean T, Fisher M, Friel S, Baum F (2020) A framework to assess cultural safety in Australian public policy. Health Promotion International 35(2), 340-351.
| Crossref | Google Scholar | PubMed |

Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R, Ward K, Tobin S, Gwynne K (2021) Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health 18(6), 3014.
| Crossref | Google Scholar | PubMed |

Stringer ET, Aragon AO (2021) ‘Action research.’ 5th edn. (Sage Publications: Melbourne, Vic., Australia)

Wilson A, Wilson R, Delbridge R, Tonkin E, Palermo C, Coveney J, Hayes C, Mackean T (2020) Resetting the narrative in Australian Aboriginal and Torres Strait Islander nutrition research. Current Developments in Nutrition 4(5), NZAA080.
| Crossref | Google Scholar |

Yashadhana A, Fields T, Burnett A, Zwi AB (2021) Re-examining the gap: a critical realist analysis of eye health inequity among Aboriginal and Torres Strait Islander Australians. Social Science & Medicine 284, 114230.
| Crossref | Google Scholar | PubMed |