Skip to main content

Table 1 Factors that influence patient-clinician engagement and the adverse consequences

From: Study Protocol: establishing good relationships between patients and health care providers while providing cardiac care. Exploring how patient-clinician engagement contributes to health disparities between indigenous and non-indigenous Australians in South Australia

Concept

Features

Adverse consequences

Cultural Safety

· Health professional are self-aware of their ontology, epistemology and axiology.

Actions that diminish, demean or disempower the cultural identity and well-being of an individual is unsafe clinical practice [3, 4].

 

· An environment that facilitates and nurtures relationships

Patients viewed the medical system as cold, indifferent and inflexible [2]

 

· Health services do not comprise the patients legitimate cultural rights, views and values.” [1]

 
 

· High staff turnover [2]

 

(Mis) Communication

· Language (verbal and non-verbal),

· May result in misdiagnosis; ineffective and inefficient clinical management; and marginalisation of the patient 6–8.

 

· Rules, conventions and etiquette;

 
 

Communication between the community primary health care provider and the tertiary institution [5]

· An inefficient model of care i.e. ‘no shows’ in patient travel and patient has limited understanding of their clinical care [5].

(Dis) Empowerment

· A distressing patient journey [5]

· Patients feel disempowered, discriminated by their race and clinicians show a lack of empathy toward them [2, 3, 5].

 

· Financial burden

 
 

· Language barriers

 
 

· Lack of culturally appropriate resources

 
 

· Inadequate pre-operative preparation and post-operative follow-up.

 
 

· Lack of cognitive control [2, 3].

 

(Mis) Trust

· Informed by a whole of life experience; which included systemic oppression and discrimination with societal institutions (particularly justice and education settings).

· In response to racist treatment people felt ashamed, humiliated, powerless and fearful; which in turn contributed to the lack of trust [3].

 

· In an individual encounter.

 

Biomedical Model

· The dominance of medical language used to explain clinical diagnosis, management and long-term care.

· Removes the opportunity to construct a shared understanding of health care [20].

 

· Marginalisation of the patience preferred language or knowledge [2, 20].

· Patients feel alienated and less likely to participate with the recommended care [16]