Enhancing Awareness of Cultural Safety Among Midwifery Academics

Abstract

This PhD aimed to improve awareness of Cultural Safety amongst midwifery academics. The provision of culturally safe educational experiences and learning and teaching practices are key strategies to improving the academic success of First Peoples students. This PhD thesis with publication is presented in nine chapters and consists of six manuscripts which have been published or are under review. The first chapter introduces the background, aim, significance, and an overview of the studies. Chapter two is presented in three parts. Part one explores the intersection between my PhD research program, my position as a non-Indigenous researcher, and my reflexive self. Part two outlines the development of a conceptual framework that underpins this research. A reframed standpoint theory was developed that blends cultural, Indigenous and feminist standpoint theories. This reframed standpoint theory guided the mixed methods used across this PhD program and is described in Part three. Study one was an integrative systematic review of educational strategies to promote academic success and resilience in undergraduate Indigenous students. The included papers were critiqued from a standpoint theory approach that reflected feminism, cultural respect, and humanism. Key strategies for Indigenous student success were found to be multi-faceted and underpinned by principles of respect, relationships, and responsibility. The review identified a relative lack of published research in this field and few validated measures. Study two was an integrative review of the literature on the scope and efficacy of professional development interventions to increase awareness of Cultural Safety by midwifery academics. Papers were assessed using the Critical Appraisals Skills Program (CASP) guidelines. Concepts were mapped thematically. Five broad themes emerged: Cultural Terms, Knowledge of Culture, Cultural Education, Cultural Aspirations/Desire and Culture in Curricula. This study found no agreed best practice framework to support awareness of Cultural Safety for midwifery academics. Cultural Safety needs to be embedded into professional development plans for midwifery academics. Study three aimed to develop a tool measuring awareness of Cultural Safety. A staged model for tool development included; generation of items, content validity testing and expert First Peoples cultural review, administration of items to a convenience sample of academics, and psychometric testing. An online survey was completed by academics (n = 42). The Awareness of Cultural Safety Scale (ACSS) was found to be reliable (Cronbach’s alpha of 0.87) and valid. Three factors were generated with sound internal reliability. There was a significant correlation between ACSS and Awareness of Racism scores. Study four implemented and evaluated a continuing professional development intervention to improve midwifery academics’ awareness of Cultural Safety. A prepost intervention mixed methods design was used. The intervention consisted of two workshops and five yarning circles across a semester. Data included responses on the ACSS, self-assessment on cultural knowledge and perceptions of racism, evaluation of the intervention, participants’ journal entries, and researcher’s reflections. Participants awareness of Cultural Safety improved after attending the professional development program. Participants reported a high level of satisfaction with the workshops and yarning circles. Study five explored the impact of yarning circles within a professional development program to enhance midwifery academics’ awareness of Cultural Safety with eight participants. Interviews were analysed using a staged thematic analysis process. Six key themes that centred on participants’ sense of belonging, sense of safety, sense knowing, sense of support, sense of difference, and sense of challenge were identified. These concepts were supportive of participants’ developing awareness of Cultural Safety. Study Six examined awareness of Cultural Safety within the broader midwifery profession. An online survey design included the Awareness of Cultural Safety Scale – Revised (ACSS-R), Self-assessment of Cultural Knowledge and Perceptions of Racism scales. Members of the Australian College of Midwives or the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives were invited to participate. The ACSS-R was found to be reliable and valid, but the low response rate (n=92) may reflect implicit bias in the workforce towards Cultural Safety. The thesis concludes with a discussion of the overall findings and conclusions. The limitations of the program of work are outlined. Implications and recommendations for further research, education and practice are outlined.