Case story

Sharing the True Stories: for Better Communication in Health Care

Although language plays a crucial role in any effective relationship between doctor and patient most Aboriginal people from remote communities in the NT speak English only as a third or fourth language, and few doctors speak even one Aboriginal language. Over five years, the ‘Sharing the True Stories’ project used participatory action research methods to chart this communication gap and to develop and evaluate communication strategies and resources.

The project involved Aboriginal patients from the Yolngu language group of north-east Arnhem Land who came to Darwin for haemodialysis and transplant services in Darwin, their medical, nursing and allied professional carers, Aboriginal interpreters and families. Project leader Isaac Brown was supported by a large project management team. The research partners were Northern Territory University (now Charles Darwin University), Royal Darwin Hospital, Nightcliff Renal Unit, Menzies School of Health Research, North-east Arnhem Land Aboriginal communities and Aboriginal Resource and Development Services.

The first stage of the project focused on gathering data through videotaped interactions between patients and staff, and in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication. In the second stage, a suite of communication strategies and Yolngu and English language resources were developed and evaluated.

The initial study found that a shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. There were many sources of miscommunication including: lack of patient control over the language, timing, content and circumstances of interactions; differing Western and Yolngu modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; lack of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance between people; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.

As one doctor commented: ‘We knew we had problems with communication – we didn’t realise we weren’t getting anything across.’ 

The researchers concluded that miscommunication is pervasive. Trained interpreters provide only a partial solution and fundamental change is required for Aboriginal patients to have significant input into the management of their illness. They concluded that educational resources were needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people. This was the focus of the second stage of the project, which had many practical knowledge exchange outcomes.

Using research for change – the outcomes:

Aboriginal Interpreter Services Guidelines were launched and used across the delivery of health care in the NT. The use of interpreters at the Royal Darwin Hospital increased. Nightcliff Renal Unit re-organised its activity so that patients from a particular language group attended the unit on the same day, making access to interpreters easier and ensuring patients were not isolated from family.

Other hospitals, health services and renal units across the NT have sought the help of the project team to improve their own cross-cultural communication.

A new education support program has been developed using print, video, CD-Rom, DVD, and web site formats. The ‘Sharing The True Stories’ web site has intercultural communication strategies, educational resources and related links which are continuously updated. The educational resources are used and evaluated in health delivery and staff in-service training.

Factors that contributed to knowledge exchange were that:

• The project was carried out within health services, where practitioners and patients were able to pass on and ‘champion’ the findings with their peers.
• Yolngu clients and community groups in Darwin and in a number of Yolngu remote communities were consulted when strategies and resources were being developed. They validated the strategies and resources.
• The strategies and resources developed through the research were promoted through in-service sessions in the Aboriginal health workplaces.
• Policy-makers, middle management and the public were made aware of the research through ministerial launches of strategies and resources.
• Professional development and cultural awareness programs included the strategies and resources in staff training programs.
• The researchers wrote articles and delivered many presentations and keynote addresses at international, national and local conferences and workshops.
• Yolngu interpreters were mentored, educated and trained in health interpreting specific to hospital, renal unit and self-care home haemodialysis settings.
• The Sharing the True Stories web site and project database is used as a repository for project findings and resources and a link to related research.
• The commitment and broad range of expertise that people brought to the research processes, and to the development of resources.

Related links:

• For reports and resources - Sharing the True Stories website
• CRCAH Project Page: Sharing the True Stories
• Coulehan, K., Brown, I., Christie, M., Gorham, G., Lowell, A., Marrŋanyin., and Patel, B., 2005, Sharing the true stories, Evaluating strategies to improve communication between health staff and Aboriginal patients, STAGE 2 Report, Cooperative Research Centre for Aboriginal Health, Darwin.
• Northern Territory Department of Local Government, Housing and Sport, Guidelines to Determine if an Aboriginal Interpreter is Required, Aboriginal Interpreter Service Darwin and Alice Springs.
• Northern Territory Department of Local Government, Housing and Sport, Useful Hints on Working with an Aboriginal Language Interpreter, Aboriginal Interpreter Service Darwin and Alice Springs.