Chapter 1: A mixed-methods exploration of staff capability and self-efficacy to embed Aboriginal and Torres Strait Islander content, perspectives and pedagogies into the health curricula

Acknowledgements

Shawn Somerset, Associate Professor Tanya Lawlis and Dr Rati Jani, are acknowledged for their input into the grant application and quantitative study. Ms Namoi Wolfe is acknowledged for her consultation and the sharing of her research survey design and outputs that informed our quantitative research study.

Abstract  

In order to address the impact of colonisation, racism and privilege on health outcomes, there is a need to prioritise Aboriginal worldviews in the health curricula. This research aimed to explore the capability and self-efficacy of health academics to embed Aboriginal content, perspectives and pedagogies to indigenise the health curricula. Using a ‘two eyed seeing’ approach, a sequential, exploratory mixed-methods study was conducted with health academics using a Western methodology (research-based pilot-tested online survey) followed by an Aboriginal methodology (yarning circles). Data was analysed and reported separately and then discussed together. In the survey, participants (n=52; response rate=38%) reported insufficient knowledge to select (48%) and deliver, (40%) and a perceived insufficient right to teach (29%) this curriculum. A purposeful sample of health students and academics (n= 32) participated in five homogeneous yarning circles guided by semi-structured interview questions. Four researchers independently reviewed the transcripts using an exploratory, inductive and process-orientated approach and documented preliminary themes. Three researchers together reviewed the transcripts, and considered the relational and collectivist implications of the methodology, thereby  reaching consensus on the following themes: (1) There is a notable knowledge gap and an opportunity for shared learning; (2) This research was challenging: all learners and educators need to feel safe; (3) As a collective, ‘we’ can deliver this curriculum; and (4) A system of supported responsibility is required. This research supports a progressive structure for personal development that aligns Aboriginal supervision and educator capability.

Keywords

Aboriginal and Torres Strait Islander peoples; Aboriginal Australians; cultural responsiveness; First Nations; Indigenous health education; professional development.

Learning objectives

1. Identify opportunities for shared learning to enhance cultural capability.
2. Recognise the need for Aboriginal and non-Aboriginal people to feel safe as they learn and practice.
3. Adopt a collective and collaborative approach to culturally responsive health curricula development and delivery.
4. Identify opportunities to support educators in their professional development towards cultural capability.

Background

Globally, there are estimated to be 370 million Indigenous people living in over 70 countries (Francis-Cracknell et al., 2019). The United Nations Declaration on the Rights of Indigenous People (United Nations, 2007) includes the right to attain physical and mental health, yet, the health inequities faced by Indigenous people are indisputable (Anderson et al., 2016). An International Consensus Statement ‘Educating for Indigenous Health Equity’ (Jones et al., 2019) identifies colonisation, racism and privilege as the central themes that must be explored when addressing this disparity.

In Australia, Aboriginal and Torres Strait Islander peoples (herein respectfully referred to as Aboriginal) have been custodians of their unceded lands and waters for over 60,000 years and have the oldest continuous culture in the world (Malaspinas et al., 2016). Colonisation has resulted in the systematic destruction of their society including epidemics, massacres, disposession from their lands, removal of their children, and prohibition of their languages, cultures and knowledges (Jalata, 2013). This has directly affected the health and wellbeing of Aboriginal people, with a decline in population in the first 100 years of colonisation from approximately 750,000 to 1,000,000 in total at the time of settlement. The population fell to an estimated low of 72,000 in 1921, then climbed to around 517,200 (Behrendt, 2012). The Close the Gap Campaign Report 2021 (Lowitja Institute, 2021) calls attention to a disease burden of 2.3 times that of other Australians. Currently, one third of Aboriginal people do not access mainstream health settings due to mistrust, institutional and interpersonal racism (Australian Health Ministers’ Advisory Council, 2017; Baba, Brolan & Hill, 2014).

Australia’s Aboriginal Health and Cultural Safety Strategy 2020-2025, which was endorsed by 43 organisations, academics and individuals, including the Australian Health Practitioner Regulation Agency [Ahpra], national boards, accreditation authorities and Aboriginal health experts, aims to achieve health equity by 2031. A central priority of this strategy is developing the Aboriginal health workforce across all disciplines. While the number of Aboriginal people employed in health related occupations is increasing (Australian Institute of Health & Welfare [AIHW], 2020), Aboriginal peoples are still significantly under-represented in the health workforce [relative to population size, Aboriginal people were employed in registered health professions at a rate that is about one-third that of non-indigenous Australians (AIHW, 2023)]. Inherent racism in the Australian health workforce directly impacts Aboriginal health workforce retention (Bond et al., 2019).

Many of us work in white male-dominated environments, often belonging to the first generation of Indigenous professionals and we have to manage and negotiate white systems, knowledges, practices and people (Moreton-Robinson, 2015, p. 99).

The National Aboriginal Health Workforce Strategic Framework (2016 – 2023) places the responsibility of health equity and Aboriginal workforce development with the health sector, mandating the need to provide a culturally safe healthcare environment (Australian Health Ministers Advisory Council, 2020). Cultural safety is determined by the person receiving the care and requires the lifelong critical reflection of healthcare professionals’ knowledge, skills, attitudes, practising behaviours and power differentials (Ahpra, 2020). The Aboriginal Health and Cultural Safety Strategy (Ahpra, 2020) has recognised the key role of higher education in achieving a culturally safe healthcare system by endorsing the Aboriginal Health Curriculum Framework (Department of Health [DoH], 2014).

This framework is guided by the following principles: (1) the centrality of culture in health service delivery (reflecting the diversity of countries / language groups and a holistic view of health); (2) the need to develop a health workforce with appropriate clinical and cultural capabilities; (3) the imperative to collaborate with Aboriginal health professionals and communities; (4) the necessity for Aboriginal workforce development and leadership; and (5) the underpinning of reliable data to inform these practices. This work is also supported by discipline specific accreditation standards and curriculum frameworks, for example, the Australian Indigenous Psychology Education Project (AIPEP) Curriculum Framework (Dudgeon et al., 2016); the Cultural Responsiveness in Action Framework (Indigenous Allied Health Australia (IAHA), 2019); and the Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework (Congress of Aboriginal and Torres Strait Islander Nursing and Midwifery (CATSINM), 2017). However, according to the First Report from Universities Australia (UA) Indigenous Strategy 2017-2020, while the number of Aboriginal students participating in higher education has more than doubled in the last decade, with 22% of these enrolled in health degrees, little progress has been made with developing Indigenous graduate capabilities (UA, 2019).

There are some published works demonstrating positive steps towards implementing Aboriginal health curricula in Australian higher education. These include Faculty approaches (Virdun et al., 2013; Fildes et al., 2021); workshops (Gray et al., 2019); discrete units (Wilson et al., 2015; Francis-Cracknell et al., 2018; Mills et al., 2018) and integrated curricula (McCartann et al., 2021).  Some studies provided evaluation measures (mostly self-assessed) including changes in students’ knowledge, attitudes and / or confidence (Francis-Cracknell et al., 2018; McCartann et al., 2021; Mills et al., 2018).  

Currently, there are no longitudinal studies that report on the impact of Aboriginal health curricula on culturally safe, health service delivery. Similarly, while some placement studies have been conducted, no studies have examined the impact of Aboriginal health curricula on learning and teaching in standard clinical education. This is critically important given that, contradictory to popular belief, most Aboriginal people need to travel to access health services in mainstream urban centres (AIHW, 2018), in part because there are no services in their local area, reflecting access concerns (Lincoln, 2021). Some students have also struggled to see the relevance of Aboriginal health enbedded into curricula or have viewed the content as disempowering / blaming and emotionally draining (Francis-Cracknell et al., 2018; McCartann et al., 2021; Mills et al., 2018). These negative responses have highlighted the need for a greater understanding of the relationship between ‘discomfort’ and transformative learning (Mills et al., 2018). Learners have also reported that educators’ preparedness has impacted on their engagement with this curriculum, with evidence suggesting that educators were not well–prepared (Jones et al., 2013; Virdun et al., 2013; Wilson et al., 2015; Wolfe et al., 2019). 

Theoretical framework

Critical Race Theory (Delgado & Stefancic, 2001; Singleton & Linton, 2006) has been recommended as a theoretical framework to inform an Aboriginal health curricula (DoH 2014), as it acknowledges the complexities of the contested space between divergent knowledge systems, and necessitates the need for personal reflection and discourse (Nakata, 2007). As explained using Transformative Learning Theory (Mezirow, 2003), through these learning strategies students can be supported to challenge existing understandings and assumptions, and make new personal meanings. Challenging one’s own beliefs and assumptions can lead to uncomfortable emotions, such as defensiveness, anger and fear, as is evident in the negative responses reported by some students after participating in the Aboriginal health curricula (Francis-Cracknell et al., 2018; McCartann et al., 2021; Mills et al., 2018). This response has been described by Boler (1999) as the ‘Pedagogy of Discomfort’ and is recognised as an enabler of transformative learning (Mezirow, 2003).

Yunkaporta (2009) is one example of an Aboriginal academic who has used Indigenous pedagogies, such as yarning, to enable teachers to explore learning at this cultural interface. One Australian university (Fildes et al., 2021) has taken this approach and describes a process of ‘Curriculum Reconciliation’ based on respect and reciprocity, whereby Aboriginal knowledges are epistemologically equal and sit along-side Western knowledges; where students learn from rather than about Aboriginal knowledges. In this research, the Aboriginal research method and pedagogy of yarning is used both as a research methodology and as a potentially transformative learning experience for the academic participants, helping them to understand their own and the university’s cultural context (Geia et al., 2013; Yunkaporta, 2009).

Research question

To explore staff capability and self-efficacy to embed Aboriginal content, perspectives and pedagogies into the health curricula at an Australian university.

Methods

Theoretical stance

This research used a ‘two eyed seeing’ philosophical stance which values both Aboriginal (Geia et al., 2013) and Western research methodologies, allowing their differences and strengths to be preserved alongside each other, maintaining their individual integrity and preventing the dominance of one over another (McKivett et al., 2020). This research: (1) upheld the need for transparency by considering and reflecting on the individual positioning of each researcher; (2) embraced difference, divergent viewpoints and the non-avoidance of difficult conversations; and (3) required reciprocity through the sharing of knowledge and the fair distribution of power.

An analytical framework consistent with this approach was also adopted. An Expert Advisory Group – EAG (consisting of Aboriginal academics, an Aboriginal student with education expertise and a non-indigenous academic with extensive experience teaching health curricula that incorporates Aboriginal perspectives and pedagogy) provided advice on the scope of the project, the methodology, the interpretation of the results and its implications for practice. The research team and research assistants consisted of Aboriginal and non-indigenous researchers. The University of Canberra’s Commmittee for Ethics in Human Research approved the study (CEHR, 2011) that conformed to the provisions of the Declaration of Helsinki and the AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research (2020).

A sequential, mixed methods approach was used to allow a more comprehensive exploration of the capability and self-efficacy of health academics to embed Aboriginal content, perspectives and pedagogy in the health curricula. Stage 1 was informed by previous health education research (Wolfe, 2019), which used a Western methodology and identified the research and learning gap addressed in the subsequent stage. Stage 2 used an Aboriginal methodology and was designed to both support the co-creation of knowledge and the transformative learning of the participants and researchers. The methods and results from both stages will be presented sequentially and then discussed together. This approach allows further exploration and negotiation of perspectives, with the intent of the research results informing future practice.

Setting

This research was conducted in 2019, in an Australian urban university within the Health Faculty (offering allied health, nursing and midwifery). At the time, the university had strong Aboriginal leadership including an Aboriginal Elder in Residence, a recently appointed Aboriginal Educational Designer and an Aboriginal Student Centre. The university had an Indigenous Strategy which supported a Reconciliation Action Plan, and Employment and Research Strategies. The university was in the developmental stages of drafting Indigenous Graduate Attributes and an ‘Indigenising the Curriculum Framework’ (see Table 1). This research was funded as part of an internal Teaching Innovation Generating Education Research Project that covered 4 phases: (1) Raising Awareness; (2) Safety; (3) Knowledge Translation; and (4) Curricula Operational. The research aimed to fulfil the requirements of  Phase 1. In Phase 2, 50 academic staff were supported to attend a one or two day Cultural Safety / Cultural Responsiveness workshop delivered by Aboriginal health organisations. Aligned with the funding arrangement, Phases 3 and 4 supported new learnings from Phases 1 and 2, to be implemented into a post-graduate dietetics course, with the intent of developing a model to strengthen staff capability and self-efficacy to embed Aboriginal content, perspectives and pedagogies across the whole health curricula.

Table 1: Current system of supported responsibility

Western methodology

In September 2019, those Faculty of Health university academics, who were currently convening health units, were invited to participate in an online survey. All health academics (N=138) were contacted due to their direct ability to impact curricula. Continuation past a participant information screening process indicated they had consented to be included in the study.

The distributed survey was developed using Qualtrics and included: five demographic questions (gender, discipline, teaching years, professional experience, Indigenous descent); and 14 quantitative questions (3 used a 5-point Likert scale, 2 were yes/no questions, 3 were rank-order questions and 5 were multiple-choice questions). These questions were based, with permission, on findings from previous research (Wolfe et al., 2019) covering current educational practices (Indigenous content, resources), academic capability (professional development and attitudes), implementation challenges, and resources required to embed Indigenous knowledge systems within current health curricula. Four open-ended questions were also included to allow staff to identify helpful resources and professional development, and to provide feedback specifically on the curriculum or for general comments. The Nutrition and Dietetics discipline piloted the survey to evaluate readability and face validity. Feedback was also invited from faculty representatives to ensure clarity and validity. The final version of the survey was approved by the EAG to ensure the survey and language was culturally appropriate. Once finalised, the survey was distributed via email using methods to optimise response rate, including two reminder emails sent at different times of the day.

Aboriginal methodology

Yarning circles were used to develop a deeper understanding, within a theoretical framework, of how to effectively build the capacity of non-indigenous academics to support the delivery of Aboriginal health curricula. Yarning methodology had been used by staff within the faculty, for Elder led teaching of Indigenous health studies, and was a methodology that the researchers were familiar with. Yarning has traditionally been used by Aboriginal communities to preserve and pass on cultural knowledge, to learn by way of storytelling and sharing, and to share and build respect and harmony within communities. As a research method, yarning is relational and has a more equal power balance than focus groups, requiring both the researchers and participants to be vulnerable and to contribute to the co-creation of knowledge (Byrne et al., 2021).

The purposes of the yarning circles were:

(1) to gain a deeper understanding of the perceptions of staff and students about the current capability of the Faculty of Health staff at the university to prepare health graduates to be culturally responsive health professionals; and

(2) to provide participants (students and staff) the opportunity to engage in a traditional Aboriginal practice and to explore their own beliefs and assumptions about Aboriginal culture.

Participants for the yarning circle were purposefully selected and included dietetics students (aligned with Phases 3 and 4 of the project) and academics (who were also invited to attend the cultural safety / responsiveness training in Phase 2 of the project) from allied health, nursing and midwifery. The yarning circles were held at the university and were conducted over 2 hours. The yarning circles were facilitated by a Ngunnawal Elder and/or Wiradjuri, Kamilaroi and Gadagal knowledge holder (n=4). Six research questions covering academic knowledge, teaching practices and graduate outcomes in cultural responsiveness, guided each yarning circle. Each yarning circle used an Aboriginal ‘message stick’ which when held, allowed that person to tell their story without interruption or comment, following cultural leadership by the Aboriginal cultural Elder or knowledge holder leading the yarning circle. Each Elder or knowledge holder also shared experiences, illustrating experiential knowledge, trust and reciprocity in the sharing of personal stories. Each yarn was audio-recorded and transcribed verbatim.

The transcripts were initially independently and thematically analysed by the research team, using an exploratory-, inductive- and process-orientated approach. The research team discussed and reflected on interpretations of the data and decided that further analysis was required to better consider the relational and collectivist implication of the employed methodology, and to reach a consensual decision. Three researchers then analysed the transcripts together to facilitate comparisons and interpretations, and to challenge potential biases. Reflexivity involved reflecting on the research and data collection process and the interpretation of the data (the personal experiences, knowledge, values and biases of each researcher). The triangulation of the expertise and lived experiences of these three researchers, which included expertise in health (nursing and allied health), Aboriginal methodologies, qualitative research and health, increased the authenticity and credibility of the analysis.

Results

Western methodology

A response rate of 38% (52/138) was achieved, with representatives from all health faculties except pharmacy and optometry. There was an 18% dropout rate throughout the survey. Most respondents were female (n=42, 72%) and 4% of participants identified as Aboriginal and/or Torres Strait Islander (n=2). Seventy three percent (37/51) of academics had 10 or more years professional experience, conversely, for teaching experience the majority (59%, 30/51) had 10 or less years.

Most academics (65%, 28/43) indicated that they had some form of Aboriginal content/resources in their curricula, however many participants (49%, 21/43) did not use Aboriginal authored content. The most popular resources to be used were journals (24), texts (23), and Aboriginal learning strategies such as narratives, storytelling, or yarning (19).

A 5-point Likert scale (1= Non-confident, 5 = Very-confident) was used to indicate confidence in teaching students about Aboriginal issues. Staff indicated that they were comfortable teaching Aboriginal students in general (2.97 + 1.25, n=39), however were less comfortable teaching about Aboriginal issues to both non-indigenous (2.85 + 1.22, n=41) and Aboriginal students (2.62 + 1.17, n =42). Neither of these differences were deemed statistically significant via t-test. Staff confidence in teaching Aboriginal students about Aboriginal issues strongly and positively correlated with teaching non-indigenous students about Aboriginal issues (p<0.01, r=0.621).

There were many explanations for why participants feel less confident teaching about Aboriginal issues. Challenges to teaching Indigenous issues included: 48% of participants indicated they felt they did not have knowledge (25/52), 40% felt they lacked experience (21/52), 35% were worried about offending Aboriginal people (18/52), 33% were unsure if they had the right to teach Aboriginal issues (17/52), and 29% felt they did not have the right to teach Aboriginal content (15/52). Additionally, 42% also felt that a crowded curriculum (42/52) was a major challenge.

All participants had undertaken related professional development, the most common being workshops (67%, 35/52), reading academic literature (64%, 33/52) and consulting specialised media (40%, 21/52). Knowing how to teach Aboriginal content (65%, 34/52), having access to appropriate resources (64%, 33/52), and knowing what to teach (56%, 29/52) were the most desired outcomes from future professional development.

Academic staff reported that the most important resource to be funded was for Aboriginal community members to provide expertise and cultural mentoring (2.00 + 1.20). Similarly, at an individual level, 65% (34/52) participants felt that a face-to-face, on campus expert contact would be beneficial. At a discipline level, 60% (31/52) of participants felt they needed guidance on how to integrate content into existing units and 54% (28/52) felt cultural guidance, direct consultation with Aboriginal health workers, and lectures/tutorials prepared by Aboriginal staff were needed.

Aboriginal methodology: Yarning

Five yarning circles with 32 participants [dietetics students (n=6); allied health academics from clinical master programs (n=5; n=6) and; nursing and midwifery academics (n=6; n=9)] were conducted. The yarning circles enabled participants to share knowledge and practices and to co-create the following understandings / themes: (1) There is a notable knowledge gap and an opportunity for shared learning; (2) This research was challenging – all learners and educators need to feel safe; (3) As a collective ‘we’ can deliver this curriculum; and (4) A system of supported responsibility is required. Table 2 presents these themes together with their subthemes, an explanation and key quotes as data illustrating the themes.

Reflexivity and the transformative learning experiences of the researchers

This research was undertaken at the ‘cultural interface’ (Nakata, 2007) and necessitated sense making, through reflexive practice, for the three researchers involved in the second round of thematic analysis. This process required critical discussions and vulnerability. It was, at times, uncomfortable and messy as the researchers (one Aboriginal and two non-Aboriginal) unpacked their perspectives, biases and the impact of different knowledge systems and processes. Personal feelings were embraced as a part of this valuable, transformative learning experience.

Table 2 Main themes and subthemes: perceptions of academics from different health professions on their capability to embed Indigenous content within curricula in an Australian university setting

Discussion

This research demonstrates a gap in the capability and self-efficacy of health academics to embed Aboriginal ways of knowing, being and doing into the health curricula. Our findings are consistent with and strengthen the original research by Wolfe and colleagues (2017). The response rate of our survey was comparably higher (38%; 19.5%) and is supported by a more in-depth understanding of the responses through the yarning circle study. Despite academics completing relevant professional development (100%; 90%;) and embedding related content (65%; 63%), our findings suggest that the agenda across Australian universities to ‘Indigenise the Curriculum’ is likely to ‘perpetuate Western values and pedagogical dominance’ (Wolfe et al., 2017). Conscious and unconscious bias and racism persist, and to address this issue, educators should adopt a progressive structure for personal development that aligns Aboriginal supervision with educator capability. This would enable a shared understanding, enhanced deep knowledge, cultural safety, and true reconciliation in action by the academics (Geia et al., 2020; McGough et al., 2022).

In this study, 62% of participants reported that they were either unsure if they had the right, or felt they did not have the right to teach content about Aboriginal topics, which is of concern. There is a need to accommodate curricula writing that aligns with Country and cultural contexts, such that the rational and pragmatic knowledges harmonise with the emotional and imaginal experiences to achieve a holistic and balanced approach to pedagogy (Wyld & Fredericks, 2015). While Aboriginal leadership is critical, in essence, the responsibility and call to action sits with allyship of the non-indigenous majority, and the intentional decolonisation of curricula. The yarning circle findings suggest that, for most academics, an inaccurate colonised history was provided in their formal education, and poorly informed public discourse potentiates the harms associated with misinformation and racist interpretations, yet it is too easy to use this as an excuse. As evident through the yarning circles, there is a plethora of opportunities available if one engages with reflexivity at the cultural interface for transformative and educative, cultural responsive practice (Nakata, 2007; Nicholls, 2009).

The discomfort associated with the delivery of these curricula is acknowledged in the literature (Delbridge et al., 2021; Geia et al., 2021; Jones et al., 2013; Virdun et al., 2013; Wilson et al., 2015; Wolfe et al., 2019) and was also the experience of researchers and participants involved in this research. Non-indigenous academics reported feeling a lack of confidence, being ill-equipped, nervous they would do something wrong, scared they would offend and guilt for the actions of the dominant culture with which they identified. For some, the relevance of these curricula is not always evident, it can generate negative and emotional responses, and further, poor experiences of cultural training may reinforce racist views (Downing et al., 2011). White fragility, or the pedagogy of discomfort, may help to understand these responses. Certainly these unintended consequences reinforce the imperative to adequately prepare academic staff for this task. With a ‘two eyed seeing’ philosophical stance (McKivett et al., 2020) and a posture of curiosity and cultural humility (Tervalon & Murray-Garcia, 1998), engaging at the cultural interface offers the opportunity to better prepare health professional graduates.  They can develop skills to provide culturally responsive healthcare, and to build trust by listening and being guided by the wisdom of knowledge holders of the oldest surviving culture in the world.

Findings from this research support a progressive structure for personal development that aligns Indigenous supervision and educator capability (see Table 1 – Individual supports). Clinical supervision is a common practice used by clinicians across the health disciplines. It is defined:

“as a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, and is acknowledged to be a life-long process (Edwards et al., 2005; Simpson & Sparkes, 2008). This type of supervision involves reflective thinking, discussion regarding professional development issues, case-load, clinical issues, and staff interpersonal issues.” Fone 2006 (as cited in Martin et al., 2014).

This research proposes that a similar concept be applied to further support the development of culturally responsive practice by health academics involved in embedding Aboriginal ways of knowing, being and doing (IAHA, 2019) within the curricula. An academic appointment of a Aboriginal scholar has since been created at the university where this research was conducted. This appointment is to implement this concept (see Table 1) and to support the work of the Ngunnawal Elder in Residence (Traditional Owner of the land), who the university appointed for cultural guidance and support for all students and staff. As a new initiative, a decolonising, participatory action research cycle will be used to develop a program of cultural supervision. This action research cycle will be aligned with the current capabilities, experiences and professional development needs of non-indigenous academics, better enabling them to deliver curricula safely to meet the needs of Aboriginal and Torres Strait Islander students, academics and others within the university community. The ultimate goal being to create shared understandings and walk together in a reconciled way.

Within the international context, the ‘Black Lives Matter’ movement has demonstrated the growing impetus and a call for action for change in the health disciplines; to confront the long term impact of colonisation, racism and white privilege (Geia et al., 2020). More specifically, this is now also reflected in the health and education sectors, as evidenced by strategic documents from the government, regulatory, university and health service sectors, and the realisation that structural institutional racism continues to harm Aboriginal Australians (Watego et al., 2021). Some gains have been made at the university where this research was conducted (see Table 1), yet there is still much work to be done. For example, to achieve employment parity there is a need for more time and resourcing to increase the number of Aboriginal academics across the University, and also to recognise the significant workload requirements of non-indigenous academics to authentically and credibly commit to this work beyond tokenism.

This relational work of reconciliation is not always evident in colonised academic performance frameworks. Ideas of emotional intelligence, reconciled relationships and power structures that value healing and growth towards equity for Aboriginal peoples, need to be integrated into performance reviews. Initiatives to improve the attractiveness to work at the institution and the retention of Aboriginal academic appointments also require attention, including performance expectations that recognise the equivalent cultural contributions when compared to other recognised responsibilities (research, teaching and engagement).

During the reporting phase for this research an Aboriginal academic resigned from the university. This is noteworthy because it highlights the disruptions that impact Indigenisation of educational programs, with generally few Aboriginal health professional academics employed in higher education institutions. The loss of this scant human resource is significant as they are not easily replaced, and more work needs to be done by employers to bolster the cultural safety of Aboriginal academics to ensure vocational security and stability. This includes respectfully engaging in uncomfortable discourse and ensuring fair remuneration aligned with the additional, informal responsibilties experienced by Aboriginal academics in supporting, educating and caring for their non-Aboriginal counterparts, as was seen in our research.

This study’s strength lies in the collaboration between Elders/leaders and custodians of Indigenous knowledge, along with Aboriginal and non-indigenous academics, employing decolonising methodologies (Geia et al., 2013) to examine and comprehend the contrasting perspectives and lived experiences of Aboriginal and non-indigenous individuals. The objective was to foster reconciliation, build mutual trust, and enhance relationships, while collectively exploring pathways for progress and cultivating mutual respect.

Recommendations

Several implications have emerged from this study. Firstly, the implementation of culturally responsive and secure, academic social architecture and practice is essential for prioritising the development of an Indigenised curriculum in the health professions. This objective aligns with policies aimed at addressing disparities, known as the ‘closing the gap’ strategy, specifically pertaining to the Australian context and Aboriginal communities. Secondly, non-Aboriginal educators should have increased access to professional development opportunities regarding Aboriginal health and culture. This will enable better informed teaching, debunk myths, promote truth-telling, and reduce racism. Thirdly, the utilisation of yarning research methods in this study has demonstrated the potential for incorporating these methods into teaching and learning processes. Doing so can facilitate knowledge, exchanging and enhancing contextual understanding, particularly concerning the epistemological nuances inherent in Aboriginal ways of knowing, being, and doing. Consequently, adopting yarning techniques within educational frameworks presents an opportunity to further Indigenise the curricula. Lastly, there is a crucial need for Aboriginal leadership within the higher education sector. Universities should prioritise the professional development, cultural safety, and vocational security of Aboriginal academics to strengthen and expand the workforce supply in this field.

Conclusion

This research employed a sequential, exploratory mixed-method approach to investigate the capacity and self-efficacy of health academics in incorporating Aboriginal content, perspectives and pedagogies into health curricula. The findings revealed that health professional academics encountered numerous challenges and lacked confidence when addressing Aboriginal topics in the health professions’ curricula. While most academics expressed interest in enhancing their engagement to contribute to curricula Indigenisation, they hesitated due to the absence of adequate professional development and culturally enriched guidance. Both Aboriginal and non-Aboriginal academic staff emphasised the importance of safety, yet the research process uncovered discomforts and biases, highlighting the need for cultural safety and appropriate professional development as universities strive for authentic Indigenisation of curricula within the health professions. Ultimately, prioritising the support and equitable employment of Aboriginal health professional academics is crucial for closing the health disparity gap and achieving aspirations for Aboriginal health improvement.

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Funding: This research was funded by an internal Teaching Innovation Generating Education Research (TIGER) grant.

Compliance with ethical standards: The University of Canberra’s Commmittee for Ethics in Human Research approved the study (CEHR 2011) that conformed to the provisions of the Declaration of Helsinki.

Competing interest:  All authors declare that they have no conflicts of interest.