Talking together

Establishing respectful relationships 

When a good relationship has been established between you and another person, everything else will flow much more easily. Make good relations your first priority when caring for an Aboriginal or Torres Strait Islander person and their family. If you genuinely commit yourself to interacting with the person respectfully on a personal level, she or he may quickly come to see you are a helpful person, and will communicate more easily. Better health outcomes will flow from good relationships. When people get to know each other, build rapport, and trust each other, then they can work well together. [1] In essence, forming positive relationships with a patient and the key people associated with them is essential in providing optimal care. [2]

Treat Everyone as an Individual

Everyone is different. Just like all cultural groups, Aboriginal and Torres Strait Islander people and communities share things in common, but are also very diverse. What is true for one Aboriginal or Torres Strait Islander person is definitely not true for all Aboriginal or Torres Strait Islander peoples. So when an Aboriginal or Torres Strait Islander person comes to your health service, be aware there may be cultural differences, but don’t assume their presence. For example, protocols of eye contact, name usage, or kinship patterns, may be different for each family. So you need to be aware that these protocols may be important, but don’t assume they are. In short, 'get to know people as a human being, not as a stereotype'.[1]

Listen then Ask; Don't 'Tell'

One of the keys to building good relationships is to listen more than you speak. As you get to know each other and rapport develops between you, it then becomes appropriate to ask questions. Once it becomes appropriate, ask questions more than give opinions. [1]

You might like to ask:

'Are there cultural or spiritual practices that affect the way you wish to be cared for?'
'How can I provide the best care for you?'
'Are there other people that should be included in talks about your health care?'

Understanding the context

Context is important for many Aboriginal and Torres Strait Islander people. As a health care provider you may be aware of trajectory of health conditions but people with health concerns may not. After you introduce yourself, it is good to discuss the context of your interactions and how long your interactions will occur, regularity of consultations, who to ring if there is a problem. If a person has a chronic health condition, your interactions will be for their lifetime, responding to symptoms and addressing the decrease in functional abilities. People like consistency in their service providers, so clarifying if you will consistently provide services or if there will be a rotation of service providers, helps people to prepare for those situations.

Tips for talking together 

Reconciliation Australia's Share our Pride website's section on Respectful Relationships provides useful tips on how to 'Speak and Listen Well' - things to consider when communicating with Aboriginal and Torres Strait Islander people. They point out that of course, many of these tips apply to all people. [1]

• Don’t assume anything.
• Don’t talk too fast.
• If you need to use jargon and technical language, always explain the terms.
• Don’t mimic Aboriginal and Torres Strait Islander ways of speaking (i.e. words, slang, speech, accent).
• Be consciously open minded – try to leave your own opinions behind.
• Never be boastful about your ideas.
• Don’t be too direct as this can be taken as confrontational and/or rude.
• Some people culturally avoid eye contact, so don’t assume that, if they’re not looking at you, they’re not interested.
• Don’t ask hypothetical questions.
• Deal in practical, real issues, not theoretical ideas.
• Ask advice. Do not try to be an ‘expert’ on Aboriginal and Torres Strait Islander culture. Be interested instead. People appreciate it.
• Be a listener more than a speaker. Ask questions rather than giving answers.
• Take the lead from others in how you join in or run conversations – don’t assume your way of conversing will always be the best way.
• Remember that building relationship is just as important as outcomes or achievements. So don’t rush to ‘business’.
• Allow people to hold their different values. This does not mean letting go of yours. It just means not imposing those values on others."

Share our Pride also suggests asking yourself the following questions when assessing the success of your communication with Aboriginal and Torres Strait Islander people and their family. [1]

• 'Have I really understood what this person needs?'
• 'Am I using language that s/he understands?'
• 'Am I being as respectful as I can?'
• 'Am I going out of my way to demonstrate how keen I am to help her or him?'

Tips for good communication in health care settings 

Effective communication is an essential element to ensuring the right health care for a patient and their family. [2] Other tips related to good communication in health care settings may also include: [2-14]

1. Be aware of underlying attitudes, assumptions, and cultural biases you may hold about Aboriginal or Torres Strait Islander people. This will influence your perceptions and may create obstacles to effective communication.
2. Treat Aboriginal or Torres Strait Islander patients as if you are working with the family and/or the community of that patient as well. Don’t treat them in isolation from their kin.
3. Ensure that the right information is being shared with the right person/family member.
4. Determine what communication strategies may be appropriate for the patient, eg, consider if an interpreter is required, offer the option of family meetings, and teleconferences when family are far away.
5. Body language – be aware of yours. Be guided by the non-verbal and body language cues demonstrated by family members, such as body position, the use of eye contact, periods of silence, and facial expressions.
6. Allocate enough time to facilitate meaningful discussions. Be patient, don’t try to hurry things up.
7. Traditional Aboriginal ‘deep listening’ practices such as ‘dadirri’ can be very useful in working with Aboriginal and Torres Strait Islander people. Somewhat like mindful contemplation, a big part of dadirri is inner deep listening which draws beyond more than what is simply heard, really tuning-in and being profoundly aware and respectful of all that surrounds us. The other part of dadirri is quiet still awareness. This involves waiting for things to take their natural course, and being comfortable with periods of silence. We have two ears and only one mouth – so we should listen twice as much as you speak.
8. Start interactions by introducing yourself and simply ‘having a yarn’. This is a ‘social yarn’ where you show an interest in the patient, get to know them and their family, and find and share common ground. This might be about family, places visited, and where you are both from. Finding a connection or shared life experience will help to develop a trusting relationship. Once rapport is developed, this then allows the conversation to progress gradually to the clinical issue at hand.
9. A comprehensive holistic clinical assessment that addresses physical, social, emotional, spiritual and cultural needs can be achieved through ‘clinical yarning’. Here you allow the patient’s story in relation to their health to unfold, and can direct the yarn towards the health information needed through open-ended questions. This involves actively and respectfully listening to the patient’s health story. You may need to do this over a period of time to allow for relationships and trust to grow.
10. Try to avoid asking direct questions. An alternative is to try presenting options and the possible outcomes of each. When questions are asked, open-ended questions (that can’t be easily answered with yes or no) are best.
11. Check frequently to see if the message has been understood
    • by the health professional - by summarising what you think the patient has said to check if your understanding is accurate; and
    • by the patient/family - by asking the patient/family member to tell you what they think you have said in their own words
12. Acceptable terms to describe Aboriginal and/or Torres Strait Islander peoples are Aboriginal person, Torres Strait Islander person, and First Australian. Terms such as full or half blood, half caste or part-Aboriginal are offensive. Never abbreviate the word ‘Aboriginal’, as this is offensive, as is referring to people by the acronym ‘ATSI’ in any written or verbal communications.
13. Identify the nationhood of the individual and their family. ‘Nation’ refers to a culturally distinct group of Aboriginal or Torres Strait Islander people associated with a particular, culturally defined area of land or country.

Useful resources 

The references listed at the end of this page are great sources of detailed information on this topic. Some key examples are:

• Reconciliation Australia has a website called Share our Pride, which aims to celebrate the cultures of Australia's First People. It includes a section on building Respectful Relationships to progress reconciliation between Indigenous and non-indigenous Australians.
• Communicating effectively with Aboriginal and Torres Strait Islander people (341kb pdf) is a practical factsheet from Queensland Health and a very useful introduction to this area.
• For a more comprehensive understanding of Aboriginal and Torres Strait Islander cultures, and communication and relationship building guidelines, see:
  • Didja Know: Cultural information & communication guide (17.30MB pdf) from Northern Sydney Local Health District
  • ‘Yarn with me’: applying clinical yarning to improve clinician–patient communication in Aboriginal health care is a journal article by Lin, Green and Bessarab, that was recently published in Australian Journal of Primary Health. It describes the application of yarning as a communication strategy in clinical settings.
  • Working and walking together: Supporting family relationship services to work with Aboriginal and Torres Strait Islander families and organisations (5.60MB pdf) from the Secretariat of National Aboriginal and Islander Child Care
  • Strategies for improving communication in Indigenous health care, from the Sharing the True Stories project, and in particular Guidelines for health staff.
• From a more systems-level perspective, see Building better partnerships: Working with Aboriginal communities and organisations: a communication guide for the Department of Human Services (2.39MB pdf). Page 38 describes steps to successful Indigenous and non-Indigenous collaborations, including demonstrating respect, choosing the right words, taking responsibility for learning, be self-aware, demonstrate honesty and integrity, provide adequate information, and follow up after involvement.