Cultural respect in general practice : a mixed method cluster randomised controlled trial

Context: Australia is struggling to address the disparity in health of Indigenous Australians. The Ways of Thinking and Ways of Doing (WoTWoD) cultural respect intervention comprises a toolkit, one half-day workshop, cultural mentor support for practices, and a local care partnership between local Primary Health Networks and Aboriginal Community Controlled Health Services to guide the program and facilitate community engagement. Objective: To examine whether WoTWoD improves clinically appropriate anticipatory care in general practice and cultural respect displayed by medical practice staff as measured by rates of claims for MBS item 715 (health assessment for Indigenous Australians), recording of chronic disease risk factors; and changes in cultural quotient (CQ) scores of practice staff. Design: Mixed methods, cluster randomised controlled trial with a participatory action research approach. Setting/Participants: Fifty-six general practices in Sydney and Melbourne during 2014-2017. Findings: Complete data were available for 28 intervention (135 GPs, 807 Indigenous patients) and 25 control practices (210 GPs, 1554 Indigenous patients). Participants reported positive experiences. However, 12-month rates of MBS item 715 claims and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in CQ scores, regardless of staff category and practice attributes. Implication(s) for practice: While it was well-received, the WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation.