Clinical trial NCT05629416: The Communicate Study Partnership
Official title: The Communicate Study Partnership - Improving Healthcare Experiences and Outcomes for Aboriginal Peoples Through Delivery of Culturally Safe Healthcare in First Languages
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Aboriginal Health
Cultural Safety
Access to Interpreters
Healthcare Provider Training
Lead sponsor: Menzies School of Health Research
Sponsor class: OTHER
Collaborators: name: Northern Territory of Australia as represented by the Department of Health
name: Djalkiri Foundation Aboriginal Corporation
name: Charles Darwin University
name: National Accreditation Authority for Translators and Interpreters
name: Northern Territory Government as represented by the Department of The Chief Minister and Cabinet
First posted: 2022-11-29
Enrollment: 340
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Interventions to transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The vision of the Communicate Study Partnership is to ensure more Aboriginal patients receive culturally safe healthcare in their first language.

The Communicate Study Partnership will implement and evaluate creative ways to embed cultural safety training and increase use of Aboriginal Interpreters and Aboriginal Health Practitioners at Northern Territory Top End hospitals.

Quantitative outcomes (interpreter uptake, outcomes including leave against medical advice, costs) will be measured using time-series analysis. Qualitative outcomes derived from interviews with patient, healthcare provider and interpreter participants, will be informed by decolonising theory and participatory approaches.

Successful project implementation will improve experience of care and health outcomes for Aboriginal people, build Aboriginal workforce, and improve healthcare provider satisfaction.

Detailed description: The goal of "The Communicate Study: partnership across the Top End to improve Aboriginal patients' experience and outcomes of healthcare" is to achieve sustainable organisational change to provide excellence in cultural and clinical safety for Aboriginal people utilising NT Health facilities.

Aim 1: Transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples

- Develop, implement and evaluate anti-racism training using 'Ask the specialist-Plus'. This comprises moderated discussion and reflection on 'Ask the Specialist' podcast episodes held during in-service and clinical teaching timeslots for healthcare providers

Aim 2: Strengthen the tools and strategies required underpinning culturally safe practice

1. Improve demand for Aboriginal interpreters and Aboriginal health practitioners through improved cultural understanding and recognition of patient needs
2. Improve supply of interpreters and Aboriginal health practitioners willing to work in the hospital environment by creating a culturally safe workplace and supporting career pathways
3. Effectiveness strategies tailored to participating sites such as

   * positioning interpreters at points of need and embedding them in medical and surgical teams
   * Optimising workflow to facilitate efficiency and availability across hospital departments

Aim 3: Evaluate outcomes using comprehensive qualitative and quantitative measures

1. Qualitative enquiry to assess cultural safety from patient perspectives, and understand experiences of Aboriginal and Non-Aboriginal healthcare providers and interpreters
2. Quantitative outcomes including

   * performance across key indicators: changes in documentation of language; Interpreter bookings made; Interpreter bookings completed; % Aboriginal patients in need getting access to an interpreter
   * Impact of intervention: proportion of admissions with and without interpreters ending in self-discharge; unplanned re-admissions and changes in hospital length of stay
   * economic analysis of the costs and cost benefits of interpreter use to decrease self-discharge and re-admission rates.

Eligibility criteria: Inclusion Criteria:

Different patient and provider participants (e.g. Aboriginal patients, Aboriginal interpreters, healthcare providers of any ethnicity) will be invited to participate in interviews, observations and surveys to assess effectiveness of study activities

Exclusion Criteria:

None

Primary outcomes:
measure: Self discharge among Aboriginal inpatients at Royal Darwin Hospital, Palmerston Hospital, Katherine Hospital and Gove District Hospital
timeFrame: Up to 4 years. (Health system level data are collected and summarised quarterly during July 1 2022 - June 30 2026, and compared with the baseline phase July 1 2020 - June 30 2022)
measure: Patient experience (qualitative evaluation)
timeFrame: Up to 4 years. Interview data will be collected at regular intervals throughout the study (2022-2026) to track any change in patient experience during the course of the intervention period
Secondary outcomes:
measure: Documentation of language in hospital medical records
timeFrame: Up to 4 years. (Documentation of language will be tracked throughout the 4-year intervention period.)
measure: Access to an interpreter during admission
timeFrame: Up to 4 years. (Documentation of interpreter access will be tracked throughout the 4-year intervention period.)
measure: Healthcare provider experience
timeFrame: Up to 4 years. Interview data will be collected at regular intervals throughout the study (2022-2026) to track any change in healthcare provider experience during the course of the intervention period
measure: Cost
timeFrame: Up to 4 years. Continuous data (daily data, summarised monthly) will be assessed during - the two-year baseline phase July 1 2020 - June 30 2022 - the four-year intervention (activity) period July 1 2022 - June 30 2026
measure: Unplanned readmission within 28 days
timeFrame: Up to 4 years. Continuous data (daily data, summarised monthly) will be assessed during - the two-year baseline phase July 1 2020 - June 30 2022 - the four-year intervention (activity) period July 1 2022 - June 30 2026
Other outcomes:
Locations:
city: Darwin
country: Australia
facility: Royal Darwin Hospital
state: Northern Territory
city: Darwin
country: Australia
facility: Palmerston Hospital
state: Northern Territory
city: Katherine
country: Australia
facility: Katherine Hospital
state: Northern Territory
city: Nhulunbuy
country: Australia
facility: Gove District Hospital
state: Northern Territory
Study officials:
affiliation: Menzies School of Health Research
name: Anna Ralph, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Kerrigan V, McGrath SY, Herdman RM, Puruntatameri P, Lee B, Cass A, Ralph AP, Hefler M. Evaluation of 'Ask the Specialist': a cultural education podcast to inspire improved healthcare for Aboriginal peoples in Northern Australia. Health Sociol Rev. 2022 Jul;31(2):139-157. doi: 10.1080/14461242.2022.2055484. Epub 2022 Apr 3.
citation: O'Connor E, Kerrigan V, Aitken R, Castillon C, Mithen V, Madrill G, Roman C, Ralph AP. Does improved interpreter uptake reduce self-discharge rates in hospitalised patients? A successful hospital intervention explained. PLoS One. 2021 Oct 12;16(10):e0257825. doi: 10.1371/journal.pone.0257825. eCollection 2021.
citation: Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. "The talking bit of medicine, that's the most important bit": doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care. Int J Equity Health. 2021 Jul 23;20(1):170. doi: 10.1186/s12939-021-01507-1.
citation: Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. From "stuck" to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital. BMC Health Serv Res. 2021 Jun 4;21(1):548. doi: 10.1186/s12913-021-06564-4.
citation: Mithen V, Kerrigan V, Dhurrkay G, Morgan T, Keilor N, Castillon C, Hefler M, Ralph AP. Aboriginal patient and interpreter perspectives on the delivery of culturally safe hospital-based care. Health Promot J Austr. 2021 Feb;32 Suppl 1:155-165. doi: 10.1002/hpja.415. Epub 2020 Dec 4.
citation: Communicate Study group*. Improving communication with Aboriginal hospital inpatients: a quasi-experimental interventional study. Med J Aust. 2020 Aug;213(4):180-181. doi: 10.5694/mja2.50700. Epub 2020 Jul 25. No abstract available.
citation: Kerrigan V, Lewis N, Cass A, Hefler M, Ralph AP. "How can I do more?" Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload. BMC Med Educ. 2020 May 29;20(1):173. doi: 10.1186/s12909-020-02086-5.
citation: Ralph AP, Lowell A, Murphy J, Dias T, Butler D, Spain B, Hughes JT, Campbell L, Bauert B, Salter C, Tune K, Cass A. Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia's Northern Territory. BMC Health Serv Res. 2017 Nov 15;17(1):733. doi: 10.1186/s12913-017-2689-y.