Chiropractors` experience and readiness to work in Indigenous Australian Communities: a preliminary cross-sectional survey to explore preparedness, perceived barriers and facilitators for chiropractors practising cross-culturally

Vindigni et al. Chiropractic & Manual Therapies (2017) 25:13 DOI 10.1186/s12998-017-0144-0 RESEARCH Open Access Chiropractors` experience and readiness to work in Indigenous Australian Communities: a preliminary cross-sectional survey to explore preparedness, perceived barriers and facilitators for chiropractors practising cross-culturally Dein Vindigni1, Barbara I. Polus1*, Sonja Cleary2 and Aunty Kerrie Doyle2 Abstract Background: Indigenous people make up approximately 3% of the total Australian population and score poorer on all health indices, including back pain. Chiropractors are well placed to alleviate back pain, yet there is no research that considers chiropractors’ readiness to treat Indigenous patients. This study explores chiropractors` experience working with Indigenous Australians, describes perceived barriers and facilitators to chiropractors’ participation in Indigenous Healthcare and their willingness to engage in cultural competency training. Methods: This study used a non-representative cross-sectional design and a convenience sample. Participants were recruited via email invitation to complete an online survey and encouraged to send the invitation on to colleagues. A 17-item online-survey measured demographic data, perceived barriers and facilitators related to caring for Indigenous Australians, participants` level of comfort when working in Indigenous health, and their willingness to participate in cultural competency programs to enhance their skills, knowledge and cultural capacity when engaging with Indigenous Australians. Analysis of the data included descriptive statistics as well as thematic analysis of qualitative free text. Results: One hundred and twenty-five chiropractors participated in the survey. The majority of participants (86%, n = 108) were employed in private practice. 62% of respondents were members of the Chiropractors' Association of Australia, 41% were Chiropractic and Osteopathic College of Australasia members. 60% of chiropractors considered that they had, or do treat Indigenous patients yet only 4% of respondents asked their patients if they identified as Indigenous. A majority of participants expressed a high level of ‘comfort’ or confidence in working with Indigenous people while only 17% of respondents had undertaken some form of cultural proficiency training. A majority of respondents (62.7%, n = 74) expressed an interest in working with Indigenous Australians and a majority (91%, n = 104) were willing to participate in training to develop Indigenous cultural competency. (Continued on next page) * Correspondence: 1 Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Plenty Road Bundoora, Victoria 3083, Australia Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Vindigni et al. Chiropractic & Manual Therapies (2017) 25:13 Page 2 of 9 (Continued from previous page) Conclusions: The study points to a need for chiropractors to have access to cultural proficiency training in order to develop the capability and confidence to engage respectfully with their Indigenous patients. This preliminary study has provided the researchers with valuable insights aiding the development and implementation of an Indigenous cultural proficiency program for chiropractors. Keywords: Chiropractors, Experience, Indigenous, Australian, Cultural competency Background The gap in all health and quality of life outcomes for Indigenous Australians continues to be of great concern [1] and this gap also exists in musculoskeletal disorders. Chronic back pain, for example, is experienced by 12.7% of Australians, with low back pain (LBP) being the second highest burden of chronic disease [2]. While there are no census data measuring LBP across all geo-locations of Indigenous Communities, Lin et al. [3] recorded back pain as ‘profoundly disabling’ in some Indigenous Communities, and Vindigni et al. [4] demonstrated that in regional and remote Indigenous communities, LBP is the most prevalent musculoskeletal condition with financial disadvantage, limited geographical access to allied health professionals (such as chiropractors, osteopaths and physiotherapists) and sociocultural barriers identified as contributing to the burden of illness. Thus accessible and effective strategies for managing musculoskeletal pain experienced by Indigenous peoples are indicated. The explanations given for the ongoing gap in health status between Indigenous and non-Indigenous people have been well described in the published literature (e.g. [5, 6]). The underlying causes relate to disadvantage across a spectrum of determinants including include social, political, educational, economic, geographical and cultural determinants of health [7]. Given the poorer overall health status of Indigenous people, it might be expected that the use of primary health services would be higher for Indigenous than non-Indigenous peoples, but this is not the case [8, 9]. Some of the barriers to accessing primary health care in Indigenous communities include a lack of appropriate health services, affordability and social/cultural acceptability of the service [10]. Considering the population distribution of Indigenous Australian people and the spread of chiropractic clinics in urban, rural and remote Australia, there is an expectation that a lack of geographically accessible health services should not be a barrier to chiropractic care. There are approximately 5000 registered chiropractors in Australia [11]. Of the 3310 chiropractors that are members of the Chiropractors’ Association of Australia (CAA), 322 (9.7%) have registered practices with postcodes classified as remote or very remote and 21.7% have registered practices with postcodes classified as outer regional (CAA database of geographical location of CAA members) While these figures do not include all registered chiropractors, the CAA remains recognised as the peak body representing the majority of chiropractors in Australia. In Victoria 754 chiropractors are members of the CAA. Of these, 169 (22.4%) have practice postcodes classified as outer regional or remote (CAA database of geographical location of CAA members). When examining the geographical location of Indigenous Australians it was found that only 20% of Indigenous people live in remote or very remo (...truncated)