Representation of Indigenous health knowledges within health literacy related policy and practice documents across Australia, Canada and New Zealand

摘要

Australia, Canada and New Zealand are multicultural societies that are considered to have world-class health systems. Extensive efforts are being made by governments and the healthcare sector to improve overall health and quality of life outcomes. The task remains challenging, particularly within the many Indigenous minority populations across all three countries. One of the emerging strategies of the health promotion sectors is to enhance health literacy skills in an attempt to address the ongoing health disparities between Indigenous and non-Indigenous people. It is also being increasingly recognised that cultural beliefs strongly influence the way health and wellbeing are defined, assessed, maintained and promoted.A review of the literature identified concerns that Indigenous health related knowledges are marginalised or disregarded within health policies and that current research is limited. This research study conducted a critical in-depth investigation of health literacy related policy and practice documents from Australia, Canada and New Zealand. It aimed to explore how, and to what extent, Indigenous health knowledges are recognised within health literacy related policy and practice documents. This research question was answered by conducting an exploratory qualitative content analysis of selected health literacy related policy and practice documents. The documents were purposefully selected from Australia, Canada and New Zealand and selection was confined to the last 10 years, ranging from January 2005 to December 2015. A total of 108 documents were considered relevant to the research question and further analysed with the use of the qualitative research software QSR NVivo10. This in-depth analysis of documents identified 6 main themes and 19 sub-themes.The study findings suggest that health literacy related policy and practice documents from all three countries increasingly acknowledge that Indigenous concepts and languages should be considered. The findings also support contentions made within the literature that the construction and dissemination of health information continues to be largely confined to the hegemony of Western knowledges, pedagogies and paradigms. As such, it frequently disregards the value of Indigenous knowledges, paradigms and practices. It is further argued that colonial concepts and structures are generally maintained within health literacy related policy and practice documents. Disregard for, diminution or confinement of Indigenous knowledges, paradigms and practices, may contribute to feelings of disempowerment and isolation amongst Indigenous populations.Further studies are recommended to investigate current processes of policy development. These might pay particular regard to approaches made to enable Indigenous consultation, participation and self-determination. A detailed analysis of the underpinning power-relationships that inform the construction of knowledge and thereby affect policy outcomes and practices within the health literacy environment would be useful. The exploration of personal perceptions, experiences and expectations from health organisations and Indigenous stakeholders, regarding the status and value of Indigenous knowledges, could be a further, helpful research topic. It appears likely that differences exist between policy documents and everyday practice.