Confidence working with First Nations Australians: Pre/post-rural placement survey of allied health students

Background: Together with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. However, the impact of placements on and determinants of student confidence around Indigenous people has not been investigated quantitatively. We used rural placements data systematically collected from students, including commencement- and end-of-placement questionnaire responses, to investigate these.

Methods: The study comprised data from all allied health students supervised by the WA Centre for Rural Health during the period 2019–2022 who completed questionnaires at both the commencement and end of their placement. Five-point ordered responses to the question 'How confident do you feel about working with Aboriginal people?' were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥1 point) during the placement using crude and adjusted multivariable robust Poisson regression.

Results: Participating students (N=453) were from diverse allied health disciplines (including pharmacy n=92; 20.3%; chiropractic and social work each n=59, 13.0%; occupational therapy and physiotherapy each n=56, 12.4%). Confidence in dealing with Aboriginal people was higher at commencement among males compared with females (adjusted relative risk [aRR] 1.51; 95% confidence interval [CI] 1.22–1.86), students of Australian rural origin compared with others (aRR 1.46; CI 1.18–1.80), and those who reported previous experience working with Indigenous people (aRR 1.40; CI 1.13–1.72). Notably, for all three of these categories, complementary subgroup 'catch-up' during the placement was evident. Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.15; CI 1.17–3.98), placement model reflecting more structured academic supervision (aRR 1.22; CI 1.04–1.43), and placement length (aRR per additional day 1.002; CI 1.001–1.004).

Conclusions: Survey data from a large sample of health students before and after a rural placement enables detailed investigation of personal and placement-related determinants of educational outcomes of potential importance for future practice. While influenced by students’ demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people. Opportunities for direct, meaningful, ideally immersive involvement of students with Indigenous communities are recommended as part of rural placements.