Traditional methods of imparting knowledge are known as yarning to Australian Aboriginal Elders and talking circles to North American First Nations peoples. Yarning is a relational methodology for transferring Indigenous knowledge. This article describes an emerging research methodology with yarning at its core, which provides respect and honour in a culturally safe environment. Yarning is highly structured, with protocols and principles providing participants control over the process and their stories. The methodology is embedded in a yarning space, which is framed by six protocols and seven principles. The protocols are gift, control, freedom, space, inclusiveness and gender specificity, and the principles are reciprocity, responsibility, relationship, dignity, equality, integrity and self-determination—to protect participants, stories and data. This is ensured through respectful and honouring relationships, responsibility and accountability between participants. The key camps in which the yarning journey is segmented are the Ancestors, protocols, principles, connections, data, analysis, processing and reporting, and the wider community.
12 January 2021 in AlterNative: An International Journal of Indigenous Peoples
In this article, we open up Yarning as a fundamentally relational methodology. We discuss key relationships involved in Indigenous research, including with participants, Country, Ancestors, data, history, and Knowledge. We argue that the principles and protocols associated with the deepest layers of yarning in an Indigenous Australian context create a protected space which supports the researcher to develop and maintain accountability in each of these research relationships. Protection and relational accountability in turn contribute to research which is trustworthy and has integrity. Woven throughout the article are excerpts of a yarn in which the first author reflects on his personal experience of this research methodology. We hope this device serves to demonstrate the way yarning as a relational process of communication helps to bring out deeper reflection and analysis and invoke accountability in all of our research relationships.
The community’s awareness of Tuberculosis (TB) and delays in health care seeking remain important issues in Indonesia despite the extensive efforts of community-based TB programs delivered by a non-government organisation (NGO). This study explored the knowledge and behaviours in relation to TB and early diagnosis before and after an asset-based intervention designed to improve these issues. Six villages in Flores, Indonesia were purposively selected to participate in this study. Three villages served as intervention villages and the other three villages provided a comparison group. Data collection included interviews, group discussions, observations, field notes and audit of records. In total, 50 participants across six villages were interviewed and three group discussions were conducted in the intervention villages supplemented by 1 – 5 h of observation during monthly visits. Overall, participants in all villages had limited knowledge regarding the cause and transmission of TB before the intervention. The delay in health seeking behaviour was mainly influenced by ignorance of TB symptoms. Health care providers also contributed to delayed diagnosis by ignoring the symptoms of TB suspects at the first visit and failing to examine TB suspects with sputum tests. Stigmatisation of TB patients by the community was reported, although this did not seem to be common. Early case detection was less than 50 % in four of the six villages before the asset-based intervention. Knowledge of TB improved after the intervention in the intervention villages alongside improved education activities. Early case detection also increased in the intervention villages following this intervention. The behaviour changes related to prevention of TB were also obvious in the intervention villages but not the comparison group. This small project demonstrated that an asset-based intervention can result in positive changes in community’s knowledge and behaviour in relation to TB and early case detection. A continuing education process is like to be required to maintain this outcome and to reach a wider community. Promoting community involvement and local initiatives and engaging health care providers were important elements in the community-based TB program implemented.
Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end‐stage kidney disease in Australian Aboriginal people is eight times higher than non‐Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the “costly” crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family‐focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal‐led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.
Objectives Australian Aboriginal people have at least eight times the incidence of end-stage kidney disease, requiring dialysis, as the non-Aboriginal population. Provision of health services to rural Aboriginal people with renal disease is challenging due to barriers to access and cultural differences. We aimed to describe the experiences of Aboriginal people receiving haemodialysis in rural Australia, to inform strategies for improving renal services. Design A qualitative design incorporating: Indigenist research methodology and Community Based Participatory Research principles. In-depth interviews used a ‘yarning’ and storytelling approach. Thematic analysis was undertaken and verified by an Aboriginal Community Reference Group. Setting A health district in rural New South Wales, Australia. Participants Snowball sampling recruited 18 Aboriginal haemodialysis recipients. Results Six themes emerged which described the patient journey: ‘The biggest shock of me life,’ expressed the shock of diagnosis and starting the dialysis; ‘Beats the alternative but it messes up your life,’ explained how positive attitudes to treatment develop; ‘Family is everything’, described the motivation and support to continue dialysis; ‘If I had one of them nurses at home to help me’, depicted acute hospital settings as culturally unsafe; ‘Don't use them big jawbreakers’, urged service providers to use simple language and cultural awareness; ‘Stop ‘em following us onto the machine’, emphasised the desire for education for the younger generations about preventing kidney disease. An Aboriginal interpretation of this experience, linked to the analysis, was depicted in the form of an Aboriginal painting. Conclusions Family enables Aboriginal people to endure haemodialysis. Patients believe that priorities for improving services include family-centred and culturally accommodating healthcare systems; and improving access to early screening of kidney disease. Inclusion of Aboriginal patients in cultural education for renal staff is recommended. Providing opportunities for patients to educate young Aboriginal people about kidney disease prevention may be highly effective and empowering.