Structured controversy exercise

CSIRO PUBLISHING

INDIGENOUS HEALTH

Australian Health Review, 2016, 40, 459–465 http://dx.doi.org/10.1071/AH15103

Role of non-Indigenous researchers in Indigenous health research in Australia: a review of the literature

Marion A. Gray1,2 BOccTher, MHSc, PhD, Discipline Lead Occupational Therapy Florin I. Oprescu1 MD, MBA, MPH, PhD, Senior Lecturer Health Promotion

1Cluster for Health Improvement, ML33, School of Health and Sport Science, Health and Sport

Centre, Building T, Faculty of Science, Health and Education, University of the Sunshine Coast, Maroochydore DC, Qld 4558, Australia. Email: [email protected]

2Corresponding author. Email: [email protected]

Abstract

Objective. This paper explores the body of knowledge around Indigenous health research and aims to outline what roles are appropriate for non-Indigenous researchers within Indigenous health research in Australia. Methods. A literature reviewwas conducted usingCINAHL, PubMed andScopus inMay2015. The search termswere ‘non-Indigenous researchers’ AND ‘Indigenous health research’ and other combinations of these terms. Additional documents were sourced by hand using the reference lists of key articles. Results. Seven thematic categories were identified: (1) Closing the Gap: implications for research; (2) history of Indigenous research; (3) developing Indigenous research using a capacity-building approach; (4) the cultural interface between Western paradigms and Indigenous knowledge; (5) ethical Indigenous research; (6) culturally safe Indigenous research; and (7) positive roles for non-Indigenous researchers in Indigenous research. Conclusion. It is important that non-Indigenous researchers become more aware of culturally appropriate ways in which to undertake Indigenous research and to ensure that the research undertaken is safe, ethical and useful for participants. Fostering partnerships between non-Indigenous academic organisations and researchers and Indigenous health researchers is an important development that can promote and enhance the emerging field of Indigenous inquiry. Actively contributing to capacity building with Indigenous researchers and research initiatives is a key role that non-Indigenous researchers and academic institutions can have in improving Indigenous health. Self-determination throughhealth research capacity building and evidence-based advocacy may provide the most useful outcomes for Indigenous people.

The health status of Indigenous Australians is well below that of other Australians. Historically, research about Indigenous health has been undertaken by non-Indigenous researchers using Western research paradigms. There is a need to identify appropriate roles for non-Indigenous researchers supportive of culturally safe and ethical research. This paper synthesises available knowledge about the role of non-Indigenous researcherswith

What is known about the topic?

Whatdoes this paper add?

Indigenous health research and provides suggestions for their contribution to Indigenous research practice.

Non-Indigenous researchers need to: (1) focus on culturally safe research practices; (2) be willing to address power imbalances within the research process; and (3) advocate for change within academic institutions to support culturally safe research practices.

What are the implications for practitioners?

Additional keyword: cultural safety. Received 3 June 2015, accepted 31 August 2015, published online 26 October 2015

Introduction

It galls us that Western researchers and intellectuals can assume to know all that is possible to know about us, on the basis of brief encounters with some of us.1

This quote highlights the crux of the issue for non-Indigenous involvement in Indigenous research. However, because re search is required in order to address many issues facing

Journal compilation

AHHA 2016 Open Access

Indigenous populations, non-Indigenous researchers and aca demics, many well intentioned, continue to be involved. Their involvement remains important and can be instrumental in building the capacity of Indigenous researchers, particularly in health.

Statistics highlight that the health of Indigenous Australians is poorer than that of other Australians.2 Research into causes and solutions around this inequality in health status may provide

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some answers; however, it is argued that the way research is conducted can be problematic.1

Previously, Indigenous-focused research has been used to highlight differences in health status and often feeds the dis courses of blame.3 Much academic research with Indigenous groups has provided little benefit to those who were researched and instead served to benefit the academics who gained qualifica tions and status.1,4 From a social justice perspective, it is critical to explore the following question: What are appropriate roles for non-Indigenous researchers in Indigenous health research in Australia?

This paper reviews the body of knowledge around the issue of non-Indigenous researchers’ involvement in Indigenous health research. The overall aim is to outline some of the positive roles that non-Indigenous researchers can play in Indigenous health research in Australia and elsewhere. This paper focuses on providing a broad perspective of the issue from a historical and present-day context. Because much of the literature around this topic comes from Aotearoa/New Zealand and Canada, for the purposes of this article, theword ‘Indigenous’will also be used to refer to Aboriginal and Torres Strait Islander people.

Methods

This paper is a narrative review of recent literature focused on the issue of non-Indigenous researchers’ involvement in Indigenous health research and seeks to provide an overview of the relevant available evidence.5 In doing so, the intent of this paper is to summarise and provide a thematic analysis of researchfindings in order to inform current practice and future directions for policy and research development.5

A search of the literature was conducted in CINAHL and Scopus in July 2015 (see Fig. 1). In addition, Google Scholar and Google were used to identify any additional literature (specifi cally grey literature and books) using the same keywords as within the database search. The keywords included: Australian, non-Indigenous researchers, Indigenous, health and research. Truncation was used where appropriate. Boolean combinations were used. Articles were also sourced by hand searching the reference lists of key articles.

25 articles were selected for final inclusion 32 articles were assessed for eligibility by the two authors 25 individual studies were identified from the 32 articles Included Eligibility 1725 articles underwent title and abstract screening and duplicate removal 44 articles were identified for full text screening Screening 32 articles were identified for inclusion 1725 articles identified through database searching 3 articles identified through reference list search of key articles Identification

Reference lists were identified and the relevant titles and abstracts explored to ensure articles were specific to the inclusion criteria. Full copies of relevant articles were obtained and exam ined to further justify inclusion in the review. The inclusion criteriawere: (1) full-text English articles; and (2) published peer reviewed articles that provided an explicit opinion or guide on the role or responsibilities of non-Indigenous researchers in Indigenous research. Research reports that merely mentioned non-Indigenous researchers as part of their methodology were excluded. Selected articles were read and the major themes are summarised herein.

Results

This paper presents an overview of the literature reviewed, organised into the following thematic categories: (1) Closing the Gap: implications for research; (2) history of Indigenous research; (3) developing Indigenous research: a capacity-building approach; (4)Western paradigms and Indigenous knowledge: the cultural interface; (5) ethical Indigenous research; (6) culturally safe Indigenous research; and (7) positive roles for non-Indige nous researchers in Indigenous research practice.

Closing the Gap: implications for research

The health status of Indigenous Australians is reported to be well below that of other Australians.2 The issues are complex and involve multiple health issues often of a chronic nature.6 Indig enous people have recently been shown to be twice as likely as non-Indigenous people to report fair or poor health. This inequal ity in self-perceived health status has not changed since 2002.2 Nationally for 2005–07, the life expectancy gap between Indig enous and non-Indigenous Australians was 11.5 years for men and 9.7 years for women.2

Closing the Gap, a government-driven strategy endorsed in 2008, set out to reduce this disadvantage, particularly in life expectancy, child mortality, educational achievement and em ployment. The premise of this strategy is to achieve Indigenous health equality within 25 years.7

One of the principles in the Prime Minister’s 2010 report on ‘Closing the Gap’ is resetting the relationship between Indigenous

Fig. . 1

and non-Indigenous Australians through various strategies that encourage ‘respect and understanding’.7 Although this is a useful principle, that document merely serves to outline the government actions currently being undertaken to meet this principle. There is little or nodiscussion about the types of research needed to identify how best to implement these actions and/or the need to discover what further actions need to occur.

To truly ‘close the gap’, appropriate and culturally safe research that empowers Indigenous Australians and allows them to have a key role in the discovery of and decision making about their own health reforms is required. Self-determination and capacity building in Indigenous research are critical areas to consider.8

As highlighted by Henderson et al.,9 some Indigenous health research, even that undertaken by non-Indigenous researchers, has been of ‘immense use’ in designing interventions that have helped improve the health status of Indigenous people. However, it is essential for future research endeavours to ensure that non Indigenous researchers act appropriately.10

History of Indigenous health research

The history of Indigenous health research is bound up in the history of colonisation.11 In Western-style research on Indige nous people, the researcher has been described as a coloniser and the participants as the colonised.12

Throughout the last century, Indigenous people were sub jected to relentless study, resulting, in some instances, in exploi tation, disrespectful experimentation, theft of Indigenous knowledge and beliefs and the representation of communities through the lens ofWestern prejudice.11On occasion, Indigenous research has been conducted without permission, consultation or involvement from Indigenous people, with the primary benefit being to the researcher. Many research outcomes have created more harm than good for Indigenous people, resulting in exploi tation, oppression and infringement of deeply held values.4,12,13 Because of this history of excessive and inappropriate re search, it is not unexpected that there is residual mistrust, ani mosity and resistance from Indigenous people to contemporary research initiatives.13 By the 1970s, Indigenous activism resulted in the emergence of groups such as the Foundation forAboriginal and Islander Research Action. The Foundation called for Indig enous control of Indigenous research.14 The culmination of this activism was that Indigenous people reclaimed research and developed alternative Indigenous ways of undertaking enquiry. Thus, the concept of an Indigenous research perspective based on empowerment emerged.4,12

At the end of the last century, Indigenous empowerment created a challenge to non-Indigenous researchers to become more appropriate in terms of how they undertake Indigenous research and to accept the emergingfield of Indigenous enquiry as legitimate and valid.11 As a result, Indigenous research needs to be undertaken from within an Indigenous world view where the perspectives of both Indigenous and non-Indigenous researchers are identified.12

Development of Indigenous research: a capacity building approach

The development of Indigenous research within the academic domain has necessitated the need to conceptualise Indigenous ways of knowing that go beyond theWesternways of knowing.15 However, because of fundamental differences between Western and Indigenous perspectives, partnership models of research have inherent problems. Issues include criticisms that Western research is too linear, static and time oriented and its inherent inflexibility impedes Indigenous community involvement.15

It is important to recognise that an Indigenous model of research would most likely be implemented from the ground up (where the research is driven and owned by Indigenous commu nities), whereas the Western model usually involves a top-down approach.15 A focus on understanding and transforming power relationships that goes beyond the concepts of partnerships between Indigenous and non-Indigenous researchers has been suggested.15

These new directions have led to accusations of political correctness from some in the academic establishment, and some traditional academics have successfully managed to silence Indigenous opposition to Western established methods of re search.16 Such ethnocentric perspectives could be seen as insti tutional racism17 and are counter-productive in enabling changes that potentially enhance fundamental goals of academic institu tions of learning and innovation. Although some levels of resis tance or institutional racism may still exist, there is a willingness among someacademics to conduct culturally safe and appropriate research that may reduce inequity and inequality in research and health outcomes.8,10

Chino and DeBruyn15 and Pyett8 called for non-Indigenous researchers to become allies and supporters for Indigenous researchers in promoting Indigenous research methods. Such an approach provides Indigenous researchers with access to spe cialist research skills and research traditions that can be used to develop and implement their own modes of inquiry.14,16 In enabling Indigenous research to be undertaken in communities by the community representatives, the role of the non-Indigenous researcher can be that of facilitator of the process of social change that is essential for the decolonisation of research.18

Indigenous people are now increasingly controlling their own research, which ensures that it is sensitive to their values, iden tities and history.18 Research undertaken via Indigenous ways of knowing is also described as ‘Indigenist research’. Indigenist research is culturally safe and is based on three principles: (1) resistance as an emancipatory imperative; (2) political integ rity; and (3) privileging Indigenous voices.13 It is acknowledged that Indigenous or Indigenist research, at least in the beginning stages, will occur alongside Western paradigms, often within traditionally Western institutions. In such circumstances, non Indigenous researchers have an important capacity-building role by providing a culturally appropriate space and guidance for upcoming Indigenous researchers.Thus, the relationshipbetween Indigenous and Western paradigms is important to explore.

Western paradigms and Indigenous knowledge: the cultural interface

Nakata19 described the concept of the cultural interface from the perspective of an Indigenous academic. He outlined that where Western paradigms meet Indigenous knowledge, there are a myriad of conversations to be had between Indigenous academics and non-Indigenous academics and people from Indigenous communities. These conversations can create an interface or intersection of knowledge that is complex and impacted on by history. Nakata19 proposed that Indigenous people may have difficulty in identifying an Indigenouspositionwithin this context and such conversations, over time, will assist in the development of a different research perspective. Key to the development of an Indigenous view of research is the acceptance on the part of Indigenous people of ambiguity as part of being Indigenous, instead of self-regulating as the subjugated ‘Other’.19 The meet ing ofWestern and Indigenous knowledge, the cultural interface, can provide a place of learning and enrichment for researchers from both cultures.8

From the perspective of a non-Indigenous researcher, this cultural interface is a place of continual questioning of what is ‘thought to be known’ and learning about an alternative knowl edge system that is embedded in the cultural experience of IndigenousAustralians.20The cultural interface is not determined by what is right and wrong, but by understanding that knowledge is culturally relative.21 It is important that non-Indigenous researchers interested in Indigenous research understand this concept if they are to become culturally safe and effective researchers in this particular context.

From the perspective of an Indigenous student in a Western academic system, there are those non-Indigenous academics who speak about Indigenous issueswithout everwanting to speakwith Indigenous people.22 In these interactions, non-Indigenous aca demics become privileged interpreters of Indigenous issues, rendering Indigenous people voiceless. By doing research devoid of direct input of Indigenous voices, institutions of higher learn ing risk becoming places of objectification, instead of emanci pation.21 The adoption of Indigenous research methods within higher education facilities and reflective consideration by non Indigenous researchers about their own practices can counter this objectification.

Rix et al.23 highlighted the need for reflexive practice as a non Indigenous researcher working with Indigenous people. These authors described themselves as ‘merely the research instrument’ whose role it is to rigorously act as a conduit between Indigenous people and thehealth system inorder to return Indigenouspatients to a degree of self-determination.

It is important that non-Indigenous researchers recognise and analyse the Western bias that they may bring to research.24 This recognition will allow non-Indigenous researchers to better un dertake culturally safe research, which is performed and trans lated in such a way that Indigenous people are the first and foremost recipients of the research benefits.4 Research without direct benefit to participants has little justification from an ethical perspective.

Ethical Indigenous research

From an ethical perspective it is essential that Indigenous people are empowered participants in any research project that concerns them through sharing an understanding of the aims and methods of the research, and sharing the results of the work.25 As such, there have been various incarnations of ethical guidelines pro duced to help guide Indigenous research.

Henderson et al.9 described a process inwhich theDepartment of Rural Health at The University of Melbourne successfully worked in partnership with the Indigenous communities with whom they were engaged in research (the Koorie Health part nership). The process contained key ethical strategies, including community consultation, community involvement, supervision of non-Indigenous researchers and rules about who controls the data or information. These strategies were based on the 1991 National Health and Medical Research Council (NHMRC) Guidelines on Ethical Matters in Aboriginal and Torres Strait Islander Health Research.26

However, these guidelines have been reported as a somewhat ‘watered down’ version of what had been requested by Indige nous people.11 In 1999, the NHMRC updated guidelines for Indigenous research and included these in the Statement on Ethical Conduct in Research Involving Humans.27 However, according to Humphery,11 these were still interim and required review to determine the level of adherence by non-Indigenous researchers.

Furtherguidelines for ethical conduct inAboriginal andTorres Strait Islander research have been published by the NHMRC in 2003.28Theseguidelines inform the researchdesign fromavalues approach. Six values that should underpin research in Indigenous populations are: spirit and integrity; reciprocity; respect; equality; survival and protection; and responsibility.28 The first of these, Spirit and Integrity, is an overarching value that binds the others into a whole. All those interested in Indigenous research have a responsibility to demonstrate consistency with the above values.

Culturally safe Indigenous research

In order to undertake research in an ethical way, the non-Indig enous researcher must become aware of the concept of culturally safe health research. The concept of cultural safety first appeared in New Zealand in the field of nursing29 and has since been adopted by other professions and researchers. The cultural safety process entails a journey across a continuum of understanding of historical issues, power relationships, the health professional’s own attitudes, and the consequent effect of these factors on health and health care delivery.29

Cultural safety originated as a means of rectifying the poor health status of the Indigenous people of New Zealand (Maori). The focus of cultural safety in a research context is not about learning cultural norms, but rather on attitudinal change towards those who are culturally different from the researchers and on recognising the power imbalances that occur between researcher and participants. Becoming culturally safe ismore than just being culturally competent. Although these two concepts are similar in that they both focus on the development of knowledge of cultural issues and self-reflection, cultural competence does not share the emphasis on sociopolitical analysis that is inherent to cultural safety.17 This attitudinal change and learning associated with this analysis can enable those in relative power, in this instance non Indigenous researchers, to deal more appropriately with people from diverse cultures30,31 while advocating for more individuals from Indigenous backgrounds to become researchers in the field.

Indigenous students remain poorly represented within health professions and in academia. Indigenous students may face additional barriers to completion of studies such as finances, heightened self-doubt, racism and learning style differences.32 Changing the structure of the academic institutions to become more accepting of alternative perspectives could make these institutions safer and more attractive for Indigenous students, who, in turn, may become productive health researchers of the future within and outside of their communities.

Positive roles for non-Indigenous researchers in Indigenous research practice

There are some examples of successful health research processes conducted in partnership with Indigenous communities. For example, The Footprints in Time: The Longitudinal Study of Indigenous Children outlines a successful consultation process with Indigenous stakeholders.33 This process included issues of extended time frames, talking to the right people and enough people and the importance of listening well. That study described some of the issues of researching in Indigenous communities as highlighted in Fig. 2.33

In terms of the use of the data generated by research in Indigenous contexts, there is an immediate need for understand ing the role of culture or loss of it. Furthermore, it is important to explore the effect of culture on family, quality of life and health in general. Penman34 found that the needs of the community were best met if results were local and qualitative. Thus, it is important for non-Indigenous researchers to ensure that any research en deavour is empowering, positive and practical in its orientation.

Discussion

Even though there has been criticism of a research partnership model between Indigenous and non-Indigenous researchers,15

there are several successful models of non-Indigenous research involvement that have been described in the literature. Central to the success of these is the awareness of the power imbalance that exists between the researcher and those being researched. Stew art35 highlighted that there is never a power balance in research and the participants are always vulnerable, so in order to ensure sound intent, the researcher needs to ask ‘why am I doing this study andwhowill it benefit?’. If the participant is not the primary beneficiary, then the ethics of the research need to be reassessed.

As a non-Indigenous researcher, Stewart35 advocated for the use of adapted Western qualitative methodologies. Reassessing the use ofWestern researchmethods rather than totally discarding them can lead to the creation of new theory andmore flexible and culturally safe approaches to research. Culturally appropriate methodological approaches require amore respectful relationship with Indigenous participants and require non-Indigenous researchers to promote open and respectful communication, including difficult dialogues. Such communication can provide ways to restructure Indigenous–non-Indigenous relationships and address power imbalances.35

In another example of adaptation of a Western research method, Whitman36 describes the Wis Wei Youpla Health re search project, in which the authors used a critical ethnographic case study approach. Data analysis was reconstructed and dia logically negotiated with participants. This method allowed for power relationships between the researchers and the researched to be explicit, exposing the privileged standpoint of the re searcher and giving voice to marginalised participants. Non Indigenous researchers could promote social justice and empowerment by providing a voice for those who do not have it. Such voice can be further strengthened by encouraging, advising and mentoring emerging researchers from Indigenous backgrounds.

This current paper has explored the literature with the purpose of identifying appropriate roles for non-Indigenous researchers in Indigenous health research in Australia. It is well accepted that the health of Indigenous Australians urgently needs addressing. Although traditional Western research has been of use in helping improve the health status of Indigenous people, the continued health disparity between Indigenous and non-Indigenous Aus tralians indicates an urgent need to increase the research capacity

Communities Communities do not necessarily represent kinship groups There is a need for a sense of ownership Capacity building must be achieved through Indigenous involvement and control Empowerment Families Families are extended and complex in structure Many families are mobile with changing careers There is a lack of trust in government agencies Trust

Fig. . 2

of Indigenous researchers and to create an Indigenous research perspective.

It is important that non-Indigenous researchers become more aware of culturally safe ways in which to undertake Indigenous research and ensure that the research undertaken is appropriate, ethical and useful for participants. The creation of partnerships between non-Indigenous academic organisations and researchers and Indigenous health researchers is an important development that will promote the recognition of the emerging field of Indig enous inquiry.

Conclusion

Actively contributing to capacity building for Indigenous researchers and research initiatives is a key role that non-Indig enous researchers and academic institutions can have for improv ing Indigenous health. Non-Indigenous researchers are well placed to assist both the building of the capacity of Indigenous researchers and supporting the construction of an Indigenous research perspective. However, non-Indigenous researchers need to understand and work with the differences between Western research paradigms and Indigenous ways of knowing. To do this, non-Indigenous researchers must acknowledge the power rela tionships that exist in all research and act appropriately by developing culturally safe research practices that strictly adhere to the ethical principles developed for working with Indigenous groups. The development of culturally safe research practices must involve self-reflection, adaptation and respect.

Culturally safe research practices also need to be enshrined within institutional policy. Non-Indigenous researchers have an important role as advocates for change in order to ensure these practices and policies are implemented. Such practices will support the empowerment of Indigenous people to undertake necessary research for themselves. Although giving over power or control in this way may seem to some non-Indigenous aca demics somewhat counterproductive to their own personal aca demic goals, ultimately the self-determination of Indigenous health researchers and reforms is likely to provide the most successful and sustainable outcomes for Indigenous people.

Competing interests

None declared.

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