Working Right Ways: Investigating Health Practitioners' Perspectives of Challenges and Barriers to Providing Good Foot Care With and for First Nations Peoples

BACKGROUND: Ongoing colonisation of the land now known of Australia includes Western hegemony in biomedical knowledge systems dominating healthcare provision. Racism remains structurally entrenched in Australian systems of health and wellbeing. This has serious implications for First Nations foot health outcomes. The purpose of this work is to empower First Nations-led codesign of ways of working in foot health research to investigate challenges to attending, and barriers to providing, good foot care with and for First Nations Peoples. METHODS: Aboriginal Participatory Action Research ways of working in this study are documented in previous publication; 'Working right ways in foot health with and for First Nations Peoples: research method guided and governed by First Nations ways of knowing, being, and doing in cross-sectional qualitative study design'. First Nations-led study design used decolonised language in semi-structured interviewing to talk with consenting participants. Data analysis included all transcripts being anonymised and transcribed verbatim by researchers manually. First Nations-led ways of doing thematic analysis was agreed upon by all authors. RESULTS: Two talking points discussed First Nations and non-Indigenous health practitioners' perspectives of providing good foot care with and for First Nations Peoples: (1) What challenges exist in attending individual/organisational services? (2) What are barriers to providing good foot care? In interviews, themes emerged of relationships, disempowerment, education, and clinical governance. Additionally, racism, distance, and funding were perceived as influencing foot care provision. Although not themed, the constructs of time and their importance, were interwoven through results. CONCLUSION: Participants described relationships which were not culturally centred, nor longer term, and which therefore limited trust, as being a challenge to attending foot health services. This research identified service barriers to providing good foot care with and for First Nations Peoples as distance and funding. Compounding barriers was lack of health professional cultural capability education impacting clinical services; this being dependant on individuals' behaviours and knowledges, and services' governance. Further work needs to centre the cultures and leadership of First Nations individuals, families, and Communities in working with and for them to keep feet strong.