REM: A Collaborative Framework for Building Indigenous Cultural Competence.

The well-documented health disparities between the Australian Indigenous and non-Indigenous population mandates a comprehensive response from health professionals. This article outlines the approach taken by one faculty of health in a large urban Australian university to enhance cultural competence in students from a variety of fields. Here we outline a collaborative and deeply respectful process of Indigenous and non-Indigenous university staff collectively developing a model that has framed the embedding of a common faculty Indigenous graduate attribute across the curriculum. Through collaborative committee processes, the development of the principles of "Respect; Engagement and sharing; Moving forward" (REM) has provided both a framework and way of "being and doing" our work. By drawing together the recurring principles and qualities that characterize Indigenous cultural competence the result will be students and staff learning and bringing into their lives and practice, important Indigenous cultural understanding.

Community-based interventions to promote management for older people: an integrative review.

AIMS AND OBJECTIVES: To review community programmes promoting self-care or self-management for older people with chronic disease in Thailand. BACKGROUND: Identifying successful elements of culturally appropriate and effective community-based interventions to promote self-care with chronic illness is increasingly important. DESIGN: Integrative review. DATA SOURCES: CINAHL, Medline, Health Source Nursing Academic databases. METHODS: Integrative review of peer-reviewed articles written between 1946-2012. Articles were included if they described self-care, self-management, chronic disease and community care interventions targeting older people in Thailand. RESULTS: Of the 58 articles retrieved, only 13 articles met the eligibility criteria. Elements of effective interventions included: (1) providing culturally sensitive information, (2) including approaches of shared decision-making and mutual goal setting and (3) flexibility within the intervention to adapt to participant needs. CONCLUSIONS: Shared decision-making and mutual goal setting between interventionists and patients improved health behaviours and outcomes. Moreover, the flexibility to adopt the intervention to local characteristics demonstrated positive results. RELEVANCE TO CLINICAL PRACTICE: Promoting effective self-care and self-management behaviours is critical to improving outcomes for chronic conditions. The tailoring and targeting of interventions appropriate to individuals and communities are likely to be most effective in leveraging behaviour change. This review has identified that mutual goal setting improved health behaviours. The flexibility to adopt self-care interventions to community-based settings showed improved patient outcomes.