Indigenous students’ journeys to and through allied healthcare programs
NCSEHE Equity Fellowship final report
Andrea Simpson, La Trobe University
Communication between practitioner and patient is key in developing a trusting clinical relationship. However, interactions between Aboriginal and/or Torres Strait Islander patients and medical and allied health practitioners can be problematic due to cultural misunderstandings. Many Indigenous people have reported poor past experiences with their non-Indigenous healthcare providers, a significant barrier to the delivery of successful health care for Indigenous people (Downing et al., 2011). Building capacity in the Indigenous health workforce has been suggested as one way of improving the healthcare experience, thereby enhancing Indigenous health outcomes.
At the time of writing, Indigenous people were poorly represented in healthcare professions with 0.4% of medical professionals and 0.4% of allied healthcare professionals identifying as Indigenous (IAHA, 2018; AMA, 2014). Publicly available statistics on the percentage of Indigenous practitioners for many healthcare professions can be found by searching the appropriate regulatory body. However, the numbers of Indigenous students within healthcare fields, particularly the allied health fields, are less well known. Examining Indigenous student participation for specific allied health professions was therefore one aim of the current Fellowship.
Across higher education, Indigenous students comprise 1.7% of the Australian domestic student population in higher education, whilst comprising 3.1% of the Australian working-age population (Department of the Prime Minister and Cabinet, 2018). In addition to having lower enrolment rates, Indigenous students are substantially less likely to complete their studies (Department of the Prime Minister and Cabinet, 2018). By contrast, higher numbers of Indigenous enrolments are found in the vocational education and training (VET) sector, where Indigenous Australians participate at a higher rate than the non-Indigenous population (Windley, 2017).
The difference between VET and higher education participation for Indigenous students has led some scholars to recommend articulated pathways between VET-sector and higher-degree qualifications as a potential means of increasing Indigenous representation in higher education (Frawley et al.,2017a; Smith et al., 2017). Given the higher numbers of Indigenous learners in the VET sector, of interest to the current Fellowship was whether VET qualifications in the healthcare field held potential for increasing Indigenous representation in higher degree healthcare study.
This report details the findings and recommendations from the National Centre for Student Equity in Higher Education [NCSEHE] Research Fellowship entitled Indigenous Participation in Higher Degree and Vocational Education Healthcare Programs. This one-year study investigated the national profile of Indigenous students enrolled in select higher education and vocational education allied healthcare study, as well as the institutional factors linked with success in access and retention. In undertaking the Fellowship, existing research and policy documents were considered including the Behrendt Review (2012), the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework – 2016–2023, and the Aboriginal and Torres Strait Islander Health Curriculum Framework.
A subset of 10 allied health professions was chosen for inclusion in the Fellowship: psychology, physiotherapy, occupational therapy, podiatry, optometry, audiology, dietetics, exercise physiology, speech pathology, and social work. VET program data on health and human welfare studies and services fields of education were also examined. The Fellowship adopted a mixed methods approach to data collection. Quantitative data on the socio-demographic profile of Indigenous students was sourced from the Department of Education, Skills and Employment (DESE) and the National Centre for Vocational Education Research (NCVER). This data was complemented by qualitative semi-structured interviews and online survey responses provided by Indigenous students and graduates, as well as stakeholders in the higher education and vocational education sectors.
Of the 10 professions examined, psychology, exercise physiology, and social work were the most widely offered areas of study at Australian universities, while optometry and audiology were the smallest disciplines on offer. Psychology, exercise physiology, and social work were also well represented as areas of study at regional universities, whereas dietetics, optometry, and audiology were poorly represented.
Professions differed with regards to the development of Indigenous inclusion policies with nine of the 10 professions signatories, or co-signatories, on Reconciliation Action Plans [RAPs] and three professions – speech pathology, physiotherapy, and psychology – requesting higher education programs include Indigenous admission strategies to enter the profession as part of accreditation standards.
In 2013, total Indigenous enrolment share in higher education was 1.7%, which increased to 2.2% by 2018. Quantitative analysis found a comparable increase of Indigenous enrolment share within the allied health professions from 1.6% in 2013 to 2.1% in 2018, although Indigenous representation varied widely by profession. Removal of the larger professions of social work and psychology from the analysis found Indigenous enrolment share was under 1% for the remaining professions, with no growth over the past decade. Progression in Indigenous enrolment share was therefore found in only a few of the allied healthcare professions included in the study.
Within the VET sector, across all fields of study, approximately 20% of Indigenous program completions were at Certificate IV or Diploma level, compared to 33% of non-Indigenous students. However, when narrowing the analysis to include only qualifications in healthcare, Indigenous students were just as likely to complete qualifications at Certificate IV or above when compared to their non-Indigenous peers. Within the vocational qualifications on offer, Indigenous completions were found to be concentrated in a small number of individual programs of study, with the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care the most prominent. Given the substantial gap in higher education retention rates, it is striking that Indigenous students in VET healthcare qualifications were seen to complete at the same rate as their non-Indigenous peers.
For the larger professions of social work and psychology, Indigenous students used previous VET qualifications as a means of admission into allied health study in higher numbers than their non-Indigenous peers, although the numbers of students transitioning from VET to higher education were small. For the remaining professions, there was no difference between Indigenous students and their non-Indigenous peers in the use of VET qualifications for admission. One possible reason for this is because there are limited established pathways between VET and higher education in many of the professions: VET qualification credit transfers, where present, were likely to have been on an ad-hoc or individual basis. Interview participants supported the establishment of clearly defined, articulated pathways between VET health study and higher education qualifications in allied health: the Aboriginal and/or Torres Strait Islander Primary Health Care Cert IV was the qualification most cited to have the potential to align with the curriculum content of other allied health qualifications.
For Indigenous students enrolled in higher education health study, support from others – or a lack thereof – is a consistent theme in the literature (Taylor et al, 2019), and students with supportive family, community, and peer networks are identified as more likely to persist with their studies (Buckskin et al., 2018; Frawley et al., 2017b; Kinnane et al., 2014; West et al., 2016). The Fellowship’s findings were consistent with the existing literature: predominant qualitative themes were found to be the importance of the Indigenous Student Support Units in providing academic, financial, social, emotional, and cultural support; and the presence – or absence – of a sense of ‘belonging’ which was perceived as critical to success.
Although the current Fellowship primarily focused on the allied healthcare field, alignments were found with past recommendations made more broadly within the higher education sector, including but not limited to, the Behrendt and NATSIHEC Reviews. Future growth in Indigenous enrolment share within higher education allied healthcare programs could thus be achieved by continuing to build upon these recommendations, specifically: improving Indigenous governance and leadership within professional bodies, localised target setting by profession and/or institution, strategic expansion of course offerings into regional areas; improved partnerships between the VET sector and higher education providers; credit transfer arrangements for VET qualifications which align with allied health curricula; an education campaign within the VET sector on career transition opportunities; dual enrolments; support for VET articulation from higher education providers; and continued Indigenous Student Success Program (ISSP) funding to support the Indigenous Student Support Centres.
Key recommendations derived from the study are outlined in the following section.
 In this report, the term ‘Indigenous’ will be used from here on to refer to Aboriginal and/or Torres Strait Islander people and/or Australian First Nations people. The author acknowledges the diversity of views with regards to using these terms.
Read the full report, Indigenous students’ journeys to and through allied healthcare programs
Equity Fellowship Snapshot — Indigenous students’ journeys to & through allied healthcare programs
This Equity Fellowship was conducted under the NCSEHE Equity Fellows Program, funded by the Australian Government Department of Education, Skills and Employment.