title: Exploring undergraduate midwifery students' readiness to deliver culturally secure care for pregnant and birthing Aboriginal women.
abstract: BACKGROUND
  Culturally secure health care settings enhance accessibility by Aboriginal Australians and improve their satisfaction with service delivery. A culturally secure health service recognises and responds to the legitimate cultural rights of the recipients of care. Focus is upon the health care system as well as the practice and behaviours of the individuals within it. In an attempt to produce culturally secure practitioners, the inclusion of Aboriginal content in health professional programs at Australian universities is now widespread. Studies of medical students have identified the positive impact of this content on knowledge and attitudes towards Aboriginal people but relatively little is known about the responses of students in other health professional education programs. This study explored undergraduate midwifery students' knowledge and attitudes towards Aboriginal people, and the impact of Aboriginal content in their program.
  
  
  METHODS
  The study surveyed 44 students who were in their first, second and third years of a direct entry, undergraduate midwifery program at a Western Australian (WA) university. The first year students were surveyed before and after completion of a compulsory Aboriginal health unit. Second and third year students who had already completed the unit were surveyed at the end of their academic year.
  
  
  RESULTS
  Pre- and post-unit responses revealed a positive shift in first year students' knowledge and attitudes towards Aboriginal people and evidence that teaching in the unit was largely responsible for this shift. A comparison of post-unit responses with those from students in subsequent years of their program revealed a significant decline in knowledge about Aboriginal issues, attitudes towards Aboriginal people and the influence of the unit on their views. Despite this, all students indicated a strong interest in more clinical exposure to Aboriginal settings.
  
  
  CONCLUSIONS
  The inclusion of a unit on Aboriginal health in an undergraduate midwifery program has been shown to enhance knowledge and shift attitudes towards Aboriginal people in a positive direction. These gains may not be sustained, however, without vertical integration of content and reinforcement throughout the program. Additional midwifery-specific Aboriginal content related to pregnancy and birthing, and recognition of strong student interest in clinical placements in Aboriginal settings provide opportunities for future curriculum development.
authors.affiliation: Western Australian Centre for Rural Health, University of Western Australia, Perth, Western Australia, Australia. rosalie.thackrah@research.uwa.edu.au.|Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia. rosalie.thackrah@research.uwa.edu.au.
authors.forename: Rosalie D
authors.initials: RD
authors.lastname: Thackrah
authors.affiliation: Western Australian Centre for Rural Health, University of Western Australia, Perth, Western Australia, Australia. sandra.thompson@uwa.edu.au.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
authors.affiliation: School of Dentistry, University of Western Australia, Perth, Western Australia, Australia. angela.durey@uwa.edu.au.|Centre for Aboriginal Studies, Curtin University, Perth, Western Australia, Australia. angela.durey@uwa.edu.au.
authors.forename: Angela
authors.initials: A
authors.lastname: Durey
mesh_terms: D000293:Adolescent; D000328:Adult; D065246:Culturally Competent Care; D003479:Curriculum; D003695:Delivery of Health Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008880:Midwifery / Q000193:education*; D011247:Pregnancy; D013338:Students, Nursing / Q000523:psychology*; D014904:Western Australia; D055815:Young Adult