Indigenous health and cultural safety in interdisciplinary tertiary education: A multi-method evaluation of student...

Aboriginal and Torres Strait Islander peoples experience persistent health inequities shaped by colonisation and its ongoing impacts, including racism, and structural and social determinants of health. Culturally safe tertiary education is essential for preparing a responsive health and human services workforce.

To explore shifts in undergraduate and post-graduate nursing, midwifery, and social work students' knowledge, attitudes, beliefs and learning experiences during a mandatory Cultural Safety and Indigenous Health and Wellbeing interdisciplinary course at an Australian university.

A sequential multi-method research design used a pre-and post-curriculum online survey (Ganngaleh nga Yagaleh) alongside open-ended qualitative questions. Quantitative data were analysed using non-parametric tests and mixed-effects models; qualitative responses were analysed using reflexive thematic analysis.

Of 481 enrolled students, 182 (37.8%) completed all survey components. While no significant change was observed in Commitment to Culturally Safe Practice (coefficient 1.11, 95% CI -0.32-2.53, p = 0.13), significant improvements were found in Understanding of History and Power (co-efficient 2.59, 95% CI 1.55-3.62, p < 0.001), and Attitudes, Values and Beliefs (coefficient 3.44, 95% CI 1.95-4.92, p < 0.001). Qualitative findings demonstrated richer, more nuanced shifts: students moved from general awareness to more contextualised understandings of colonisation, systemic inequity and their own positionality. Many described emotional journeys characterised by discomfort, vulnerability, empathy, and renewed commitment to ethical and culturally safe practice, while others expressed resistance or uncertainty. Students emphasised the importance of Indigenous-led teaching, yarning-based learning environments and relational, reflective pedagogy in supporting transformative learning. These data also indicated the need for indigenising curriculum beyond one course to enable students' earlier exposure to racially determined negative health outcomes.

The course fostered meaningful cognitive, emotional and reflective shifts in students' understandings of cultural safety. Findings emphasise the value of Indigenous-led, relational, and decolonising pedagogies and the importance of embedding cultural safety education earlier and more consistently across health curricula.