{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T06:24:19Z","timestamp":1774938259123,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100025520","name":"Medical Research Future Fund","doi-asserted-by":"crossref","award":["#2025062"],"award-info":[{"award-number":["#2025062"]}],"id":[{"id":"10.13039\/501100025520","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Racism in healthcare remains a barrier to health equity for Aboriginal and Torres Strait Islander people in Australia. This study protocol outlines the development and evaluation of a novel programme for racism reduction, drawing on aspects of cognitive behavioural therapy, motivational interviewing and the transtheoretical model of behaviour change. The project is led and governed by Aboriginal and Torres Strait Islander people and responds to the lived experience of Aboriginal and Torres Strait Islander people within the health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>An interactive educational programme has been developed, with seven modules designed to move people from \u2018precontemplation\u2019 through to identifying unhelpful beliefs and moving towards healthy relationships with themselves and others. An iterative developmental evaluation methodology will enable adaptation and improvement of the programme over three phases of implementation. Phase 1 will involve programme refinement and development of in-person and eLearning modules, informed by qualitative interviews with Aboriginal and Torres Strait Islander and non-Indigenous staff and students, and a cross-sectional survey of racist attitudes and beliefs among non-Indigenous people. In phase 2, an initial pilot to assess acceptability and feasibility will be carried out both in person (n=20) and online (n=30). Following further refinement, phase 3 will involve a larger pilot study with health professionals (n=50) and university students (n=50). The evaluation will incorporate pre-programme and postprogramme surveys and per-module evaluations, alongside qualitative interviews at key points during the project. The experiences of Aboriginal and Torres Strait Islander staff, patients and visitors will be monitored via an established patient experience measure (Yarn-Up Survey) already included in routine practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study has been approved by the Central Adelaide Local Health Network Human Research Ethics Committee (2024\/HRE0057) and the Aboriginal Health Council of South Australia Aboriginal Health Research Ethics Committee (04\u201324-1130). Research dissemination will occur through presentations to stakeholders, academic journals and conference presentations. Refining the model at each phase will maximise its readiness for scalability across multiple health, medical education and potentially broader sectors in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111483","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:55:59Z","timestamp":1774932959000},"page":"e111483","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Proactive anti-racism training for healthcare: study protocol for the development and evaluation of an Australian cognitive-behavioural therapy-informed racism reduction programme"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2107-9187","authenticated-orcid":false,"given":"Rachel","family":"Reilly","sequence":"first","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"},{"name":"School of Psychology, College of Education, Behavioural and Social Sciences, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Morey","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"},{"name":"School of Public Health, College of Health, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Libby","family":"Hammond","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Pedler","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"},{"name":"Flinders Wellbeing Centre, Flinders University, Bedford Park, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngara","family":"Keeler","sequence":"additional","affiliation":[{"name":"Aboriginal and Torres Strait Islander Health and Wellbeing Hub, Central Adelaide Local Health Network, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trish","family":"Laccos","sequence":"additional","affiliation":[{"name":"Aboriginal and Torres Strait Islander Health and Wellbeing Hub, Central Adelaide Local Health Network, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Chur-Hansen","sequence":"additional","affiliation":[{"name":"School of Psychology, College of Education, Behavioural and Social Sciences, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Larkin","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1729-731X","authenticated-orcid":false,"given":"Elissa","family":"Elvidge","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, The University of Newcastle Australia, Callaghan, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katina","family":"D\u2019Onise","sequence":"additional","affiliation":[{"name":"Public Health Programs, Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leda","family":"Sivak","sequence":"additional","affiliation":[{"name":"School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Brodie","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"},{"name":"Colllege of Education, Behavioural and Social Sciences, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Larkin","sequence":"additional","affiliation":[{"name":"Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lou","family":"Turner","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne","family":"Clark","sequence":"additional","affiliation":[{"name":"Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Kwenda","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Lovegrove","sequence":"additional","affiliation":[{"name":"Department of Child Protection, Government of South Australia, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-6509","authenticated-orcid":false,"given":"Odette","family":"Pearson","sequence":"additional","affiliation":[{"name":"Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"},{"name":"School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"2026033021551740000_16.3.e111483.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-017-0612-0","article-title":"The impact of racial discrimination on the health of Australian Indigenous children aged 5-10 years: analysis of national longitudinal data","volume":"16","author":"Shepherd","year":"2017","journal-title":"Int J Equity Health"},{"key":"2026033021551740000_16.3.e111483.2","unstructured":"Calma T , Hirvonen T , Bray A . Relationship between systemic anti indigenous racism and social and emotional wellbeing and mental health: recent national and international evidence, policy and programs. Canberra: Australian Institute of Health and Welfare, 2025."},{"key":"2026033021551740000_16.3.e111483.3","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-012-9404-3"},{"key":"2026033021551740000_16.3.e111483.4","doi-asserted-by":"publisher","DOI":"10.1037\/a0029938"},{"key":"2026033021551740000_16.3.e111483.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0189900","article-title":"Racism and health service utilisation: A systematic review and meta-analysis","volume":"12","author":"Ben","year":"2017","journal-title":"PLoS One"},{"key":"2026033021551740000_16.3.e111483.6","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617712000628"},{"key":"2026033021551740000_16.3.e111483.7","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s12546-016-9159-y","article-title":"Colonisation, racism and indigenous health","volume":"33","author":"Paradies","year":"2016","journal-title":"J Pop Research"},{"key":"2026033021551740000_16.3.e111483.8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3390\/ijerph18126577","article-title":"Prevalence of Everyday Discrimination and Relation with Wellbeing among Aboriginal and Torres Strait Islander Adults in Australia","volume":"18","author":"Thurber","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026033021551740000_16.3.e111483.9","doi-asserted-by":"crossref","first-page":"108681","DOI":"10.1016\/j.drugalcdep.2021.108681","article-title":"Structural racism and violence as social determinants of health: Conceptual, methodological and intervention challenges","volume":"222","author":"Bluthenthal","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2026033021551740000_16.3.e111483.10","unstructured":"UN . United Nations declaration on the rights of indigenous peoples. United Nations: New York, 2007."},{"key":"2026033021551740000_16.3.e111483.11","doi-asserted-by":"crossref","first-page":"271","DOI":"10.5116\/ijme.5bc7.21e2","article-title":"Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review","volume":"9","author":"Kurtz","year":"2018","journal-title":"Int J Med Educ"},{"key":"2026033021551740000_16.3.e111483.12","unstructured":"Reconciliation Australia . Australian reconciliation barometer 2022: full research report. Canberra Reconciliation Australia; 2022."},{"key":"2026033021551740000_16.3.e111483.13","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1177\/0011000020904454","article-title":"A Meta-Analysis of the Relationship Between Internalized Racial Oppression and Health-Related Outcomes","volume":"48","author":"Gale","year":"2020","journal-title":"Couns Psychol"},{"key":"2026033021551740000_16.3.e111483.14","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1111\/j.1467-9620.2006.00776.x","article-title":"Refraining Internalized Oppression and Internalized Domination: From the Psychological to the Sociocultural","volume":"108","author":"Tappan","year":"2006","journal-title":"Teach Coll Rec (1970)"},{"key":"2026033021551740000_16.3.e111483.15","unstructured":"Commonwealth of Australia . National strategic framework for aboriginal and Torres Strait Islander peoples\u2019 mental health and social and emotional wellbeing 2017-2023. Canberra ACT Department of the Prime Minister and Cabinet; 2017."},{"key":"2026033021551740000_16.3.e111483.16","unstructured":"Renehan C , Hayman NE , Askew DA , et al . Report to inform the development of an anti-racism strategy. Adelaide South Australian Aboriginal Chronic Disease Consortium; South Australia Health and Medical Research Institute; 2022."},{"key":"2026033021551740000_16.3.e111483.17","unstructured":"Perdersen A , Walker I , Rapley M , et al . Anti-racism-what works. An evaluation of the effectiveness of anti-racism strategies. Perth, Australia: Centre for Social Change & Social Equity, Murdoch University, 2003."},{"key":"2026033021551740000_16.3.e111483.18","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18062993","article-title":"Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review","volume":"18","author":"Hassen","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026033021551740000_16.3.e111483.19","unstructured":"Beck JS . Cognitive behavior therapy: basics and beyond. 2nd edn. 2011: The Guilford Press,"},{"key":"2026033021551740000_16.3.e111483.20","doi-asserted-by":"crossref","unstructured":"Helms JE . Black and white racial identity: theory, research, and practice. Greenwood Press, 1990.","DOI":"10.1037\/t06697-000"},{"key":"2026033021551740000_16.3.e111483.21","doi-asserted-by":"publisher","DOI":"10.1177\/1745691614554658"},{"key":"2026033021551740000_16.3.e111483.22","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-12.1.38"},{"key":"2026033021551740000_16.3.e111483.23","doi-asserted-by":"crossref","unstructured":"Miller WR , Rollnick S . Motivational interviewing: preparing people for change. 2nd edn. The Guilford Press, 2002.","DOI":"10.1097\/01445442-200305000-00013"},{"key":"2026033021551740000_16.3.e111483.24","unstructured":"Caban R . Development and intitial validation of the multicultural competence scale for psychology trainees. In: Department of counseling psychology and human services and the graduate school. University of Oregon, 2010."},{"key":"2026033021551740000_16.3.e111483.25","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1080\/10376178.2022.2025876","article-title":"Measuring effectiveness of cultural safety education in First Peoples health in university and health service settings","volume":"57","author":"West","year":"2021","journal-title":"Contemp Nurse"},{"key":"2026033021551740000_16.3.e111483.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026033021551740000_16.3.e111483.27","doi-asserted-by":"publisher","DOI":"10.1080\/26895269.2022.2129597"},{"key":"2026033021551740000_16.3.e111483.28","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1071\/AH19227","article-title":"Cultural safety in hospitals: validating an empirical measurement tool to capture the Aboriginal patient experience","volume":"44","author":"Elvidge","year":"2020","journal-title":"Aust Health Rev"},{"key":"2026033021551740000_16.3.e111483.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-111483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:56:08Z","timestamp":1774932968000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-111483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,30]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjopen-2025-111483"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-111483","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}