Proactive anti-racism training for healthcare: study protocol for the development and evaluation of an Australian cognitive-behavioural therapy-informed racism reduction programme.

INTRODUCTION: 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.

METHODS AND ANALYSIS: An interactive educational programme has been developed, with seven modules designed to move people from 'precontemplation' 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.

ETHICS AND DISSEMINATION: 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 (04-24-1130). 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.