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Everson G, Spring B, Middleton J, Richardson A, Gardiner FW. Culturally appropriate psychotherapy and its retention: An example from Far North Queensland (Australia). Acta Psychol (Amst) 2024; 242:104122. [PMID: 38145592 DOI: 10.1016/j.actpsy.2023.104122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Culturally appropriate mental health care is essential in remote Australia. However, while associated with the development of an effective therapeutic alliance, current literature insufficiently reports the retention and psychotherapy outcomes of Indigenous adults. We aimed to describe the characteristics and retention of clients attending the Far North Mental Health and Wellbeing Service (FNS). METHODS We conducted a retrospective cross-sectional study on clients who received one or more psychotherapy consultations between 1st July 2019 and 31st December 2020. Population, entrance, and treatment characteristics were described, with retention compared between the major cultural groups. Entrance characteristics comprised referral pathway and reason for presentation and were investigated as alternative predictors of client retention. FINDINGS There were 186 non-Indigenous (68.3 % female) and 174 Indigenous (62.6 % female) clients, with a median number of 3.0 consultations (IQR 2.0-5.3). Indigenous status did not significantly predict retention. Referral pathway significantly predicted the number of consultations (Wald X2(6) = 17.67, p = .0071) and immediate discontinuation (Wald X2(6) = 12.94, p = .044), with self-referred clients having the highest retention. Initial presentation reason significantly predicted the number of consultations (Wald X2(5) = 13.83, p = .017), with clients with potential health hazards related to socioeconomic and psychosocial circumstances having the lowest retention. Significantly more Indigenous clients presented for this reason (20.1 % vs 4.3 %). INTERPRETATION Comparable retention of Indigenous clients suggests cultural appropriateness of the psychotherapy being delivered by the FNS. Services might use the described therapeutic approach as a guide for culturally appropriate care.
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Affiliation(s)
- George Everson
- The ANU School of Medicine and Psychology, Australian National University, ACT, Canberra, Australia
| | - Breeanna Spring
- Royal Flying Doctor Service of Australia, 10-12 Brisbane Avenue, Barton, ACT, Australia; Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Jocelyn Middleton
- Royal Flying Doctor Service of Australia, 12 Casuarina Street, Brisbane Airport, QLD, Australia
| | - Alice Richardson
- The Statistical Support Network, Australian National University, ACT, Canberra, Australia
| | - Fergus W Gardiner
- The ANU School of Medicine and Psychology, Australian National University, ACT, Canberra, Australia; Royal Flying Doctor Service of Australia, 10-12 Brisbane Avenue, Barton, ACT, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, WA, Australia.
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Saxby K, Byrnes J, de New SC, Nghiem S, Petrie D. Does affirmative action reduce disparities in healthcare use by Indigenous peoples? Evidence from Australia's Indigenous Practice Incentives Program. HEALTH ECONOMICS 2023; 32:853-872. [PMID: 36609870 DOI: 10.1002/hec.4645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Globally, Indigenous populations experience poorer health but use less primary healthcare than their non-Indigenous counterparts. In 2010, the Australian government introduced a targeted reform aimed at reducing these disparities. The reform reduced, or abolished prescription medicine co-payments and provided financial incentives for GPs to better manage chronic disease care for Indigenous peoples. Exploiting the framework of a natural experiment, we investigate how the reform affected these health disparities in primary and specialist healthcare utilization using longitudinal administrative data from 75,826 Australians, including 1896 Indigenous peoples, with cardiovascular disease. The differences-in-differences estimates indicate that the reform increased primary healthcare use among Indigenous peoples, including 12.9% more prescription medicines, 6.6% more GP services, and 34.0% more chronic disease services, but also reduced specialist attendances by 11.8%. Increases in primary care were larger for those who received the largest co-payment relief and lived in metropolitan regions, whereas the reduction in specialist attendances was concentrated among lower income Indigenous patients. Affirmative action can reduce inequalities in Indigenous use of primary healthcare, albeit careful design is required to ensure that benefits are equitable and do not lead to substitution away from valuable, or necessary, care.
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Affiliation(s)
- Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Caulfield East, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Queensland, Nathan, Australia
| | - Sonja C de New
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Caulfield East, Australia
- Institute for the Study of Labor (IZA Bonn), RWI Research Network, Essen, Germany
| | - Son Nghiem
- College of Health & Medicine, Australian National University, Australian Capital Territory, Canberra, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Caulfield East, Australia
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Kaphle S, Hungerford C, Blanchard D, Doyle K, Ryan C, Cleary M. Cultural Safety or Cultural Competence: How Can We Address Inequities in Culturally Diverse Groups? Issues Ment Health Nurs 2022; 43:698-702. [PMID: 34807792 DOI: 10.1080/01612840.2021.1998849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sabitra Kaphle
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | | | - Denise Blanchard
- School of Nursing and Midwifery, University of Newcastle, Central Coast Clinical School, New South Wales, Australia
| | - Kerrie Doyle
- Indigenous Health, School of Medicine, Western Sydney University, Sydney, Australia
| | - Colleen Ryan
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Queensland, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
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Flemington T, Fraser J, Gibbs C, Shipp J, Bryant J, Ryan A, Wijetilaka D, Marks S, Scarcella M, Tzioumi D, Ramanathan S, Clague L, Hartz D, Lonne B, Lock (Ngiyampaa) M. The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5381. [PMID: 35564775 PMCID: PMC9102959 DOI: 10.3390/ijerph19095381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced "Dahl-beer-weer gum-um-be-goo" in the Gumbaynggirr language means 'safe children') model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety in health care settings, and privileges the cultural voices of many diverse Aboriginal peoples. When adapted appropriately for local clinical and cultural contexts, it will contribute to a patient journey experience of respect, dignity and empowerment.
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Affiliation(s)
- Tara Flemington
- Nursing, Midwifery and Service Reform, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jennifer Fraser
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
- Nursing, Midwifery and Education, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
| | - Clinton Gibbs
- Health Reform, Opportunities and Transition, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joanne Shipp
- Integrated Child, Youth and Family Wellbeing, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joe Bryant
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Amanda Ryan
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Devika Wijetilaka
- Paediatrics, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Susan Marks
- Child Protection Unit, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Mick Scarcella
- Aboriginal Health, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Dimitra Tzioumi
- Child Protection Unit, The Sydney Children’s Hospitals Network, Randwick, NSW 2031, Australia;
- Child Protection and Wellbeing, Ministry of Health, St Leonards, NSW 2065, Australia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia;
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Liesa Clague
- School of Nursing, Midwifery, Health Science and Physiotherapy, The University of Notre Dame, Darlinghurst, NSW 2010, Australia;
| | - Donna Hartz
- School of Nursing and Midwifery, College of Medicine Health & Wellbeing, University of Newcastle, Gosford, NSW 2250, Australia;
| | - Bob Lonne
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Mark Lock (Ngiyampaa)
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
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Henson C, Rambaldini B, Carlson B, Wadolowski M, Vale C, Gwynne K. A new path to address health disparities: How older Aboriginal & Torres Strait Islander women use social media to enhance community health (Protocol). Digit Health 2022; 8:20552076221084469. [PMID: 35273808 PMCID: PMC8902196 DOI: 10.1177/20552076221084469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Digital health offers a fresh avenue to address health disparities
experienced by Aboriginal and Torres Strait Islanders. Despite the scant
evidence about how Aboriginal and Torres Strait Islanders access and use
health technology, the Australian government has prioritised research that
uses technology to enable people to manage their health and promote better
health outcomes. Older Aboriginal and Torres Strait Islander women are
cultural leaders in their communities, enabling them to provide valuable
insights about the safety and efficacy of health care messaging. However, no
research has engaged older Aboriginal and Torres Strait Islander, women as
partners in digital health research. Objective This paper provides a protocol for co-designed translational research that
privileges older Aboriginal & Torres Strait Islander women’s cultural
expertise to design and test a framework for accessible, culturally safe and
feasible digital health technologies. Methods This mixed-methods research project will use the collective impact approach,
a user-centred, co-design methodology and yarning circles, a recognised
Indigenous research methodology. A series of yarning circles with three
different communities will elucidate enablers and barriers to access health
information; co-create a framework clarifying what works and does not work
for digital health promotion in their communities; and test the framework by
co-creating three digital health information programs. Conclusions Privileging the cultural expertise of older Aboriginal and Torres Strait
Islander women will provide a novel perspective and vital guidance that end
users and developers can trust and rely upon to create and evaluate
culturally safe and efficacious digital health promotion programs.
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Affiliation(s)
- Connie Henson
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia
| | - Boe Rambaldini
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Sydney, New South Wales, Australia
| | - Bronwyn Carlson
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Faculty of Arts, Macquarie University, New South Wales, Australia
| | - Monika Wadolowski
- Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia
| | | | - Kylie Gwynne
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia
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Yashadhana A, Howie A, Veber M, Cullen P, Withall A, Lewis E, McCausland R, Macniven R, Andersen M. Experiences and perceptions of ageing among older First Nations Australians: A rapid review. Australas J Ageing 2021; 41:8-19. [PMID: 34905642 DOI: 10.1111/ajag.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify and describe articles reporting the experiences and perceptions of ageing among older First Nations Australians. METHODS Following rapid review and PRISMA guidelines, we searched five databases for peer-reviewed articles published prior to October 2019 that reported qualitative accounts of ageing among older (≥ 45 years) First Nations Australians. Data were extracted and synthesised thematically. RESULTS Twenty-one articles were included in the final synthesis. Priorities in ageing highlighted the role of Elders, family, community, culture and connection to ancestral lands. Experiences and perceptions of ageing reflected cultural marginalisation in aged and health care services, and highlighted the importance of cultural identity, resilience and survival as key to ageing well. CONCLUSIONS Our review suggests that mainstream ageing frameworks do not fully reflect the priorities of older First Nations Australians. This has important implications for ageing policy and the design and delivery of culturally safe aged and health care services.
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Affiliation(s)
- Aryati Yashadhana
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Health Equity Training Research & Evaluation (CHETRE), University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Adam Howie
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Madelene Veber
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia Cullen
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Ngarruwan Ngadju, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Adrienne Withall
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ebony Lewis
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth McCausland
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Institute for Global Development, University of New South Wales, Sydney, New South Wales, Australia
| | - Rona Macniven
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Andersen
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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Rheault H, Coyer F, Bonner A. Chronic disease health literacy in First Nations people: A mixed methods study. J Clin Nurs 2021; 30:2683-2695. [PMID: 34180097 DOI: 10.1111/jocn.15757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/02/2021] [Accepted: 03/05/2021] [Indexed: 01/29/2023]
Abstract
AIM To explore chronic disease education, self-management and health literacy abilities from First Nations Australian adults with chronic disease through the integration of qualitative and quantitative findings. BACKGROUND Chronic disease management requires good health literacy abilities to manage long-term health needs. First Nations people have a higher burden of chronic disease although little is known regarding chronic disease health literacy of First Nations people. DESIGN A concurrent embedded mixed methods study reported using the Consolidated Criteria for Reporting Qualitative Research guidelines. METHODS Data were collected from First Nations people with one or more chronic diseases living in remote Australia between February-November 2017. Quantitative data (n = 200) were collected using the Health Literacy Questionnaire along with demographic and health data. Qualitative data (n = 20) were collected via face-to-face interviews to examine chronic disease education and self-management experiences. Data were analysed separately then integrated to develop meta-inferences. RESULTS Poor communication from healthcare providers coupled with low health literacy abilities is a major barrier to both active and successful management of chronic disease. Communicating in medical jargon resulted in individuals being placed in a power differential causing lack of trust and relationship breakdowns with healthcare providers affecting active chronic disease self-management. The perception of inevitability and ambivalence towards chronic disease and the notion of futility towards self-management were concurred with the low level of active engagement in health care. CONCLUSIONS Yarning is an important strategy used by First Nations people for communication. For nurses, understanding and developing skills in yarning will facilitate cultural safety, communication and understanding about chronic disease self-management in contexts where health literacy abilities are challenged. RELEVANCE TO CLINICAL PRACTICE Using yarning, and plain language visual aids, and teach-back will readdress the power differential experienced by First Nations people and may also improve understanding of chronic disease self-management.
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Affiliation(s)
- Haunnah Rheault
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Advanced Heart Failure and Transplant Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia.,NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Herston, Queensland, Australia.,Kidney Health Service, Metro North Hospital and Health Service, Herston, Queensland, Australia
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The Association between Post-Migration Nutrition and Lifestyle Transition and the Risk of Developing Chronic Diseases among Sub-Saharan African Migrants: A Mixed Method Systematic Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094706. [PMID: 33925056 PMCID: PMC8124406 DOI: 10.3390/ijerph18094706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
Sub-Saharan African (SSA) migrants face nutrition and lifestyle changes upon arrival in a host country. The shift in diet and lifestyle reflects post-migration acculturation and could predispose migrants to nutrition- and lifestyle- related chronic diseases. A mixed-methods systematic review of published studies and the grey literature on post-migration nutrition and lifestyle transition among SSA migrants will be undertaken. Studies published in English and conducted from 2000 to 2020 using quantitative and/or qualitative methods will be included. Ten bibliographic databases will be searched: Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, PubMed, ProQuest, PsycINFO, Informit and Web of Science. Data extraction will be informed by the Cochrane PROGRESS-Plus framework and the Joanna Briggs Institute manual. The quality of the included studies will be appraised for risk of bias using validated tools. An integrated approach to quantitative and qualitative data synthesis through data transformation will be undertaken, and a narrative synthesis of the findings will be provided. This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and provides insight into the scope and parameters of the systematic review to be conducted. The aim of the review is to evaluate the association between post-migration nutrition and lifestyle transition and the risk of developing chronic diseases among SSA migrants in Australia. This review will provide insight into possible areas for interventions to improve the health of migrants. Systematic Review Registration: The protocol was registered with the PROSPERO international prospective register of systematic reviews CRD42020206560.
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