1
|
Janssen H, Owen S, Thompson A, Newberry-Dupe J, Ciccone N, Smallwood R, Neville Sampson U, Brandy V, Miller J, Trindall AA, Peake R, Usher K, Levi C. Creating "a Safe Place to Go": Yarning With Health Workers About Stroke Recovery Care for Aboriginal Stroke Survivors-A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2024:10497323241268776. [PMID: 39197158 DOI: 10.1177/10497323241268776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
Stroke affects Aboriginal people at disproportionate rates compared to other populations in Australia. Aboriginal peoples are less likely to receive a timely stroke diagnosis, or timely culturally responsive treatment, as there are very few stroke resources and recovery plans that have been developed by Aboriginal peoples for Aboriginal peoples. Understanding how to develop and implement culturally responsive stroke care requires research approaches that are informed by and with Aboriginal people. A qualitative Indigenous research methodology including "yarning" was undertaken to understand the experiences of both Aboriginal and non-Aboriginal health workers from nine health services providing stroke rehabilitation and recovery support to Aboriginal people living within the participating communities. Data were analyzed using an inductive approach driven by an Indigenous research approach. Yarns revealed three themes: (i) the role of culturally safe health environments to support stroke survivors, their family, and health workers; and how (ii) complicated, under-resourced systems impede the capacity to support stroke survivors; and (iii) collaborative and adaptive practices prevent people "falling through the cracks." This study highlights the need to scrutinize the cultural safety of health care, current health systems, workforce, and culture and how these influence the capacity of health workers to provide care that is responsive to the individual needs of Aboriginal stroke survivors and their families. These learnings will inform the co-design of a culturally responsive stroke recovery care strategy to improve the recovery experience and health and well-being of Aboriginal people and their families living with stroke.
Collapse
Affiliation(s)
- Heidi Janssen
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Simone Owen
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
| | - Amy Thompson
- Consumer With Lived Experience, Kempsey Community Health Centre, Kempsey, NSW, Australia
| | - Jackson Newberry-Dupe
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Reakeeta Smallwood
- Newcastle's Department of Rural Health, University of Newcastle, Tamworth, NSW, Australia
| | | | - Vickie Brandy
- Hunter New England Health Local Health District, New Lambton Heights, NSW, Australia
| | - Joe Miller
- Consumer With Lived Experience, Tamworth Community Health Centre, Tamworth, NSW, Australia
| | - Aunty Audrey Trindall
- Community Elder, Tamworth Community Health Centre, Tamworth, NSW, Australia
- Consumer With Lived Experience, Tamworth Community Health Centre, Tamworth, NSW, Australia
| | - Rachel Peake
- Hunter New England Local Health District, Tamworth, NSW, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, NSW, Australia
| | - Christopher Levi
- Heart and Stroke Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter New England Health Local Health District, New Lambton Heights, NSW, Australia
| |
Collapse
|
2
|
Katzenellenbogen JM, White J, Robinson M, Thompson SC, Epstein A, Stanley M, Klobas J, Haynes E, Armstrong EA, Coffin J, Skoss R. Process evaluation of a randomised controlled trial intervention designed to improve rehabilitation services for Aboriginal Australians after brain injury: the Healing Right Way Trial. BMC Health Serv Res 2024; 24:946. [PMID: 39164676 PMCID: PMC11334317 DOI: 10.1186/s12913-024-11390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a stepped-wedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staff and 2.Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service received, and improved hospital experience. Assessments were undertaken at baseline, 12- and 26-weeks post-injury. Only MPCs and hospital experience were found to improve among intervention patients. We report on the process evaluation aiming to support interpretation and translation of results. METHODS Using mixed methods, the evaluation design was informed by the Consolidated Framework for Implementation Research. Data sources included minutes, project logs, surveys, semi-structured interviews, and observations. Four evaluation questions provided a basis for systematic determination of the quality of the trial. Findings from separate sources were combined to synthesise the emerging themes that addressed the evaluation questions. Three components were considered separately: the trial process, CST and ABIC. RESULTS The complex HRW trial was implemented to a satisfactory level despite challenging setting factors, particularly rural-urban system dynamics. Patient recruitment constraints could not be overcome. The vulnerability of stepped-wedge designs to time effects influenced recruitment and trial results, due to COVID. Despite relatively high follow-up, including to rural/remote areas, data points were reduced. The lack of culturally appropriate assessment tools influenced the quality/completeness of assessment data. The ABIC role was deemed feasible and well-received. The CST involved complex logistics, but rated highly although online components were often incomplete. Project management was responsive to staff, patients and setting factors. CONCLUSIONS Despite mostly equivocal results, the ABIC role was feasible within mainstream hospitals and the CST was highly valued. Learnings will help build robust state-wide models of culturally secure rehabilitation for Aboriginal people after brain injury, including MPC, workforce, training and follow-up.
Collapse
Affiliation(s)
- Judith M Katzenellenbogen
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Stirling Highway, Nedlands, Perth, WA, 6009, Australia.
| | - Jane White
- School of Medical and Health Science, Edith Cowan University, Perth, Australia.
| | - Melanie Robinson
- Department of Health of Western Australia, Child and Adolescent Health Service, Perth, Australia
- Murdoch University, Perth, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Australia
| | - Amy Epstein
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Stirling Highway, Nedlands, Perth, WA, 6009, Australia
| | - Mandy Stanley
- School of Medical and Health Science, Edith Cowan University, Perth, Australia
| | - Jane Klobas
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Stirling Highway, Nedlands, Perth, WA, 6009, Australia
| | - Emma Haynes
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Stirling Highway, Nedlands, Perth, WA, 6009, Australia
| | - Elizabeth A Armstrong
- University Centre for Rural Health South West, Edith Cowan University, Bunbury, Australia
| | | | - Rachel Skoss
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Stirling Highway, Nedlands, Perth, WA, 6009, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, Australia
- Telethon Kids Institute, Perth, WA, Australia
| |
Collapse
|
3
|
Wills E, Fitts M. Listening to the Voices of Aboriginal and Torres Strait Islander Women in Regional and Remote Australia About Traumatic Brain Injury From Family Violence: A Qualitative Study. Health Expect 2024; 27:e14125. [PMID: 39032155 PMCID: PMC11259743 DOI: 10.1111/hex.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/24/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024] Open
Abstract
INTRODUCTION Indigenous women experience high rates of family violence-related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence-related traumatic brain injury (TBI), including impacts on life, as well as decision-making processes about healthcare access and engagement. METHODS Purposeful sampling was used to complete semi-structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. RESULTS Three themes were conceptualised based on the data and research aims: interweaving of the past and the present-ways women experience brain injury; factors that inform decision-making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long-term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. CONCLUSIONS The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow-up support, co-designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. PUBLIC OR PATIENT CONTRIBUTION Indigenous women shared their views and experiences of TBI from family violence as well as decision-making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research.
Collapse
Affiliation(s)
- Elaine Wills
- Institute for Culture and SocietyWestern Sydney UniversityParramattaNew South WalesAustralia
| | - Michelle Fitts
- Institute for Culture and SocietyWestern Sydney UniversityParramattaNew South WalesAustralia
- Menzies School of Health ResearchCharles Darwin UniversityAlice SpringsNorthern TerritoryAustralia
- Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityVictoriaBundooraAustralia
| |
Collapse
|
4
|
Cormick A, Graham A, Stevenson T, Owen K, O'Donnell K, Kelly J. Co-designing a Health Journey Mapping resource for culturally safe health care with and for First Nations people. Aust J Prim Health 2024; 30:PY23172. [PMID: 38621019 DOI: 10.1071/py23172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
Background Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Results The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.
Collapse
Affiliation(s)
- Alyssa Cormick
- Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia
| | - Amy Graham
- Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia
| | - Tahlee Stevenson
- Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia
| | - Kelli Owen
- Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia
| | - Kim O'Donnell
- Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia; and College of Medicine and Public Health, Flinders University, Kaurna Yarta, Bedford Park, SA 2100, Australia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Kaurna Yarta, North Terrace, Adelaide, SA 5000, Australia
| |
Collapse
|
5
|
Drew N, McAllister M, Coffin J, Robinson M, Katzenellenbogen J, Armstrong E. Healing Right Way randomised control trial enhancing rehabilitation services for Aboriginal people with brain injury in Western Australia: translation principles and activities. BRAIN IMPAIR 2024; 25:IB23109. [PMID: 38640359 DOI: 10.1071/ib23109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
Background This report provides the theory, method and practice of culturally secure translation and knowledge exchange in the Healing Right Way Clinical Trial (2017-2022), outlining activities to date. Healing Right Way was a stepped wedge cluster randomised controlled trial conducted in Western Australia, aimed at enhancing rehabilitation services and quality of life for Aboriginal Australians following acquired brain injury. The trial translation plan was aspirational and action-oriented, with its implementation iterative and ongoing. Translational activities aimed to inform service and research planning for Aboriginal people with brain injury. Situated in the intercultural space, the work guards against undertaking activities that are monocultural, colonial and appropriating in favour of work that is authentically viewed through the dual lens of whiteness and Aboriginal and Torres Strait Islander ways of knowing, being and doing, and is strengths-based. Methods Three translational and knowledge exchange components were identified, relating to the role of Aboriginal Brain Injury Coordinators, cultural training of hospital staff and the research process itself. Knowledge plans were developed for key audiences, with potential translation products to be monitored for ongoing impact. Results Results demonstrate that translational and knowledge exchange were iteratively embedded throughout the trial life cycle. Data sources included community engagement, partnership meetings and interviews. Activities involved presentations to diverse audiences including bureaucrats, community and participants. Conclusions This report provides a snapshot of the first translation knowledge exchange plan and activities constructed in relation to brain injury rehabilitation services for Aboriginal people. Challenges encountered, as well as successes to date, are discussed.
Collapse
Affiliation(s)
- Neil Drew
- Kurongkurl Katitjin, Edith Cowan University, Perth, WA, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Juli Coffin
- Ngangk Yira Institute for Change, Murdoch University, Broome, WA, Australia
| | - Melanie Robinson
- Ngangk Yira Institute for Change, Murdoch University, Broome, WA, Australia
| | - Judith Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Elizabeth Armstrong
- University Department of Rural Health South West, Edith Cowan University, Bunbury, Australia
| |
Collapse
|
6
|
Cochrane F, Singleton-Bray J, Canendo W, Cornwell P, Siyambalapitiya S. "Working together… I can't stress how important it is": Indigenous Health Liaison Officers' insights into working with speech-language pathologists and Aboriginal and Torres Strait Islander peoples with stroke and TBI. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:149-161. [PMID: 37552611 DOI: 10.1080/17549507.2023.2181225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE Providing culturally safe speech-language pathology services to Aboriginal and Torres Strait Islander peoples with acquired communication disorders (ACDs) may be challenging for non-Indigenous speech-language pathologists (SLPs). Indigenous Health Liaison Officers (IHLOs) may share common histories and culture with patients, and provide valuable insights about cultural safety. The study aim was to explore IHLOs' experiences of working with Aboriginal and Torres Strait Islander adults post-stroke or traumatic brain injury (TBI), and with the SLPs who provide services to these peoples. METHOD Using an interpretive description collaborative research design informed by culturally responsive principles, IHLOs (n = 7) participated in interviews facilitated by Aboriginal researchers and the principal investigator. Data were analysed using qualitative content analysis, informed by perspectives of Aboriginal researchers. RESULT Two themes, Connection and Spirit and Emotion, and six interdependent categories described how Aboriginal and Torres Strait Islander peoples have, and need, strong connections to family, country, health professionals, and ACD practices. Without these connections, patients' wellbeing may be deeply affected. CONCLUSION SLPs must collaborate with IHLOs and patients' family members and draw on their cultural knowledge, expertise, and guidance when working with Aboriginal and Torres Strait Islander peoples and ensure connections are created. These connections contribute to culturally safe and responsive speech-language pathology practice.
Collapse
Affiliation(s)
- Frances Cochrane
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Jenna Singleton-Bray
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Waverley Canendo
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Petrea Cornwell
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Samantha Siyambalapitiya
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| |
Collapse
|
7
|
Sarovich E, Lowrie D, Geia L, Kris S, Cairns A. Different meanings… what we want in our lives… a qualitative exploration of the experience of Aboriginal and/or Torres Strait Islander peoples in a co-designed community rehabilitation service. Disabil Rehabil 2024; 46:354-361. [PMID: 36576264 DOI: 10.1080/09638288.2022.2161645] [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: 05/26/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Promoting positive psychological, social and functional health outcomes for Aboriginal and Torres Strait Islander people requires health services to be culturally safe, respecting culture as central to the individuals and their communities. This study explored the experience of Aboriginal and Torres Strait Islander people, participating in a co-designed student-assisted community rehabilitation service in a remote Aboriginal community in Far North Queensland. MATERIALS AND METHODS Observation, informal yarning and semi-structured interviews with older Aboriginal and Torres Strait Islander people (n = 6) engaged in the service was conducted over a 7 week period. Interpretive phenomenological analysis was applied through inductive thematic analysis. RESULTS Four themes illustrated that experiences within the program promoted: A connection to people, both within the program and those significant in people's lives; a connection to past experiences, roles and events; a connection to the future of cultural knowledge; and a sense of achievement and fun. Participants shared their unique stories on their positive experience of the culturally responsive approach in the activities. CONCLUSIONS These results suggest that knowledge translation and reciprocity provide a strong foundation for rehabilitation programs that support healthy ageing for Aboriginal and Torres Strait Islander people and encourage active and ongoing individual and community involvement.
Collapse
Affiliation(s)
- Emma Sarovich
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Daniel Lowrie
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Lynore Geia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sylvia Kris
- College of Healthcare Sciences, James Cook University, Weipa, Australia
| | - Alice Cairns
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| |
Collapse
|
8
|
Cochrane F, Siyambalapitiya S, Cornwell P. Assessment and rehabilitation of acquired communication disorders in Aboriginal and Torres Strait Islander adults with stroke or traumatic brain injury: a retrospective chart review. Disabil Rehabil 2023; 45:1154-1164. [PMID: 35343342 DOI: 10.1080/09638288.2022.2055160] [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] [Indexed: 11/03/2022]
Abstract
PURPOSE Speech-language pathologists' (SLP) management practices for Aboriginal and Torres Strait Islander adults with acquired communication disorder (ACD), following stroke or traumatic brain injury (TBI), are not well understood. This study explores SLPs' management approaches for ACDs for Aboriginal and Torres Strait Islander adults post-stroke or TBI. MATERIALS AND METHODS SLPs' documented notes were analysed from a two-year retrospective medical record review of Aboriginal and Torres Strait Islander adults (≥18 years), admitted to a regional Queensland hospital with principal diagnoses of stroke or TBI. RESULTS SLPs frequently used informal approaches to assess ACDs. English-language formal assessment tools were also used in conjunction with the informal approaches. ACD diagnosis was more common in stroke than TBI patients. One-third of patients with ACD received inpatient rehabilitation at the study site. SLPs infrequently documented cultural or linguistic adaptions to assessment or interventions. CONCLUSIONS Informal approaches to assess ACDs were commonly employed which may be because they are perceived to be more culturally appropriate. Clinical guidelines for stroke and TBI should accommodate the diversity of cultures and languages. Better consideration of Aboriginal and Torres Strait Islander communication styles and incorporation of these into SLP ACD management approaches may facilitate accurate diagnosis and culturally safe rehabilitation services.Implications for RehabilitationInformal approaches for assessment and intervention of ACDs, that incorporate yarning and salient tasks, are likely to be more culturally appropriate and safe for Aboriginal and Torres Strait Islander peoples.More flexibility and guidance in the use of culturally and linguistically appropriate alternative assessment approaches are required in the National stroke guidelines for Aboriginal and Torres Strait Islander peoples.The adoption of enhanced models of culturally secure ACD service provision, that incorporate frequent SLP engagement with an Aboriginal or Torres Strait Islander support person during assessment and rehabilitation, are needed.There is an imperative for health professionals to actively account for culture and language difference in rehabilitation practices to ensure Indigenous peoples worldwide receive equitable and culturally-responsive services.
Collapse
Affiliation(s)
- Frances Cochrane
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Samantha Siyambalapitiya
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Petrea Cornwell
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| |
Collapse
|
9
|
Armstrong E, Mcallister M, Coffin J, Robinson M, Thompson S, Katzenellenbogen J, Colegate K, Papertalk L, Hersh D, Ciccone N, White J. Communication services for First Nations peoples after stroke and traumatic brain injury: Alignment of Sustainable Development Goals 3, 16 and 17. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:147-151. [PMID: 36412124 DOI: 10.1080/17549507.2022.2145356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Colonisation and continuing discrimination have significantly and negatively impacted the physical, social and emotional wellbeing of First Nations peoples globally. In Australia, Aboriginal cultures thrive despite ongoing barriers to health care. This paper describes challenges and new initiatives for Australian Aboriginal people with acquired communication disability after brain injury and their alignment with the global aims forming the Sustainable Development Goals. RESULT Research undertaken by an Aboriginal and non-Aboriginal multidisciplinary team over a decade in Western Australia identified and responded to mismatches between community needs and services. Initiatives described include the Missing Voices, Healing Right Way, Brain Injury Yarning Circles and Wangi/Yarning Together projects. Recommendations implemented related to (a) greater incorporation of Aboriginal cultural protocols and values within services, (b) more culturally secure assessment and treatment tools, (c) support after hospital discharge, (d) Aboriginal health worker involvement in support. Implementation includes cultural training of hospital staff, trialling new assessment and treatment methods, and establishing community-based Aboriginal Brain Injury Coordinator positions and relevant peer support groups. CONCLUSION Culturally secure brain injury rehabilitation in Australia is in its infancy. Our initiatives challenge assumptions about worldviews and established Western biomedical models of healthcare through incorporating Indigenous methodologies and leadership, and community-driven service delivery. This commentary paper focuses on Sustainable Development Goals 3, 16 and 17.
Collapse
Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Meaghan Mcallister
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Juli Coffin
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Broome, Australia
| | - Melanie Robinson
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Broome, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | | | | | - Lenny Papertalk
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Deborah Hersh
- Speech Pathology, School of Allied Health, Curtin University, Perth, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jane White
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| |
Collapse
|
10
|
Armstrong E, Rai T, Hersh D, Thompson S, Coffin J, Ciccone N, Flicker L, Cadilhac D, Godecke E, Woods D, Hayward C, Hankey GJ, McAllister M, Katzenellenbogen J. Statistical analysis plan for the stepped wedge clinical trial Healing Right Way-enhancing rehabilitation services for Aboriginal Australians after brain injury. Trials 2022; 23:886. [PMID: 36273182 PMCID: PMC9587581 DOI: 10.1186/s13063-022-06800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. METHODS: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL-5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. DISCUSSION The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018.
Collapse
Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Broadway, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome, Australia.,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Broome, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia
| | | | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University and Sir Charles Gairdner and Osborne Park Healthcare Group, Perth, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - Colleen Hayward
- Centre for Indigenous Australian Education and Research, Kurongkurl Katitjin, Australia Edith Cowan University, Perth, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Medical and Health Sciences, University of Western Australia, Perth, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | | |
Collapse
|
11
|
Jackson SM, Neibling BA, Barker RN. Stroke survivors' perspectives on recovering in rural and remote Australia: A systematic mixed studies review. Aust Occup Ther J 2021; 69:214-230. [PMID: 34918349 DOI: 10.1111/1440-1630.12779] [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: 08/18/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Stroke survivors recovering in rural and remote locations often have little or no access to rehabilitation services. The purpose of this study was to review the literature on recovering in rural and remote Australia, from the perspective of stroke survivors. Use of technology to support recovery was also explored. METHODS A systematic mixed studies review was conducted and reported according to the ENTREQ and PRISMA statements. MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, PsycINFO (ProQuest), Cochrane Library and Google Scholar were searched from inception to May 2021 for studies investigating stroke survivors' perspectives on recovering in rural or remote Australia. Qualitative, quantitative or mixed methods studies were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Studies were not excluded or weighted according to methodological quality. To review the perspectives of stroke survivors on recovering, findings of included studies were mapped to the Living My Life framework and integrated using a convergent qualitative synthesis. The review protocol was registered on PROSPERO (CRD42017064990). RESULTS Eight studies met the inclusion criteria: six qualitative, one quantitative and one mixed methods. Methodological quality of the small number of studies ranged from low to high, indicating further high-quality research is needed. Included studies involved 152 stroke survivors in total. Review findings indicated that recovering was driven by working towards what mattered to stroke survivors, in ways that matched their beliefs and preferences and that worked for them in their world, including use of technology. CONCLUSION Stroke survivors recovering in rural and remote locations want to live their life by doing what matters to them, despite the challenges they face. They want support in ways that work for them in their environment. Further research is required to tailor support for stroke survivors that is specific to their life in rural and remote locations.
Collapse
Affiliation(s)
- Sarah M Jackson
- College of Healthcare Sciences, James Cook University, Townsville, Australia.,Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Bridee A Neibling
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Ruth N Barker
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia.,College of Healthcare Sciences, James Cook University, Cairns, Australia
| |
Collapse
|
12
|
Armstrong E, McCoy K, Clinch R, Merritt M, Speedy R, McAllister M, Heine K, Ciccone N, Robinson M, Coffin J. The development of aboriginal brain injury coordinator positions: a culturally secure rehabilitation service initiative as part of a clinical trial. Prim Health Care Res Dev 2021; 22:e49. [PMID: 34585654 PMCID: PMC8488978 DOI: 10.1017/s1463423621000396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 11/07/2022] Open
Abstract
Brain injury, resulting from stroke and traumatic brain injury, is a common occurrence in Australia, with Aboriginal people affected at a significant rate and impact felt by individuals, families and communities. Access to brain injury rehabilitation services for Aboriginal people is reported to be often limited, with very little support outside the hospital environment. Our research involving Aboriginal brain injury survivors and their families to date has revealed that people often manage 'on their own' following such events. Following recommendations from survivors and their families, the Healing Right Way clinical trial, currently underway in Western Australia, has created the role of Aboriginal Brain Injury Coordinator (ABIC) to assist in navigating information and services, particularly after discharge from hospital. Eight positions for this role have been instigated across metropolitan and rural regions in the state. Healing Right Way's aim is to enhance rehabilitation services and improve quality of life for Aboriginal Australians after brain injury. The ABIC's role is to provide education, support, liaison and advocacy services to participants and their families over a six-month period, commencing soon after the participant's stroke or injury has occurred. This paper outlines the development of this role, the partnerships involved, experiences to date and identifies some facilitators and barriers encountered that may impact the role's ongoing sustainability. Details of components of the planned full Process Evaluation of Healing Right Way related to the ABIC role and the partnerships surrounding it are also provided. In combination with the trial's ultimate results, this detail will assist in future service planning and provide a model of culturally secure care for stroke and brain injury services that can also inform other sub-acute and primary care models.
Collapse
Affiliation(s)
- Elizabeth Armstrong
- Foundation Chair in Speech Pathology, Edith Cowan University, Perth, Australia
| | - Kathy McCoy
- Executive Director, Neurological Council of Western Australia, Perth, Australia
| | - Rebecca Clinch
- Aboriginal Brain Injury Coordinator, Neurological Council of Western Australia, Perth, Australia
| | - Maureen Merritt
- Aboriginal Brain Injury Coordinator, Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - Renee Speedy
- Aboriginal Brain Injury Coordinator, Neurological Council of Western Australia, Perth, Australia
| | - Meaghan McAllister
- Healing Right Way Project Manager, Edith Cowan University, Perth, Australia
| | - Kym Heine
- Community Nurse Consultant, Neurological Council of Western Australia, Perth, Australia
| | - Natalie Ciccone
- Associate Dean Allied Health, Edith Cowan University, Perth, Australia
| | - Melanie Robinson
- Aboriginal Research and Engagement Fellow, Murdoch University, Perth, Australia
| | - Juli Coffin
- Ellison Professor Aboriginal Health and Wellbeing, Telethon Kids Institute, the Kimberley, Nedlands, WA, Australia
| |
Collapse
|
13
|
Armstrong E, Coffin J, Hersh D, Katzenellenbogen JM, Thompson S, Flicker L, McAllister M, Cadilhac DA, Rai T, Godecke E, Hayward C, Hankey GJ, Drew N, Lin I, Woods D, Ciccone N. Healing Right Way: study protocol for a stepped wedge cluster randomised controlled trial to enhance rehabilitation services and improve quality of life in Aboriginal Australians after brain injury. BMJ Open 2021; 11:e045898. [PMID: 34588230 PMCID: PMC8479943 DOI: 10.1136/bmjopen-2020-045898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 08/31/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Despite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury. METHODS AND ANALYSIS: Design: Stepped wedge cluster randomised control trial design; intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals.Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury.Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants.Primary outcome: Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference.Secondary outcome measures: Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role.Evaluations: An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks. ETHICS AND DISSEMINATION The study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers. TRIAL REGISTRATION NUMBER ACTRN12618000139279.
Collapse
Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome, Western Australia, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | | | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Colleen Hayward
- School of Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Western Australia, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Neil Drew
- School of Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, University of Western Australia - Geraldton Campus, Geraldton, Western Australia, Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| |
Collapse
|
14
|
Skoss R, White J, Stanley MJ, Robinson M, Thompson S, Armstrong E, Katzenellenbogen JM. Study protocol for a prospective process evaluation of a culturally secure rehabilitation programme for Aboriginal Australians after brain injury: the Healing Right Way project. BMJ Open 2021; 11:e046042. [PMID: 34588232 PMCID: PMC8479980 DOI: 10.1136/bmjopen-2020-046042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/05/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Aboriginal) people are Australia's First Peoples, having the longest continuous culture in the world and deep spiritual connections with ancestral land. Improvements in their health and well-being is a major policy goal of Australian governments, as the legacy of colonisation and disruption of cultural practices contribute to major health challenges. Lack of culturally secure services impacts participation of Aboriginal people in health services. Aboriginal people with a brain injury typically experience poor access to rehabilitation and support following hospital discharge. 'Healing Right Way' (HRW) is a randomised control trial aiming to improve access to interdisciplinary and culturally secure rehabilitation services for Aboriginal people after brain injury in Western Australia, improve health outcomes and provide the first best practice model. This protocol is for the process evaluation of the HRW trial. METHODS AND ANALYSIS A prospective mixed methods process evaluation will use the Consolidated Framework for Implementation Research to evaluate implementation and intervention processes involved in HRW. Data collection includes qualitative and quantitative data from all sites during control and intervention phases, relating to three categories: (1) implementation of trial processes; (2) cultural security training; and (3) Aboriginal Brain Injury Coordinator role. Additional data elements collected from HRW will support the process evaluation regarding fidelity and intervention integrity. Iterative cross-sectional and longitudinal data synthesis will support the implementation of HRW, interpretation of findings and inform future development and implementation of culturally secure interventions for Aboriginal people. ETHICS AND DISSEMINATION This process evaluation was reviewed by The University of Western Australia Human Research Ethics Committee (RA/4/20/4952). Evaluation findings will be disseminated via academic mechanisms, seminars at trial sites, regional Aboriginal health forums, peak bodies for Aboriginal health organisations and the Australian Indigenous HealthInfoNet (https://healthinfonet.ecu.edu.au/). TRIAL REGISTRATION NUMBER ACTRN12618000139279.
Collapse
Affiliation(s)
- Rachel Skoss
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Jane White
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mandy J Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Melanie Robinson
- Ngangk Yira Research Centre for Aboriginal Health Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Sandra Thompson
- Combined Universities Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Armstrong
- Department of Health and Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
15
|
Zingelman S, Pearce WM, Saxton K. Speech-language pathologists' perceptions and experiences when working with Aboriginal and Torres Strait Islander children. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:225-235. [PMID: 32781836 DOI: 10.1080/17549507.2020.1779345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE This study explored the perceptions of speech-language pathologists with regards to culturally responsive service delivery, assessment practices, and confidence when working with Aboriginal and Torres Strait Islander children. METHOD An online survey was used. Descriptive statistics were analysed with SPSS. Themes were derived from text responses using Braun and Clarke's thematic analysis method. RESULT The 48 respondents were almost all non-Indigenous, equally spread across metropolitan and non-metropolitan regions, and had varied levels of experience. Respondents reported moderate to high levels of confidence. Identified barriers included accessibility, policy, impacts of colonisation, awareness of services and expectations and speech pathologist knowledge, training and experience. Engagement emerged as a facilitator to provision of culturally responsive services. A variety of speech-language pathology assessment methods were reported, not all of which were consistent with current recommendations. CONCLUSION Identified barriers and facilitators were consistent with previous research exploring work with adults with acquired communication disorders. A need to explore the perspectives of Aboriginal and Torres Strait Islander communities as users of speech-language pathology services was identified. Clinical implications are described for future training, clinical guidelines, and flexible service delivery.
Collapse
Affiliation(s)
- Sally Zingelman
- Australian Catholic University, McAuley Campus, Brisbane, QLD, Australia
| | - Wendy M Pearce
- Australian Catholic University, MacKillop Campus, North Sydney, NSW, Australia
| | - Kate Saxton
- Australian Catholic University, McAuley Campus, Brisbane, QLD, Australia
| |
Collapse
|
16
|
Cairns A, Geia L, Kris S, Armstrong E, O'Hara A, Rodda D, McDermott R, Barker R. Developing a community rehabilitation and lifestyle service for a remote indigenous community. Disabil Rehabil 2021; 44:4266-4274. [PMID: 33756085 DOI: 10.1080/09638288.2021.1900416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Community rehabilitation is an essential health service that is often not available to remote Australians. This paper describes the first cycle of a collaborative project, between local community members, allied health professionals and a university, to co-design a community rehabilitation and lifestyle service to support adults and older people to stay strong and age well in place. METHODS An action research framework was used to develop the service for adults in two remote communities, one being a discrete Aboriginal community. The first cycle involved planning for, and trialling of a service, with observations, reflections and feedback from clients, community members, university students and health service providers, to inform the subsequent service. RESULTS Over two years, stakeholders worked collaboratively to plan, trial, reflect and replan an allied health student-assisted community rehabilitation service. The trial identified the need for dedicated clinical and cultural supervision. During replanning, three key elements for culturally responsive care were embedded into the service: reciprocity and yarning; holistic community-wide service; and Aboriginal and Torres Strait Islander mentorship. CONCLUSIONS An action-research approach to co-design has led to the establishment of a unique community rehabilitation service to address disability and rehabilitation needs in two remote Australian communities.Implications for rehabilitationCo-design of community rehabilitation services between Aboriginal and Torres Strait Islander community members and the local allied health professionals can lead to development of an innovative service model for remote Aboriginal communities.Culturally responsive community rehabilitation services in Aboriginal and Torres Strait Islander communities requires holistic and community-wide perspectives of wellbeing.Incorporating Aboriginal and Torres Strait Islander ways of engaging and communicating, and leadership and mentorship for non-Indigenous allied health professionals and students are essential components for students-assisted culturally responsive services.
Collapse
Affiliation(s)
- Alice Cairns
- Centre for Rural and Remote Health, James Cook University, Weipa, Australia
| | - Lynore Geia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sylvia Kris
- Community Research Partner, Napranum, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Amy O'Hara
- Centre for Rural and Remote Health, James Cook University, Weipa, Australia.,Torres and Cape Hospital and Health Service, Weipa, Australia
| | - Danielle Rodda
- Centre for Rural and Remote Health, James Cook University, Weipa, Australia
| | | | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| |
Collapse
|
17
|
Jackson SM, Solomon SD, Barker RN. Recovering is about living my life, as it evolves: perspectives of stroke survivors in remote northwest Queensland. Disabil Rehabil 2021; 44:3843-3852. [PMID: 33625948 DOI: 10.1080/09638288.2021.1890242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Recovering from stroke in remote Australia has rarely been considered, even though rehabilitation services are generally scarce. The primary purpose of this study was to explore stroke recovery, from the perspective of stroke survivors in remote northwest Queensland (NWQ), to explicate the lens through which they view recovering. The secondary purpose was to explore the role of technology to support stroke survivors in remote locations along their recovery journey. METHODS A qualitative study was undertaken using elements of constructivist grounded theory for data collection and analysis. Semi-structured interviews were conducted with fifteen stroke survivors and two partners living, working or travelling in remote NWQ. RESULTS From the participants' perspective, recovering in a remote area after stroke is about living my life, as it evolves by endeavouring to recover my way and navigating my recovery in my world. Technology was only considered helpful when it supported participants to recover their way in their world. CONCLUSION Recovering from stroke from the perspective of stroke survivors in remote NWQ is about living their life, as they want it to be, and as it unfolds within their own context. Technology only has a place when it can support them to recover their way in their world. These findings reinforce the importance of health professionals listening, learning about, and enabling stroke survivors along their recovery journey, within their remote context and support network.Implications for RehabilitationRecovering from the perspective of stroke survivors is about living their life as it evolves.To support stroke survivors from remote areas, health professionals need to listen to and learn from each stroke survivor about what matters to them, what works for them, and about their world; including the challenges (e.g., switching between services) and enablers (e.g., community support) as the stroke survivor perceives them.Finding ways to utilise the strengths within and around them, may improve the recovery process for the stroke survivor in a remote area, ensuring they can access care that meets their needs in their world.Working together with stroke survivors, health professionals need to consider how technology could help them to live their life, while recovering their way and in their world.
Collapse
Affiliation(s)
- Sarah M Jackson
- College of Healthcare Sciences, James Cook University, Townsville, Australia.,Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - S D Solomon
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - R N Barker
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia.,College of Healthcare Sciences, James Cook University, Cairns, Australia
| |
Collapse
|