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Jessop S, Hill S, Bicanin K, Day T, Turner J, O'Connell M, Highfold R, Revesz T. Aboriginal children with cancer: The patient and healthcare worker perspective. Pediatr Blood Cancer 2024; 71:e30747. [PMID: 37880841 DOI: 10.1002/pbc.30747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
There are inequitable health outcomes for Aboriginal children with cancer. A quality improvement audit performed at our institution through interviews with families and healthcare workers has highlighted individual, systematic and cultural barriers to equitable and culturally safe healthcare for Aboriginal patients, in addition to facilitators and recommendations for improvements.
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Affiliation(s)
- Sophie Jessop
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- University of Adelaide, North Adelaide, South Australia, Australia
| | - Shandelle Hill
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Kon Bicanin
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Tanya Day
- Aboriginal Health Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jess Turner
- Taikurrinthi Aboriginal Liaison Office, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Megan O'Connell
- Taikurrinthi Aboriginal Liaison Office, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Rose Highfold
- Taikurrinthi Aboriginal Liaison Office, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Tom Revesz
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- University of Adelaide, North Adelaide, South Australia, Australia
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Jones J, Durey A, Strobel N, McAuley K, Edmond K, Coffin J, McAullay D. Perspectives of health service providers in delivering best-practice care for Aboriginal mothers and their babies during the postnatal period. BMC Pregnancy Childbirth 2023; 23:8. [PMID: 36604651 PMCID: PMC9814443 DOI: 10.1186/s12884-022-05136-6] [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: 01/31/2022] [Accepted: 10/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Evidence suggests that Aboriginal babies in Western Australia are not receiving adequate primary health care in their first 3 months of life, leading to questions about enablers and constraints to delivering such care. This paper presents findings from a qualitative research project investigating health providers' perceptions and experiences of best and current practice in discharge planning, postnatal care and health education for Aboriginal mothers and their newborn babies. METHODS Constructivist grounded theory guided this research involving 58 semi-structured interviews conducted with health providers who deliver care to Aboriginal mothers and infants. Participants were recruited from hospital-based and primary health sites in metropolitan Perth, and regional and remote locations in Western Australia. RESULTS Structural factors enabling best practice in discharge planning, postnatal care, and health education for mothers included health providers following best practice guidelines and adequate staffing levels. Organisational enablers included continuity of care throughout pregnancy, birth and postnatally. In particular, good communication between services around discharge planning, birth notifications, and training in culturally respectful care. Structural and organisational constraints to delivering best practice and compromising continuity of care were identified as beyond individual control. These included poor communication between different health and social services, insufficient hospital staffing levels leading to early discharge, inadequate cultural training, delayed receipt of birth notifications and discharge summaries received by Aboriginal primary health services. CONCLUSION Findings highlight the importance of examining current policies and practices to promote best practice in postnatal care to improve health outcomes for mothers and their Aboriginal babies.
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Affiliation(s)
- Jocelyn Jones
- National Drug Research Institute, Curtin University, WA, Perth, Australia.
| | - Angela Durey
- grid.1012.20000 0004 1936 7910School of Population and Global Health, The University of Western Australia, WA Perth, Australia
| | - Natalie Strobel
- grid.1038.a0000 0004 0389 4302Kurongkurl Katitjin, Edith Cowan University, WA Perth, Australia
| | - Kimberley McAuley
- grid.1012.20000 0004 1936 7910School of Population and Global Health, The University of Western Australia, WA Perth, Australia
| | - Karen Edmond
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Juli Coffin
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, WA Perth, Australia
| | - Daniel McAullay
- grid.1038.a0000 0004 0389 4302Kurongkurl Katitjin, Edith Cowan University, WA Perth, Australia
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Strobel N, Moylan C, Durey A, Edmond K, McAuley K, McAullay D. Understanding an Aboriginal and Torres Strait Islander child’s journey through paediatric care in Western Australia. Aust N Z J Public Health 2020; 44:95-101. [DOI: 10.1111/1753-6405.12974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Carol Moylan
- Medical SchoolUniversity of Western Australia
- Poche Centre for Indigenous HealthUniversity of Western Australia
| | | | - Karen Edmond
- Medical SchoolUniversity of Western Australia
- Kings College London UK
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Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000-2012): A Record Linkage Cohort Study. Pediatr Infect Dis J 2019; 38:169-175. [PMID: 29620723 DOI: 10.1097/inf.0000000000002063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gastroenteritis is a leading cause of childhood morbidity worldwide. We aimed to assess the maternal and infant characteristics and population attributable fractions associated with childhood gastroenteritis-related hospitalizations. METHODS We conducted a whole-of-population retrospective birth cohort study of 367,476 children live-born in Western Australia 2000-2012. We identified hospital admissions up to <15 years of age pertaining to these children, with a principal diagnosis code for infectious gastroenteritis. Cox regression was used to obtain the adjusted hazard ratios with 95% confidence intervals and the population attributable fractions associated with each risk factor in Aboriginal and non-Aboriginal children for their first gastroenteritis-related hospital admission. RESULTS There were a total of 15,888 gastroenteritis-related hospital admissions (25.7% occurring among non-Aboriginal children). The overall gastroenteritis hospitalization rate for children <15 years of age was 4.6/1000 child-years for non-Aboriginal children and 21.5/1000 child-years for Aboriginal children. Male gender, <20 years of maternal age, preterm birth, low birth weight, residence in remote regions of Western Australia and birth in the pre-rotavirus vaccine era were significant independent risk factors for gastroenteritis hospitalization in both Aboriginal and non-Aboriginal children. Additionally, birth by caesarean section and low socioeconomic status were identified as being associated with gastroenteritis hospitalization in non-Aboriginal children. Population attributable fractions suggest that 39% of all gastroenteritis hospitalizations in non-Aboriginal children (38% in Aboriginal children) could be averted if all children receive the rotavirus vaccine. CONCLUSIONS Given the beneficial effect of infant rotavirus vaccination in preventing all-cause gastroenteritis hospitalization, efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk.
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Andersen MJ, Skinner A, Williamson AB, Fernando P, Wright D. Housing conditions associated with recurrent gastrointestinal infection in urban Aboriginal children in NSW, Australia: findings from SEARCH. Aust N Z J Public Health 2018; 42:247-253. [PMID: 29644760 DOI: 10.1111/1753-6405.12786] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/01/2017] [Accepted: 02/01/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the associations between housing and gastrointestinal infection in Aboriginal children in urban New South Wales. METHODS A total of 1,398 Aboriginal children were recruited through four Aboriginal Community Controlled Health Services. Multilevel regression modelling of survey data estimated associations between housing conditions and recurrent gastrointestinal infection, adjusting for sociodemographic and health factors. RESULTS Of the sample, 157 children (11%) had recurrent gastrointestinal infection ever and 37 (2.7%) required treatment for recurrent gastrointestinal infection in the past month. Children in homes with 3+ housing problems were 2.51 (95% CrI 1.10, 2.49) times as likely to have recurrent gastrointestinal infection ever and 6.79 (95% CrI 2.11, 30.17) times as likely to have received recent treatment for it (versus 0-2 problems). For every additional housing problem, the prevalence of recurrent gastrointestinal infection ever increased by a factor of 1.28 (95% CrI 1.14, 1.47) and the prevalence of receiving treatment for gastrointestinal infection in the past month increased by a factor of 1.64 (95% CrI 1.20, 2.48). CONCLUSIONS Housing problems were independently associated with recurrent gastrointestinal infection in a dose-dependent manner. Implications for public health: The role of housing as a potential determinant of health in urban Aboriginal children merits further attention in research and policy settings.
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Affiliation(s)
- Melanie J Andersen
- School of Public Health and Community Medicine, The University of New South Wales.,The Sax Institute, New South Wales
| | - Adam Skinner
- School of Public Health and Community Medicine, The University of New South Wales
| | - Anna B Williamson
- The Sax Institute, New South Wales.,The University of Sydney, New South Wales
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McNamara B, Gubhaju L, Jorm L, Preen D, Jones J, Joshy G, Shepherd C, McAullay D, Eades S. Exploring factors impacting early childhood health among Aboriginal and Torres Strait Islander families and communities: protocol for a population-based cohort study using data linkage (the 'Defying the Odds' study). BMJ Open 2018; 8:e021236. [PMID: 29599395 PMCID: PMC5875609 DOI: 10.1136/bmjopen-2017-021236] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Empirical evidence on family and community risk and protective factors influencing the comparatively high rates of potentially preventable hospitalisations and deaths among Aboriginal and Torres Strait Islander infants and children is limited. As is evidence on geographical variation in these risks. The 'Defying the Odds' study aims to explore the impact of perinatal outcomes, maternal social and health outcomes and level of culturally secure service availability on the health outcomes of Western Australian (WA) Aboriginal infants and children aged 0-5 years. METHODS AND ANALYSIS The study combines a retrospective cohort study that uses state-wide linked health and administrative data from 12 data sources for multiple generations within Aboriginal families in WA, with specifically collected survey data from health and social services supporting Aboriginal families in regions of WA. Data sources include perinatal/birth registration, hospital, emergency department, mental health services, drug and alcohol service use, mortality, infectious disease notifications, and child protection and family services. Multilevel regression models will be used to examine the intensity of admissions and presentations, mortality, intensity of long stays and morbidity-free survival (no admissions) for Aboriginal children born in WA in 2000-2013. Relationships between maternal (and grand-maternal) health and social factors and child health outcomes will be quantified. Community-level variation in outcomes for Aboriginal children and factors contributing to this variation will be examined, including the availability of culturally secure services. Online surveys were sent to staff members at relevant services to explore the scope, reach and cultural security of services available to support Aboriginal families across selected regions of WA. ETHICS AND DISSEMINATION Ethics approvals have been granted for the study. Interpretation and dissemination are guided by the study team's Aboriginal leadership and reference groups. Dissemination will be through direct feedback and reports to health services in the study and via scientific publications and policy recommendations.
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Affiliation(s)
- Bridgette McNamara
- Aboriginal Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Lina Gubhaju
- Aboriginal Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Kensington, New South Wales, Australia
| | - David Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jocelyn Jones
- Faculty of Health Services, Curtin University of Technology—Shenton Park Campus, Perth, Western Australia, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Daniel McAullay
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Sandra Eades
- Aboriginal Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Falster K, Banks E, Lujic S, Falster M, Lynch J, Zwi K, Eades S, Leyland AH, Jorm L. Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study. BMC Pediatr 2016; 16:169. [PMID: 27769208 PMCID: PMC5073450 DOI: 10.1186/s12887-016-0706-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/04/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. METHODS This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. RESULTS There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6-10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6-9.7)). CONCLUSIONS We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap.
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Affiliation(s)
- Kathleen Falster
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- The Sax Institute, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- The Sax Institute, Sydney, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - Michael Falster
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - John Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Karen Zwi
- Sydney Children’s Hospitals Network, Sydney, Australia
- School of Women and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Sandra Eades
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia
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McAullay D, McAuley K, Marriott R, Pearson G, Jacoby P, Ferguson C, Geelhoed E, Coffin J, Green C, Sibosado S, Henry B, Doherty D, Edmond K. Improving access to primary care for Aboriginal babies in Western Australia: study protocol for a randomized controlled trial. Trials 2016; 17:82. [PMID: 26869181 PMCID: PMC4751713 DOI: 10.1186/s13063-016-1206-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/29/2016] [Indexed: 11/26/2022] Open
Abstract
Background Despite a decade of substantial investments in programs to improve access to primary care for Aboriginal mothers and infants, more than 50 % of Western Australian Aboriginal babies are still not receiving primary and preventative care in the early months of life. Western Australian hospitals now input birth data into the Western Australian electronic clinical management system within 48 hours of birth. However, difficulties have arisen in ensuring that the appropriate primary care providers receive birth notification and clinical information by the time babies are discharged from the hospital. No consistent process exists to ensure that choices about primary care are discussed with Aboriginal families. Methods/Design We will undertake a population-based, stepped wedge, cluster randomized controlled trial of an enhanced model of early infant primary care. The intervention is targeted support and care coordination for Aboriginal families with new babies starting as soon as possible during the antenatal period or after birth. Dedicated health professionals and research staff will consult with families about the families’ healthcare needs, provide information about healthcare in the first 3 months of life, offer assistance with birth and Medicare forms, consult with families about their choice for primary care provider, offer to notify the chosen primary care provider about the baby’s health needs, and offer assistance with healthcare coordination at the time of discharge from the hospital. We will evaluate this model of care using a rigorous stepped wedge approach. Our primary outcome measure is a reduced hospitalization rate in infants younger than 3 months of age. Secondary outcome measures include completed Aboriginal and Torres Strait Islander child health screening assessments, immunization coverage, and satisfaction of the families about early infant primary care. We will also assess the cost effectiveness of the model of care. Discussion This study will be conducted over a 4-year period in partnership with birthing hospitals and primary care providers including Western Australian Aboriginal Community Controlled Health Services and the new Primary Health Networks. The results of our trial will be used to develop improved primary care models and to improve health outcomes for all Aboriginal infants. These are vital steps toward more equitable health service delivery for the Aboriginal and Torres Strait Islander children in Australia. Trial Registration Australian New Zealand Clinical Trials Registry Registration number: ACTRN12615000976583 Date registered: 17 September 2015
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Affiliation(s)
- Daniel McAullay
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Edith Cowen University, 2 Bradford St, Mount Lawley, WA, 6050, Australia.
| | - Kimberley McAuley
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Rhonda Marriott
- Murdoch University, 90 South St, Murdoch, WA, 6150, Australia.
| | - Glenn Pearson
- Telethon Kids Institute, 100 Roberts Rd, Subiaco, WA, 6008, Australia.
| | - Peter Jacoby
- Telethon Kids Institute, 100 Roberts Rd, Subiaco, WA, 6008, Australia.
| | - Chantal Ferguson
- Western Australia Department of Health, 189 Royal Street, East Perth, WA, 6004, Australia.
| | - Elizabeth Geelhoed
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Juli Coffin
- Geraldton Regional Aboriginal Medical Service, Holland St, Geraldton, WA, 6530, Australia.
| | - Charmaine Green
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Geraldton Regional Aboriginal Medical Service, Holland St, Geraldton, WA, 6530, Australia.
| | - Selina Sibosado
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Geraldton Regional Hospital, 51-85 Shenton St, Geraldton, WA, 6530, Australia.
| | - Barbara Henry
- Derbarl Yerrigan Aboriginal Medical Service, 156 Wittenoom St, East Perth, WA, 6004, Australia.
| | - Dorota Doherty
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,King Edward Memorial Hospital, 374 Bagot Rd, Subiaco, WA, 6008, Australia.
| | - Karen Edmond
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Princess Margaret Hospital for Children, Roberts Rd, Subiaco, WA, 6008, Australia.
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