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Harfield S, Purcell T, Schioldann E, Ward J, Pearson O, Azzopardi P. Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA. BMC Health Serv Res 2024; 24:553. [PMID: 38693527 PMCID: PMC11062015 DOI: 10.1186/s12913-024-10796-5] [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: 08/18/2023] [Accepted: 02/28/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. METHODS We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. RESULTS A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. CONCLUSION This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.
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Affiliation(s)
- Stephen Harfield
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia.
- School of Public Health, University of Queensland, Herston, Australia.
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia.
- School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Tara Purcell
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Eliza Schioldann
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia
| | - Odette Pearson
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Peter Azzopardi
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Seff I, Steven S, Deitch J, Akika V, Puls C, Okoro C, Sughrue S, Stark L. Developing ACASI questionnaires in Borno State, Nigeria during COVID-19: Using data-informed processes to address complexity, sensitivity, and functionality of family functioning and wellbeing measures. Glob Public Health 2022; 17:3611-3626. [PMID: 35770693 DOI: 10.1080/17441692.2022.2095654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Audio Computer-Assisted Self-Interview (ACASI) has become increasingly popular for collecting data on sensitive topics among populations with lower levels of literacy. However, the development of an ACASI tool is an involved process that can be further complicated when working in humanitarian contexts during the COVID-19 pandemic. This study describes the development of an ACASI tool to be used in a family-focused intervention evaluation. Participants included adolescent girls aged 10-14, adolescent boys aged 15-19, and caregivers in Borno State, Nigeria. Data to inform the tool's development were collected using cognitive interviews, ACASI demonstrations, and post-demonstration assessments with adolescent girls, adolescent boys, and caregivers, as well as a focus group discussion with enumerators. Data found high levels of acceptance for the tool and helped identify appropriate visual representations for various answer options to maximize usability. The survey was found to be too long to administer solely through ACASI; the final tool employs a combination of ACASI and computer-assisted personal interview formats. Findings highlight the importance of repeatedly piloting and testing these types of tools to ensure content and language resonate with intended users. However, the steps employed demonstrate that researchers can maintain a commitment to developing high-quality, community-grounded research tools despite challenges germane to humanitarian settings.
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Affiliation(s)
- Ilana Seff
- Washington University in St. Louis, Abuja, Nigeria
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D’Costa B, Lobo R, Sibosado A, Leavy JE, Crawford G, Ward J. Evaluation of the Young, Deadly, Syphilis Free multi-media campaign in remote Australia. PLoS One 2022; 17:e0273658. [PMID: 36084099 PMCID: PMC9462794 DOI: 10.1371/journal.pone.0273658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Since 2011, remote Australian Aboriginal and Torres Strait Islander communities have experienced an outbreak of infectious syphilis, with young people aged 15–29 years over-represented in notifications. The Young Deadly Syphilis Free multi-media campaign was implemented in 12 remote regions in four Australian jurisdictions over nine months from 2017–2018. Campaign components included television and radio advertisements, social media posts, and health promotion resources available via a dedicated website. The aim of this research was to evaluate the impacts (proximal, mediator, distal) of the Young Deadly Syphilis Free campaign for young Aboriginal people and health and community workers residing in remote campaign regions.
Methods
A cross-sectional (post-only) evaluation design was used. Data were collected through online surveys; metrics for social media (Facebook, Instagram) were also collected to determine campaign engagement via social media. A 22-item young people survey assessed campaign awareness, exposure, message recognition and diagnostics (proximal variables); along with intended behaviour and knowledge and attitudes (mediator variables). A 24-item health and community worker survey assessed campaign awareness, exposure, message recognition and diagnostics (proximal variables); and changes in professional practice (distal variable). Descriptive statistics summarised demographic characteristics and univariate analysis examined associations between key variables.
Results
Just over half (n = 25, 58%) of young people and three quarters (n = 36; 75%) of health and community workers were aware of the campaign. Recognition of key campaign messages was high for both participant groups (>64%), and television, Facebook, and website were the most common campaign exposure routes. Positive impacts on intended behaviour (young people) and professional practice (health and community workers) were also reported. Facebook was effective in engaging some young people in campaign content and was preferred by young people for accessing information.
Conclusion
The findings point to the value of utilising a multi-media campaign in raising awareness about syphilis among young Aboriginal people and health and community workers in remote Australian regions. A longer-term campaign that accommodates the diverse needs of Aboriginal young people from geographically remote communities would optimise campaign impacts and support behavioural change.
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Affiliation(s)
- Belinda D’Costa
- Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Roanna Lobo
- Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Amanda Sibosado
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Justine E. Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gemma Crawford
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- UQ Poche Centre for Indigenous Health, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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Freeburn B, Loggins S, Lee KSK, Conigrave KM. Coming of age: 21 years of providing opioid substitution treatment within an Aboriginal community-controlled primary health service. Drug Alcohol Rev 2021; 41:260-264. [PMID: 34233017 DOI: 10.1111/dar.13345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
In Australia, Aboriginal and Torres Strait Islander community controlled health services have been established since 1971 to provide accessible, quality and culturally-appropriate primary healthcare. The first of these services, the Aboriginal Medical Service Cooperative Redfern ('the AMS'), created its own Drug and Alcohol Unit ('the Unit') in 1999. The Unit initially prescribed opioid substitution treatment (OST) and its coordinator, Bradley Freeburn, a Bundjalung man, provided counselling. Soon afterwards, the Unit started dispensing OST. It now cares for around 150 individuals, each of whom is understood in the context of family, community and culture. The Unit is on the same site as the AMS's primary care service, specialised medical and mental health clinics, and dental clinic. This allows for integrated physical and mental health care. The Unit contributes to drug and alcohol workforce development for other AMS staff, state-wide and nationally. Several Aboriginal and Torres Strait Islander community controlled health services around Australia now offer OST prescription, and a small number administer slow-release buprenorphine. We are not aware of others that dispense Suboxone. In the USA and Canada, over the last 10 years, First Nations communities have also responded to lack of treatment access, by creating standalone OST clinics. We were not able to find examples of Māori-controlled OST clinics in Aotearoa, New Zealand. The feasibility of this model of readily accessible OST, situated within a holistic, culturally-grounded primary health-care service recommends it for consideration and evaluation, for Indigenous or non-Indigenous communities.
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Affiliation(s)
- Bradley Freeburn
- The Drug and Alcohol Unit, Aboriginal Medical Service Redfern Cooperative, Sydney, Australia
| | - Summer Loggins
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia
| | - K S Kylie Lee
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,Health Sciences, Curtin University, National Drug Research Institute, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Katherine M Conigrave
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
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