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Sadler S, Gerrard J, West M, Lanting S, Charles J, Searle A, Chuter V. Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health: a systematic review. J Foot Ankle Res 2022; 15:55. [PMID: 35869536 PMCID: PMC9308327 DOI: 10.1186/s13047-022-00557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ongoing colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for Aboriginal and Torres Strait Islander Peoples. As a consequence, within the domain of lower limb health, foot disease has severe impacts for First Nations Peoples. Central to developing culturally safe healthcare and driving positive foot health change for First Nations Peoples, is the need for health professionals to develop understanding of First Nations perspectives of foot health. The aim of this systematic review was to evaluate studies investigating Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health.
Methods
PubMeD, Ovid (Embase, Emcare, Medline), CINAHL, Informit Indigenous collection, and grey literature sources were searched to 23rd July 2021. We included any published reports or studies that examined Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health, or meanings of, or attitudes to, foot and lower limb health.
Results
Four studies with a total of 1515 participants were included. Studies found that Aboriginal and Torres Strait Islander people self-assessed foot health with a demonstrated ability to perceive their feet as healthy relative to Western clinical measures of peripheral blood supply and neurological function. Footwear, including ill-fitting or lack of footwear was considered a contributing factor to reduced foot and lower limb health. Foot pain affected up to 60% of participants with up to 70% of foot pain untreated. Lack of access to culturally safe health care delivered by culturally capable health professionals was perceived to contribute to worse foot and lower limb health outcomes.
Conclusions
Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health are influenced by multiple complex interrelated factors. The limited number of studies in this area indicates ongoing failings to consult First Nations Peoples regarding their own lower limb and foot health. It is therefore essential that healthcare service and cultural capability implementation is led by Aboriginal and Torres Strait Islander Peoples in co-design. Urgent need for further research that exemplifies design and delivery of culturally safe care is required.
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Sikimić V. How to Improve Research Funding in Academia? Lessons From the COVID-19 Crisis. Front Res Metr Anal 2022; 7:777781. [PMID: 35368439 PMCID: PMC8971746 DOI: 10.3389/frma.2022.777781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/21/2022] [Indexed: 01/01/2023] Open
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Quigley R, Russell SG, Larkins S, Taylor S, Sagigi B, Strivens E, Redman-MacLaren M. Aging Well for Indigenous Peoples: A Scoping Review. Front Public Health 2022; 10:780898. [PMID: 35223727 PMCID: PMC8866315 DOI: 10.3389/fpubh.2022.780898] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
As life expectancy increases for Indigenous populations, so does the number of older adults with complex, chronic health conditions and age-related geriatric syndromes. Many of these conditions are associated with modifiable lifestyle factors that, if addressed, may improve the health and wellbeing of Indigenous peoples as they age. If models of healthy aging are to be promoted within health services, a clearer understanding of what aging well means for Indigenous peoples is needed. Indigenous peoples hold a holistic worldview of health and aging that likely differs from Western models. The aims of this review were to: investigate the literature that exists and where the gaps are, on aging well for Indigenous peoples; assess the quality of the existing literature on Indigenous aging; identify the domains of aging well for Indigenous peoples; and identify the enablers and barriers to aging well for Indigenous peoples. A systematic search of online databases, book chapters, gray literature, and websites identified 32 eligible publications on Indigenous aging. Reflexive thematic analysis identified four major themes on aging well: (1) achieving holistic health and wellbeing; (2) maintaining connections; (3) revealing resilience, humor, and a positive attitude; and (4) facing the challenges. Findings revealed that aging well is a holistic concept enabled by spiritual, physical, and mental wellbeing and where reliance on connections to person, place, and culture is central. Participants who demonstrated aging well took personal responsibility, adapted to change, took a positive attitude to life, and showed resilience. Conversely, barriers to aging well arose from the social determinants of health such as lack of access to housing, transport, and adequate nutrition. Furthermore, the impacts of colonization such as loss of language and culture and ongoing grief and trauma all challenged the ability to age well. Knowing what aging well means for Indigenous communities can facilitate health services to provide culturally appropriate and effective care.
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Affiliation(s)
- Rachel Quigley
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
- *Correspondence: Rachel Quigley
| | - Sarah G. Russell
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
| | - Sarah Larkins
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
| | - Sean Taylor
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Northern Territory Health, Darwin, NT, Australia
| | | | - Edward Strivens
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
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Gardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, Davis SM, Quinlan F, Worley P. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine 2021; 42:101181. [PMID: 34765955 PMCID: PMC8573152 DOI: 10.1016/j.eclinm.2021.101181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. METHODS An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. FINDINGS Indigenous Australians reported significantly higher prevalence of HSVD at 229.0 per-1000 as compared to 152.0 per-1000 non-Indigenous Australians: risk ratio 1.5 (95% CI 1.2-1.8). 583 remote patients received an EPE for HSVD, consisting of 388 (66.6%; 95% CI: 62.6-70.4) males and 195 (33.0%; 95% CI: 29.6-37.4) females. There were 289 (49.6%; 95% CI 45.4- 53.7) patients who identified as Indigenous, and 294 (50.4%; 95% CI 46.3- 54.6) as non-Indigenous. The mean Indigenous age during EPE was 48.0 (95% CI 45.9-50.1) years old, significantly lower than the non-Indigenous mean age of 55.6 (95% CI 53.8-57.4). Indigenous patients hospitalised for HSVD were younger, the majority younger than 65 years (n=21175; 73.7% 95% CI 73.2-74.2) as compared to non-Indigenous patients (n= 357654; 33.1% 95% CI 33.0-33.15). When adjusted for HSVD prevalence, remote Indigenous patients had a higher hospitalisation rate as compared to non-remote Indigenous patients (rate ratio: 1.6; 95% CI 1.3-2.0) and remote non-Indigenous patients (rate ratio: 1.2; 95% CI 1.0-1.5). More Indigenous patients died of HSVD before the age of 65 years (n=1875; 56.5% 95% CI 54.8-58.2) as compared to non-Indigenous patients (n= 16161; 10.6% 95% CI 10.45-10.8). INTERPRETATION Indigenous Australians have a higher prevalence, and younger age during EPE, and hospitalisation for HSVD than non-Indigenous Australians. FUNDING This is a self/internally-funded study, with the lead organisation being the Royal Flying Doctor Service (RFDS) of Australia. For the duration of the study period, the RFDS provided in-kind support including one full-time equivalent (FTE) and resources (office space, computer, research software, and office equipment). There was no external funding source that had a role in study design or data analysis or interpretation.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia
- Corresponding author. Dr Fergus W Gardiner, Royal Flying Doctor Service, Level 2, 10-12 Brisbane Avenue, Barton ACT 2600 Australia
| | - Kristopher Rallah-Baker
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Angela Dos Santos
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | | | - Leonid Churilov
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Geoffrey A Donnan
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Stephen M. Davis
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Frank Quinlan
- The Royal Flying Doctor Service, Canberra, Australia
| | - Paul Worley
- Riverland Mallee Coorong Local Health Network, Murray Bridge, Australia
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Dalach P, Savarirayan R, Baynam G, McGaughran J, Kowal E, Massey L, Jenkins M, Paradies Y, Kelaher M. "This is my boy's health! Talk straight to me!" perspectives on accessible and culturally safe care among Aboriginal and Torres Strait Islander patients of clinical genetics services. Int J Equity Health 2021; 20:103. [PMID: 33865398 PMCID: PMC8052687 DOI: 10.1186/s12939-021-01443-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander people do not enjoy equal access to specialist health services that adequately meet their needs. Clinical genetics services are at the vanguard of realising the health benefits of genomic medicine. As the field continues to expand in clinical utility and implementation, it is critical that Aboriginal and Torres Strait Islander people are able to participate and benefit equally to avoid further widening of the existing health gap. This is the first study to explore barriers to accessing clinical genetics services among Aboriginal and Torres Strait Islander people, which has been acknowledged as a key strategic priority in Australian genomic health policy. METHODS A participatory design process engaged a majority-Aboriginal Project Reference Group and Aboriginal End-User Group. 63 semi-structured interviews were conducted with Aboriginal and/or Torres Strait Islander people who had accessed the government-funded clinical genetics service in Western Australia, Queensland or the Northern Territory between 2014 and 2018. The sample included patients, parents and carers. Participants were asked to recount their 'patient journey', from referral through to post-appointment and reflect on their perceptions of genetics and its implications for the health of themselves and their families. Analysis tracked chronological service engagement, followed by an inductive thematic approach. RESULTS Barriers to access and engagement were present at each stage of the patient journey. These included challenges in obtaining a referral, long waiting periods, limited genetic literacy, absence of Aboriginal support services, communication challenges and lack of adequate psychosocial support and follow-up after attendance. Participants' overall experiences of attending a genetic health service were varied, with positive perceptions tied closely to a diagnosis being achieved. The experience of (and expectation for) recognition of cultural identity and provision of culturally safe care was low among participants. Unaddressed concerns continued to cause significant distress in some people years after their appointment took place. CONCLUSIONS There is significant scope for improving the care provided to Aboriginal and Torres Strait Islander people at clinical genetics services. Immediate attention to minimising logistical barriers, developing relationships with Aboriginal Community Controlled Health Services and providing practical and specific cultural safety training for practitioners is required at the service-level. Our findings strongly support the development of guidelines or policies recognising the collective cultural needs of Aboriginal and Torres Strait Islander people in relation to genomic health care.
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Affiliation(s)
- Philippa Dalach
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute and University of Melbourne, Parkville, Victoria, Australia
| | - Gareth Baynam
- Western Australian Department of Health, Genetic Services of Western Australia, Perth, Western Australia, Australia
- Western Australian Register of Developmental Anomalies, Western Australian Department of Health, Perth, Australia
- Telethon Kids Institute and Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Emma Kowal
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Geelong, Victoria, Australia
| | - Libby Massey
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
- James Cook University, Townsville, Queensland, Australia
| | - Misty Jenkins
- Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Geelong, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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Saunders P, Doyle K. Gambling Interventions in Indigenous Communities, from Theory to Practice: A Rapid Qualitative Review of the Literature. J Gambl Stud 2021; 37:947-982. [PMID: 33751361 DOI: 10.1007/s10899-021-10019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/24/2022]
Abstract
Indigenous populations globally experience problem gambling at higher rates than mainstream communities, often leading to adverse outcomes in social, cultural, and health domains (The term 'indigenous' within this paper refers to all first nations people from the specified countries. When capitalised, this refers to Australian Indigenous people specifically.). Problem gambling in indigenous communities has been linked to relative poverty and social disadvantage. The sweeping impacts of problem gambling for indigenous communities are holistic in nature and are felt throughout many aspects of the community, including the local economy, education, employment, and cultural kinship obligations. The social links inherent in many gambling activities in addition to the motivations of players and complex socio-cultural milieu can make it very difficult to renounce the practice. This paper aims to evaluate the indigenous gambling literature to discern appropriate and effective principles to guide intervention development in the context of problem gambling pertaining to the Australian Indigenous population. A rapid review will be undertaken to gather, analyse, and interpret appropriate theoretical and empirical literature relating to gambling interventions for indigenous populations. Papers from Canada, Australia, New Zealand, and U.S.A (CANZUS) will be considered in the review and thematic analysis will be undertaken to ascertain a broad understanding of effective and appropriate problem gambling intervention principles applicable to these population groups. Despite the relative dearth of empirical evidence within this field, approaches to problem gambling intervention within indigenous populations must be culturally-centred and underpinned by a public health framework that considers the broad socio-politico-cultural context of the whole community. The importance of community-control, collaboration, community capacity building, workforce competence, a holistic approach, and gambling regulation cannot be overstated. The available literature focusses on an alternative approach to addressing problem gambling in indigenous communities, with much of the findings highlighting key indigenist principles within a context-based method of engagement and intervention, including addressing the social, political, and cultural determinants of problem gambling at a community-level.
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Affiliation(s)
- Paul Saunders
- Indigenous Health, School of Medicine, Western Sydney University, Narellan Rd, Campbelltown, NSW, Australia.
| | - Kerrie Doyle
- Indigenous Health, School of Medicine, Western Sydney University, Narellan Rd, Campbelltown, NSW, Australia
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7
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Rheault H, Coyer F, Bonner A. Time to listen: Chronic disease yarning with Aboriginal and Torres Strait Islander peoples living in remote Australia. Collegian 2021. [DOI: 10.1016/j.colegn.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Lin CY, Loyola-Sanchez A, Boyling E, Barnabe C. Community engagement approaches for Indigenous health research: recommendations based on an integrative review. BMJ Open 2020; 10:e039736. [PMID: 33247010 PMCID: PMC7703446 DOI: 10.1136/bmjopen-2020-039736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Community engagement practices in Indigenous health research are promoted as a means of decolonising research, but there is no comprehensive synthesis of approaches in the literature. Our aim was to assemble and qualitatively synthesise a comprehensive list of actionable recommendations to enhance community engagement practices with Indigenous peoples in Canada, the USA, Australia and New Zealand. DESIGN Integrative review of the literature in medical (Medline, Cumulative Index to Nursing and Allied Health Literature and Embase) and Google and WHO databases (search cut-off date 21 July 2020). ARTICLE SELECTION Studies that contained details regarding Indigenous community engagement frameworks, principles or practices in the field of health were included, with exclusion of non-English publications. Two reviewers independently screened the articles in duplicate and reviewed full-text articles. ANALYSIS Recommendations for community engagement approaches were extracted and thematically synthesised through content analysis. RESULTS A total of 63 studies were included in the review, with 1345 individual recommendations extracted. These were synthesised into a list of 37 recommendations for community engagement approaches in Indigenous health research, categorised by stage of research. In addition, activities applicable to all phases of research were identified: partnership and trust building and active reflection. CONCLUSIONS We provide a comprehensive list of recommendations for Indigenous community engagement approaches in health research. A limitation of this review is that it may not address all aspects applicable to specific Indigenous community settings and contexts. We encourage anyone who does research with Indigenous communities to reflect on their practices, encouraging changes in research processes that are strengths based.
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Affiliation(s)
- Chu Yang Lin
- Office of Undergraduate Medical Education, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Adalberto Loyola-Sanchez
- Sanchez Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Elaine Boyling
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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9
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Larke BM, Broe GA, Daylight G, Draper B, Cumming RG, Allan W, Donovan T, Costa D, Lah S, Radford K. Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australians. Australas J Ageing 2020; 40:145-153. [PMID: 33155390 DOI: 10.1111/ajag.12864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine preferences for health and aged care services in Aboriginal and Torres Strait Islander Australians and explore related factors. METHODS Mixed-method, cross-sectional study including 336 Aboriginal and Torres Strait Islander people aged 60 years and older from regional and urban areas. RESULTS Exclusive preference for Aboriginal Community Controlled services was most common. This preference significantly increased when preferences for, and use of, aged care and disability services were considered. The likelihood of holding an exclusive preference for Aboriginal Community Controlled services was higher in regional settings compared to urban and in those reporting lower engagement in traditional activities during childhood. CONCLUSIONS These findings suggest that the majority of older Australian Aboriginal and Torres Strait Islander people prefer aged and disability care provided by Aboriginal services. Given the anticipated increase in service demand in this population, there is a growing need for culturally safe services, particularly in regional settings.
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Affiliation(s)
- Benjamin M Larke
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Gerald A Broe
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,UNSW Ageing Futures Institute and UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gail Daylight
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Brian Draper
- UNSW Ageing Futures Institute and UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Allan
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Terrence Donovan
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Daniel Costa
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,UNSW Ageing Futures Institute and UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Older Aboriginal Australians' Health Concerns and Preferences for Healthy Ageing Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207390. [PMID: 33050541 PMCID: PMC7600369 DOI: 10.3390/ijerph17207390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians’ perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants’ health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.
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Welch S, McMillan F, Moles R. Hospital pharmacy services supporting Aboriginal or Torres Strait Islander peoples in Australia: a systematic review. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Susan Welch
- Senior Pharmacist St. Vincent's Hospital Sydney Australia
- Clinical Associate Lecturer Sydney Pharmacy School The Faculty of Medicine and Health University of Sydney CamperdownSydney Australia
| | - Faye McMillan
- School of Nursing, Midwifery and Indigenous Health Charles Sturt University Wagga Wagga Australia
| | - Rebekah Moles
- Sydney Pharmacy School The Faculty of Medicine and Health University of Sydney Camperdown Sydney Australia
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12
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Gall A, Anderson K, Diaz A, Matthews V, Adams J, Taylor T, Garvey G. Exploring traditional and complementary medicine use by Indigenous Australian women undergoing gynaecological cancer investigations. Complement Ther Clin Pract 2019; 36:88-93. [PMID: 31383451 DOI: 10.1016/j.ctcp.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Indigenous Australian women experience worse gynaecological cancer outcomes than non-Indigenous women. While traditional and complementary medicine (T&CM) is increasingly used by cancer patients alongside conventional treatments, little is known about T&CM use by Indigenous women. This study aimed to explore the beliefs, attitudes and experiences related to T&CM use and disclosure among Indigenous women undergoing gynaecological cancer investigations. METHODS A mixed-methods design explored T&CM use among Indigenous women who presented for gynaecological cancer investigation at an urban Queensland hospital (September 2016 and January 2018). RESULTS Fourteen women participated. The reported use (86%) and perceived value of T&CM was high among the participants, however, women reported major challenges in communicating with healthcare providers about T&CM, commonly associated with trust and rapport. CONCLUSIONS These findings highlight the need for strategies to facilitate culturally-appropriate doctor-patient communication around T&CM to foster trust and transparency in gynaecological cancer care for Indigenous women.
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Affiliation(s)
- A Gall
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - K Anderson
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - A Diaz
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - V Matthews
- The University of Sydney, University Centre for Rural Health, Lismore, Australia.
| | - J Adams
- University of Technology Sydney, Ultimo, Australia.
| | - T Taylor
- Endeavour College of Natural Health, Brisbane, Australia.
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
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13
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Rheault H, Coyer F, Jones L, Bonner A. Health literacy in Indigenous people with chronic disease living in remote Australia. BMC Health Serv Res 2019; 19:523. [PMID: 31349842 PMCID: PMC6659262 DOI: 10.1186/s12913-019-4335-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Health literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics. Methods Using a cross-sectional design, 200 ATSI adults with a diagnosis of chronic disease/s (cardiovascular disease, diabetes, respiratory disease and/or chronic kidney disease) were recruited from two sites with the assistance of Aboriginal Health Workers. Data were collected using the HLQ, a multidimensional 44 item instrument to assess nine domains of health literacy. Demographic and health data were also collected. Analysis of variance using backwards modelling was used to determine predictors of health literacy. Results Participants were mostly male (53.5%) and aged between 19 and 89 years. The most prevalent chronic disease was cardiovascular disease (74%) followed by diabetes (67.5%). More than half (62%) had two or more chronic diseases. There was at least one independent predicator for each of the nine health literacy domains. Age, number of chronic diseases, gender, and level of education were all highly significant predictors of health literacy. Conclusion Improved health literacy will enable individuals to take an active role in their health. Understanding the health literacy of ATSI adults is a crucial first step. Our findings can assist Australian healthcare organisations to review their health literacy responsiveness and examine ways to improve patients’ needs and health capabilities to better support people to engage in effective self-management for chronic diseases. Electronic supplementary material The online version of this article (10.1186/s12913-019-4335-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haunnah Rheault
- School of Nursing, Queensland University of Technology, Brisbane, Australia. .,Advanced Heart Failure and Transplant Unit, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology, Brisbane, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Lee Jones
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.,NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Australia
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Fejzic J, Barker M. Pharmacy practitioners' lived experiences of culture in multicultural Australia: From perceptions to skilled practice. PLoS One 2019; 14:e0217673. [PMID: 31216322 PMCID: PMC6584003 DOI: 10.1371/journal.pone.0217673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of 'culture' in their everyday practice environment. METHODS Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: "We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person's culture or it made you more aware of your own culture? Please briefly describe the incident." Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison. RESULTS AND SIGNIFICANCE The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards 'other' cultures, (vi) Perceived 'sameness' of different cultures. The study has provided valuable insights into community pharmacists' experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner.
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Affiliation(s)
- Jasmina Fejzic
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Michelle Barker
- Griffith Business School, Department of Business Strategy and Innovation, Griffith University, Gold Coast, QLD, Australia
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Aron Y, Rounsefell K, Browne J, Walker R, Helson C, Atkinson P, MacDonald C, Palermo C. Victorian local government priority for Aboriginal health and wellbeing: a mixed-methods study. Aust J Prim Health 2019; 25:457-463. [PMID: 31138398 DOI: 10.1071/py18149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/01/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study is to identify if Victorian local governments prioritise Aboriginal health and wellbeing issues through policy and explore the key factors influencing policy and program development and implementation. A sequential explanatory mixed-methods study design utilised a survey to quantify commitment to Aboriginal health policy followed by in-depth interviews that explored how and why policy or programs were in place. Data were analysed separately and then interpreted together. Representatives from 39 of Victoria's 79 local governments (49%) responded to the survey and 14 were interviewed. Seventy-four per cent had policy and programs addressing Aboriginal health and wellbeing. The key factors influencing policy and program development were: (i) the process of policy and program development and implementation and the role of other policies; (ii) the influence of Aboriginal community characteristics; and (iii) advocacy for Aboriginal health and wellbeing. Underpinning these factors was that local government is 'working together (in partnership and through collaboration) towards reconciliation'. Victorian local governments that participated in this study appear to prioritise Aboriginal health and wellbeing, especially where collaboration with the Aboriginal community is strong. The effect of policies and their subsequent programs on the health of Aboriginal peoples warrants further exploration.
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Affiliation(s)
- Yudit Aron
- Monash University, Department of Nutrition, Dietetics and Food, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Kim Rounsefell
- Monash University, Department of Nutrition, Dietetics and Food, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Jennifer Browne
- Victorian Aboriginal Community Controlled Health Organisation, 17-23 Sackville Street, Collingwood, Vic. 3066, Australia
| | - Ruth Walker
- Monash University, Department of Nutrition, Dietetics and Food, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Catherine Helson
- Monash University, Department of Nutrition, Dietetics and Food, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Petah Atkinson
- Victorian Aboriginal Community Controlled Health Organisation, 17-23 Sackville Street, Collingwood, Vic. 3066, Australia
| | - Catherine MacDonald
- Victorian Aboriginal Community Controlled Health Organisation, 17-23 Sackville Street, Collingwood, Vic. 3066, Australia
| | - Claire Palermo
- Monash University, Department of Nutrition, Dietetics and Food, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
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Dunbar T, Bourke L, Murakami-Gold L. More than just numbers! Perceptions of remote area nurse staffing in Northern Territory Government health clinics. Aust J Rural Health 2019; 27:245-250. [PMID: 31062896 DOI: 10.1111/ajr.12513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. DESIGN This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. SETTING Seven diverse remote Aboriginal communities in the Northern Territory with government-run health clinics were visited. PARTICIPANTS Non-random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. RESULTS Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. CONCLUSIONS Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment.
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Affiliation(s)
- Terry Dunbar
- Indigenous Social and Wellbeing Centre, School of Population Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lisa Bourke
- University Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Lorna Murakami-Gold
- Poche Centre for Indigenous Health and Well-Being, Flinders Northern Territory, Alice Springs, NT, Australia
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Liaw S, Wade V, Furler JS, Hasan I, Lau P, Kelaher M, Xuan W, Harris MF. Cultural respect in general practice: a cluster randomised controlled trial. Med J Aust 2019; 210:263-268. [DOI: 10.5694/mja2.50031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Siaw‐Teng Liaw
- UNSW Sydney Sydney NSW
- Centre for Primary Health Care and EquityUNSW Sydney Sydney NSW
| | - Vicki Wade
- Menzies School of Health Research Darwin NT
| | | | - Iqbal Hasan
- Centre for Primary Health Care and EquityUNSW Sydney Sydney NSW
| | | | | | - Wei Xuan
- Ingham Institute of Applied Medical Research Sydney NSW
| | - Mark F Harris
- UNSW Sydney Sydney NSW
- Centre for Primary Health Care and EquityUNSW Sydney Sydney NSW
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Holdsworth S, Corscadden L, Levesque J, Russell G. Factors associated with successful chronic disease treatment plans for older Australians: Implications for rural and Indigenous Australians. Aust J Rural Health 2019; 27:290-297. [DOI: 10.1111/ajr.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 01/07/2023] Open
Affiliation(s)
- Stuart Holdsworth
- Faculty of Medicine James Cook UniversityTownsville Queensland Australia
- Bureau of Health Information ChatswoodNew South WalesAustralia
- Centre for Primary Health Care and Equity University of New South Wales Sydney New South WalesAustralia
| | - Lisa Corscadden
- Bureau of Health Information ChatswoodNew South WalesAustralia
- Australian Institute of Tropical Health and Medicine James Cook University Townsville QueenslandAustralia
| | - Jean‐Frederic Levesque
- Bureau of Health Information ChatswoodNew South WalesAustralia
- Agency for Clinical Innovation ChatswoodNew South WalesAustralia
- Centre for Primary Health Care and Equity University of New South Wales Sydney New South WalesAustralia
| | - Grant Russell
- Department of General Practice Monash University Melbourne Victoria Australia
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Julien N, Lacasse A, Labra O, Asselin H. Review of chronic non-cancer pain research among Aboriginal people in Canada. Int J Qual Health Care 2018; 30:178-185. [PMID: 29346613 DOI: 10.1093/intqhc/mzx195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose Aboriginal people in Canada are disproportionately affected by chronic illnesses, compared to non-Aboriginal Canadians. The purpose of this review was to determine whether differences exist between the two groups with respect to chronic non-cancer pain (CNCP) in order to better inform clinical practice and to identify research gaps. Data sources Four electronic databases were searched for the period of 1990-2015. Study selection Only English and French language original studies that examined CNCP prevalence, assessment tools and beliefs among Aboriginal people in Canada were considered. Data extraction Data extracted included Aboriginal group, geographic location, study setting and pain definition (for prevalence studies only). Results of data synthesis A total of 11 studies matched the selection criteria: 10 reported estimates of chronic pain prevalence among Aboriginal people in Canada, 1 was about a culturally adapted pain assessment tool, and no study was found about CNCP beliefs within Aboriginal people. Conclusion CNCP among Aboriginal people is still a largely unexplored research field. The limited evidence available so far does not allow us to conclude that CNCP affects a higher proportion of Aboriginal than non-Aboriginal people in Canada. However, arthritis, a specific condition associated with chronic pain, is more prevalent in Aboriginal than non-Aboriginal people. Additional research is needed on other CNCP types and conditions. Furthermore, pain assessment tools are not culturally adapted and clinicians should inquire more about the beliefs of Aboriginal patients to make them feel safer and to better target interventions.
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Affiliation(s)
- Nancy Julien
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, 445, boulevard de l'Université, Rouyn-Noranda, Quebec, Canada J9X 5E4
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, 445, boulevard de l'Université, Rouyn-Noranda, Quebec, Canada J9X 5E4
| | - Oscar Labra
- Département des sciences du développement humain et social, Université du Québec en Abitibi-Témiscamingue, 445, boulevard de l'Université, Rouyn-Noranda, Quebec, Canada J9X 5E4
| | - Hugo Asselin
- École d'études autochtones, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada J9X 5E4.,Chaire de recherche du Canada en foresterie autochtone, Université du Québec en Abitibi-Témiscamingue, 445, boulevard de l'Université, Rouyn-Noranda, Quebec, Canada J9X 5E4
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20
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Angell B, Laba T, Lukaszyk C, Coombes J, Eades S, Keay L, Ivers R, Jan S. Participant preferences for an Aboriginal-specific fall prevention program: Measuring the value of culturally-appropriate care. PLoS One 2018; 13:e0203264. [PMID: 30169525 PMCID: PMC6118364 DOI: 10.1371/journal.pone.0203264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 08/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Culturally-specific services are central to efforts to improve the health of Aboriginal Australians. Few empirical studies have demonstrated the value of such services relative to mainstream alternatives. OBJECTIVE To assess the preferences and willingness to pay (WTP) of participants for attending a class and the relative importance of transport, cost and cultural-appropriateness in the choices made by participants. DESIGN A discrete choice experiment (DCE) was conducted alongside a study of a culturally-specific fall-prevention service. Attributes that were assessed were out-of-pocket costs, whether transport was provided and whether the class was Aboriginal-specific. Choices of participants were modelled using panel-mixed logit methods. RESULTS 60 patients completed the DCE. Attending a service was strongly preferred over no service (selected 99% of the time). Assuming equivalent efficacy of fall-prevention programs, participants indicated a preference for services that were culturally-specific (OR 1.25 95% CI: 1.00-1.55) and incurred lower out-of-pocket participant costs (OR 1.19 95% CI 1.11-1.27). The provision of transport did not have a statistically significant influence on service choice (p = 0.57). DISCUSSION AND CONCLUSIONS This represents the first published DCE in the health field examining preferences amongst an Aboriginal population. The results empirically demonstrate the value of the culturally-specific element of a program has to this cohort and the potential that stated-preference methods can have in incorporating the preferences of Aboriginal Australians and valuing cultural components of health services. NOTE ON TERMINOLOGY As the majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (97.2%), this population will be referred to as 'Aboriginal' in this manuscript.
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Affiliation(s)
- Blake Angell
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The Poche Centre for Indigenous Health, Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Tracey Laba
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The University of Sydney, Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Caroline Lukaszyk
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Julieann Coombes
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Lisa Keay
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Pitama SG, Palmer SC, Huria T, Lacey C, Wilkinson T. Implementation and impact of indigenous health curricula: a systematic review. MEDICAL EDUCATION 2018; 52:898-909. [PMID: 29932221 DOI: 10.1111/medu.13613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/13/2017] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT The effectiveness of cultural competency education in improving health practitioner proficiency and addressing health inequities for minoritised patient groups is uncertain. Identification of institutional factors that shape or constrain development of indigenous health curricula may provide insights into the impact of these factors on the broader cultural competency curricula. METHODS We undertook a systematic review using actor-network theory to inform our interpretive synthesis of studies that reported indigenous health curricula evaluated within medical, nursing and allied health education. We searched the MEDLINE, OVID Nursing, Educational Resources Information Center (ERIC), PsycINFO, EMBASE, Web of Science and PubMed databases to December 2017 using exploded MeSH terms 'indigenous' and 'medical education' and 'educational professional' and 'health professional education'. We included studies involving undergraduate or postgraduate medical, nursing or allied health students or practitioners. Studies were eligible if they documented indigenous health learning outcomes, pedagogical practices and student evaluations. RESULTS Twenty-three studies were eligible for the review. In an interpretive synthesis informed by actor-network theory, three themes emerged from the data: indigenous health as an emerging curriculum (drivers of institutional change, increasing indigenous capacity and leadership, and addressing deficit discourse); institutional resource allocation to indigenous health curricula (placement within the core curriculum, time allocation, and resources constraining pedagogy), and impact of the curriculum on learners (acceptability of the curriculum, learner knowledge, and learner behaviour). CONCLUSIONS Systemic barriers acting on and within educational networks have limited the developmental capacity of indigenous health curricula, supported and sustained hidden curricula, and led to insufficient institutional investment to support a comprehensive curriculum. Future research in health professional education should explore these political and network intermediaries acting on cultural competence curricula and how they can be overcome to achieve cultural competency learning outcomes.
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Affiliation(s)
- Suzanne G Pitama
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tania Huria
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Tim Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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22
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Goldberg LR, Cox T, Hoang H, Baldock D. Addressing dementia with Indigenous peoples: a contributing initiative from the Circular Head Aboriginal community. Aust N Z J Public Health 2018; 42:424-426. [DOI: 10.1111/1753-6405.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Ha Hoang
- Centre for Rural HealthUniversity of Tasmania
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Battersby M, Lawn S, Kowanko I, Bertossa S, Trowbridge C, Liddicoat R. Chronic condition self-management support for Aboriginal people: Adapting tools and training. Aust J Rural Health 2018; 26:232-237. [PMID: 29682843 DOI: 10.1111/ajr.12413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Chronic conditions are major health problems for Australian Aboriginal people. Self-management programs can improve health outcomes. However, few health workers are skilled in self-management support and existing programs are not always appropriate in Australian Aboriginal contexts. DESIGN The goal was to increase the capacity of the Australian health workforce to support Australian Aboriginal people to self-manage their chronic conditions by adapting the Flinders Program of chronic condition self-management support for Australian Aboriginal clients and develop and deliver training for health professionals to implement the program. STRATEGIES FOR CHANGE Feedback from health professionals highlighted that the Flinders Program assessment and care planning tools needed to be adapted to suit Australian Aboriginal contexts. Through consultation with Australian Aboriginal Elders and other experts, the tools were condensed into an illustrated booklet called 'My Health Story'. Associated training courses and resources focusing on cultural safety and effective engagement were developed. EFFECTS OF CHANGE A total of 825 health professionals across Australia was trained and 61 people qualified as accredited trainers in the program, ensuring sustainability. LESSONS LEARNT The capacity and skills of the Australian health workforce to engage with and support Australian Aboriginal people to self-manage their chronic health problems significantly increased as a result of this project. The adapted tools and training were popular and appreciated by the health care organisations, health professionals and clients involved. The adapted tools have widespread appeal for cultures that do not have Western models of health care and where there are health literacy challenges. My Health Story has already been used internationally.
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Affiliation(s)
- Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Inge Kowanko
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Sue Bertossa
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Coral Trowbridge
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Raylene Liddicoat
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
- Maryborough District Health Service, Maryborough, Victoria, Australia
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Nugus P, Désalliers J, Morales J, Graves L, Evans A, Macaulay AC. Localizing Global Medicine: Challenges and Opportunities in Cervical Screening in an Indigenous Community in Ecuador. QUALITATIVE HEALTH RESEARCH 2018; 28:800-812. [PMID: 29571278 DOI: 10.1177/1049732317742129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This participatory research study examines the tensions and opportunities in accessing allopathic medicine, or biomedicine, in the context of a cervical cancer screening program in a rural indigenous community of Northern Ecuador. Focusing on the influence of social networks, the article extends research on "re-appropriation" of biomedicine. It does so by recognizing two competing tensions expressed through social interactions: suspicion of allopathic medicine and the desire to maximize one's health. Semistructured individual interviews and focus groups were conducted with 28 women who had previously participated in a government-sponsored cervical screening program. From inductive thematic analysis, the article traces these women's active agency in navigating coherent paths of health. Despite drawing on social networks to overcome formidable challenges, the participants faced enduring system obstacles-the organizational effects of the networks of allopathic medicine. Such obstacles need to be understood to reconcile competing knowledge systems and improve health care access in underresourced communities.
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Affiliation(s)
- Peter Nugus
- 1 McGill University, Montreal, Québec, Canada
| | | | | | - Lisa Graves
- 4 Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Andrea Evans
- 5 University of Toronto, Toronto, Ontario, Canada
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Worrall-Carter L, Daws K, Rahman MA, MacLean S, Rowley K, Andrews S, MacIsaac A, Lau PM, McEvedy S, Willis J, Arabena K. Exploring Aboriginal patients' experiences of cardiac care at a major metropolitan hospital in Melbourne. AUST HEALTH REV 2018; 40:696-704. [PMID: 26954753 DOI: 10.1071/ah15175] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/08/2016] [Indexed: 01/03/2023]
Abstract
Objectives The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne. Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data. Results Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences. Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community. What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system. What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care. What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.
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Affiliation(s)
| | - Karen Daws
- St. Vincent's Hospital Melbourne, Fitzroy, Vic. 3065, Australia.
| | - Muhammad Aziz Rahman
- St. Vincent's Centre for Nursing Research, Australian Catholic University, East Melbourne, Vic. 3002, Australia. Email
| | - Sarah MacLean
- Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia.
| | - Kevin Rowley
- Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia.
| | - Shawana Andrews
- School of Health Sciences, The University of Melbourne, Carlton South, Vic. 3053, Australia
| | - Andrew MacIsaac
- The Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Vic. 3002, Australia
| | - Phyllis M Lau
- Department of General Practice, The University of Melbourne, Carlton, Vic. 3053, Australia. Email
| | - Samantha McEvedy
- St. Vincent's Centre for Nursing Research, Australian Catholic University, East Melbourne, Vic. 3002, Australia. Email
| | - John Willis
- St. Vincent's Hospital Melbourne, Fitzroy, Vic. 3065, Australia.
| | - Kerry Arabena
- Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia.
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Davy C, Kite E, Sivak L, Brown A, Ahmat T, Brahim G, Dowling A, Jacobson S, Kelly T, Kemp K, Mitchell F, Newman T, O'Brien M, Pitt J, Roesch K, Saddler C, Stewart M, Thomas T. Towards the development of a wellbeing model for aboriginal and Torres Strait islander peoples living with chronic disease. BMC Health Serv Res 2017; 17:659. [PMID: 28915842 PMCID: PMC5602951 DOI: 10.1186/s12913-017-2584-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/30/2017] [Indexed: 11/22/2022] Open
Abstract
Background Re-defining the way in which care is delivered, to reflect Aboriginal and Torres Strait Islander peoples’ needs and values, is essential for improving the accessibility of primary healthcare. This study focused on developing a Framework to support the quality of care and quality of life of, as well as treatment for, Aboriginal and Torres Strait Islander peoples living with chronic disease. Methods A team of researchers, including thirteen experienced Aboriginal healthcare professionals, came together to undertake this important work. Using a Participatory Action Approach, this study actively engaged people with local knowledge to ensure that the Framework was developed by and for Aboriginal people. Results The final Wellbeing Framework consists of two core values and four elements, each supported by four principles. Importantly, the Framework also includes practical examples of how the principles could be applied. National Reference Group members, including community representatives, policy makers and healthcare providers, reviewed and approved the final Framework. Conclusion The outcome of this collaborative effort is a Framework to guide primary healthcare services to develop locally relevant, flexible approaches to care which can respond to communities’ and individuals’ varied understandings of wellbeing.
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Affiliation(s)
- Carol Davy
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Elaine Kite
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Leda Sivak
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Timena Ahmat
- Wuchopperen Health Service, 22C Evans St, Atherton, QLD, 4883, Australia
| | - Gary Brahim
- Wirraka Maya Health Service Aboriginal Corporation, 17 Hamilton Road, South Hedland, WA, 6722, Australia
| | - Anna Dowling
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Shaun Jacobson
- Nunkuwarrin Yunti Inc, 182-190 Wakefield Street, Adelaide, South Australia, 5000, Australia
| | - Tania Kelly
- Wirraka Maya Health Service Aboriginal Corporation, 17 Hamilton Road, South Hedland, WA, 6722, Australia
| | - Kaylene Kemp
- Maari Ma Health Aboriginal Corporation, 428 Argent St, Broken Hill, NSW, 2880, Australia
| | - Fiona Mitchell
- Maari Ma Health Aboriginal Corporation, 428 Argent St, Broken Hill, NSW, 2880, Australia
| | - Tina Newman
- Tharawal Aboriginal Corporation, 187 Riverside Dr, Airds, NSW, 2560, Australia
| | - Margaret O'Brien
- Danila Dilba Health Service, 1/26 Knuckey St, Darwin, Northern Territory, 0800, Australia
| | - Jason Pitt
- Tharawal Aboriginal Corporation, 187 Riverside Dr, Airds, NSW, 2560, Australia
| | - Kesha Roesch
- Nunkuwarrin Yunti Inc, 182-190 Wakefield Street, Adelaide, South Australia, 5000, Australia
| | - Christine Saddler
- Winnunga Nimmityjah Aboriginal Health Service, 63 Boolimba Cres, Narrabundah, ACT, 2604, Australia
| | - Maida Stewart
- Danila Dilba Health Service, 1/26 Knuckey St, Darwin, Northern Territory, 0800, Australia
| | - Tiana Thomas
- Wuchopperen Health Service, 22C Evans St, Atherton, QLD, 4883, Australia
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Quinn E, O’Hara BJ, Ahmed N, Winch S, McGill B, Banovic D, Maxwell M, Rissel C. Enhancing the get healthy information and coaching service for Aboriginal adults: evaluation of the process and impact of the program. Int J Equity Health 2017; 16:168. [PMID: 28877697 PMCID: PMC5586001 DOI: 10.1186/s12939-017-0641-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable chronic diseases in Australia contribute to approximately 85% of the total burden of disease; this proportion is greater for Aboriginal communities. The Get Healthy Service (GHS) is effective at reducing lifestyle-based chronic disease risk factors among adults and was enhanced to facilitate accessibility and ensure Aboriginal cultural appropriateness. The purpose of this study is to detail how formative research with Aboriginal communities was applied to guide the development and refinement of the GHS and referral pathways; and to assess the reach and impact of the GHS (and the Aboriginal specific program) on the lifestyle risk factors of Aboriginal participants. METHODS Formative research included interviews with Aboriginal participants, leaders and community members, healthcare professionals and service providers to examine acceptability of the GHS; and contributed to the redesign of the GHS Aboriginal program. A quantitative analysis employing a pre-post evaluation design examined anthropometric measures, physical activity and fruit and vegetable consumption of Aboriginal participants using descriptive and chi square analyses, t-tests and Wilcoxon signed-rank tests. RESULTS Whilst feedback from the formative research was positive, Aboriginal people identified areas for service enhancement, including improving program content, delivery and service promotion as well as ensuring culturally appropriate referral pathways. Once these changes were implemented, the proportion of Aboriginal participants increased significantly (3.2 to 6.4%). There were significant improvements across a number of risk factors assessed after six months (average weight loss: 3.3 kg and waist circumference reduction: 6.2 cm) for Aboriginal participants completing the program. CONCLUSIONS Working in partnership with Aboriginal people, Elders, communities and peak bodies to enhance the GHS for Aboriginal people resulted in an enhanced culturally acceptable and tailored program which significantly reduced chronic disease risk factors for Aboriginal participants. Mainstream telephone based services can be modified and enhanced to meet the needs of Aboriginal communities through a process of consultation, community engagement, partnership and governance.
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Affiliation(s)
- E. Quinn
- Public Health Unit, Sydney Local Health District, Level 9, King George Building, RPAH, Missenden Road, Camperdown, 2050 Australia
| | - B. J. O’Hara
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Level 6, The Hub, Charles Perkins Centre D17, 2006 Camperdown, Australia
| | - N. Ahmed
- NSW Office of Preventive Health, NSW Ministry of Health, Liverpool Hospital, Level 1, Don Everett Building, West End, Elizabeth Street, Liverpool, NSW 2170 Australia
| | - S. Winch
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW 2540 Australia
| | - B. McGill
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Level 6, The Hub, Charles Perkins Centre D17, 2006 Camperdown, Australia
| | - D. Banovic
- Planning Unit, Sydney Local Health District, KGV Missenden Road, Camperdown, NSW 2050 Australia
| | - M. Maxwell
- Centre for Population Health, NSW Ministry of Health, 73 Miller Street, North Sydney, 2060 Australia
| | - C. Rissel
- NSW Office of Preventive Health, NSW Ministry of Health and Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, Australia
- NSW Office of Preventive Health, Liverpool Hospital, Level 1, Don Everett Building, West End, Elizabeth Street, Liverpool, NSW 2170 Australia
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Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Soc Sci Med 2017; 187:164-173. [PMID: 28689090 DOI: 10.1016/j.socscimed.2017.06.046] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 06/21/2017] [Accepted: 06/30/2017] [Indexed: 01/15/2023]
Abstract
RATIONALE There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. OBJECTIVE The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. METHOD The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. RESULTS Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. CONCLUSION It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings.
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McKillop A, Shaw J, Sheridan N, Gray CS, Carswell P, Wodchis WP, Connolly M, Denis JL, Baker GR, Kenealy T. Understanding the Attributes of Implementation Frameworks to Guide the Implementation of a Model of Community-based Integrated Health Care for Older Adults with Complex Chronic Conditions: A Metanarrative Review. Int J Integr Care 2017; 17:10. [PMID: 28970751 PMCID: PMC5624227 DOI: 10.5334/ijic.2516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive. However, in the implementation of integrated community-based and integrated health care, it is still not well known which approaches work best. METHODS We conducted a systematic review and metanarrative synthesis of literature on implementation frameworks, theories and models in support of a research programme investigating CBPHC for older adults with chronic health problems. RESULTS Thirty-five reviews met our inclusion criteria and were appraised, summarised, and synthesised. Five metanarratives emerged 1) theoretical constructs; 2) multiple influencing factors; 3) development of new frameworks; 4) application of existing frameworks; and 5) effectiveness of interventions within frameworks/models. Four themes were generated that exposed the contradictions and synergies among the metanarratives. Person-centred care is fundamental to integrated CBPHC at all levels in the health care delivery system, yet many implementation theories and frameworks neglect this cornerstone. DISCUSSION The research identified perspectives central to integrated CBPHC that were missing in the literature. Context played a key role in determining success and in how consumers and their families, providers, organisations and policy-makers stay connected to implementing the best care possible. CONCLUSIONS All phases of implementation of a new model of CBPHC call for collaborative partnerships with all stakeholders, the most important being the person receiving care in terms of what matters most to them.
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Iyngkaran P, Toukhsati SR, Harris M, Connors C, Kangaharan N, Ilton M, Nagel T, Moser DK, Battersby M. Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice. Curr Cardiol Rev 2016; 12:270-284. [PMID: 27397492 PMCID: PMC5304248 DOI: 10.2174/1573403x12666160703183001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/23/2022] Open
Abstract
Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
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Moynihan V, Turner A. Coordination of diabetic retinopathy screening in the Kimberley region of Western Australia. Aust J Rural Health 2016; 25:110-115. [DOI: 10.1111/ajr.12290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Verity Moynihan
- Centre for Ophthalmology & Visual Sciences (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Angus Turner
- Centre for Ophthalmology & Visual Sciences (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
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Ramjan L, Hunt L, Salamonson Y. Predictors of negative attitudes toward Indigenous Australians and a unit of study among undergraduate nursing students: A mixed-methods study. Nurse Educ Pract 2016; 17:200-7. [DOI: 10.1016/j.nepr.2015.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/01/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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Smylie J, Kirst M, McShane K, Firestone M, Wolfe S, O'Campo P. Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review. Soc Sci Med 2016; 150:128-43. [DOI: 10.1016/j.socscimed.2015.12.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 12/08/2015] [Accepted: 12/13/2015] [Indexed: 11/29/2022]
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Nelson A, Mills K, Dargan S, Roder C. “I Am Getting Healthier”. Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program. Health (London) 2016. [DOI: 10.4236/health.2016.86057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Freeman T, Edwards T, Baum F, Lawless A, Jolley G, Javanparast S, Francis T. Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Aust N Z J Public Health 2015; 38:355-61. [PMID: 25091076 DOI: 10.1111/1753-6405.12231] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/01/2013] [Accepted: 02/01/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE There is little literature on health-service-level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies, which involved one Aboriginal community controlled health care service and one state government-managed primary health care service, to examine cultural respect strategies, client experiences and barriers to cultural respect. METHODS Data were drawn from 22 interviews with staff from both services and four community assessment workshops, with a total of 21 clients. RESULTS Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included: being grounded in a social view of health, including advocacy and addressing social determinants; employing Aboriginal staff; creating a welcoming service; supporting access through transport, outreach, and walk-in centres; and integrating cultural protocol. Barriers included: communication difficulties; racism and discrimination; and externally developed programs. CONCLUSIONS Service-level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing. IMPLICATIONS Primary health care's social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system.
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Affiliation(s)
- Toby Freeman
- Southgate Institute for Health, Society, and Equity, Flinders University, South Australia
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Blatchford L, Morey P, McConigley R. Identifying type 2 diabetes risk classification systems and recommendations for review of podiatric care in an Australian Aboriginal health clinic. J Foot Ankle Res 2015; 8:34. [PMID: 26229555 PMCID: PMC4520286 DOI: 10.1186/s13047-015-0089-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/15/2015] [Indexed: 11/26/2022] Open
Abstract
Background There are several risk classification systems developed to facilitate diabetic foot assessments and prioritise diabetes patients for foot prevention services according to risk factors. Utilisation of both The University of Texas Diabetic Foot Risk Classification System (UTDFRCS) and The National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes), allows guidance for the podiatrist in terms of review timeframes for future assessments and treatment. The aim of this clinical audit was to classify Aboriginal type 2 diabetes subjects’ risk status according to UTDFRCS and identify if evidence based standards are being met for podiatry services at the Albury-Wodonga Aboriginal Health Service in New South Wales, Australia. Methods A retrospective clinical audit over a twenty six month period was undertaken at the Albury-Wodonga Aboriginal Health Service, New South Wales. This is a primary health care facility that started podiatry services in August 2011. The primary variables of interest were the UTDFRCS for each subject and whether those participants met or did not meet the National Evidence-Based Guideline for review appointment timeframes. Other variables of interest include age, gender, duration of diabetes, occasions of visits and cancelled and failure to attend appointments to the podiatry service over the data collection period. Results There was excellent overall adherence (94 %) of this sample population (n = 729) to the National Evidence-Based Guideline for podiatric review timeframes according to their risk status. Males were reported to be less likely to comply with the review timeframes compared to women. There was no association between risk status and age (OR = 1.04, p = 0.11), duration of diabetes (OR = 1.03, p = 0.71) or gender (OR = 0.77, p = 0.67). Conclusions Regular foot examinations aid in stratifying patients according to risk status, guiding podiatry interventions to reduce the likelihood of ulceration and amputation. This primary health care setting has achieved podiatric evidence based standards for Aboriginal people with type 2 diabetes, demonstrated by acceptable timeframes for review appointments.
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Affiliation(s)
- Lauren Blatchford
- Albury-Wodonga Aboriginal Health Service, 644 Daniel St, Glenroy, NSW 2640 Australia
| | - Pam Morey
- WoundsWest, Curtin University, GPO U 1987, Perth, WA 6845 Australia
| | - Ruth McConigley
- School of Nursing and Midwifery, Curtin University, GPO U 1987, Perth, WA 6845 Australia
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Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.
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Jobling K, Lau P, Kerr D, Higgins RO, Worcester MU, Angus L, Jackson AC, Murphy BM. Bundap Marram Durn Durn: Engagement with Aboriginal women experiencing comorbid chronic physical and mental health conditions. Aust N Z J Public Health 2015; 40 Suppl 1:S30-5. [PMID: 26122180 DOI: 10.1111/1753-6405.12382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/01/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore antecedents of health service engagement and experience among urban Aboriginal people with comorbid physical and mental health conditions. METHODS Focus groups and interviews were conducted with Aboriginal people who had comorbid health conditions and were accessing Aboriginal and/or mainstream services. RESULTS Nineteen participants, all women, were recruited. Participants' personal histories and prior experience of health services affected effective service utilisation. Participants' service experiences were characterised by long waiting times in the public health system and high healthcare staff turnover. Trusted professionals were able to act as brokers to other clinically and culturally competent practitioners. CONCLUSIONS Many urban Aboriginal women attended health services with multiple comorbid conditions including chronic disease and mental health issues. Several barriers and enablers were identified concerning the capacity of services to engage and effectively manage Aboriginal patients' conditions. IMPLICATIONS Results indicate the need to explore strategies to improve health care utilisation by urban Aboriginal women.
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Affiliation(s)
- Karmen Jobling
- Heart Research Centre, Victoria.,Wurundjeri Tribe Land and Compensation Cultural Heritage Council, Victoria
| | - Phyllis Lau
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Victoria
| | - Diane Kerr
- Wurundjeri Tribe Land and Compensation Cultural Heritage Council, Victoria
| | | | - Marian U Worcester
- Heart Research Centre, Victoria.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria
| | - Lynnell Angus
- Heart Research Centre, Victoria.,Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Alun C Jackson
- Heart Research Centre, Victoria.,Centre on Behavioural Health, University of Hong Kong
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Thomson A, Morgan S, O'Mara P, Tapley A, Henderson K, van Driel M, Oldmeadow C, Ball J, Scott J, Spike N, McArthur L, Magin P. The recording of Aboriginal and Torres Strait Islander status in general practice clinical records: a cross-sectional study. Aust N Z J Public Health 2015; 40 Suppl 1:S70-4. [PMID: 26123403 DOI: 10.1111/1753-6405.12400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/01/2014] [Accepted: 02/01/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To document the frequency of recording of Aboriginal and Torres Strait Islander status in general practice (GP) clinical records and to establish associations of this recording. METHODS Cross-sectional analysis of recording of patients' Aboriginal and Torres Strait Islander status in GP clinical records from GP training practices in four Australian states. RESULTS Of the 9,704 clinical records examined, the patients' Aboriginal and Torres Strait Islander status had been documented in 5,165 (53.2%). Higher rates of recording were associated with older patient age, practices outside a major city, patients who were not new to the practice and the patient being Aboriginal and Torres Strait Islander. In encounters with Aboriginal and Torres Strait Islander patients, the patient's status had been documented in 82% of records. Those attending larger practices were less likely to have had their status recorded. CONCLUSIONS This is the first report of Aboriginal and Torres Strait Islander status recording in GP clinical records. Almost 20% of Aboriginal and Torres Strait Islander patients did not have their status recorded in the clinical record, with indications that recording may be unsystematic. IMPLICATIONS Our findings reinforce the need for a systematic approach to identification of Aboriginal and Torres Strait Islander status in general practice and will inform policy and practice in this important area.
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Affiliation(s)
- Allison Thomson
- Discipline of General Practice, University of Newcastle, New South Wales
| | - Simon Morgan
- General Practice Training Valley to Coast, New South Wales
| | - Peter O'Mara
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Wollotuka Institute, University of Newcastle, New South Wales
| | - Amanda Tapley
- General Practice Training Valley to Coast, New South Wales
| | - Kim Henderson
- General Practice Training Valley to Coast, New South Wales
| | | | - Christopher Oldmeadow
- Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, New South Wales
| | - Jean Ball
- Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, New South Wales
| | - John Scott
- General Practice Training Valley to Coast, New South Wales
| | - Neil Spike
- Department of General Practice, University of Melbourne, Victoria.,Victorian Metropolitan Alliance
| | | | - Parker Magin
- Discipline of General Practice, University of Newcastle, New South Wales.,General Practice Training Valley to Coast, New South Wales
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Stuhlmiller CM, Tolchard B. Developing a student-led health and wellbeing clinic in an underserved community: collaborative learning, health outcomes and cost savings. BMC Nurs 2015; 14:32. [PMID: 26085815 PMCID: PMC4470340 DOI: 10.1186/s12912-015-0083-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. METHODS Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. RESULTS Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. CONCLUSIONS The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.
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Affiliation(s)
| | - Barry Tolchard
- School of Health, University of New England, Armidale, NSW 2351 Australia
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Colles SL, Belton S, Brimblecombe J. Insights into nutritionists' practices and experiences in remote Australian Aboriginal communities. Aust N Z J Public Health 2015; 40 Suppl 1:S7-13. [PMID: 25903118 DOI: 10.1111/1753-6405.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/01/2014] [Accepted: 11/01/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore and describe methods of communication, education practices, perceived challenges and the potential role of nutritionists working in remote Australian Aboriginal communities in order to inform future public health efforts. METHODS Nutritionists who work or have worked in remote Aboriginal communities in Australia's Northern Territory within the past decade were identified via purposive and snowball sampling, and responded to a semi-structured survey in 2012. Content and interpretive thematic analysis was used to generate themes. RESULTS Working approaches of 33 nutritionists are presented, representing 110 years of working experience in the Northern Territory. Emerging themes included: 'Community consultation is challenging', 'Partnering with local people is vital', 'Information is not behaviour', 'Localisation of nutrition education is important' and 'Evaluation is tricky'. Available time, training background and workforce structure were said to constrain practice and those nutritionists with longer experience described a more culturally competent practice. CONCLUSIONS Modifications in structure, training and support of the public health nutrition workforce, facilitation of professional and cultural partnerships, outcome evaluation and localisation and evaluation of health messages may promote more meaningful nutrition communication in remote communities. IMPLICATIONS Findings can inform further investigation into the structures needed to improve public health skills for nutritionists transitioning from mainstream practice into the challenging cross-cultural context of Aboriginal health settings.
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Tsou C, Haynes E, Warner WD, Gray G, Thompson SC. An exploration of inter-organisational partnership assessment tools in the context of Australian Aboriginal-mainstream partnerships: a scoping review of the literature. BMC Public Health 2015; 15:416. [PMID: 25902772 PMCID: PMC4419564 DOI: 10.1186/s12889-015-1537-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
Background The need for better partnerships between Aboriginal organisations and mainstream agencies demands attention on process and relational elements of these partnerships, and improving partnership functioning through transformative or iterative evaluation procedures. This paper presents the findings of a literature review which examines the usefulness of existing partnership tools to the Australian Aboriginal-mainstream partnership (AMP) context. Methods Three sets of best practice principles for successful AMP were selected based on authors’ knowledge and experience. Items in each set of principles were separated into process and relational elements and used to guide the analysis of partnership assessment tools. The review and analysis of partnership assessment tools were conducted in three distinct but related parts. Part 1- identify and select reviews of partnership tools; part 2 – identify and select partnership self-assessment tool; part 3 – analysis of selected tools using AMP principles. Results The focus on relational and process elements in the partnership tools reviewed is consistent with the focus of Australian AMP principles by reconciliation advocates; however, historical context, lived experience, cultural context and approaches of Australian Aboriginal people represent key deficiencies in the tools reviewed. The overall assessment indicated that the New York Partnership Self-Assessment Tool and the VicHealth Partnership Analysis Tools reflect the greatest number of AMP principles followed by the Nuffield Partnership Assessment Tool. The New York PSAT has the strongest alignment with the relational elements while VicHealth and Nuffield tools showed greatest alignment with the process elements in the chosen AMP principles. Conclusions Partnership tools offer opportunities for providing evidence based support to partnership development. The multiplicity of tools in existence and the reported uniqueness of each partnership, mean the development of a generic partnership analysis for AMP may not be a viable option for future effort.
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Affiliation(s)
- Christina Tsou
- Western Australian Centre for Rural Health (WACRH), University of Western Australia; Inner East Primary Care Partnership, 6 Lakeside Drive, Burwood East, VIC, 3151, Australia.
| | - Emma Haynes
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, M706, 35 Stirling Highway, Stirling, 6009, WA, Australia.
| | - Wayne D Warner
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, 167 Fitzgerald St, Geraldton, 6530, WA, Australia.
| | - Gordon Gray
- Midwest Aboriginal Organisations Alliance (MAOA), Eastward Rd, Utakarra, WA, 6530, Australia.
| | - Sandra C Thompson
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, 167 Fitzgerald St, Geraldton, 6530, WA, Australia.
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Hunt L, Ramjan L, McDonald G, Koch J, Baird D, Salamonson Y. Nursing students' perspectives of the health and healthcare issues of Australian Indigenous people. NURSE EDUCATION TODAY 2015; 35:461-7. [PMID: 25499968 DOI: 10.1016/j.nedt.2014.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/07/2014] [Accepted: 11/20/2014] [Indexed: 05/12/2023]
Abstract
BACKGROUND Indigenous people are the most disadvantaged population within Australia with living conditions comparable to developing countries. The Bachelor of Nursing programme at the University of Western Sydney has embedded Indigenous health into the undergraduate teaching programme, with an expectation that students develop an awareness of Indigenous health and healthcare issues. AIM To gain insight into students' perceptions of Indigenous people and whether the course learning and teaching strategies implemented improved students' learning outcomes and attitude towards Indigenous people and Indigenous health in Australia. DESIGN A mixed methods prospective survey design was chosen. METHODS Students enrolled in the Indigenous health subject in 2013 were invited to complete pre- and post-subject surveys that contained closed- and open-ended questions. Students' socio-demographic data was collected at baseline, but the 'Attitude Toward Indigenous Australians' (ATIA) scale, and the 3-item Knowledge, Interest and Confidence to nursing Australian Indigenous peoples scale were administered at both pre- and post-subject surveys. RESULTS 502 students completed the baseline survey and 249 students completed the follow-up survey. There was a statistically significant attitudinal change towards Indigenous Australians, measured by the ATIA scale, and participants' knowledge, intent to work with Indigenous Australians and confidence in caring for them increased significantly at follow-up. Based on the participants' responses to open-ended questions, four key themes emerged: a) understanding Indigenous history, culture and healthcare; b) development of cultural competence; c) enhanced respect for Indigenous Australians' culture and traditional practices; and d) enhanced awareness of the inherent disadvantages for Indigenous Australians in education and healthcare. There were no statistically significant socio-demographic group differences among those who commented on key themes. CONCLUSION Addressing health inequalities for Indigenous Australians is paramount. Nurses need cultural awareness and sensitivity to deliver culturally appropriate healthcare in Australia.
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Affiliation(s)
- Leanne Hunt
- University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Lucie Ramjan
- University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Glenda McDonald
- University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Jane Koch
- University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - David Baird
- University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Yenna Salamonson
- University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Solberg HS, Steinsbekk A, Solbjør M, Granbo R, Garåsen H. Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions. BMC Health Serv Res 2014; 14:562. [PMID: 25380808 PMCID: PMC4229612 DOI: 10.1186/s12913-014-0562-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/24/2014] [Indexed: 11/17/2022] Open
Abstract
Background Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users’ and health professionals’ perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Methods Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. Results The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. Conclusions The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients’ every-day life situations. The user informants’ perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals’ competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.
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Stoneman A, Atkinson D, Davey M, Marley JV. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Serv Res 2014; 14:481. [PMID: 25288282 PMCID: PMC4282197 DOI: 10.1186/1472-6963-14-481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Methods Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. Results A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Conclusions Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.
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Affiliation(s)
- Alice Stoneman
- Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, TAS 7250, Australia.
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Sarrami-Foroushani P, Travaglia J, Debono D, Braithwaite J. Implementing strategies in consumer and community engagement in health care: results of a large-scale, scoping meta-review. BMC Health Serv Res 2014; 14:402. [PMID: 25230846 PMCID: PMC4177168 DOI: 10.1186/1472-6963-14-402] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is growing recognition of the importance of the active involvement of consumers and community members in health care. Despite the long history of consumer and community engagement (CCE) research and practice, there is no consensus on the best strategies for CCE. In this paper, we identify various dimensions of CCE-related strategies and offer a practical model to assist policy-makers, practitioners and researchers. METHODS We undertook a large-scale, scoping meta-review and searched six databases using a list of nine medical subject headings (MeSH) and a comprehensive list of 47 phrases. We identified and examined a total of 90 relevant systematic reviews. RESULTS Identified reviews show that although there is a significant body of research on CCE, the development of the field is hindered by a lack of evidence relating to specific elements of CCE. They also indicate a diverse and growing enterprise, drawing on a wide range of disciplinary, political and philosophical perspectives and a mix of definitions, targets, approaches, strategies and mechanisms. CCE interventions and strategies aim to involve consumers, community members and the public in general, as well as specific sub-groups, including children and people from culturally and linguistically diverse backgrounds. Strategies for CCE vary in terms of their aim and type of proposed activity, as do the methods and tools which have been developed to support them. Methods and tools include shared decision making, use of decision aids, consumer representation, application of electronic and internet-based facilities, and peer support. The success of CCE is dependent on both the approach taken and contextual factors, including structural facilitators such as governmental support, as well as barriers such as costs, organisational culture and population-specific limitations. CONCLUSIONS The diversity of the field indicates the need to measure each component of CCE. This meta-review provides the basis for development of a new eight stage model of consumer and community engagement. This model emphasises the importance of clarity and focus, as well as an extensive evaluation of contextual factors within specific settings, before the implementation of CCE strategies, enabling those involved in CCE to determine potential facilitators and barriers to the process.
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Affiliation(s)
- Pooria Sarrami-Foroushani
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Joanne Travaglia
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
- />School of Public Health and Community Medicine (SPHCM), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Deborah Debono
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Jeffrey Braithwaite
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
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Prowse PT, Nagel T. Developing an instrument for assessing fidelity of motivational care planning: The Aboriginal and Islander Mental health initiative adherence scale. Int J Ment Health Syst 2014; 8:36. [PMID: 25221622 PMCID: PMC4161858 DOI: 10.1186/1752-4458-8-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to design and trial an Adherence Scale to measure fidelity of Motivational Care Planning (MCP) within a clinical trial. This culturally adapted therapy MCP uses a client centered holistic approach that emphasises family and culture to motivate healthy life style changes. Methods The Motivational Care Planning-Adherence Scale (MCP-AS) was developed through consultation with Aboriginal and Islander Mental Health Initiative (AIMhi) Indigenous and non-Indigenous trainers, and review of MCP training resources. The resultant ten-item scale incorporates a 9-Point Likert Scale with a supporting protocol manual and uses objective, behaviourally anchored criteria for each scale point. A fidelity assessor piloted the tool through analysis of four audio-recordings of MCP (conducted by Indigenous researchers within a study in remote communities in Northern Australia). File audits of the remote therapy sessions were utilised as an additional source of information. A Gold Standard Motivational Care Planning training video was also assessed using the MCP-AS. Results The Motivational Care Planning-Adherence Scale contains items measuring both process and content of therapy sessions. This scale was used successfully to assess therapy through observation of audio or video-recorded sessions and review of clinical notes. Treatment fidelity measured by the MCP-AS within the pilot study indicated high fidelity ratings. Ratings were high across the three domains of rapport, motivation, and self-management with especially high ratings for positive feedback and engagement, review of stressors and goal setting. Conclusions The Motivational Care Planning-Adherence Scale has the potential to provide a measure of quality of delivery of Motivation Care Planning. The pilot findings suggest that despite challenges within the remote Indigenous community setting, Indigenous therapists delivered therapy that was of high fidelity. While developed as a research tool, the scale has the potential to support fidelity of delivery of Motivation Care Planning in clinical, supervision and training settings. Larger studies are needed to establish inter-rater reliability and internal and external validity.
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Affiliation(s)
- Phuong-Tu Prowse
- Student/ Clinical Psychologist Menzies School of Health Research Monash University: School of Psychiatry and Psychological Medicine, Wellington Rd, Clayton, VIC 3800 Australia
| | - Tricia Nagel
- Menzies School of Health Research and Charles Darwin University, PO Box 40196, Casuarina, Australia
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Kelaher MA, Ferdinand AS, Paradies Y. Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Med J Aust 2014; 201:44-7. [PMID: 24999898 DOI: 10.5694/mja13.10503] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/09/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine experiences of racism in health settings and their impact on mental health among Aboriginal Australians. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey of experiences of racism and mental health was conducted in two metropolitan and two rural Victorian local government areas (LGAs) between 1 December 2010 and 31 October 2011. Participants included 755 Aboriginal Australians aged over 18 years who had resided in the relevant LGA for at least a year. The response rate across all LGAs was 99%. MAIN OUTCOME MEASURES Being above or below the threshold for high or very high psychological distress on the Kessler Psychological Distress Scale. RESULTS 221 participants reported experiences of racism in health settings in the past 12 months. The results suggested that people experiencing racism in health settings (OR, 4.49; 95% CI, 2.28-8.86) and non-health settings (OR, 2.66; 95% CI, 1.39-5.08) were more likely than people who did not experience racism to be above the threshold for high or very high psychological distress. CONCLUSIONS Experiencing interpersonal racism in health settings is associated with increased psychological distress over and above what would be expected in other settings. This finding supports the rationale for improving cultural competency and reducing racism as a means of closing the health gap between Aboriginal and other Australians. Capitalising on this investment will require explicitly evaluating the impact of these initiatives on reducing patient experiences of racism.
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Affiliation(s)
- Margaret A Kelaher
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia.
| | | | - Yin Paradies
- Centre for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
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Ballestas T, McEvoy S, Swift-Otero V, Unsworth M. A metropolitan Aboriginal podiatry and diabetes outreach clinic to ameliorate foot-related complications in Aboriginal people. Aust N Z J Public Health 2014; 38:492-3. [PMID: 25167893 DOI: 10.1111/1753-6405.12268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Teresa Ballestas
- South Metropolitan Population Health Unit, South Metropolitan Health Service, Department of Health, Western Australia
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Rix EF, Barclay L, Stirling J, Tong A, Wilson S. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study. Hemodial Int 2014; 19:80-9. [PMID: 25056441 PMCID: PMC4309474 DOI: 10.1111/hdi.12201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the “costly” crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.
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Affiliation(s)
- Elizabeth F Rix
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
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