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Christensen D, Gibberd A, McNamara B, Eades S, Shepherd C, Preen DB, McAullay D, Strobel N. Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study. Paediatr Perinat Epidemiol 2023; 37:691-703. [PMID: 37983972 PMCID: PMC10946741 DOI: 10.1111/ppe.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. OBJECTIVES Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. METHODS We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. RESULTS In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. CONCLUSIONS The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.
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Affiliation(s)
- Daniel Christensen
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Alison Gibberd
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Data Sciences, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong, Victoria, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carrington Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel McAullay
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Natalie Strobel
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
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2
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Brew BK, Gibberd A, Marks GB, Murphy VE, Jorm L, Chambers GM, Hartz D, Eades S, McNamara B. Maternal asthma in Australian indigenous women and perinatal outcomes: A whole population-linked study. Int J Gynaecol Obstet 2023; 160:653-660. [PMID: 35869950 PMCID: PMC10952457 DOI: 10.1002/ijgo.14363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the association between maternal asthma and adverse perinatal outcomes in an Australian Indigenous population. METHODS This prospective cohort study included all Indigenous mother and baby dyads for births from 2001 to 2013 in Western Australia (n = 25 484). Data were linked from Western Australia Births, Deaths, Midwives, Hospital, and Emergency Department collections. Maternal asthma was defined as a self-reported diagnosis at an antenatal visit or hospitalization or emergency visit for asthma during pregnancy or less than 3 years before pregnancy. Associations with birth, labor, and pregnancy outcomes were assessed using generalized estimating equations. Asthma exacerbation during pregnancy and stratification by remoteness was also assessed. RESULTS Maternal asthma was associated with placental abruption (adjusted odds ratio [aOR], 1.59 [95% confidence interval (CI), 1.07-2.35]), threatened preterm labor (aOR, 1.58 [95% CI, 1.39-1.79]), and emergency cesarean sections (aOR, 1.27 [95% CI, 1.13-1.44]). These risks increased further with an asthma exacerbation during pregnancy or if the mother was from a remote area. No associations were found for low birth weight, preterm birth, small for gestational age, or perinatal mortality. CONCLUSION Maternal asthma in Indigenous women is associated with an increased risk of emergency cesarean sections, placental abruption, and threatened preterm labor. These risks may be mitigated by improved management of asthma exacerbations during pregnancy.
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Affiliation(s)
- Bronwyn K. Brew
- Centre for Big Data Research in HealthUNSWSydneyNew South WalesAustralia
- National Perinatal and Statistics UnitSchool of Clinical Medicine & Centre for Big Data Research in Health, UNSWSydneyNew South WalesAustralia
| | - Alison Gibberd
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Guy B. Marks
- Woolcock Institute of Medical ResearchSydneyNew South WalesAustralia
- South West Sydney Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
| | - Vanessa E. Murphy
- Priority Research Centre for Health Lungs, School of Medicine and Public HealthUniversity of Newcastle, and Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Louisa Jorm
- Centre for Big Data Research in HealthUNSWSydneyNew South WalesAustralia
| | - Georgina M. Chambers
- Centre for Big Data Research in HealthUNSWSydneyNew South WalesAustralia
- National Perinatal and Statistics UnitSchool of Clinical Medicine & Centre for Big Data Research in Health, UNSWSydneyNew South WalesAustralia
| | - Donna Hartz
- College of Health Medicine and Wellbeing, School of Nursing and MidwiferyUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Sandra Eades
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Bridgette McNamara
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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3
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Chan J, Gidding HF, Blyth CC, Fathima P, Jayasinghe S, McIntyre PB, Moore HC, Mulholland K, Nguyen CD, Andrews R, Russell FM. Levels of pneumococcal conjugate vaccine coverage and indirect protection against invasive pneumococcal disease and pneumonia hospitalisations in Australia: An observational study. PLoS Med 2021; 18:e1003733. [PMID: 34343186 PMCID: PMC8376256 DOI: 10.1371/journal.pmed.1003733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/19/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is limited empiric evidence on the coverage of pneumococcal conjugate vaccines (PCVs) required to generate substantial indirect protection. We investigate the association between population PCV coverage and indirect protection against invasive pneumococcal disease (IPD) and pneumonia hospitalisations among undervaccinated Australian children. METHODS AND FINDINGS Birth and vaccination records, IPD notifications, and hospitalisations were individually linked for children aged <5 years, born between 2001 and 2012 in 2 Australian states (New South Wales and Western Australia; 1.37 million children). Using Poisson regression models, we examined the association between PCV coverage, in small geographical units, and the incidence of (1) 7-valent PCV (PCV7)-type IPD; (2) all-cause pneumonia; and (3) pneumococcal and lobar pneumonia hospitalisation in undervaccinated children. Undervaccinated children received <2 doses of PCV at <12 months of age and no doses at ≥12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. There were strong inverse associations between PCV coverage and the incidence of PCV7-type IPD (adjusted incidence rate ratio [aIRR] 0.967, 95% confidence interval [CI] 0.958 to 0.975, p-value < 0.001), and pneumonia hospitalisations (all-cause pneumonia: aIRR 0.991 95% CI 0.990 to 0.994, p-value < 0.001) among undervaccinated children. Subgroup analyses for children <4 months old, urban, rural, and Indigenous populations showed similar trends, although effects were smaller for rural and Indigenous populations. Approximately 50% coverage of PCV7 among children <5 years of age was estimated to prevent up to 72.5% (95% CI 51.6 to 84.4) of PCV7-type IPD among undervaccinated children, while 90% coverage was estimated to prevent 95.2% (95% CI 89.4 to 97.8). The main limitations of this study include the potential for differential loss to follow-up, geographical misclassification of children (based on residential address at birth only), and unmeasured confounders. CONCLUSIONS In this study, we observed substantial indirect protection at lower levels of PCV coverage than previously described-challenging assumptions that high levels of PCV coverage (i.e., greater than 90%) are required. Understanding the association between PCV coverage and indirect protection is a priority since the control of vaccine-type pneumococcal disease is a prerequisite for reducing the number of PCV doses (from 3 to 2). Reduced dose schedules have the potential to substantially reduce program costs while maintaining vaccine impact.
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Affiliation(s)
- Jocelyn Chan
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Heather F. Gidding
- Northern Clinical School, The University of Sydney, Sydney Australia
- Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Peter B. McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kim Mulholland
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cattram D. Nguyen
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ross Andrews
- Global & Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona M. Russell
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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4
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Gibberd AJ, Tyler J, Falster K, Preen DB, Hanly M, Clarke MJ, McNamara BJ, Eades SJ, Scurrah KJ. Pregnancy and birth characteristics of Aboriginal twins in two Australian states: a data linkage study. BMC Pregnancy Childbirth 2021; 21:448. [PMID: 34182932 PMCID: PMC8240393 DOI: 10.1186/s12884-021-03945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Perinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies. Yet multifetal pregnancies and births are often more complicated and have poorer outcomes than singleton pregnancies. We describe the pregnancies, births and perinatal outcomes for Aboriginal twins born in Western Australia (WA) and New South Wales (NSW) with comparisons to Aboriginal singletons in both states and to non-Aboriginal births in NSW. Materials and methods Whole-population birth records and birth and death registrations were linked for all births during 2000–2013 (WA) and 2002–2008 (NSW). Hospital records and the WA Register of Developmental Anomalies - Cerebral Palsy were linked for all WA births and hospital records for a subset of NSW births. Descriptive statistics are reported for maternal and child demographics, maternal health, pregnancy complications, births and perinatal outcomes. Results Thirty-four thousand one hundred twenty-seven WA Aboriginal, 32,352 NSW Aboriginal and 601,233 NSW non-Aboriginal births were included. Pregnancy complications were more common among mothers of Aboriginal twins than Aboriginal singletons (e.g. 17% of mothers of WA twins had hypertension/pre-eclampsia/eclampsia vs 8% of mothers of singletons) but similar to mothers of NSW non-Aboriginal twins. Most Aboriginal twins were born in a principal referral, women’s or large public hospital. The hospitals were often far from the mother’s home (e.g. 31% of mothers of WA Aboriginal twins gave birth at hospitals located more than 3 h by road from their home). Outcomes were worse for Aboriginal liveborn twins than Aboriginal singletons and non-Aboriginal twins (e.g. 58% of NSW Aboriginal twins were preterm compared to 9% of Aboriginal singletons and 49% non-Aboriginal twins). Conclusions Mothers of Aboriginal twins faced significant challenges during the pregnancy, birth and the postnatal period in hospital and, in addition to accessible specialist medical care, these mothers may need extra practical and psychosocial support throughout their journey. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03945-9.
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Affiliation(s)
- Alison J Gibberd
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
| | - Jessica Tyler
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Kathleen Falster
- School of Population Health, The University of New South Wales, Sydney, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Marilyn J Clarke
- Mid North Coast Local Health District, Port Macquarie, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Sandra J Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,Curtin Medical School, Curtin University, Perth, Australia
| | - Katrina J Scurrah
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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5
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Lloyd-Johnsen C, Eades S, McNamara B, D'Aprano A, Goldfeld S. A global perspective of Indigenous child health research: a systematic review of longitudinal studies. Int J Epidemiol 2021; 50:1554-1568. [PMID: 33864092 DOI: 10.1093/ije/dyab074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rigorously designed longitudinal studies can inform how best to reduce the widening health gap between Indigenous and non-Indigenous children. METHODS A systematic review was performed to identify and present the breadth and depth of longitudinal studies reporting the health and well-being of Indigenous children (aged 0-18 years) globally. Databases were searched up to 23 June 2020. Study characteristics were mapped according to domains of the life course model of health. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Reported level of Indigenous involvement was also appraised; PROSPERO registration CRD42018089950. RESULTS From 5545 citations, 380 eligible papers were included for analysis, representing 210 individual studies. Of these, 41% were located in Australia (n = 88), 22.8% in the USA (n = 42), 11.9% in Canada (n = 25) and 10.9% in New Zealand (n = 23). Research tended to focus on either health outcomes (50.9%) or health-risk exposures (43.8%); 55% of studies were graded as 'good' quality; and 89% of studies made at least one reference to the involvement of Indigenous peoples over the course of their research. CONCLUSIONS We identified gaps in the longitudinal assessment of cultural factors influencing Indigenous child health at the macrosocial level, including connection to culture and country, intergenerational trauma, and racism or discrimination. Future longitudinal research needs to be conducted with strong Indigenous leadership and participation including holistic concepts of health. This is critical if we are to better understand the systematic factors driving health inequities experienced by Indigenous children globally.
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Affiliation(s)
- Catherine Lloyd-Johnsen
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anita D'Aprano
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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6
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Brew B, Gibberd A, Marks GB, Strobel N, Allen CW, Jorm L, Chambers G, Eades S, McNamara B. Identifying preventable risk factors for hospitalised asthma in young Aboriginal children: a whole-population cohort study. Thorax 2021; 76:539-546. [PMID: 33419952 DOI: 10.1136/thoraxjnl-2020-216189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population. AIM To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1-4 years of age). METHODS Birth, hospital and emergency data for all Aboriginal children born 2003-2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life. RESULTS There were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at <33 weeks' gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight <1500 g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%-7%. We did not observe a higher risk of asthma in those children who were from remote areas. CONCLUSION Improving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.
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Affiliation(s)
- Bronwyn Brew
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia .,School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
| | - Alison Gibberd
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Clare Wendy Allen
- Children's Hospital Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgina Chambers
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
| | - Sandra Eades
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Bridgette McNamara
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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7
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Gubhaju L, Williams R, Jones J, Hamer D, Shepherd C, McAullay D, Eades SJ, McNamara B. "Cultural Security Is an On-Going Journey…" Exploring Views from Staff Members on the Quality and Cultural Security of Services for Aboriginal Families in Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8480. [PMID: 33207696 PMCID: PMC7697803 DOI: 10.3390/ijerph17228480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
Cultural security is a key element of accessible services for Indigenous peoples globally, although few studies have examined this empirically. We explored the scope, reach, quality, and cultural security of health and social services available to Aboriginal and/or Torres Strait Islander families in Western Australia (WA), from the point of view of staff from the services. We recruited staff from health and social services for Aboriginal people in the Perth, Kalgoorlie, Great Southern, and South West regions of WA between December 2015 and September 2017 to complete online surveys. We examined the proportions of participants that responded saying the service was culturally secure, the reasons for the response, and perceived factors related to a high-quality service. Sixty participants from 21 services responded to the survey. Seventy-three percent stated the service was culturally secure; however, only 36% stated that the staff employed at the service had sufficient knowledge on cultural security. Participants suggested having Aboriginal staff and better cultural awareness training as methods to improve cultural security within the service. Participants highlighted that staffing, funding for resources, and patient financial difficulties in accessing care as key areas for quality improvement. Much greater effort is required in improving knowledge through on-going training of staff in the practice of culturally safe care. Organisations must also be required to meet specific standards in cultural safety.
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Affiliation(s)
- Lina Gubhaju
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Robyn Williams
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, 7 Parker Place, Technology Park, Bentley, WA 6102, Australia;
| | - David Hamer
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Carrington Shepherd
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia;
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, 90 South Street, Murdoch, WA 6150, Australia
| | - Dan McAullay
- Kurongkurl Katitjin, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia;
| | - Sandra J. Eades
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
- Curtin Medical School, Curtin University, 410 Koorliny Way, Bentley, WA 6102, Australia
| | - Bridgette McNamara
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
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8
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McNamara BJ, Jones J, Shepherd C, Gubhaju L, Joshy G, McAullay D, Preen DB, Jorm L, Eades SJ. Identifying young Aboriginal and Torres Strait Islander children in linked administrative data: A comparison of methods. Int J Popul Data Sci 2020; 5:1100. [PMID: 32935045 PMCID: PMC7473276 DOI: 10.23889/ijpds.v5i1.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background In the ongoing debate on optimum methods for identification of Indigenous people within linked administrative data, few studies have examined the impacts of method on population counts and outcomes in family-based linkage studies of Aboriginal children. Objective To quantify differences between three algorithms in ascertaining Aboriginal and Torres Strait Islander children in linked administrative data. Methods Linked administrative health data for children born in Western Australia (WA) from 2000-2013, were used to examine the cohorts identified by three methods: A) the Indigenous Status Flag (ISF, derived by the WA Data Linkage Branch using a multistage-median approach) for the children alone; B) the ISF of the children, their parents and grandparents; and C) Indigenous status of the child, mother or father on either of the child's perinatal records (Midwives or birth registration), to determine differing characteristics of each cohort. Results Method B established a larger cohort (33,489) than Method C (33,306) and Method A (27,279), with all methods identifying a core group of 26,790 children (80-98%). Compared with children identified by Method A, additional children identified by Methods B or C, were from less-disadvantaged and more urban areas, and had better perinatal outcomes (e.g. lower proportions of small-for-gestational age, 10% vs 16%). Differences in demographics and health outcomes between Methods C and B were minimal. Conclusions Demographic and perinatal health characteristics differ by Aboriginal identification method. Using perinatal records or the ISF of parents and grandparents (in addition to the ISF of the child) appear to be more inclusive methods for identifying young Indigenous children in administrative datasets. Keywords Aboriginal health, identification, data linkage, Indigenous, child, methodology.
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Affiliation(s)
- B J McNamara
- Centre of Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - J Jones
- Faculty of Health and Medical Sciences University of Western Australia, Perth, Australia
| | - Ccj Shepherd
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch, Western Australia
| | - L Gubhaju
- Centre of Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - G Joshy
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - D McAullay
- Faculty of Health and Medical Sciences University of Western Australia, Perth, Australia
| | - D B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - L Jorm
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - S J Eades
- Centre of Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
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