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Lloyd-Johnsen C, Hampton A, Stubbs E, Moore S, Eades S, D'Aprano A, Goldfeld S. "I want to see them thrive!": exploring health service research priorities for young Aboriginal children growing up in Alice Springs - a qualitative study. BMC Health Serv Res 2024; 24:205. [PMID: 38355508 PMCID: PMC10868103 DOI: 10.1186/s12913-024-10642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
To better understand the specific influences of early life on the long-term health and well-being of local Aboriginal children in Alice Springs, high-quality local longitudinal data is required. The Central Australian Aboriginal Congress and the Murdoch Children's Research Institute are exploring the feasibility of establishing a cohort study to fill this gap. A nested qualitative study was conducted to identify priority issues that can be translated into research questions answerable through the proposed cohort study. Semi-structured interviews and focus group discussions (FGDs) were conducted with a range of key community stakeholders, parents and caregivers of young Aboriginal children from Alice Springs in the Northern Territory between 2020 and 2021. Two Aboriginal and two non-Aboriginal researchers conducted 27 interviews and 3 FGDs with 42 participants. Three broad themes were constructed through reflexive thematic analysis representing the areas of focus community stakeholders and parents want future research to prioritise: (1) social determinants of health (2) building positive connections, and (3) making sure kids grow up strong and healthy. Priority setting for future research should be driven by Aboriginal and Torres Strait Islander peoples in order to be of practical benefit to their community. This qualitative study found that housing, transport and positive connections through nurturing and engaged parents were some of the most important issues raised. Participants also wanted future research to focus on issues specific to children such as nutrition, hearing loss, language development and capacity to learn. These findings will guide future work led by local Aboriginal researchers to co-design the proposed cohort study.
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Affiliation(s)
- C Lloyd-Johnsen
- Centre for Community Child Health, Murdoch Children's Research Institute, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - A Hampton
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - E Stubbs
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - S Moore
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Flinders University, Adelaide, SA, Australia
| | - S Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - A D'Aprano
- Centre for Community Child Health, Murdoch Children's Research Institute, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - S Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
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Lloyd-Johnsen C, Hampton A, Stubbs E, Moore S, Eades S, D'Aprano A, Goldfeld S. "It's gotta be done right way": a qualitative study exploring the acceptability of a proposed longitudinal cohort study of young Aboriginal children in Alice Springs. BMC Health Serv Res 2023; 23:1210. [PMID: 37932724 PMCID: PMC10626690 DOI: 10.1186/s12913-023-10148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/15/2023] [Indexed: 11/08/2023] Open
Abstract
There is a need for quality longitudinal data on the health and well-being of young Aboriginal and Torres Strait Islander children (hereafter Aboriginal) in Alice Springs that can be used for research, planning and evaluation. The primary aim of this descriptive qualitative study was to determine whether or not a proposed cohort study would be acceptable to the local community. The proposed cohort study will prospectively examine various factors, events and exposures in early life that give Aboriginal children the best chance to grow up strong and lead a healthy happy life. Decisions on specific priority issues to be addressed and study procedures will be determined by local Aboriginal researchers and community members during a future co-design phase. 27 semi-structured interviews and 3 focus group discussions (FGD) were conducted with a range of community stakeholders and parents/caregivers of young Aboriginal children from Alice Springs in the Northern Territory (NT) of Australia. Audio recorded data were transcribed and imported into NVivo12 qualitative software for reflexive thematic analysis. Three major themes concerning acceptability of the concept were constructed from the analysis: (1) Have to be mindful, (2) Duplication of data, and (3) "It's gotta be done right way". There was general support for the concept, however, many participants felt that a cautious and slow approach was necessary. Recommendations included focusing on building trust, taking it slow, and ensuring the study is conducted by local Aboriginal researchers. Barriers to feasibility noted included the high mobility of families, competing demands, and privacy concerns. Findings from this qualitative study support the feasibility and acceptability of a future cohort study of young Aboriginal children in Alice Springs. Leadership from respected local Aboriginal researchers and key stakeholders will be critical to its success.
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Affiliation(s)
- Catherine Lloyd-Johnsen
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Angela Hampton
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Emma Stubbs
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Sam Moore
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Flinders University, Adelaide, SA, Australia
| | - Sandra Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Anita D'Aprano
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
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D'Aprano A, Lloyd-Johnsen C, Cameron D, Wunungmurra A, Hull C, Boyle C, Naylon M, Brunette R, Campbell J, Matthews V. Trusting relationships and learning together: A rapid review of Indigenous reference groups in Australian Indigenous health research. Aust N Z J Public Health 2023; 47:100051. [PMID: 37182503 DOI: 10.1016/j.anzjph.2023.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/14/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE This rapid review aims to identify how Indigenous research governance is conceptualised, implemented and documented within Australian Indigenous health research studies. METHODS We searched for peer-reviewed English-language articles in two databases and for web-based grey literature published from database inception to November 2021. Reference lists were searched to identify additional articles. Data relating to research governance were extracted and analysed thematically. RESULTS A total of 1120 records were screened, and 27 articles were included. Most articles providing detailed description of Indigenous research governance activities were qualitative studies (n=15, 55.6%). Key themes included members are experts; respectful relationships; flexibility; and key logistic considerations (nuts 'n' bolts). CONCLUSIONS Although Indigenous research governance is recognised as an essential part of ethical research, activities and contributions made by Indigenous reference group (IRG) members are underreported. This important work needs greater visibility in the published literature to share best practice in Indigenous research governance that foregrounds Indigenous expert knowledge, perspectives, and experiences. IMPLICATIONS FOR PUBLIC HEALTH The study provides a synthesis of factors to consider when establishing and facilitating an IRG for research with Indigenous communities. This has implications for researchers who can adapt and apply the findings to their practice.
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Affiliation(s)
- Anita D'Aprano
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Catherine Lloyd-Johnsen
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Daniele Cameron
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | | | - Charmaine Hull
- South Australian Department of Health, Port Augusta, SA, Australia
| | - Cassie Boyle
- Northern Territory Department of Education, Alice Springs, NT, Australia
| | - Marjorie Naylon
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Raelene Brunette
- Sunrise Health Service Aboriginal Corporation, Katherine, NT, Australia
| | - Jeannie Campbell
- Northern Territory Central Australia Health Service, Tri Tree, NT, Australia
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
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Gonzalez T, Harris R, Williams R, Wadwell R, Barlow-Stewart K, Fleming J, Buckman M. Exploring the barriers preventing Indigenous Australians from accessing cancer genetic counseling. J Genet Couns 2020; 29:542-552. [PMID: 32173983 DOI: 10.1002/jgc4.1251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022]
Abstract
In Australia, individuals of Aboriginal and Torres Strait Islander descent (Indigenous Australians) have poorer health outcomes than the general population, including higher incidence of cancer and reduced life expectancy up to 14 years compared to non-Indigenous Australians. Although differences in engagement with healthcare and beliefs about disease/cancer exist between Indigenous communities, a number of common barriers have been identified hindering attendance at mainstream health services. To inform exploration of barriers that may impact access to a cancer genetic counseling service, consultations with Aboriginal stakeholders were undertaken. Ethical principles for studies that engage Indigenous communities were followed throughout the research endeavor. Using a stakeholder-endorsed focus group approach, the views of an Aboriginal Elders group (n = 9) were sought with additional semi-structured interviews with social science and genetics researchers working with Indigenous communities in Australia (n = 7). Thematic analysis of the results identified three themes: explanatory models of illness, barriers to keeping well and attending services, and recommendations for improvements to access/attendance. Barriers common to accessing both mainstream health services and clinical genetic services were identified, including attributions of illness and cancer. Specific genetic counseling barriers included the cultural inclusivity and accessibility of services, and a lack of awareness of genetic counseling both in the community and by clinicians unfamiliar with genetics. Recommendations included developing flexible service delivery models and culturally appropriate resources for Indigenous patients. These findings may inform future studies to improve Indigenous health outcomes and promote a more accessible, culturally appropriate approach to provision of cancer genetics services for Australia's First Peoples.
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Affiliation(s)
- Tina Gonzalez
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Camperdown, NSW, Australia.,Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rebecca Harris
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Camperdown, NSW, Australia.,Westmead Familial Cancer Service, Westmead Hospital, Westmead, NSW, Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia
| | - Rose Wadwell
- Aboriginal Health Unit, Tamworth Rural Referral Hospital, Tamworth, NSW, Australia
| | - Kristine Barlow-Stewart
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Jane Fleming
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Melissa Buckman
- Tamworth Genetics Service, Tamworth Community Health Centre, Tamworth, NSW, Australia
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Ristevski E, Thompson S, Kingaby S, Nightingale C, Iddawela M. Understanding Aboriginal Peoples' Cultural and Family Connections Can Help Inform the Development of Culturally Appropriate Cancer Survivorship Models of Care. JCO Glob Oncol 2020; 6:124-132. [PMID: 32031446 PMCID: PMC6998014 DOI: 10.1200/jgo.19.00109] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To explore the cancer diagnosis, treatment, and survivorship experiences of Aboriginal people in the Gippsland region, Victoria, Australia, and identify factors critical to the development of a culturally appropriate cancer survivorship model of care. PATIENTS AND METHODS Yarning circles were used to capture the stories of 15 people diagnosed with cancer and/or those of family members. Yarning circles were conducted in two locations in the Gippsland region. Sessions were facilitated by an Aboriginal Elder, audio recorded, and transcribed verbatim. Thematic analysis of the data were triangulated among three researchers and incorporated researcher reflexivity. RESULTS Cultural connections and family were critical supports on the cancer journey. Putting the needs of the family first and caring for sick family members were more important than an individual's own health. There was "no time to grieve" for one's own cancer diagnosis and look after oneself. Cancer was a private experience; however, the constancy of deaths highlighted the importance of raising family awareness. Health professionals did not always understand the importance of people's cultural and family supports in their treatment and recovery. There were negatives attitudes in hospitals when family come to visit, seeing family as too large and overstaying visiting times. Health professionals did not seek family assistance with communication of information to family members whose literacy level was low, nor did they include family in treatment decision-making. Access to services depended on family support with transport, finances, and family responsibilities, often resulting in lapses in treatment and follow-up services. CONCLUSION Understanding the importance of Aboriginal peoples' cultural and family connections can help to inform the development of culturally safe cancer survivorship models of care.
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Affiliation(s)
| | | | - Sharon Kingaby
- Latrobe Community Health Service, Traralgon, Victoria, Australia
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Hersh D, Armstrong E, McAllister M, Ciccone N, Katzenellenbogen J, Coffin J, Thompson S, Hayward C, Flicker L, Woods D. General practitioners' perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders. PATIENT EDUCATION AND COUNSELING 2019; 102:2310-2317. [PMID: 31427169 DOI: 10.1016/j.pec.2019.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners' (GPs') perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context. METHODS A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically. RESULTS GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations. CONCLUSION GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people. PRACTICE IMPLICATIONS GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial.
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Affiliation(s)
- Deborah Hersh
- Speech Pathology, Edith Cowan University, Perth, Australia.
| | | | | | | | - Judith Katzenellenbogen
- Telethon Kids Institute, Broome and Perth, Australia; WA Centre for Rural Health, University of Western Australia, Perth, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome and Perth, Australia
| | - Sandra Thompson
- WA Centre for Rural Health, University of Western Australia, Perth, Australia
| | | | - Leon Flicker
- WA Centre for Rural Health, University of Western Australia, Perth, Australia; Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
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Tapia KA, Garvey G, McEntee MF, Rickard M, Lydiard L, Brennan PC. Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia. Aust N Z J Public Health 2019; 43:334-339. [PMID: 31268228 DOI: 10.1111/1753-6405.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare breast screening attendances of Indigenous and non-Indigenous women. METHODS A total of 4,093 BreastScreen cases were used including 857 self-identified Indigenous women. Chi-squared analysis compared data between Indigenous and non-Indigenous women. Logistic regression was used for groupings based on visits-to-screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. RESULTS Indigenous women were younger and had fewer visits to screening compared with non-Indigenous women. Non-English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3-2.9). Living remotely was associated with fewer visits for non-Indigenous women only (OR 1.3, 95%CI 1.1-1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1-18.8; and OR 11.5, 95%CI 9.6-13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3-3.3; and OR 1.8, 95%CI 1.5-2.1, respectively). CONCLUSIONS Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non-Indigenous women. Implications for public health: Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote-living non-Indigenous women should also be addressed.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales
| | - Gail Garvey
- Faculty of Health Sciences, The University of Sydney, New South Wales.,Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division Menzies School of Health Research, Northern Territory
| | - Mark F McEntee
- Department of Medicine, University College Cork, Ireland
| | - Mary Rickard
- Faculty of Health Sciences, The University of Sydney, New South Wales.,BreastScreen New South Wales
| | | | - Patrick C Brennan
- Faculty of Health Sciences, The University of Sydney, New South Wales
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Tapia KA, Garvey G, Mc Entee M, Rickard M, Brennan P. Breast Cancer in Australian Indigenous Women: Incidence,
Mortality, and Risk Factors. Asian Pac J Cancer Prev 2017; 18:873-884. [PMID: 28545182 PMCID: PMC5494235 DOI: 10.22034/apjcp.2017.18.4.873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Indigenous people of Australia face significant health gaps compared with the general population, with lower life
expectancies, higher rates of death, and chronic illness occurring more often than in non-indigenous Australians. Cancer
is the second largest contributor to the burden of disease with breast cancer being the most common invasive cancer
diagnosed for females. Despite a lower breast cancer incidence compared with non-indigenous women, fatalities occur
at an elevated rate and breast cancers have an earlier age of onset. For indigenous women there are also more advanced
and distant tumours at diagnosis, fewer hospitalisations for breast cancer, and lower participation in breast screening.
Concomitantly there are demographic, socio-economic and lifestyle factors associated with breast cancer risks that
are heavily represented within Indigenous communities. The aim of this two-part narrative review is to examine the
available evidence on breast cancer and its risk factors in Australian Indigenous women. Part One presents a summary
of the latest incidence, survival and mortality data. Part Two presents the risk factors most strongly associated with
breast cancer including age, place of residence, family risk, genetics, reproductive history, tobacco use, alcohol intake,
physical activity, participation in screening and breast density. With increasing emphasis on personalized health care, a
clear understanding of breast cancer incidence, survival, mortality, and causal agents within the Indigenous population
is required if breast cancer prevention and management is to be optimized for Indigenous Australians.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
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Lavoie JG, Kaufert J, Browne AJ, O’Neil JD. Managing Matajoosh: determinants of first Nations' cancer care decisions. BMC Health Serv Res 2016; 16:402. [PMID: 27538389 PMCID: PMC4991084 DOI: 10.1186/s12913-016-1665-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/12/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. METHODS The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15). RESULTS Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. CONCLUSIONS We argue that a whole system's approach is required in order to address these limitations.
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Affiliation(s)
- Josée G. Lavoie
- MFN – Centre for Aboriginal Health Research, University of Manitoba, #715, 727 McDermot Avenue, Winnipeg, MB R3P 3E4 Canada
| | - Joseph Kaufert
- Department of Community Health Sciences, University of Manitoba, College of Medicine - University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Annette J. Browne
- UBC School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - John D. O’Neil
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, V5A 1S6 BC Canada
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Thewes B, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, He VY, Yip D, Garvey G. Routine screening of Indigenous cancer patients' unmet support needs: a qualitative study of patient and clinician attitudes. Int J Equity Health 2016; 15:90. [PMID: 27286811 PMCID: PMC4902957 DOI: 10.1186/s12939-016-0380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Indigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care. Methods Forty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed. Results Indigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff. Conclusions Staff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.
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Affiliation(s)
- B Thewes
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, New South Wales, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia.
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11
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Shahid S, Teng THK, Bessarab D, Aoun S, Baxi S, Thompson SC. Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: a qualitative study. BMJ Open 2016; 6:e010909. [PMID: 27259526 PMCID: PMC4893856 DOI: 10.1136/bmjopen-2015-010909] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES Delayed presentation of symptomatic cancer is associated with poorer survival. Aboriginal patients with cancer have higher rates of distant metastases at diagnosis compared with non-Aboriginal Australians. This paper examined factors contributing to delayed diagnosis of cancer among Aboriginal Australians from patient and service providers' perspectives. METHODS In-depth, open-ended interviews were conducted in two stages (2006-2007 and 2011). Inductive thematic analysis was assisted by use of NVivo looking around delays in presentation, diagnosis and referral for cancer. PARTICIPANTS Aboriginal patients with cancer/family members (n=30) and health service providers (n=62) were recruited from metropolitan Perth and six rural/remote regions of Western Australia. RESULTS Three broad themes of factors were identified: (1) Contextual factors such as intergenerational impact of colonisation and racism and socioeconomic deprivation have negatively impacted on Aboriginal Australians' trust of the healthcare professionals; (2) health service-related factors included low accessibility to health services, long waiting periods, inadequate numbers of Aboriginal professionals and high staff turnover; (3) patient appraisal of symptoms and decision-making, fear of cancer and denial of symptoms were key reasons patients procrastinated in seeking help. Elements of shame, embarrassment, shyness of seeing the doctor, psychological 'fear of the whole health system', attachment to the land and 'fear of leaving home' for cancer treatment in metropolitan cities were other deterrents for Aboriginal people. Manifestation of masculinity and the belief that 'health is women's domain' emerged as a reason why Aboriginal men were reluctant to receive health checks. CONCLUSIONS Solutions to improved Aboriginal cancer outcomes include focusing on the primary care sector encouraging general practitioners to be proactive to suspicion of symptoms with appropriate investigations to facilitate earlier diagnosis and the need to improve Aboriginal health literacy regarding cancer. Access to health services remains a critical problem affecting timely diagnosis.
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Affiliation(s)
- Shaouli Shahid
- Centre for Aboriginal Studies, Curtin University
- Western Australian Centre for Rural Health, University of Western Australia
| | | | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, University of Western Australia
| | - Samar Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University
| | | | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western 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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Durey A, Wynaden D, O'Kane M. Improving forensic mental health care to Indigenous Australians: theorizing the intercultural space. J Psychiatr Ment Health Nurs 2014; 21:296-302. [PMID: 23981233 DOI: 10.1111/jpm.12105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/29/2022]
Abstract
This paper uses the 'intercultural space' as an educational strategy to prepare nurses to work respectfully with Indigenous patients in a forensic mental health context; offers an educational approach that introduces nurses to Indigenous knowledge, beliefs and values, examines power relations in colonized countries between the dominant white cultural group and the Indigenous population and encourages nurses to critically reflect on their health care practice; and explores the intercultural space as a shared space between cultures fostering open and robust inquiry where neither culture dominates and new positions, representations and understandings can emerge. Given the disproportionately high number of Indigenous people imprisoned in colonized countries, this paper responds to research from Western Australia on the need to prepare forensic mental health nurses to deliver care to Indigenous patients with mental health disorders. The paper highlights the nexus between theory, research and education that can inform the design and implementation of programmes to help nurses navigate the complex, layered and contested 'intercultural space' and deliver culturally safe care to Indigenous patients. Nurses are encouraged to critically reflect on how beliefs and values underpinning their cultural positioning impact on health care to Indigenous patients. The paper draws on intercultural theory to offer a pedagogical framework that acknowledges the negative impacts of colonization on Indigenous health and well-being, repositions and revalues Indigenous cultures and knowledges and fosters open and robust inquiry. This approach is seen as a step towards working more effectively in the intercultural space where ultimately binary oppositions that privilege one culture over another and inhibit robust inquiry are avoided, paving the way for new, more inclusive positions, representations and understandings to emerge. While the intercultural space can be a place of struggle, tension and ambiguity, it also offers deep potential for change.
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Affiliation(s)
- A Durey
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
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Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Serv Res 2013; 13:460. [PMID: 24188503 PMCID: PMC3835135 DOI: 10.1186/1472-6963-13-460] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/26/2013] [Indexed: 11/12/2022] Open
Abstract
Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients’ psychosocial and logistical needs, and in-service coordination. Conclusion Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes.
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Affiliation(s)
- Shaouli Shahid
- Combined Universities Centre for Rural Health (CUCRH), University of Western Australia, Perth, Western Australia.
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Armstrong E, Hersh D, Hayward C, Fraser J, Brown M. Living with aphasia: three Indigenous Australian stories. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:271-280. [PMID: 22472033 DOI: 10.3109/17549507.2011.663790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The incidence of cardiovascular disorders and stroke in Australian Aboriginal communities is more than twice as high as non-Indigenous Australians. Approximately 30% of people who survive stroke are left with some level of aphasia, and yet Indigenous Australians appear to be infrequent users of speech-language pathology services, and there is virtually no research literature about the experiences of aphasia for this group of people. This paper presents the stories of living with aphasia for three Indigenous Australian men living in Perth, Western Australia. Their narratives were collected by an Indigenous researcher through in-depth, supported interviews, and were explored using both within-case and cross-case analyses for common and recurring themes. It is argued that there is value for speech-language pathologists, and other health professionals, to be aware of the broad experiences of living with aphasia for Indigenous Australians because their stories are rarely heard and because, as with people with aphasia generally, they are at risk of social isolation and tend to lack visibility in the community. This study explores the key issues which emerge for these three men and highlights the need for further research in this area.
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Affiliation(s)
- Elizabeth Armstrong
- School of Psychology and Social Science, Edith Cowan University, Speech Pathology, SPSS, 270 Joondalup Drive, Joondalup, Perth, WA 6027, Australia.
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Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Intern Med J 2012; 42:17-22. [PMID: 22032537 DOI: 10.1111/j.1445-5994.2011.02628.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Improvements in Aboriginal health have been slow. Research demonstrates ongoing discrimination towards Aboriginal Australians based on race, including in health services, leads to poor health outcomes. Using an eclectic methodology based on observations and discussions with health practitioners experienced in working with Aboriginal patients, this paper identifies how cross-cultural misunderstandings undermine the quality of care to Aboriginal patients in hospital and offers suggestions for improving practice. It also explores the concept of institutional racism and challenges doctors to reflect on their role in perpetuating power imbalances. We argue that physicians and healthcare providers need to do more than just deliver evidence-based interventions, by critically reflecting on their own attitudes to and practices with Aboriginal Australians and work collectively to effect systemic change which creates a more inclusive and safe environment for all people accessing healthcare.
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Affiliation(s)
- A Durey
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
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MILLER J, KNOTT V, WILSON C, RODER D. A review of community engagement in cancer control studies among Indigenous people of Australia, New Zealand, Canada and the USA. Eur J Cancer Care (Engl) 2012; 21:283-95. [DOI: 10.1111/j.1365-2354.2012.01325.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shahid S, Finn L, Bessarab D, Thompson SC. 'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment. AUST HEALTH REV 2011; 35:235-41. [PMID: 21612740 DOI: 10.1071/ah09835] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 07/28/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. DESIGN, SETTING AND PARTICIPANTS Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. RESULTS The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. CONCLUSION To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services.
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Affiliation(s)
- Shaouli Shahid
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
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Thompson SC, Shahid S, Bessarab D, Durey A, Davidson PM. Not just bricks and mortar: planning hospital cancer services for Aboriginal people. BMC Res Notes 2011; 4:62. [PMID: 21401923 PMCID: PMC3068108 DOI: 10.1186/1756-0500-4-62] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/14/2011] [Indexed: 11/16/2022] Open
Abstract
Background Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i) being alone and lost in a big, alien and inflexible system; (ii) failure of open communication, delays and inefficiency in the system; (iii) practicalities: costs, transportation, community and family responsibilities; (iv) the need for Aboriginal support persons; and (v) connection to the community. Conclusions Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes.
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Affiliation(s)
- Sandra C Thompson
- Winthrop Professor, Chair in Rural Health and Director, Combined Universities Centre for Rural Health, University of Western Australia, 167 Fitzgerald St, Geraldton, Western Australia 6530 Australia.
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Shahid S, Bleam R, Bessarab D, Thompson SC. "If you don't believe it, it won't help you": use of bush medicine in treating cancer among Aboriginal people in Western Australia. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2010; 6:18. [PMID: 20569478 PMCID: PMC2902429 DOI: 10.1186/1746-4269-6-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/23/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Little is known about the use of bush medicine and traditional healing among Aboriginal Australians for their treatment of cancer and the meanings attached to it. A qualitative study that explored Aboriginal Australians' perspectives and experiences of cancer and cancer services in Western Australia provided an opportunity to analyse the contemporary meanings attached and use of bush medicine by Aboriginal people with cancer in Western Australia METHODS Data collection occurred in Perth, both rural and remote areas and included individual in-depth interviews, observations and field notes. Of the thirty-seven interviews with Aboriginal cancer patients, family members of people who died from cancer and some Aboriginal health care providers, 11 participants whose responses included substantial mention on the issue of bush medicine and traditional healing were selected for the analysis for this paper. RESULTS The study findings have shown that as part of their healing some Aboriginal Australians use traditional medicine for treating their cancer. Such healing processes and medicines were preferred by some because it helped reconnect them with their heritage, land, culture and the spirits of their ancestors, bringing peace of mind during their illness. Spiritual beliefs and holistic health approaches and practices play an important role in the treatment choices for some patients. CONCLUSIONS Service providers need to acknowledge and understand the existence of Aboriginal knowledge (epistemology) and accept that traditional healing can be an important addition to an Aboriginal person's healing complementing Western medical treatment regimes. Allowing and supporting traditional approaches to treatment reflects a commitment by modern medical services to adopting an Aboriginal-friendly approach that is not only culturally appropriate but assists with the cultural security of the service.
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Affiliation(s)
- Shaouli Shahid
- Centre for International Health, Curtin University, Perth, WA, Australia.
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