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Nepal S, Bailey S, Newman J, Wright L, Smith N, Dickson M, Williamson A. Social and Emotional Wellbeing of Aboriginal Community Controlled Health Services Staff during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6060. [PMID: 37372647 DOI: 10.3390/ijerph20126060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
This study explores the impact of the COVID-19 pandemic on the work and social and emotional well-being (SEWB) of staff at Aboriginal Community Controlled Health Services (ACCHS) in Australia. Between September and November 2021, staff from three ACCHSs in New South Wales completed an online survey to report changes to their roles, concerns about becoming infected with the COVID-19 virus, and job satisfaction in the last month. The survey measured emotional exhaustion and psychological distress by using the Maslach Burnout Inventory-Human Services Survey and Kessler-5 scale, respectively. The survey determined staff's access to SEWB support. Descriptive statistics were calculated for each variable. Among 92 staff from three ACCHSs, 36% reported a COVID-19-related change in their role and 64% were concerned about becoming infected. In spite of the pandemic, most staff (69%) were satisfied with their job. While most staff were not burnt out or psychologically distressed, 25% had high emotional exhaustion and 30% had high to very high psychological distress. Relatedly, 37% had accessed SEWB support at least once in their lifetime and 24% had accessed support in the last month. As the pandemic continues, it is important to identify factors influencing burnout or psychological distress among ACCHS staff and implement evidence-based solutions.
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Affiliation(s)
| | | | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW 2800, Australia
| | - Lachlan Wright
- Tharawal Aboriginal Corporation, Airds, NSW 2560, Australia
| | - Natalie Smith
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, NSW 2650, Australia
| | - Michelle Dickson
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Anna Williamson
- Centre for Evidence and Implementation, Carlton, VIC 3053, Australia
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2
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Mitchell R, Gordon J, Bhoi GK, Nisbett N. Applying the 'Candidacy' Model to understand access to key nutrition, food & health services in LMIC contexts: a qualitative study in Odisha, India. Food Secur 2023; 15:649-660. [PMID: 37223753 PMCID: PMC10072021 DOI: 10.1007/s12571-023-01357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/17/2023] [Indexed: 04/07/2023]
Abstract
In order to make progress towards Sustainable Development Goal 2 - Zero Hunger - we must acquire a better understanding of what continues to hamper achieving food security, particularly in contexts where progress has been achieved, but has then faltered. This article investigates access to nutrition and food services in three of the Indian state of Odisha's traditionally poorer districts, where a large number of the state's most marginalised populations live. Semi-structured interviews were carried out in 11 villages. The Dixon-Woods Candidacy Model was employed to provide greater insight into the experiences of access to health and nutrition services, from both the supply and the demand sides. We found that there are many points along the journey that hamper access. We identified two levels of gatekeepers that can create (or remove) barriers, the first as front-line service providers and the second as high-level officials. The candidacy model shows that marginalisation caused by identity, poverty and education disparities hampers progress throughout this journey. This article aims to provide a view to improve our understanding of access to health, food and nutrition services, to improve food security, and to show the value of the candidacy model applied to an LMIC health setting.
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Jeyakumar R, Patel B, Coombes J, Madden T, Joshi R. "We're on the ground, we know what needs to be done": Exploring the role of Aboriginal Health Workers in primary health care. Front Public Health 2023; 10:1010301. [PMID: 36743189 PMCID: PMC9893014 DOI: 10.3389/fpubh.2022.1010301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
Background Aboriginal Health Workers (AHWs) are core providers of primary health care (PHC) for First Nations peoples in Australia. However, the national AHW workforce is aging and in short supply. There is a poor understanding of the factors contributing to this attrition from the perspectives of AHWs themselves. This study aimed to systematically explore the current functioning and sustainability of AHWs in NSW PHC by amplifying AHW voices. Materials and methods This study was co-designed with three Aboriginal health services in NSW. It included a literature review exploring the role of AHWs in NSW, and yarns with AHWs and their supervisors at participating services. Yarning is an Indigenous approach to knowledge generation centered upon storytelling. The yarns were guided by the USAID-developed Community Health Worker Assessment and Improvement Matrix. Yarn transcripts were analyzed using cyclical thematic analysis to identify key facilitators and challenges for AHW practice. Results The yarns highlighted five categories of change that are required to ensure AHW sustainability: community connection, recognition, value, support, and an inclusive health system. The yarns revealed that there are both service- and system-level factors influencing each of these categories of change. Conclusions The lived experiences of AHWs in NSW emphasize five key categories of change that are required to ensure workforce sustainability. It is evident that a system-wide paradigm shift to better include holistic approaches to health is necessary to truly ensure sustainability. Co-designing similar studies with ACCHOs across NSW can help inform this change.
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Affiliation(s)
- Ragavi Jeyakumar
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia,*Correspondence: Ragavi Jeyakumar ✉
| | - Bindu Patel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Julieann Coombes
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Ty Madden
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,School of Population Health, University of New South Wales, Sydney, NSW, Australia,The George Institute for Global Health, New Delhi, India
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‘We Want to Help but We Don’t Know What to Do’: Service Providers Working with Indigenous LGBTIQ+ Youth in Australia. SEXES 2022. [DOI: 10.3390/sexes3020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Access to adequate and appropriate service provision has a direct positive impact on health and wellbeing. Experiences of inaccessible, discriminatory, and culturally unsafe services and/or service providers are considered a root cause for the health inequalities that exist among Indigenous queer youth. Experiences of discrimination and cultural inappropriateness are commonplace, with Indigenous queer youth noting issues related to access to services and treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This paper examines the perspectives of Indigenous LGBTIQ+ youth and health service providers to identify what challenges, obstacles and opportunities are currently being faced and what could be implemented to improve the health and wellbeing outcomes for Indigenous LGBTIQ+ youth in the future.
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Wyber R, Lizama C, Wade V, Pearson G, Carapetis J, Ralph AP, Bowen AC, Peiris D. Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process. BMJ Open 2022; 12:e056239. [PMID: 35273057 PMCID: PMC8915338 DOI: 10.1136/bmjopen-2021-056239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To establish the priorities of primary care providers to improve assessment and treatment of skin sores and sore throats among Aboriginal and Torres Strait Islander people at risk of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). DESIGN Modified eDelphi survey, informed by an expert focus group and literature review. SETTING Primary care services in any one of the five Australian states or territories with a high burden of ARF. PARTICIPANTS People working in any primary care role within the last 5 years in jurisdiction with a high burden of ARF. RESULTS Nine people participated in the scoping expert focus group which informed identification of an access framework for subsequent literature review. Fifteen broad concepts, comprising 29 strategies and 63 different actions, were identified on this review. These concepts were presented to participants in a two-round eDelphi survey. Twenty-six participants from five jurisdictions participated, 16/26 (62%) completed both survey rounds. Seven strategies were endorsed as high priorities. Most were demand-side strategies with a focus on engaging communities and individuals in accessible, comprehensive, culturally appropriate primary healthcare. Eight strategies were not endorsed as high priority, all of which were supply-side approaches. Qualitative responses highlighted the importance of a comprehensive primary healthcare approach as standard of care rather than disease-specific strategies related to management of skin sores and sore throat. CONCLUSION Primary care staff priorities should inform Australia's commitments to reduce the burden of RHD. In particular, strategies to support comprehensive Aboriginal and Torres Strait Islander primary care services rather than an exclusive focus on discrete, disease-specific initiatives are needed.
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Affiliation(s)
- Rosemary Wyber
- Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Catalina Lizama
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Vicki Wade
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Glenn Pearson
- Aboriginal Health Institute Leadership Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- General Medicine and Inectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David Peiris
- Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia
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Askew DA, Foley W, Kirk C, Williamson D. "I'm outta here!": a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital. BMC Health Serv Res 2021; 21:907. [PMID: 34479571 PMCID: PMC8414851 DOI: 10.1186/s12913-021-06880-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Occasions of self-discharge from health services before being seen by a health profession or against medical advice are often used by health systems as an indicator of quality care. People self-discharge because of factors such as dissatisfaction with care, poor communication, long waiting times, and feeling better in addition to external factors such as family and employment responsibilities. These factors, plus a lack of cultural safety, and interpersonal and institutional racism contribute to the disproportionately higher rates of Indigenous people self-discharging from hospital. This qualitative study aimed to increase understanding about the causative and contextual factors that culminate in people self-discharging and identify opportunities to improve the hospital experience for all. METHODS Semi-structured interviews with five Aboriginal and/or Torres Strait Islander (hereafter, respectfully, Indigenous) people and six non-Indigenous people who had self-discharged from a major tertiary hospital in Brisbane, Australia, were audio-recorded, transcribed and thematically analysed. RESULTS Study participants all respected hospitals' vital role of caring for the sick, but the cumulative impact of unmet needs created a tipping point whereby they concluded that remaining in hospital would compromise their health and wellbeing. Five key categories of unmet needs were identified - the need for information; confidence in the quality of care; respectful treatment; basic comforts; and peace of mind. Although Indigenous and non-Indigenous participants had similar unmet needs, for the former, the deleterious impact of unmet needs was compounded by racist and discriminatory behaviours they experienced while in hospital. CONCLUSIONS Respectful, empathetic, person-centred care is likely to result in patients' needs being met, improve the hospital experience and reduce the risk of people self-discharging. For Indigenous people, the ongoing legacy of white colonisation is embodied in everyday lived experiences of interpersonal and institutional racism. Racist and discriminatory behaviours experienced whilst hospitalised are thus rendered both more visible and more traumatic, and exacerbate the deleterious effect of unmet needs. Decreasing self-discharge events requires a shift of thinking away from perceiving this as the behaviour of a deviant individual, but rather as a quality improvement opportunity to ensure that all patients are cared for in a respectful and person-centred manner.
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Affiliation(s)
- Deborah A Askew
- Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8, Health Sciences Building, Qld, 4029, Brisbane, Australia.
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia.
| | - Wendy Foley
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia
| | - Corey Kirk
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, 33 Charlotte Street, Qld, 4001, Brisbane, Australia
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MacKay D, Freeman N, Boyle JA, Campbell S, McLean A, Peiris D, Corpus S, Connors C, Moore E, Wenitong M, Silver B, McIntyre HD, Shaw JE, Brown A, Kirkham R, Maple-Brown L. Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation. Int J Gynaecol Obstet 2021; 155:179-194. [PMID: 34331708 DOI: 10.1002/ijgo.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. METHODS A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff. RESULTS Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. CONCLUSION The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
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Affiliation(s)
- Diana MacKay
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Natasha Freeman
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Queensland, Australia
| | - Anna McLean
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - David Peiris
- Centre for Health Systems Science, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Mark Wenitong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - H David McIntyre
- Clinical Unit, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Renae Kirkham
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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8
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Carlisle K, Matthews Quandamooka V, Redman-MacLaren M, Vine K, Turner Anmatyerre/Jaru NN, Felton-Busch Yangkaal/Gangalidda C, Taylor J, Thompson S, Whaleboat Meriam Le D, Larkins S. A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services. BMC Health Serv Res 2021; 21:431. [PMID: 33957914 PMCID: PMC8101223 DOI: 10.1186/s12913-021-06383-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. Methods A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. Results A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce). Conclusions These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06383-7.
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Affiliation(s)
- Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia. .,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.
| | | | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Nguma-bada Campus, QLD, Australia
| | - Kristina Vine
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | | | - Catrina Felton-Busch Yangkaal/Gangalidda
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Murtupuni Centre for Rural & Remote Health, James Cook University, Mt Isa, QLD, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | - Sandra Thompson
- Western Australia Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Donald Whaleboat Meriam Le
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
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9
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What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children. Burns 2020; 46:430-440. [DOI: 10.1016/j.burns.2019.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/29/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022]
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Peiris D, Wright L, News M, Corcoran K. Community-Based Chronic Disease Prevention and Management for Aboriginal People in New South Wales, Australia: Mixed Methods Evaluation of the 1 Deadly Step Program. JMIR Mhealth Uhealth 2019; 7:e14259. [PMID: 31638591 PMCID: PMC6913719 DOI: 10.2196/14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/23/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022] Open
Abstract
Background Chronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Objective This study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people. Methods In 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted. Results Overall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19%) female, 957 (91.49%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08%] participants at high cardiovascular disease (CVD) risk, 173 [16.54%] with diabetes, and 181 [17.30%] with albuminuria). A minority at high risk of CVD (99/231 [42.9%]) and with diabetes (73/173 [42.2%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4%) with 85.1% reporting satisfaction with event organization and information gained and 6.1% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43% of participants had a medical review recorded postevent with wide intersite variability (10.5%-85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential. Conclusions 1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden.
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Affiliation(s)
- David Peiris
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Lachlan Wright
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Madeline News
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
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11
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Hofer A, McDonald M. Continuity of care: why it matters and what we can do. Aust J Prim Health 2019; 25:214-218. [PMID: 31196382 DOI: 10.1071/py19041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/20/2019] [Indexed: 11/23/2022]
Abstract
Continuity of care matters; however, expansion and specialisation of the health system tends to fragment care. Continuity of care is accompanied by a range of patient benefits, including reduced all-cause mortality; lower rates of hospital presentation and preventable admission; and improved patient satisfaction. Potential concerns have been raised about some aspects of continuity of care, but these are outweighed by the perceived benefits. There are many barriers to achieving continuity, especially in rural and remote settings. Some practical solutions have been proposed that include adapting clinic procedures, utilising a small team approach, improving staff retention and ongoing advocacy.
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Affiliation(s)
- Alexandra Hofer
- Torres and Cape Hospital and Health Service, 163 Douglas Street, Thursday Island, Qld 4875, Australia; and Corresponding author
| | - Malcolm McDonald
- Australian Institute for Tropical Health and Medicine, James Cook University, Cairns Campus, PO Box 6811, Cairns, Qld 4870, Australia
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12
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Larkins S, Carlisle K, Turner N, Taylor J, Copley K, Cooney S, Wright R, Matthews V, Thompson S, Bailie R. 'At the grass roots level it's about sitting down and talking': exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services. BMJ Open 2019; 9:e027568. [PMID: 31129590 PMCID: PMC6538044 DOI: 10.1136/bmjopen-2018-027568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Improving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a mismatch between interventions and context. This project aimed to understand the successful implementation of CQI initiatives in Aboriginal and Torres Strait Islander health services in Australia through exploring the strategies used by 'high-improving' Indigenous primary healthcare (PHC) services. DESIGN, SETTINGS AND PARTICIPANTS This strengths-based participatory observational study used a multiple case study method with six Indigenous PHC services in northern Australia that had improved their performance in CQI audits. Interviews with healthcare providers, service users and managers (n=134), documentary review and non-participant observation were used to explore implementation of CQI and the enablers of quality improvement in these contexts. RESULTS Services approached the implementation of CQI differently according to their contexts. Common themes previously reported included CQI systems, teamwork, collaboration, a stable workforce and community engagement. Novel themes included embeddedness in the local historical and cultural contexts, two-way learning about CQI and the community 'driving' health improvement. These novel themes were implicit in the descriptions of stakeholders about why the services were improving. Embeddedness in the local historical and cultural context resulted in 'two-way' learning between communities and health system personnel. CONCLUSIONS Practical interventions to strengthen responses to CQI in Indigenous PHC services require recruitment and support of an appropriate and well prepared workforce, training in leadership and joint decision-making, regional CQI collaboratives and workable mechanisms for genuine community engagement. A 'toolkit' of strategies for service support might address each of these components, although strategies need to be implemented through a two-way learning process and adapted to the historical and cultural community context. Such approaches have the potential to assist health service personnel strengthen the PHC provided to Indigenous communities.
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Affiliation(s)
- Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Nalita Turner
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Kerry Copley
- CQI Team, Aboriginal Medical Services Association, Northern Territory, Darwin, Northern Territory, Australia
| | - Sinon Cooney
- Manager, Primary Health Care, Katherine West Health Board Aboriginal Corp, Katherine, Northern Territory, Australia
| | - Roderick Wright
- Data Unit, Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - Veronica Matthews
- University Centre for Rural Health - North Coast, The University of Sydney, Lismore, New South Wales, Australia
| | - Sandra Thompson
- Combined Universities Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
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Thomas L, Parker S, Song H, Gunatillaka N, Russell G, Harris M. Health service brokerage to improve primary care access for populations experiencing vulnerability or disadvantage: a systematic review and realist synthesis. BMC Health Serv Res 2019; 19:269. [PMID: 31035997 PMCID: PMC6489346 DOI: 10.1186/s12913-019-4088-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Individuals experiencing disadvantage or marginalisation often face difficulty accessing primary health care. Overcoming access barriers is important for improving the health of these populations. Brokers can empower and enable people to access resources; however, their role in increasing access to health services has not been well-defined or researched in the literature. This review aims to identify whether a health service broker working with health and social service providers in the community can (a) identify individuals experiencing vulnerability who may benefit from improved access to quality primary care, and (b) link these individuals with an appropriate primary care provider for enduring, appropriate primary care. METHODS Six databases were searched for studies published between January 2008 and August 2015 that evaluated a health service broker intervention linking adults experiencing vulnerability to primary care. Relevant websites were also searched. Included studies were analysed using candidacy theory and a realist matrix was developed to identify mechanisms that may have contributed to changes in response to the interventions in different contexts. RESULTS Eleven studies were included in the review. Of the eight studies judged to provide detailed description of the programs, the interventions predominately addressed two domains of candidacy (identification of candidacy and navigation), with limited applicability to the third and fourth dimensions (permeability of services and appearances at health services). Six of the eight studies were judged to have successfully linked their target group to primary care. The majority of the interventions focused on assisting patients to reach services and did not look at ways that providers or health services could alter the way they deliver care to improve access. CONCLUSIONS While specific mechanisms behind the interventions could not be identified, it is suggested that individual advocacy may be a key element in the success of these types of interventions. The interventions were found to address some dimensions of candidacy, with health service brokers able to help people to identify their need for care and to access, navigate and interact with services. More consideration should be given to the influence of providers on patient candidacy, rather than placing the onus on patients.
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Affiliation(s)
- Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Hyun Song
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Nilakshi Gunatillaka
- The Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria 3168 Australia
| | - Grant Russell
- The Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria 3168 Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
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Panaretto KS, Dellit A, Hollins A, Wason G, Sidhom C, Chilcott K, Malthouse D, Andrews S, Mein J, Ahkee B, McDermott R. Understanding patient access patterns for primary health-care services for Aboriginal and Islander people in Queensland: a geospatial mapping approach. Aust J Prim Health 2019; 23:37-45. [PMID: 27493153 DOI: 10.1071/py15115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/13/2016] [Indexed: 11/23/2022]
Abstract
This paperexplores the patterns ofpatients'accessingsix Aboriginal and Islander CommunityControlled Health Services (AICCHSs) in Queensland. Between August 2011 and February 2014, 26199 patients made at least one visit over a 2-year period prior to at least one of six Queensland AICCHS - one urban service (RA 1) in south-east Queensland, and five services in regional towns (RA 3) in Far North Queensland. Geospatial mapping of addresses for these registered patients was undertaken. The outcomes analysed included travel times to, the proportion of catchment populations using each AICCHS and an assessment of alternative mainstream general practice availability to these patients was made. In brief, the use of AICCHS was higher than Australian Bureau of Statistics census data would suggest. Approximately 20% of clients travel more than 30min to seek Aboriginal Health services, but only 8% of patients travelled longer than 60min. In the major city site, many other general practitioner (GP) services were bypassed. The data suggest Aboriginal and Islander patients in Queensland appear to value community-controlled primary care services. The number of Indigenous clients in regional locations in the Far North Queensland registered with services is often higher than the estimated resident population numbers.
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Affiliation(s)
- K S Panaretto
- Centre for Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations, Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA 5000, Australia
| | - A Dellit
- Centre for Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations, Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA 5000, Australia
| | - A Hollins
- James Cook University, 1 James Cook Drive, Townsville City, Qld 4811, Australia
| | - G Wason
- Mulungu Corporation for Medical Corporation, 162-164 Walsh Street, Mareeba, Qld 4880, Australia
| | - C Sidhom
- Wuchopperen, Health Service, 6 Moignard Street, Manoora, Qld 4870, Australia
| | - K Chilcott
- Kalwun Health Service, 2020 Gold Coast Highway, Miami, Qld 4220, Australia
| | - D Malthouse
- Wuchopperen, Health Service, 6 Moignard Street, Manoora, Qld 4870, Australia
| | - S Andrews
- Queensland Aboriginal and Islander Health Council, 55 Russell Street, South Brisbane, Qld 4101, Australia
| | - J Mein
- Apunipima Cape York Health Council, 186 Mccoombe Street, Bungalow, Qld 4870, Australia
| | - B Ahkee
- Mamu, 10 Ernest Street, Innisfail, Qld 4860, Australia
| | - R McDermott
- Centre for Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations, Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA 5000, Australia
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Wapau H, Jans D, Hapea E, Mein J, Curnow V, McDonald M. Coming to town: Reaching agreement on a thorny issue. Aust J Rural Health 2018; 26:416-421. [PMID: 30450678 DOI: 10.1111/ajr.12430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the process of gaining consensus across regional organisations in formulating measures to improve coordination of care for people from remote Far North Queensland communities coming to town (Cairns) to access health care. DESIGN This is a descriptive study that includes survey data from workshop participants. SETTING Coming to town for health care poses great challenges, especially for Indigenous Australians from remote communities. Numerous organisations are involved, communications are fragmented and there is no central coordinating body. The system frequently fails to deliver necessary services. This generates preventable cost burdens through missed flights, missed appointments, missed treatment opportunities and extra administration. Workshop organisers invited key service providers from across Far North Queensland. MAIN OUTCOME MEASURES Using real-case scenarios, the task was to identify and prioritise the central issues and explore ways to address them. Participants jointly crafted the final recommendations and also posted suggestions on a 'wish-list' board. A participant assessment survey was conducted at the end of the workshop, followed by an online survey 6 weeks later. RESULTS There were 32 participants. The concluding survey indicated the workshop was well received and people valued the collaboration. There were six primary recommendations plus numerous wish-list suggestions. The best-supported recommendation was establishment of a coming to town Hub with a local coordinating team and community-based representatives. CONCLUSION Implementation of the workshop recommendations and support of all key service providers should be culturally acceptable and resource-efficient with better health outcomes for travellers, their families and communities.
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Affiliation(s)
- Hylda Wapau
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Diana Jans
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Emily Hapea
- Mookai Rosie Bi-Bayan Aboriginal and Torres Strait Islander Corporation, Edmonton, Queensland, Australia
| | - Jacki Mein
- Wuchopperen Health Service, Manoora, Queensland, Australia
| | - Venessa Curnow
- Aboriginal and Torres Strait Islander Health Management Unit, Cairns and Hinterland Hospital and Health Services, Queensland Health, Cairns, Queensland, Australia
| | - Malcolm McDonald
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia.,Centre for Chronic Disease Prevention, James Cook University, Smithfield, Queensland, Australia
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16
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Keay L, Hunter K, Ralph M, Porykali B, Lyford M, Clapham K, Lo W, Ivers R. Overcoming barriers to use of child car seats in an urban Aboriginal community-formative evaluation of a program for Aboriginal Community Controlled Health Services. Pilot Feasibility Stud 2018; 4:161. [PMID: 30377536 PMCID: PMC6195719 DOI: 10.1186/s40814-018-0351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the barriers to use of child car seats in Australian Aboriginal communities, or the acceptability of programs to increase appropriate car seat use. This formative evaluation sought to consult and partner with Aboriginal Community Controlled Health Services (ACCHS) to develop and evaluate the feasibility and acceptability of a program intended to improve optimal use of child car seats. Methods Focus groups were conducted with parents and carers of Aboriginal children to identify the barriers and facilitating factors for child car seat use, and staff of two ACCHS were interviewed to inform program development. Following the implementation of the resulting multi-faceted program, consisting of staff training, education, hands-on demonstrations and a subsidised car seat distribution scheme, interviews were conducted to assess process issues and acceptability with 13 staff members. Results Parents and carers in the focus groups reported a lack of awareness of child car seat use, confusion about the right car seats for different aged children but agreed about the importance of safety and community responsibility to keep children safe in cars. Interviews with service staff informed an approach to deliver relevant information. Information and resources were delivered to families, while the car seat distribution scheme supplied 33 families with child car seats. Following the conclusion of the program, staff reported that the program was relevant to their role. They also valued the car seat distribution scheme. Staff training in selection and installation of car seats increased confidence in staff knowledge. Conclusions We developed a program to promote child car seat use in ACCHS, which focused on developing capacity, made use of existing infrastructure and developed resources for use in this setting. The program shows promise as a means to promote child car seat use in Aboriginal communities; however, the impact on child car seat use will need to be evaluated in a larger scale prospective trial.
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Affiliation(s)
- Lisa Keay
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Kate Hunter
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia.,2The Poche Centre for Indigenous Health, The University of Sydney, Room 224, Edward Ford Building (A27), Sydney, Australia
| | - Martyn Ralph
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Bobby Porykali
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Marilyn Lyford
- 3Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Kathleen Clapham
- 4Australian Health Services Research Institute, University of Wollongong, Building 234 (iC Enterprise 1) Innovation Campus, Wollongong, NSW 2522 Australia
| | - Winston Lo
- 5School of Public Health and Community Medicine, University of New South Wales, Sydney, Samuels Avenue, Kensington, Sydney, 2033 Australia
| | - Rebecca Ivers
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia.,5School of Public Health and Community Medicine, University of New South Wales, Sydney, Samuels Avenue, Kensington, Sydney, 2033 Australia
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Arkles R, Jankelson C, Radford K, Jackson Pulver L. Family caregiving for older Aboriginal people in urban Australia: Disclosing worlds of meaning in the dementia experience. DEMENTIA 2018; 19:397-415. [PMID: 29877735 DOI: 10.1177/1471301218776761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia in Australia’s Aboriginal and Torres Strait Islander population is an area of significant health and community concern. In this article, we use a hermeneutic mode of interpretation to deepen understanding of experience and meaning in dementia for family carers of older Aboriginal people in urban Australia. Specifically, we draw from the hermeneutic concept of “world disclosure” to illuminate the dementia experience in three ways: through an artwork of the brain and dementia; through concrete description of the lived relation of caregiving; and through an epochal perspective on the significance of contemporary caregiving in dementia. Using narrative and visual knowledge, this three-fold approach brings to the forefront the importance of ontological and existential meanings which resonate for Aboriginal families in the dementia caregiving experience.
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Affiliation(s)
- Rachelle Arkles
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Claire Jankelson
- Macquarie Graduate School of Management, Macquarie University, Sydney, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Jackson Pulver
- Public Health Epidemiologist, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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18
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Topp SM, Edelman A, Taylor S. "We are everything to everyone": a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. Int J Equity Health 2018; 17:67. [PMID: 29848331 PMCID: PMC5977558 DOI: 10.1186/s12939-018-0779-z] [Citation(s) in RCA: 33] [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: 02/06/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health policy in Australia positions Aboriginal and Torres Strait Islander Health Workers (AHWs) as central to improving Aboriginal and Torres Strait Islander peoples' health, with high expectations of their contribution to closing the gap between Indigenous and non-Indigenous health outcomes. Understanding how AHWs' governance and accountability relationships influence their ability to address such health inequities has policy, programme and ethical significance. We sought to map the evidence of AHWs' experiences of accountability in the Australian health system. METHODS We followed an adapted qualitative systematic review process to map evidence on accountability relations in the published literature. We sought empirical studies or first-person accounts describing AHWs' experiences of working in government or Aboriginal community-controlled services anywhere in Australia. Findings were organised according to van Belle and Mayhew's four dimensions of accountability - social, political, provider and organisational. RESULTS Of 27 included studies, none had a primary focus on AHW governance or AHWs' accountability relationships. Nonetheless, selected articles provided some insight into AHWs' experiences of accountability across van Belle and Mayhew's four dimensions. In the social dimension, AHWs' sense of connection and belonging to community was reflected in the importance placed on AHWs' cultural brokerage and advocacy functions. But social and cultural obligations overlapped and sometimes clashed with organisational and provider-related accountabilities. AHWs described having to straddle cultural obligations (e.g. related to gender, age and kinship) alongside the expectations of non-Indigenous colleagues and supervisors which were underpinned by 'Western' models of clinical governance and management. Lack of role-clarity stemming from weakly constituted (state-based) career structures was linked to a system-wide misunderstanding of AHWs' roles and responsibilities - particularly the cultural components - acting as a barrier to AHWs working to their full capacity for the benefit of patients, broader society and their own professional satisfaction. CONCLUSIONS In literature spanning different geographies, service domains and several decades, this review found evidence of complexity in AHWs' accountability relationships that both affects individual and team performance. However, theoretically informed and systematic investigation of accountability relationships and related issues, including the power dynamics that underpin AHW governance and performance in often diverse settings, remains limited and more work in this area is required.
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Affiliation(s)
- Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Drive, Townsville, QLD 4810 Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC 3010 Australia
| | - Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Drive, Townsville, QLD 4810 Australia
| | - Sean Taylor
- Torres and Cape Hospital and Health Service, Community Wellness Centre, Thursday Island Hospital Campus, Thursday Island, QLD 4875 Australia
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19
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Kirkham R, Rumbold A, Hoon E, Stuart-Butler D, Moore V. Emotional labour and aboriginal maternal infant care workers: The invisible load. Women Birth 2017; 31:110-116. [PMID: 28716549 DOI: 10.1016/j.wombi.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The term 'emotional labour' has been used to describe the competing demands on midwives to empathize with clients whilst maintaining a level of professional detachment. Previous research indicates that when individuals experience difficulty managing these emotions, burnout may result. Aboriginal health care workers often have roles with large emotional demands, as they are relied upon heavily to engage clients in care. However, the concept of emotional labour has received little attention in relation to this group. AIM To explore potential sources of emotional labour for Aboriginal Maternal Infant Care workers in a maternity care program for Aboriginal women in South Australia. The program involves these workers providing care for women in partnership with midwives. METHODS We employed a phenomenological approach. Thirty in-depth interviews were conducted with staff and clients of the program. Recorded interviews were transcribed and coded and emerging themes identified. FINDINGS This workforce undertakes extensive emotional labour. Key sources include the cultural and family obligations they have to clients, complex social needs of many clients, and potential for community backlash when poor perinatal outcomes occur. A lack of respect for the role within the workplace further contributes to these experiences. CONCLUSION This study found that the responsibilities inherent to the role as both cultural broker and carer create significant emotional labour for workers. Recommendations to address this and enhance the sustainability of this workforce include: recognition and valuing of emotional work by management and other staff, enhancing cultural awareness training, and building stress-relieving activities into the workplace.
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Affiliation(s)
- R Kirkham
- School of Public Health, University of Adelaide, Australia.
| | - A Rumbold
- Robinson Research Institute, University of Adelaide, Australia
| | - E Hoon
- School of Public Health, University of Adelaide, Australia
| | - D Stuart-Butler
- Aboriginal Health Division, Acute Services, Women's and Children's Hospital, Australia
| | - V Moore
- School of Public Health, University of Adelaide, Australia; Robinson Research Institute, University of Adelaide, Australia; Fay Gale Centre for Research on Gender, University of Adelaide, Australia
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20
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O'Grady KAF, Grimwood K, Toombs M, Sloots TP, Otim M, Whiley D, Anderson J, Rablin S, Torzillo PJ, Buntain H, Connor A, Adsett D, Meng kar O, Chang AB. Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial. BMJ Open 2017; 7:e013796. [PMID: 28259853 PMCID: PMC5353349 DOI: 10.1136/bmjopen-2016-013796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/02/2016] [Accepted: 01/30/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Acute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks) cough in children following ARI is associated with decreased quality-of-life scores and increased health and societal economic costs. We will determine whether a validated evidence-based cough algorithm, initiated when chronic cough is first diagnosed after presentation with ARI, improves clinical outcomes in children compared with usual care. METHODS AND ANALYSIS A multicentre, parallel group, open-label, randomised controlled trial, nested within a prospective cohort study in Southeast Queensland, Australia, is underway. 750 children aged <15 years will be enrolled and followed weekly for 8 weeks after presenting with an ARI with cough. 214 children from this cohort with persistent cough at day 28 will be randomised to either early initiation of a cough management algorithm or usual care (107 per group). Randomisation is stratified by reason for presentation, site and total cough duration at day 28 (<6 and ≥6 weeks). Demographic details, risk factors, clinical histories, examination findings, cost-of-illness data, an anterior nasal swab and parent and child exhaled carbon monoxide levels (when age appropriate) are collected at enrolment. Weekly contacts will collect cough status and cost-of-illness data. Additional nasal swabs are collected at days 28 and 56. The primary outcome is time-to-cough resolution. Secondary outcomes include direct and indirect costs of illness and the predictors of chronic cough postpresentation. ETHICS AND DISSEMINATION The Children's Health Queensland (HREC/15/QRCH/15) and the Queensland University of Technology University (1500000132) Research Ethics Committees have approved the study. The study will inform best-practice management of cough in children. TRIAL REGISTRATION NUMBER ACTRN12615000132549.
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Affiliation(s)
- Kerry-Ann F O'Grady
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, Queensland, Australia
| | - Maree Toombs
- The University of Queensland Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
- Carbal Health Services, Toowoomba, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Michael Otim
- School of Public Health, Australian Catholic University, Sydney, New South Wales, Australia
| | - David Whiley
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Jennie Anderson
- Caboolture Community Medical, Caboolture, Queensland, Australia
| | - Sheree Rablin
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul J Torzillo
- School of Medicine, The University of Sydney, Newtown, New South Wales, Australia
| | - Helen Buntain
- Wesley Medical Centre, Brisbane, Queensland, Australia
| | - Anne Connor
- Ferny Grove Chambers Medical Practice, Brisbane, Queensland, Australia
| | - Don Adsett
- Department of Paediatrics, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Oon Meng kar
- Department of Paediatrics, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Anne B Chang
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Queensland Children's Respiratory Centre, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
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21
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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22
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Cunningham FC, Ferguson-Hill S, Matthews V, Bailie R. Leveraging quality improvement through use of the Systems Assessment Tool in Indigenous primary health care services: a mixed methods study. BMC Health Serv Res 2016; 16:583. [PMID: 27756295 PMCID: PMC5070177 DOI: 10.1186/s12913-016-1810-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/30/2016] [Indexed: 11/28/2022] Open
Abstract
Background Assessment of the quality of primary health care health delivery systems is a vital part of continuous quality improvement (CQI) processes. The Systems Assessment Tool (SAT) was designed to support Indigenous PHC services in assessing and improving their health care systems. It was based on the Assessment of Chronic Illness Care scale, and on practical experience with applying systems assessments in quality improvement in Indigenous primary health care. We describe the development and application of the SAT, report on a survey to assess the utility of the SAT and review the use of the SAT in other CQI research programs. Methods The mixed methods approach involved a review of documents and internal reports relating to experience with use of the SAT since its development in 2002 and a survey of key informants on their experience with using the SAT. Results The paper drew from documents and internal reports to describe the SAT development and application in primary health care services from 2002 to 2014. Survey feedback highlighted the benefit to the whole primary health care team from participating in the SAT, bringing to light issues that might not emerge with separate individual tool completion. A majority of respondents reported changes in their health centres as a result of using the SAT. Good organisational and management support assisted with ensuring allocation of time and resources for SAT conduct. Respondents identified the importance of having a skilled, external facilitator. Conclusions Originally designed as a measurement tool, the SAT rapidly evolved to become an important development tool, assisting teams in learning about primary health care system functioning, applying best practice and contributing to team strengthening. It is valued by primary health care centres as a lever in implementing improvements to strengthen centre delivery systems, and has potential for further adaptation and wider application in Australia and internationally. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1810-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frances C Cunningham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia.
| | - Sue Ferguson-Hill
- National Centre for Quality Improvement in Indigenous Primary Health Care, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia
| | - Veronica Matthews
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Sydney, Australia
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Schierhout G, Matthews V, Connors C, Thompson S, Kwedza R, Kennedy C, Bailie R. Improvement in delivery of type 2 diabetes services differs by mode of care: a retrospective longitudinal analysis in the Aboriginal and Torres Strait Islander Primary Health Care setting. BMC Health Serv Res 2016; 16:560. [PMID: 27717351 PMCID: PMC5055704 DOI: 10.1186/s12913-016-1812-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Addressing evidence-practice gaps in primary care remains a significant public health challenge and is likely to require action at different levels of the health system. Whilst Continuous Quality Improvement (CQI) is associated with improvements in overall delivery, little is known about delivery of different types of care processes, and their relative improvement during CQI. Methods We used data from over 15,000 clinical audit records of clients with Type 2 diabetes collected as part of a wide-scale CQI program implemented between 2005 and 2014 in 162 Aboriginal and Torres Strait Islander health centres. We abstracted data from clinical records on 15 service items recommended in clinical guidelines and categorised these items into five modes of care on the basis of the mechanism through which care is delivered: laboratory tests; generalist-delivered physical checks; specialist-delivered checks; education/counselling for nutrition and physical activity and education/counselling for high risk substance use. We calculated delivery for each patient for each of mode of care by determining the proportion of recommended services delivered for that mode. We used multilevel regression models to quantify variation attributable to health centre or client level factors and to identify factors associated with greater adherence to clinical guidelines for each mode of care. Results Clients on average received 43 to 60 % of recommended care in 2005/6. Different modes of care showed different patterns of improvement. Generalist-delivered physical checks (delivered by a non-specialist) showed a steady year on year increase, delivery of laboratory tests showed improvement only in the later years of the study, and delivery of counselling/education interventions showed early improvement which then plateaued. Health centres participating in CQI had increased odds of top quartile service delivery for all modes compared to baseline, but effects differed by mode. Health centre factors explained 20–52 % of the variation across jurisdictions and health centres for different modes of care. Conclusions Levels of adherence to clinical guidelines and patterns of improvement during participation in a CQI program differed for different modes of care. Policy and funding decisions may have had important effects on the level and nature of improvements achieved.
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Affiliation(s)
- Gill Schierhout
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | | | | | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Ru Kwedza
- Queensland Health, Cairns, QLD, Australia
| | - Catherine Kennedy
- Maari Ma Health Aboriginal Corporation, Broken Hill, Far West New South Wales, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
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Koehn S, Badger M, Cohen C, McCleary L, Drummond N. Negotiating access to a diagnosis of dementia: Implications for policies in health and social care. DEMENTIA 2016; 15:1436-1456. [DOI: 10.1177/1471301214563551] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The ‘Pathways to Diagnosis’ study captured the experience of the prediagnosis period of Alzheimer’s disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the ‘Candidacy’ framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups.
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Affiliation(s)
- Sharon Koehn
- Department of Gerontology, Simon Fraser University, Vancouver, Canada; Providence Health Care, Vancouver, Canada
| | - Melissa Badger
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Carole Cohen
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lynn McCleary
- Department of Nursing, Brock University, St. Catherines, Canada
| | - Neil Drummond
- Department of Family Medicine, University of Alberta, Edmonton, Canada
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Bailie J, Laycock A, Matthews V, Bailie R. System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data. Front Public Health 2016; 4:86. [PMID: 27200338 PMCID: PMC4854872 DOI: 10.3389/fpubh.2016.00086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/20/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders’ perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. Methods This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a “driver diagram,” an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. Results We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health literacy. Conclusion The findings identify areas of focus for development of barrier-driven, tailored interventions to improve health outcomes. They reinforce the importance of system-level action to improve health center performance and health outcomes, and of developing strategies to address system-wide challenges that can be adapted to local contexts.
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Affiliation(s)
- Jodie Bailie
- Menzies School of Health Research, Charles Darwin University , Casuarina, NT , Australia
| | - Alison Laycock
- Menzies School of Health Research, Charles Darwin University , Casuarina, NT , Australia
| | - Veronica Matthews
- Menzies School of Health Research, Charles Darwin University , Casuarina, NT , Australia
| | - Ross Bailie
- Menzies School of Health Research, Charles Darwin University , Casuarina, NT , Australia
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Dennis S, Hasan I, Jackson Pulver L, Wilson I, Zwar N. Experiences and views of a brokerage model for primary care for Aboriginal people. AUST HEALTH REV 2016; 39:26-32. [PMID: 25318845 DOI: 10.1071/ah13205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/01/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A mixed methods study was conducted to determine the views of Aboriginal people on their experiences of a brokerage model for access to community-based health services in an urban setting. METHODS A broad range of approaches, using surveys, semi-structured interviews and community forums with Aboriginal people were used to find out people's views and experiences of using the brokerage service. RESULTS Of the 1304 people invited to participate, only 127 people provided feedback on the brokerage service model for Aboriginal people. Of these, 120 people identified as being Aboriginal. Participants said that the service helped them to navigate the system and access health care. Participants felt that the health professionals involved with the service were respectful of their needs. The service was not able to improve access to dental care. CONCLUSIONS The brokerage model implemented in this area appears to have been well received and is supporting urban Aboriginal people to access some of the health care needed.
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Affiliation(s)
- Sarah Dennis
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052, Australia.
| | - Iqbal Hasan
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052, Australia.
| | - Lisa Jackson Pulver
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia. Email
| | - Ian Wilson
- School of Medicine, University of Wollongong, Wollongong, NSW 2522 Australia. Email
| | - Nicholas Zwar
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052, Australia.
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S4AC Case Study: Enhancing Underserved Seniors’ Access to Health Promotion Programs. Can J Aging 2016; 35:89-102. [DOI: 10.1017/s0714980815000586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RÉSUMÉLes Services de soutien pour les aînés projet communautaire sud-asiatique (SSAPCSA) ont été développé en réponse à la sous-utilisation des loisirs disponibles et des installations pour les aînés par des aînés sud-asiatiques qui étaient particulièrement nombreux dans une banlieue en Colombie-Britannique. Abordant ce problème a nécessité la collaboration de la municipalité et un organisme enregistré à but non-lucratif offrant un large éventail de services et de programmes aux communautés immigrantes et réfugiées. Grâce à la sensibilisation créative et l’hébergement, le projet a engagé plus de 100 personnes âgées qui parlent panjabi chaque année à diverses activités impliquant l’exercice. Les méthodes de recherche ont porté sur l’étude de cas avec le personnel et les participants actuels et anciens cadres de SSAPCSA comprennent l’observation participante, entretiens individuels, et des groupes de discussion. Les conclusions, vues à travers le prisme d'interprétation critique de la “cadre de la candidature,” révèlent les multiples façons dans lesquelles l’accès à la promotion de la santé et l’activité physique pour les immigrants plus âgés est un processus complexe et itératif de négociation à plusieurs niveaux.
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Dennis S, Noon T, Liaw ST. Is there a role for a primary health nurse in a learning support team in a disadvantaged high school? Evaluation of a pilot study. Aust J Prim Health 2016; 22:530-538. [DOI: 10.1071/py15166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/24/2015] [Indexed: 11/23/2022]
Abstract
Disadvantaged children experience more health problems and have poorer educational outcomes compared with students from advantaged backgrounds. This paper presents the quantitative and qualitative findings from a pilot study to determine the impact of the Healthy Learner model, where an experienced primary care nurse was embedded in a learning support team in a disadvantaged high school. Students entering high school with National Assessment Program, Literacy and Numeracy (NAPLAN) scores in the lowest quartile for the school were assessed by the nurse and identified health issues addressed. Thirty-nine students were assessed in 2012–13 and there were up to seven health problems identified per student, ranging from serious neglect to problems such as uncorrected vision or hearing. Many of these problems were having an impact on the student and their ability to engage in learning. Families struggled to navigate the health system, they had difficulty explaining the student’s problems to health professionals and costs were a barrier. Adding a nurse to the learning support team in this disadvantaged high school was feasible and identified considerable unmet health needs that affect a student’s ability to learn. The families needed extensive support to access any subsequent health care they required.
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Hengel B, Guy R, Garton L, Ward J, Rumbold A, Taylor-Thomson D, Silver B, McGregor S, Dyda A, Knox J, Kaldor J, Maher L. Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study. Sex Health 2015; 12:4-12. [PMID: 25426563 DOI: 10.1071/sh14080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. METHODS A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. RESULTS Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. CONCLUSIONS Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.
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Affiliation(s)
- Belinda Hengel
- Apunipima Cape York Health Council, Cairns, PO Box 12045, Earlville, Qld 4870, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Linda Garton
- NT Department of Health, Sexual Health and Blood Borne Virus Unit, Darwin, NT 0810, Australia
| | - James Ward
- Baker IDI, PO Box 1294, Alice Springs, NT, 0871, Australia
| | - Alice Rumbold
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Debbie Taylor-Thomson
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Bronwyn Silver
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Skye McGregor
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Amalie Dyda
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Janet Knox
- Lismore Sexual Health Service, NSW Health, Sydney, NSW 2480, Australia
| | - John Kaldor
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Lisa Maher
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
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Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust 2014; 200:649-52. [PMID: 24938346 DOI: 10.5694/mja13.00005] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/13/2014] [Indexed: 11/17/2022]
Abstract
The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.
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Affiliation(s)
- Kathryn S Panaretto
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia.
| | - Mark Wenitong
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia
| | - Selwyn Button
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - Ian T Ring
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Lawrence JG, Carapetis JR, Griffiths K, Edwards K, Condon JR. Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circulation 2013; 128:492-501. [PMID: 23794730 DOI: 10.1161/circulationaha.113.001477] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although acute rheumatic fever (ARF) and its sequel, rheumatic heart disease (RHD), continue to cause a large burden of morbidity and mortality in disadvantaged populations, most studies investigating the effectiveness of control programs date from the 1950s. A control program, including a disease register, in the Northern Territory of Australia where the Indigenous population has high rates of ARF and RHD allowed us to examine current disease incidence and progression. METHODS AND RESULTS ARF and RHD incidence rates, ARF recurrence rates, progression rates from ARF to RHD to heart failure, and RHD survival and mortality rates were calculated for Northern Territory residents from 1997 to 2010. For Indigenous people, ARF incidence was highest in the 5- to 14-year age group (males, 162 per 100,000; females, 228 per 100,000). There was little evidence that the incidence of ARF or RHD had declined. The ARF recurrence rate declined by 9% per year after diagnosis. After a first ARF diagnosis, 61% developed RHD within 10 years. After RHD diagnosis, 27% developed heart failure within 5 years. For Indigenous RHD patients, the relative survival rate was 88.4% at 10 years after diagnosis and the standardized mortality ratio was 1.56 (95% confidence interval, 1.23-1.96). CONCLUSIONS For Indigenous Australians in the Northern Territory, ARF and RHD incidence and associated mortality remain very high. The reduction in ARF recurrence indicates that the RHD control program has improved secondary prophylaxis; a decline in RHD incidence is expected to follow.
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Affiliation(s)
- Joanna G Lawrence
- Department of Paediatrics, Royal Children’s Hospital, Melbourne, Australia.
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