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Khatri RB, Assefa Y. Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6648138. [PMID: 37901893 PMCID: PMC10611547 DOI: 10.1155/2023/6648138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/03/2023] [Accepted: 10/07/2023] [Indexed: 10/31/2023]
Abstract
Background Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. Methods We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). Results A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Conclusion Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.
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Affiliation(s)
- Resham B. Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Endalamaw A, Erku D, Khatri RB, Nigatu F, Wolka E, Zewdie A, Assefa Y. Successes, weaknesses, and recommendations to strengthen primary health care: a scoping review. Arch Public Health 2023; 81:100. [PMID: 37268966 DOI: 10.1186/s13690-023-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Primary health care (PHC) is a roadmap for achieving universal health coverage (UHC). There were several fragmented and inconclusive pieces of evidence needed to be synthesized. Hence, we synthesized evidence to fully understand the successes, weaknesses, effective strategies, and barriers of PHC. METHODS We followed the PRISMA extension for scoping reviews checklist. Qualitative, quantitative, or mixed-approach studies were included. The result synthesis is in a realistic approach with identifying which strategies and challenges existed at which country, in what context and why it happens. RESULTS A total of 10,556 articles were found. Of these, 134 articles were included for the final synthesis. Most studies (86 articles) were quantitative followed by qualitative (26 articles), and others (16 review and 6 mixed methods). Countries sought varying degrees of success and weakness. Strengths of PHC include less costly community health workers services, increased health care coverage and improved health outcomes. Declined continuity of care, less comprehensive in specialized care settings and ineffective reform were weaknesses in some countries. There were effective strategies: leadership, financial system, 'Diagonal investment', adequate health workforce, expanding PHC institutions, after-hour services, telephone appointment, contracting with non-governmental partners, a 'Scheduling Model', a strong referral system and measurement tools. On the other hand, high health care cost, client's bad perception of health care, inadequate health workers, language problem and lack of quality of circle were barriers. CONCLUSIONS There was heterogeneous progress towards PHC vision. A country with a higher UHC effective service coverage index does not reflect its effectiveness in all aspects of PHC. Continuing monitoring and evaluation of PHC system, subsidies to the poor, and training and recruiting an adequate health workforce will keep PHC progress on track. The results of this review can be used as a guide for future research in selecting exploratory and outcome parameters.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Lyall V, Egert S, Reid N, Moritz K, Askew D. "Our Mothers Have Handed That to Us. Her Mother Has Handed That to Her": Urban Aboriginal and Torres Strait Islander Yarning about Community Wellbeing, Healthy Pregnancies, and the Prevention of Fetal Alcohol Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095614. [PMID: 37174134 PMCID: PMC10178754 DOI: 10.3390/ijerph20095614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
In Australia, fetal alcohol spectrum disorder (FASD) is a largely hidden disability that is currently under-recognized, under-resourced, and under- or misdiagnosed. Unsurprisingly, efforts to prevent FASD in urban Aboriginal and Torres Strait Islander communities are lacking. Further, mainstream approaches are not compatible with diverse and distinct Aboriginal and Torres Strait Islander ways of approaching family, pregnancy, and parenting life. To support the creation of culturally appropriate urban Aboriginal and Torres Strait Islander FASD prevention strategies, we sought to understand local perspectives, experiences, and priorities for supporting healthy and alcohol-free pregnancies. Using a narrative methodology, we undertook research yarns with eight female and two male community participants. Data were analyzed using a narrative, thematic analysis and guided by an Indigenist research practice of reflexive listening. Participant yarns provided important insights into local urban Aboriginal and Torres Strait Islander cultural, social, and structural determinants that support family and child health, alcohol-free pregnancies, and the prevention of FASD. The results provide critical guidance for Indigenizing and decolonizing FASD prevention strategies to support culturally safe, relevant, and strengths-based services. This approach has critical implications for all health and social professionals and can contribute to Aboriginal and Torres Strait Islander peoples' justice, recovery, and healing from colonization.
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Affiliation(s)
- Vivian Lyall
- Medical School, General Practice Clinical Unit, Level 8 Health Sciences Building, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia
| | - Natasha Reid
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
| | - Karen Moritz
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
| | - Deborah Askew
- Medical School, General Practice Clinical Unit, Level 8 Health Sciences Building, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
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Naidoo T, Chamunyonga C, Burbery J, Rutledge P. Identifying methods to best integrate indigenous knowledge and perspectives within the radiation therapy undergraduate curriculum. J Med Radiat Sci 2023. [PMID: 36781205 DOI: 10.1002/jmrs.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
The Australian healthcare system continues to work towards close the gap to improve and achieve equality in health and life expectancy for Aboriginal and Torres Strait Islander peoples. When culturally safe practice is forefront, it may be the driving force in improving Indigenous Australian healthcare outcomes. For students and practitioners to be equipped with the industry-required cultural safety skills, we believe Indigenous Australian knowledge and perspectives must be effectively integrated into undergraduate education. A scoping review of the literature was conducted to identify the most effective teaching and learning methods and assessment tools to best integrate Indigenous knowledge and perspectives into undergraduate radiation therapy curriculum at Queensland University of Technology (QUT). Embase, CINAHL, Scopus and PubMed-Medline were searched to access peer-reviewed studies published between 2017 and 2022. A total of 591 articles were identified with 39 full-text articles meeting the inclusion criteria. Methods of teaching and learning and independent assessment tools that promote cultural capability in undergraduate education were identified. Findings included intensive patient-specific workshops, which were reported to provide students with an immersive learning experience, better preparing them for clinical placements and future practice. Additionally, other allied healthcare professions have utilised tools such as the Cultural Capability Management Tool (CCMT) and Trans-Cultural Self-Efficacy Tool (TSET) to quantitatively assess positive shifts and highlight developmental needs. These findings will inform current educational endeavours to promote cultural safety and the cultural capability continuum in the undergraduate radiation therapy curriculum.
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Affiliation(s)
- Thashmira Naidoo
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Crispen Chamunyonga
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Burbery
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peta Rutledge
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Effective primary care management of type 2 diabetes for indigenous populations: A systematic review. PLoS One 2022; 17:e0276396. [PMID: 36355789 PMCID: PMC9648771 DOI: 10.1371/journal.pone.0276396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors. Objectives This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index. Methods Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed. Results Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven components of effective interventions were identified. These were: a need to reduce health system barriers to facilitate access to primary care (which the other six components work towards), an essential role for Indigenous community consultation in intervention planning and implementation, a need for primary care programs to account for and adapt to changes with time in barriers to primary care posed by the health system and community members, the key role of community-based health workers, Indigenous empowerment to facilitate community and self-management, benefit of short-intensive programs, and benefit of group-based programs. Conclusions This study synthesises a decade of data from communities with a high burden of Type 2 Diabetes and limited research regarding health system approaches to improve diabetes-related outcomes. Policymakers should consider applying the seven identified components of effective primary care interventions when designing primary care approaches to mitigate the impact of Type 2 Diabetes in Indigenous populations. More robust and culturally appropriate studies of Type 2 Diabetes management in Indigenous groups are needed. Trail registration Registered with PROSPERO (02/04/2021: CRD42021240098).
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Lock Ngiyampaa MJ, McMillan Wiradjuri F, Warne Oglala Lakota D, Bennett Gamilaraay B, Kidd Ngāpuhi J, Williams Bkejwanong N, Martire JL, Worley P, Hutten-Czapski P, Saurman E, Matthews Quandamooka V, Walke Bundjalung E, Edwards Worimi D, Owen Nurrunga And Ngarrendjeri J, Browne J, Roberts R. ICIRAS: Research and reconciliation with indigenous peoples in rural health journals. Aust J Rural Health 2022; 30:550-558. [PMID: 35859346 PMCID: PMC9543535 DOI: 10.1111/ajr.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/26/2022] [Indexed: 01/22/2023] Open
Abstract
Aim We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. Context This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details. Approach An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is ‘nothing about Indigenous people, without Indigenous people’ in rural health research publications. Conclusion Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals “Editing with IndigenUs and for IndigenUs”.
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Affiliation(s)
- Mark J Lock Ngiyampaa
- Faculty of Health, School of Public Health, Girra Maa Indigenous Health Discipline, University of Technology Sydney, Sydney, NSW, Australia
| | - Faye McMillan Wiradjuri
- Faculty of Medicine and Health, School of Population, Aboriginal and Torres Strait Islander Health, University of New South Wales, Samuels Building University of NSW, Sydney, NSW, Australia
| | | | - Bindi Bennett Gamilaraay
- First Nations Health, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Qld, Australia
| | - Jacquie Kidd Ngāpuhi
- Maori Advancement Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Paul Worley
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Emily Saurman
- Broken Hill University Department of Rural Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Veronica Matthews Quandamooka
- Centre for Research Excellence: Strengthening Systems for Indigenous Health Care Equity (CRE- STRIDE), University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Emma Walke Bundjalung
- Centre for Research Excellence: Strengthening Systems for Indigenous Health Care Equity (CRE- STRIDE), University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Dave Edwards Worimi
- Digital Mental Health, University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | | | - Jennifer Browne
- Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Russell Roberts
- School of Business, Charles Sturt University, Bathurst, NSW, Australia
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Mitchell A, Wade V, Haynes E, Katzenellenbogen J, Bessarab D. “The world is so white”: improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease. Aust N Z J Public Health 2022; 46:588-594. [DOI: 10.1111/1753-6405.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/01/2021] [Accepted: 01/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alice Mitchell
- School of Population & Global Health University of Western Australia
| | - Vicki Wade
- Menzies School of Health Research Charles Darwin University Northern Territory
| | - Emma Haynes
- School of Population & Global Health University of Western Australia
| | | | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health University of Western Australia
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Lock (Ngiyampaa) M, McMillan (Wiradjuri) F, Warne (Oglala Lakota) D, Bennett (Gamilaraay) B, Kidd (Ngāpuhi) J, Williams (Bkejwanong) N, Martire (Australian settler) J, Worley P, Hutten-Czapski P, Saurman E, Matthews (Quandamooka) V, Walke (Bundjalung) E, Edwards (Worimi) D, Owen (Nurrunga and Ngarrendjeri) J, Browne J, Roberts R. Indigenous cultural identity of research authors standard: Research and reconciliation with Indigenous peoples in rural health journals. CANADIAN JOURNAL OF RURAL MEDICINE 2022; 27:104-110. [DOI: 10.4103/cjrm.cjrm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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