1
|
Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
Collapse
Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
| | | | | | | | | | | |
Collapse
|
2
|
Hornby-Turner YC, Russell SG, Quigley R, Matthews V, Larkins S, Hayman N, Lakhan P, Flicker L, Smith K, McKeown D, Cadet-James D, Cass A, Garvey G, LoGiudice D, Miller G, Strivens E. Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol. Methods Protoc 2023; 6:103. [PMID: 37888035 PMCID: PMC10609630 DOI: 10.3390/mps6050103] [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: 08/08/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.
Collapse
Affiliation(s)
- Yvonne C. Hornby-Turner
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Sarah G. Russell
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW 2145, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Crawley, WA 6009, Australia;
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia
| | | | - Diane Cadet-James
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia;
| | - Gail Garvey
- School of Public Health, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dina LoGiudice
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3050, Australia
| | - Gavin Miller
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
| |
Collapse
|
3
|
Bryant J, Freund M, Ries N, Garvey G, McGhie A, Zucca A, Hoberg H, Passey M, Sanson-Fisher R. Volume, scope, and consideration of ethical issues in Indigenous cognitive impairment and dementia research: A systematic scoping review of studies published between 2000-2021. DEMENTIA 2022; 21:2647-2676. [PMID: 36054372 DOI: 10.1177/14713012221119594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION High quality research involving Indigenous people with cognitive impairment and dementia is critical for informing evidence-based policy and practice. We examined the volume, scope and ethical considerations of research related to dementia with Indigenous populations globally from January 2000-December 2021. METHODS Studies were included if they were published in English from 2000 to 2021 and provided original data that focused on cognitive impairment or dementia in any Indigenous population. RESULTS The search yielded 13,009 papers of which, 76 met inclusion criteria. The overall number of papers increased over time. Studies were mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 30; 39%). Twenty-six papers directly involved Indigenous participants with cognitive impairment or dementia. Of these studies, ethics approval was commonly required from two or more committees (n = 23, 88.5%). Ethical and legal governance frameworks were rarely discussed. DISCUSSION There is a clear need for further robust studies examining cognitive impairment and dementia with Indigenous populations. Future research should consider the ethical aspects of involving Indigenous participants with cognitive impairment in research.
Collapse
Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nola Ries
- Faculty of Law, 1994University of Technology Sydney, Sydney, NSW, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, 10095Menzies School of Health Research, Causarina, Northern Territory, Australia
| | - Alexandra McGhie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alison Zucca
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Hana Hoberg
- Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, 10095Menzies School of Health Research, Causarina, Northern Territory, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
4
|
Gubhaju L, Turner K, Chenhall R, Penny E, Drmota S, Hawea S, Carroll S, Hunt K, Eades F, Eades S. Perspectives, understandings of dementia and lived experiences from Australian Aboriginal people in Western Australia. Australas J Ageing 2022; 41:e284-e290. [PMID: 35187775 PMCID: PMC9545267 DOI: 10.1111/ajag.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/23/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We explored understandings about dementia and lived experiences from carers among community-dwelling Aboriginal people in Western Australia (WA). METHODS In partnership with Aboriginal medical services in WA, we conducted semi-structured interviews with Aboriginal people in Perth and Bunbury. All interviews were transcribed verbatim and coded thematically. RESULTS We conducted 39 interviews. Dementia was associated with 'losing your memory', a 'change in behaviour' and unhealthy lifestyles. Increasing awareness about dementia in the community was noted particularly to enable people to recognise the early signs, feel safe to ask for help and know how to best support families. Families were primarily responsible for caring for people with dementia and were finding it difficult to manage. They expressed negative experiences with currently available aged care facilities. CONCLUSIONS Increased awareness of dementia in the community through public health messaging and by health professionals and culturally secure services focussing on dementia care is required.
Collapse
Affiliation(s)
- Lina Gubhaju
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kyle Turner
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Richard Chenhall
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Elsie Penny
- South West Aboriginal Medical ServiceBunburyWestern AustraliaAustralia
| | - Susan Drmota
- South West Aboriginal Medical ServiceBunburyWestern AustraliaAustralia
| | - Shanelle Hawea
- South West Aboriginal Medical ServiceBunburyWestern AustraliaAustralia
| | | | - Kerry Hunt
- Department of HealthPerthWestern AustraliaAustralia
| | | | - Sandra Eades
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
- Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
| |
Collapse
|
5
|
Temple J, Wilson T, Radford K, LoGiudice D, Utomo A, Anstey KJ, Eades S. Demographic drivers of the growth of the number of Aboriginal and Torres Strait Islander people living with dementia, 2016-2051. Australas J Ageing 2022; 41:e320-e327. [PMID: 35993283 PMCID: PMC10087408 DOI: 10.1111/ajag.13116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the demographic drivers that contribute to the future growth in the population of Aboriginal and Torres Strait Islander peoples living with dementia in Australia. METHODS Design: Multistate, Indigenous status, cohort component, population projection model. SETTING National-level, Aboriginal and Torres Strait Islander population. DATA Data prepared by the Australian Bureau of Statistics on births, deaths, migration and identification change. Australian Institute of Health and Welfare estimates of dementia prevalence alongside estimates from several studies. MAJOR OUTCOME MEASURES Number of older people living with dementia alongside a decomposition of demographic drivers of growth. RESULTS By 2051, the relative growth in the number of Aboriginal and Torres Strait Islander peoples aged 50+ with dementia ranges from 4½ to 5½ times (under three prevalence scenarios) its 2016 estimate. Cohort flow (the gradual movement of younger cohorts into the 50+ age group, and the depletion of older cohorts from death, over time) is a key driver of the growth in the number of older people living with dementia. CONCLUSIONS High growth in the number of people living with dementia poses implications for culturally appropriate care, health-care access and support for Aboriginal and Torres Strait Islander families, carers and their communities.
Collapse
Affiliation(s)
- Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tom Wilson
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kylie Radford
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ariane Utomo
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Sandra Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Brown C, Shahid S, Bernardes CM, Toombs M, Clark PJ, Powell EE, Valery PC. Partnering with support persons and clinicians to improve the health care experiences of patients with cirrhosis. J Clin Nurs 2022; 32:2559-2574. [PMID: 35451073 DOI: 10.1111/jocn.16302] [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: 01/27/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore the care experiences of Aboriginal and Torres Strait Islander Australians diagnosed with cirrhosis with a focus on support needed. BACKGROUND Cirrhosis disproportionately affects Indigenous Australians, and liver diseases contribute to the mortality gap between Indigenous and other Australian adults. DESIGN A qualitative study. METHODS Using yarning methods, Indigenous patients (n = 13) and support persons (n = 3) were interviewed by an Aboriginal researcher during April-July, 2020. Thematic analysis was used to identify common themes using an inductive approach. RESULTS Six themes emerged. (1) Experience of diagnosis. This theme included stories of delays in the system, self-awareness of signs and symptoms and relief of being diagnosed. (2) 'Shame, shame, shame'. Experiences of prejudices and discrimination from health professionals, the lack of understanding of cirrhosis among health professionals, and stories about alcohol cessation and counselling around alcohol cessation. (3) Health literacy. Participants' understanding of cirrhosis was variable. While the importance of knowledge was recognised, 'what works for someone might not work for others'. Several patients partnered with their support persons and clinicians to bridge the health literacy gap. (4) Sources of support included family and friends, transport facilities, health professionals and peers. (5) Positive and negative aspects of communication and patient consultation were discussed. (6) Psychosocial counselling to 'look after the caring side'. The need for more mental health care services was raised. CONCLUSION Barriers related to poor health literacy, stigma and lack of practical and emotional support, and issues with communication and patient consultation, may lead to inequitable access to cirrhosis care and treatment for Indigenous Australians. RELEVANCE TO CLINICAL PRACTICE Gaining knowledge of the experiences of Indigenous Australians with cirrhosis is important for providing patient-centred and culturally appropriate care. Liver specialist nurses have an important role in bridging the health literacy gap and in supporting Indigenous patients and families.
Collapse
Affiliation(s)
- Catherine Brown
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Shaouli Shahid
- Centre for Aboriginal Studies, Curtin University, Perth, WA, Australia
| | - Christina M Bernardes
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Maree Toombs
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, Queensland, Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| |
Collapse
|