Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

Patients' experiences in the use of mobile health clinics in KwaMachi rural area of KwaZulu-Natal, South Africa

Background

A study was conducted to evaluate the role of mobile health clinics (MHCs) in providing healthcare services in rural areas, focusing on the population of KwaMachi in KwaZulu Natal, South Africa. The objective of the study was to explore the level of health promotion and health-seeking behaviour in KwaMachi, understand the services provided by the MHCs, and assess the experiences of individuals accessing healthcare through these clinics.

Methods

The study used qualitative research methods, including face-to-face interviews and focused group discussions. A sample of 20 patients, with equal representation of males and females across different age groups, was selected using purposive and convenience sampling methods. Two themes were developed: positive experiences and negative experiences. The collected data was analyzed using manual thematic analysis.

Findings

The findings of the study revealed that MHCs serve as the main entry point to the national healthcare system in rural areas, but they offer limited services, which contributes to the ongoing struggle of rural communities to access primary healthcare. While respondents generally had positive experiences with MHCs, some negative aspects need to be addressed. These included concerns about privacy during consultations, the unavailability of essential medications, limited services offered, lack of doctors, and inadequate management of clinical records leading to diagnostic inaccuracies.

Conclusion

The study highlights the challenges faced by rural communities in accessing healthcare services and the role of MHCs in addressing these challenges Based on these findings, the study concludes that there is a need for sustainable MHC programs that address the specific needs and preferences of the local population.

Recommendations

These insights are of value to policymakers seeking to enhance the impact of MHCs in improving healthcare access and outcomes in rural areas. By looking at areas of improvement in the services provided by MHCs, including addressing privacy concerns, ensuring the availability of essential medications, and improving the management of clinical records. The study provides valuable insights for policymakers to enhance the effectiveness of MHC programs in rural areas.

Preconception Health of Indigenous Peoples in Australia, Canada, New Zealand, and the United States: A Scoping Review

BACKGROUND

There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States.

METHODS

This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis.

RESULTS

We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%).

CONCLUSIONS

While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.

The role of innovative technologies in reducing health system inequity

The scarcity of Health Human Resources (HHR), regional disparities, and decentralized healthcare systems have profoundly affected health equity in Canada. Adequate HHR allocation is essential for equitable healthcare delivery, and the COVID-19 pandemic has revealed the importance of resilient and culturally diverse organizational HHR. Geography and infrastructure shortcomings aggravate healthcare equity. This study examines the role of innovative technologies in reducing inequity and provides four practice-based examples in different therapeutic areas. Long-term solutions such as collaborative networks, infrastructure improvements, and effective HHR planning can mitigate current challenges. However, in the short and medium terms, advanced medical technologies, digital health, and artificial intelligence can reduce health inequities by improving access, reducing disparities, optimizing resource utilization, and providing skill development opportunities for healthcare professionals.

Spatial methods for measuring access to health care

Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research.

Responsiveness of a rural Aboriginal community controlled health organisation: A qualitative study

INTRODUCTION

Responsiveness of health care systems is a global concept defined as the ability of systems to function in a manner that meets the expectations of individuals, and is under-studied. In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are valued by Aboriginal and Torres Strait Islander Peoples for the provision of holistic culturally safe primary health care and are well positioned to be responsive to community needs.

OBJECTIVE

To develop a conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal and Torres Strait Islander Peoples in their service region.

DESIGN

A qualitative interview study using abductive reasoning was conducted. Interviews conducted with Aboriginal clients, key informants, and ACCHO health personnel from two evaluations undertaken in partnership with a rural ACCHO located in Victoria, Australia, were analysed through an iterative process of identifying key concepts from the data and evidence. Key concepts were used to develop a conceptual framework.

FINDINGS

Across the two evaluations, 22 participants were involved in data collection and 28 interviews were undertaken. A conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal Peoples within their service region was developed and encompassed three concepts: operating within a complex adaptive system, mechanisms of responsiveness used by the ACCHO, and challenges experienced by the ACCHO when being responsive.

DISCUSSION

The developed conceptual framework expands on research supporting the value of ACCHOs in providing holistic culturally safe health care to their communities, particularly in rural settings. A key finding is the importance for ACCHOs to meet the health care needs of their community whilst navigating needs in the context of the broader health care system. When dissonance is encountered between external system components and community needs, challenges can be experienced such as adequately resourcing models of service delivery and maintaining the provision of services.

CONCLUSION

Conceptualising the health care system as a complex adaptive system in which an ACCHO operates and is responsive, highlights the competing demands experienced. Findings expand on mechanisms of responsiveness used at the service-user interface. Future research should examine how the broader health care system can support the role and functions of ACCHOs in being responsive to the health care needs of their communities.

The impact of rurality on vulvodynia diagnosis and management: Primary care provider and patient perspectives

Objective

The objective of this study was to better understand how rurality impacts the knowledge, diagnosis and management of vulvodynia by primary care providers (PCPs) practising in the geographically disparate province of Newfoundland and Labrador, Canada.

Design

This was a qualitative case study using questionnaires and semi-structured interviews with PCPs, compared with semi-structured focus groups and interviews with vulvodynia patients conducted in a previous study phase.

Results

Ten family physicians and 6 nurse practitioners participated. Over half had baseline knowledge that vulvodynia has a relatively high prevalence, but most underestimated the likelihood they would see a patient with vulvodynia in their practice. Three barriers to discussing and managing vulvodynia emerged: (1) discomfort initiating sexual/vulvar health conversations; (2) concerns about protecting patient privacy and confidentiality; and (3) time constraints and building therapeutic relationships. These issues were largely corroborated by previous findings with vulvodynia patients. Rural-informed solutions might include: (1) supporting increased education in vulvodynia and sexual health more broadly, including funding to attend continuing professional education and developing more clinical tools; (2) following practice guidelines regarding standardised initiation of sexual health conversations; (3) incentivising retention of rural providers and extending appointment times by reconsidering fee-for-service structures; and (4) researching a tailored vulvodynia toolkit and the potential advantage of mobile health units.

Conclusion

Rurality exacerbates common concerns in the identification and management of vulvodynia. Acting on recommended solutions may address the impact of rurality on the provision of timely care for those experiencing vulvodynia and other sexual health concerns.

Exploring the barriers and facilitators to accessing and utilising mental health services in regional, rural, and remote Australia: A scoping review protocol

INTRODUCTION

Australians from regional, rural, and remote areas face diverse and complex challenges in accessing and utilising mental health services. Previous research has pointed to a range of individual, community, structural, and systemic barriers at play, however, limited literature has synthesised the knowledge on this topic. Parallel to this, information on the facilitators to accessing and utilising mental health services for this group is not well documented. This protocol describes the methodology to undertake a scoping review, which aims to explore the barriers and facilitators associated with accessing and utilising mental health services in regional, rural, and remote Australia. In addition, the scoping review aims to geographically map the identified barriers and facilitators.

METHODS

This protocol is guided by Arksey and O'Malley's methodological framework. A search strategy will be developed and implemented to identify relevant peer-reviewed and grey literature. Studies will be included if they report on the barriers and/or facilitators associated with accessing and/or utilising mental health services in regional, rural, and remote Australia. Two reviewers will independently screen the data at the title/abstract and full-text stage. One reviewer will extract the relevant data using a predetermined charting form and a second reviewer will validate the included data. A Geographical Information System program will be used to map the location of the studies; locations will be stratified according to the Modified Monash Model and relationships between barriers and facilitators will be analysed. Key findings will be presented in a narrative account and in text, tables, and maps.

DISCUSSION

This scoping review will provide a contemporary account on the barriers and facilitators to accessing and utilising mental health services for regional, rural, and remote Australians. It is anticipated that the results of this scoping review will have national policy relevance and may be useful to healthcare providers.

An Aboriginal Community-Controlled Health Organization model of service delivery: qualitative process evaluation of the Tulku wan Wininn mobile clinic

BACKGROUND

Mobile clinics have been implemented in diverse clinical and geographical settings to provide proximal health care for specific populations. Primary health care mobile clinics have been implemented widely for Indigenous populations, with a paucity of research evaluations around service delivery models internationally. To redress factors impeding service accessibility for Aboriginal and Torres Strait Islander Peoples, Budja Budja Aboriginal Cooperative (Aboriginal Community Controlled Health Organisation located in a small rural town in Victoria, Australia), developed and implemented the Tulku wan Wininn primary health mobile clinic.

METHODS

A qualitative process evaluation methodology was used to explore contextual factors mediating the implementation of the mobile clinic, including the acceptability of the service to health service personnel, external key informants, and Aboriginal and/or Torres Strait Islander clients. A synthesis of international ethical guidelines, (Consolidated Criteria for strengthening reporting of health research involving Indigenous peoples (CONSIDER statement), was prospectively applied to shape the study design and research process. Semi-structured interviews were conducted with participants. Data collection occurred from July 2019 to October 2021. Inductive thematic data analysis was undertaken concurrently with data collection.

RESULTS

Data was collected from 19 participants which included 12 health service personnel and key informants, and 7 Aboriginal clients. In total, data from 22 interviews were included as interviews with three clients were undertaken twice. Four themes were developed: considerations for early implementation, maintaining face-to-face services during COVID-19, acceptability as a model of service delivery, and maintaining the mobile clinic as a service delivery model.

CONCLUSION

Evidence supporting the acceptability of a primary health care mobile clinic for Aboriginal Peoples residing in rural Victoria is provided. Despite the experience of early implementation challenges and adaptations, the mobile clinic addressed known transport and cultural barriers to accessing primary health care services. In the context of COVID-19 lockdowns, the mobile clinic was valued for the provision of face-to-face care for Aboriginal clients. Key issues for maintaining the mobile clinic include health workforce and funding. Findings are of value to other organizations seeking to implement a primary health mobile clinic service delivery model to redress barriers to accessibility experienced by the communities they serve.

Opportunities for further changes to the Medicare Benefits Schedule to support Aboriginal Community Controlled Health Organisations

The Australian Government responded promptly to the need for minimising patient-clinician contact in the primary care setting during COVID-19 by introducing new funding for telehealth services as part of the Medicare Benefits Schedule (MBS). Funding for both telephone and videoconferencing provided primary care organisations, including Aboriginal Community Controlled Health Organisations (ACCHOs), with the ability to continue meeting the healthcare needs of their Communities, particularly given that Aboriginal and Torres Strait Islander Peoples were identified as susceptible to COVID-19. This perspective considers the need for proactive changes to the MBS to support the delivery of culturally appropriate primary healthcare services, including by mobile clinics, to Aboriginal and Torres Strait Islander Peoples by ACCHOs beyond the COVID-19 pandemic.