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Adamu AA, Jalo RI, Ndwandwe D, Wiysonge CS. Exploring the complexity of the implementation determinants of human papillomavirus vaccination in Africa through a systems thinking lens: A rapid review. Hum Vaccin Immunother 2024; 20:2381922. [PMID: 39113230 PMCID: PMC11312990 DOI: 10.1080/21645515.2024.2381922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 08/11/2024] Open
Abstract
A rapid review was conducted to explore the implementation determinants of human papillomavirus (HPV) vaccination in the World Health Organization African Region and describe their dynamic relationship. PubMed and Google Scholar were searched in October 2023 to find relevant literature. A total of 64 published studies that reported factors affecting HPV vaccination were identified. Analysis of identified factors yielded 74 implementation determinants of HPV vaccination across the five domains of the Consolidated Framework for Implementation Research (CFIR): two (2.70%) were in the innovation domain, seven (9.46%) were in the outer setting domain, 14 (18.92%) were in the inner setting domain, 37 (50%) were in the individual domain and 14 (18.92%) were in the implementation process domain. A causal loop diagram of these implementation determinants revealed four balancing and seven reinforcing loops. Applying systems lens promoted a more holistic understanding of the implementation determinants of HPV vaccination, exposing leverage points for interventions.
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Affiliation(s)
- Abdu A. Adamu
- Polio Eradication Programme, World Health Organization Region Office for Africa, Djoue, Congo
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Djoue, Congo
| | - Rabiu I. Jalo
- Department of Community Medicine, Faculty of Clinical Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Djoue, Congo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Zagler J, Yu N, Cleland A. "The system allows for it to happen": the experiences of human service workers in engaging with Aboriginal participants of the National Disability Insurance Scheme. Disabil Rehabil 2024:1-9. [PMID: 39126154 DOI: 10.1080/09638288.2024.2388874] [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: 11/27/2023] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE The purpose of this study was to explore the experiences of human service workers (HSWs) in engaging with Aboriginal participants of the National Disability Insurance Scheme (NDIS). METHODS Semi-structured interviews were undertaken with HSWs engaging with Aboriginal participants of the NDIS on Kaurna Country (Adelaide, South Australia). Data were analyzed using thematic analysis. RESULTS In total, n = 10 HSWs participated in the study. Three themes impacting upon HSWs ability to effectively engage with Aboriginal participants were identified: (1) lack of access to training, support and supervision, (2) difficulties in navigating assessment and intervention, and (3) limited availability of culturally specific services. CONCLUSIONS This study contributes to Australian disability policy and practice with insights gained from the experiences of human service workers engaging with aboriginal participants of the NDIS. Systemic changes are required within policy and funding arrangements to create a system flexible enough to respond to the needs of Aboriginal Peoples with disability.
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Affiliation(s)
- Jonathon Zagler
- Justice and Society, University of South Australia, Magill, South Australia, Australia
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nilan Yu
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| | - Amy Cleland
- Justice and Society, University of South Australia, Magill, South Australia, Australia
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Lau G, Walker R, Laird P, Lewis P, Kuthubutheen J, Schultz A. Identifying barriers and facilitators for the effective diagnosis and provision of primary health care for otitis media from the perspective of carers of Aboriginal children. J Paediatr Child Health 2024. [PMID: 39032110 DOI: 10.1111/jpc.16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/21/2024] [Accepted: 07/11/2024] [Indexed: 07/22/2024]
Abstract
AIM To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children. METHODS A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development. Data underwent thematic analysis using NVivo software. RESULTS Thirty-two carers of Aboriginal children participated. Key barriers identified for the detection of OM were limited information about OM provided to carers and carers feeling disempowered to express their concerns. Key facilitators identified were the provision of health information through health promotion and the use of culturally secure resources. Having a culturally secure clinical environment was identified as essential, with Aboriginal Health Workers playing a vital role in clinical care. No barriers to management of OM in primary care were reported. Facilitators included health care practitioners (HCPs) emphasising the importance of completing antibiotic course and the clinic providing necessary medications. CONCLUSIONS A culturally secure health promotion strategy with health promotion teams, campaigns and resources is needed to increase community awareness of OM signs and symptoms and facilitate appropriate health seeking. It is essential that the local Aboriginal community co-lead and co-develop these initiatives to ensure the unique wisdom and knowledge of Aboriginal people are captured. HCPs and the clinic effectively facilitate management of OM by providing medications and emphasising completion of antibiotics.
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Affiliation(s)
- Gloria Lau
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, Perth, Western Australia, Australia
| | - Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Philomena Lewis
- Broome Regional Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Jafri Kuthubutheen
- Division of Surgery, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Brewer KM, Taueetia-Su'a T, Hanchard S, Vaka S, Ameratunga S, Tane T, Newport R, Selak V, Grey C, Harwood M. Māori and Pacific families' experiences and perspectives of cardiovascular care; A qualitative study. Aust N Z J Public Health 2024; 48:100149. [PMID: 38733861 DOI: 10.1016/j.anzjph.2024.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/18/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE This study aimed to understand the reasons behind evidence-practice gaps and inequities in cardiovascular care for Māori and Pacific people, as evidenced by the experiences and perspectives of patients and their families. METHODS The research was guided by Māori and Pacific worldviews, incorporating Kaupapa Māori Theory and Pacific conceptual frameworks and research methodologies. Template analysis was used to analyse interview data from 61 Māori and Pacific people who had experienced a cardiovascular disease (CVD) risk assessment, acute coronary syndrome, and/or heart failure. RESULTS The range of experiences relating to participants' heart health journeys are presented in five main themes: Context, Mana (maintaining control and dignity), Condition, People and Journey. CONCLUSIONS Māori and Pacific people want to take charge of their heart health but face challenges. Participants described important obligations to family, community and tikanga (the culturally correct way of doing things). Participants described times when health care undermined existing responsibilities, their dignity and/or their mana, and they felt excluded from treatment as a result. IMPLICATIONS FOR PUBLIC HEALTH Good reciprocal communication, stemming from a high-quality relationship is essential for successful outcomes. A workforce that is representative of the population it serves and is culturally safe lays the foundation for excellence in care.
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Affiliation(s)
- Karen Marie Brewer
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Tua Taueetia-Su'a
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sandra Hanchard
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sione Vaka
- The University of Waikato Te Huataki Waiora School of Health Dean's Office, Hamilton, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Te Whatu Ora | Health New Zealand - Counties Manukau, Auckland, New Zealand
| | - Taria Tane
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rochelle Newport
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Corina Grey
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Donkin L, Bidois-Putt MC, Wilson H, Hayward P, Chan AHY. An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups. JMIR Form Res 2024; 8:e50385. [PMID: 38696236 PMCID: PMC11099811 DOI: 10.2196/50385] [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: 06/29/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. OBJECTIVE This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. METHODS We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. RESULTS Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. CONCLUSIONS While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations' world views.
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Affiliation(s)
- Liesje Donkin
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | - Holly Wilson
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Penelope Hayward
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
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Yadav UN, Davis JM, Bennett-Brook K, Coombes J, Wyber R, Pearson O. A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care. Health Res Policy Syst 2024; 22:34. [PMID: 38509612 PMCID: PMC10956197 DOI: 10.1186/s12961-024-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations. METHODS We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to "Aboriginal and Torres Strait Islander peoples," "Chronic Disease," and "Primary Health Care". Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches. RESULTS Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery. CONCLUSION Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | | | | | | | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
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Oetzel J, Ngawati R, Penetito-Hemara D, Puke TT, Henry A, Povaru-Bourne S, Sika-Paotonu D. Facilitators and barriers for implementation of health programmes with Māori communities. Implement Sci Commun 2024; 5:26. [PMID: 38500225 PMCID: PMC10946171 DOI: 10.1186/s43058-024-00567-y] [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: 11/10/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Addressing health inequities that Māori (Indigenous peoples) communities face in New Zealand is a key aim of researchers and practitioners. However, there is limited understanding of the implementation processes and outcomes of health programmes for addressing these inequities. The aim of this study was twofold: (a) to identify correlates of implementation outcomes and (b) to identify facilitators and barriers to implementation effectiveness. METHODS The study involved a concurrent mixed method approach. Through an online survey, 79 participants with experience in implementing a health programme with a Māori community identified outcomes and processes of the programme. Additionally, nine Māori community providers shared their perceptions and experience of facilitators and barriers to implementation effectiveness through an in-depth interview. The quantitative and qualitative findings were integrated to address the aims of the study. RESULTS For the first aim, we identified two key outcomes: overall health impacts and sustainability. Three of the variables had significant and positive bivariate correlations with health impacts: cultural alignment, community engagement, and individual skills. The only significant correlate of sustainability was evidence-based. For the second aim, participants described four facilitators (leadership, whanaungatanga [relationships], sharing information, digestible information) and four barriers (system constraints, lack of funding, cultural constraints, lack of engagement) to effective implementation. CONCLUSION Overall, leadership, aligning culture, and building on whanaungatanga, while getting financial resources and systems support, are the core elements to supporting implementation efforts in Māori communities.
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Affiliation(s)
- John Oetzel
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Renei Ngawati
- Te Hotu Manawa Māori trading as Toi Tangata, 9 Kalmia Street, Auckland, 1051, New Zealand
| | - Darrio Penetito-Hemara
- Te Hotu Manawa Māori trading as Toi Tangata, 9 Kalmia Street, Auckland, 1051, New Zealand
| | - Tori Te Puke
- Te Hotu Manawa Māori trading as Toi Tangata, 9 Kalmia Street, Auckland, 1051, New Zealand
- South Waikato Pacific Islands Community Services Trust, 1 Maraetai Lane, Tokoroa, 3420, New Zealand
| | - Akarere Henry
- South Waikato Pacific Islands Community Services Trust, 1 Maraetai Lane, Tokoroa, 3420, New Zealand
| | - Sulita Povaru-Bourne
- South Waikato Pacific Islands Community Services Trust, 1 Maraetai Lane, Tokoroa, 3420, New Zealand
| | - Dianne Sika-Paotonu
- University of Otago, Wellington, 23A Mein Street, Wellington, 6242, New Zealand
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Gustafson P, Lambert M, Bartholomew K, Ratima M, Aziz YA, Kremer L, Fusheini A, Carswell P, Brown R, Priest P, Crengle S. Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context. Int J Equity Health 2024; 23:15. [PMID: 38280997 PMCID: PMC10822165 DOI: 10.1186/s12939-023-02087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/20/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands. METHODS A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. RESULTS The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. CONCLUSIONS The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Lisa Kremer
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | | | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054.
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Krahe MA, Hall KK, Anderson PJ, Shannon C. Mapping the knowledge structure and trends in Australian Indigenous health and wellbeing research from 2003 to 2022: a scientometric analysis. FRONTIERS IN SOCIOLOGY 2023; 8:1290322. [PMID: 38098755 PMCID: PMC10720666 DOI: 10.3389/fsoc.2023.1290322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
The health and wellbeing of Australian Indigenous peoples is a nationally sanctioned priority, but despite this, few studies have comprehensively analyzed the features and characteristics of the research in the field. In this regard, a comprehensive scientometric analysis and knowledge mapping to systematically summarize and discuss the current state of research, research trends, and emerging areas of research were conducted. Original articles and reviews published between 2003 and 2022 were obtained from the Web of Science Core Collection. CiteSpace and VOSviewer software were used to perform scientometric analysis and knowledge mapping. An examination of document and citation trends, authors, institutions, countries/regions, journals, and keywords was untaken, while co-citation, co-occurrence, and burst analysis provide insights and future development in this area. A total of 2,468 documents in this field were retrieved. A gradual increase in the number of documents over the past two decades is observed, with the number of documents doubling every ~7.5 years. Author Thompson SC and Charles Darwin University published the most documents, and 85.6% were affiliated with only Australian-based researchers. The Australian and New Zealand Journal of Public Health is the most prominent journal publishing in the field. The most commonly co-occurring keyword was "health," and the keyword "risk" had the longest citation burst. Five keyword clusters were identified; "cultural safety" was the largest. This study articulates the knowledge structure of the research, revealing a shift from population-level and data-driven studies to more applied research that informs Indigenous peoples health and wellbeing. Based on this review, we anticipate emergent research areas to (1) reflect a more comprehensive understanding of the multidimensional factors that shape Indigenous health and wellbeing; (2) move beyond a deficit-based perspective; (3) respect cultural protocols and protect the rights and privacy of Indigenous participants; (4) address racism and discrimination within the healthcare system; (5) foster respectful, equitable, and collaborative research practices with Indigenous peoples; (6) provide culturally appropriate and effective interventions for prevention, early intervention, and treatment; and (7) ensure equitable change in systems to enhance access, quality, and outcomes in health and wellbeing.
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Affiliation(s)
- Michelle A. Krahe
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Kerry K. Hall
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
| | - Peter J. Anderson
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
| | - Cindy Shannon
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
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Pandey M, Clark M, Beresh E, Nilson S, Kay C, Campbell T, Nicolay S, Skinner S. Wellness Wheel Clinics: A First Nation community-partnered care model improving healthcare access, from healthcare providers' perspectives. Health Promot Int 2023; 38:daad079. [PMID: 37590386 DOI: 10.1093/heapro/daad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
First Nation people residing in rural and remote communities have limited primary healthcare access, which often affects chronic disease management leading to poor health outcomes. Individuals with lived experiences of chronic disease and substance use, along with health directors, advocated for improved services. Subsequently, an urban healthcare team in partnership with four First Nation communities developed an Outreach clinic to address healthcare access barriers. Established in 2016, this community-led clinic improves primary care access and chronic disease management in First Nation communities. Employing a qualitative research design, interviews were conducted with 15 clinic providers and 9 community members to explore the clinic's 1-year post-implementation impacts. Thematic data analysis indicated that engagement and approval by community leadership, support from Elders and community members and collaboration with existing community healthcare staff were crucial for establishing the Outreach clinic. Initial logistical challenges with space allocation, equipment, medical supplies, funding, staffing, medical records and appointment scheduling were resolved through community consultation and creative solutions. A nurse coordinator ensured continuity of care and was integral to ensuring clients receive seamless care. The commitment of the outreach team and the collective goal of providing client-centered care were instrumental in the clinic's success. In partnership with communities, access to healthcare in First Nation communities can be enhanced by coordinating Outreach clinics through existing community healthcare facilities.
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Affiliation(s)
- Mamata Pandey
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Megan Clark
- Department of Academic Family Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
- Wellness Wheel Clinic, Regina, Saskatchewan, Canada
| | - Erin Beresh
- Department of Academic Family Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Solveig Nilson
- Department of Academic Family Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Cynthia Kay
- Health, TouchWood Agency Tribal Council, Punnichy, Saskatchewan, Canada
| | | | | | - Stuart Skinner
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
- Wellness Wheel Clinic, Regina, Saskatchewan, Canada
- Department of Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
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12
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Fournie M, Sibbald SL, Harris SB. Exploring quality improvement for diabetes care in First Nations communities in Canada: a multiple case study. BMC Health Serv Res 2023; 23:462. [PMID: 37161499 PMCID: PMC10170692 DOI: 10.1186/s12913-023-09442-3] [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: 01/21/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada. METHODS This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform the teams' QI process; (2) how the process was influenced by the context of primary care services within communities; and (3) the factors that supported or hindered their QI process. RESULTS The findings of this study demonstrate how teams drew upon multiple sources of knowledge and information to inform their QI work, the importance of strengthening relationships and building relationships with the community, the influence of organizational support and capacity, and the key factors that facilitated QI efforts. CONCLUSIONS This study contributes to the ongoing calls for research in understanding the process and factors affecting the implementation of QI strategies, particularly within Indigenous communities. The knowledge generated may help inform community action and the future development, implementation and scale-up of QI programs in Indigenous communities in Canada and globally.
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Affiliation(s)
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- The Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Granados Y, Gastelum Strozzi A, Alvarez-Nemegyei J, Quintana R, Julian-Santiago F, Santos AM, Guevara-Pacheco S, Loyola-Sanchez A, Goycochea-Robles MV, Juarez V, Garza-Elizondo MA, Rueda JC, Burgos-Vargas R, Londoño J, Pons-Estel BA, Pelaez-Ballestas I. Inequity and vulnerability in Latin American Indigenous and non-Indigenous populations with rheumatic diseases: a syndemic approach. BMJ Open 2023; 13:e069246. [PMID: 36958782 PMCID: PMC10040077 DOI: 10.1136/bmjopen-2022-069246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
UNLABELLED Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions. OBJECTIVE To estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach. DESIGN This is a secondary analysis of a previously published large-scale study on the prevalence of RMD. SETTING Studies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis. PARTICIPANTS A total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population. RESULTS The variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence. CONCLUSIONS A syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.
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Affiliation(s)
- Ysabel Granados
- Rheumatology Department, Hospital “Dr. Manuel Núñez Tovar”, Maturin, Venezuela
| | | | | | - Rosana Quintana
- Reumatology, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - Flor Julian-Santiago
- Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
| | - Ana M Santos
- Rheumatology, Universidad de La Sabana, Chia, Cundinamarca, Colombia
| | | | | | | | - Vicente Juarez
- Rheumatology Department, Hospital Señor del Milagro, Salta, Argentina
| | - Mario Alberto Garza-Elizondo
- Internal Medicine, Rheumatology Service, Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Juan Camilo Rueda
- Rheumatology, Universidad de La Sabana, Chia, Cundinamarca, Colombia
| | - Ruben Burgos-Vargas
- Rheumatology, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
| | - John Londoño
- Rheumatology, Universidad de La Sabana, Chia, Cundinamarca, Colombia
- Rheumatology, Hospital Militar Central, Chia, Cundinamarca, Colombia
| | | | - Ingris Pelaez-Ballestas
- Rheumatology Department, Hospital General de México Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
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McGuffog R, Bryant J, Booth K, Collis F, Brown A, Hughes JT, Chamberlain C, McGhie A, Hobden B, Kennedy M. Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3993. [PMID: 36901001 PMCID: PMC10001772 DOI: 10.3390/ijerph20053993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Romany McGuffog
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kade Booth
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Felicity Collis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex Brown
- Indigenous Genomics, Australia National University, Canberra, ACT 2601, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jaquelyne T. Hughes
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT 0810, Australia
| | - Catherine Chamberlain
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Alexandra McGhie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Breanne Hobden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
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Walker D, Tynan A, Tucker T, Fisher B, Fisher T. Engaging with a rural Aboriginal community to identify strategies to improve oral health within their community: a qualitative study. Aust J Prim Health 2023; 29:38-46. [PMID: 36318903 DOI: 10.1071/py22215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islanders bear a higher burden of oral disease compared to non-Indigenous persons. Rural Aboriginal and Torres Strait Islander communities are further disadvantaged due to service access difficulties. This study, initiated by community concern for oral health identified through its Health Action Group, aimed to explore a rural Aboriginal community's strategies to resolve oral health problems. CONCLUSION Community members are aware of local barriers and potential facilitators for improving oral health within their community. Their identification of priority strategies can be used to inform the delivery of oral healthcareservices and to develop oral healthcare promotion programs for the community. Co-designing solutions with the community should be an integral part of solving complex problems such as oral health. METHODS A qualitative research study using a phenomenological research design with focus group discussions and in-depth interviews was completed in partnership with a rural community in Queensland, Australia, with a predominantly Aboriginal population. The research team included Aboriginal and non-Aboriginal personnel; community and external personnel; and dental and non-dental personnel. The collaborative approach included the development, implementation, analysis and interpretation of the research involving the community through its Health Action Group. Community engagement led to the recruitment of 27 participants from local health and community groups. RESULTS Themes emerging from the data included: reducing financial barriers to accessing oral health care; integrating oral health care with other health services; increasing oral healthcare promotion activities; and ensuring local input and cultural safety within local oral healthcare services.
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Affiliation(s)
- David Walker
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Anna Tynan
- Research Support Team, Baillie Henderson Hospital, Darling Downs Health, Corner of Torr and Hogg Street, Toowoomba, Qld 4350, Australia; and Southern Queensland Rural Health, The University of Queensland, Corner of Torr and Hogg Street, Toowoomba, Qld 4350, Australia
| | - Taygan Tucker
- Oral Health Services - Nhulunbuy, Top End Health Services, Northern Territory Government, Gove Dental Clinic, Endeavour Square, Nhulunbuy, NT 0880, Australia
| | - Barry Fisher
- Kingaroy Hospital, Darling Downs Health, 166 Youngman Street, Kingaroy, Qld 4610, Australia
| | - Tarita Fisher
- Darling Downs Health, PO Box 361, Murgon, Qld 4605, Australia
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Simpson ML, Ruru S, Oetzel J, Meha P, Nock S, Holmes K, Adams H, Akapita N, Clark M, Ngaia K, Moses R, Reddy R, Hokowhitu B. Adaptation and implementation processes of a culture-centred community-based peer-education programme for older Māori. Implement Sci Commun 2022; 3:123. [DOI: 10.1186/s43058-022-00374-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities.
Methods
The study was grounded in an Indigenous methodology (Kaupapa Māori) and a participatory research approach. Data were collected from research documentation, community meeting and briefing notes, and interviews with community researchers.
Results
The data analysis resulted in several key promising practices: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers’ existing and emerging relationships with kaumātua, research partners, and each other facilitated the implementation process; and Whakaoti Rapanga (problem-solving) which centred on the joint problem-solving undertaken by the community and university researchers, particularly around safety issues. These results illustrate content, process, and relationship issues associated with implementation effectiveness.
Conclusions
This study showed that relational factors are central to the co-design process and also offers an example of a braided river, or He Awa Whiria, approach to implementation. The study offers a valuable case study in how to translate, adapt, and implement a research-based health programme to Indigenous community settings through co-design processes.
Trial registration
The project was registered on 6 March 2020 with the Australia New Zealand Clinical Trial Registry: ACTRN12620000316909. Prospectively registered.
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Beks H, Mitchell F, Charles J, McNamara K, Versace V. An Aboriginal Community-Controlled Health Organization model of service delivery: qualitative process evaluation of the Tulku wan Wininn mobile clinic. Int J Equity Health 2022; 21:163. [PMID: 36384739 PMCID: PMC9667861 DOI: 10.1186/s12939-022-01768-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/13/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- H. Beks
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria Australia
| | - F. Mitchell
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria Australia
| | - J.A. Charles
- grid.1022.10000 0004 0437 5432First Peoples Health Unit, Health Group, Griffith University, Queensland, Australia
| | - K.P. McNamara
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria Australia
| | - V.L. Versace
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria Australia
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Carman W, Ishida M, Trounson JS, Mercer SW, Anindya K, Sum G, Armstrong G, Oldenburg B, McPake B, Lee JT. Epidemiology of physical-mental multimorbidity and its impact among Aboriginal and Torres Strait Islander in Australia: a cross-sectional analysis of a nationally representative sample. BMJ Open 2022; 12:e054999. [PMID: 36220313 PMCID: PMC9557280 DOI: 10.1136/bmjopen-2021-054999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to examine the differences in multimorbidity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, and the effect of multimorbidity on health service use and work productivity. SETTING Cross-sectional sample of the Household, Income and Labour Dynamics in Australia wave 17. PARTICIPANTS A nationally representative sample of 16 749 respondents aged 18 years and above. OUTCOME MEASURES Multimorbidity prevalence and pattern, self-reported health, health service use and employment productivity by Indigenous status. RESULTS Aboriginal respondents reported a higher prevalence of multimorbidity (24.2%) compared with non-Indigenous Australians (20.7%), and the prevalence of mental-physical multimorbidity was almost twice as high (16.1% vs 8.1%). Multimorbidity pattern varies significantly among the Aboriginal and non-Indigenous Australians. Multimorbidity was associated with higher health service use (any overnight admission: adjusted OR=1.52, 95% CI=1.46 to 1.58), reduced employment productivity (days of sick leave: coefficient=0.25, 95% CI=0.19 to 0.31) and lower perceived health status (SF6D score: coefficient=-0.04, 95% CI=-0.05 to -0.04). These associations were found to be comparable in both Aboriginal and non-Indigenous populations. CONCLUSIONS Multimorbidity prevalence was significantly greater among Aboriginal and Torres Strait Islanders compared with the non-Indigenous population, especially mental-physical multimorbidity. Strategies are required for better prevention and management of multimorbidity for the aboriginal population to reduce health inequalities in Australia.
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Affiliation(s)
- William Carman
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin S Trounson
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Stewart W Mercer
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Kanya Anindya
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Gregory Armstrong
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Health Service Research, Faculty of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Chando S, Dickson M, Howell M, Tong A, Craig JC, Slater K, Smith N, Nixon J, Eades SJ, Howard K. Delivering health programs for Aboriginal and Torres Strait Islander children: Carer and staff views on what's important. Health Promot J Austr 2022; 33 Suppl 1:222-234. [PMID: 35642336 PMCID: PMC9796828 DOI: 10.1002/hpja.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/28/2022] [Accepted: 05/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The lack of evidence on the priorities of carers and their Aboriginal and Torres Strait Islander children undermines decisions to improve participant experiences and engagement. AIMS This study describes carer and staff perspectives on the aspects of health services delivery that are important to carers and children. METHODS Nineteen carers of Aboriginal and Torres Strait Islander children and 17 staff who work at child health programs across two urban Aboriginal Community Controlled Health Services (ACCHSs) and affiliate organisations in New South Wales, Australia participated in semi-structured interviews. We used thematic analysis to analyse the data. RESULTS We identified five themes: valuing relational communication (building trust by keeping relationships at the centre, empowered to optimise child's development, feeling heard and known); confidence in provider's clinical and interpersonal skills (certain that the health issue will be resolved, engaging with the child to allay fears, facilitating timely health care); finding comfort and security in community embedded services (safety and acceptance in the familiar, strengthening child's connection to culture); support to access and navigate health services (accessible information appropriately presented, easy and flexible scheduling, easing the shame of financial hardship); sustaining service use (fulfilling expectations for service standards, demonstrating commitment through ongoing programs, clarity of benefits). CONCLUSIONS Carers and staff reported that approaches to communication, the content of that communication, how access is facilitated and the service environment managed influences their decisions to interact with health services. With these data decision-makers can better focus resources to improve experiences with their services.
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Affiliation(s)
- Shingisai Chando
- Sydney School of Public HealthThe University of SydneySydneyNSWAustralia,Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNSWAustralia
| | - Michelle Dickson
- Sydney School of Public HealthThe University of SydneySydneyNSWAustralia
| | - Martin Howell
- Sydney School of Public HealthThe University of SydneySydneyNSWAustralia,Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNSWAustralia
| | - Allison Tong
- Sydney School of Public HealthThe University of SydneySydneyNSWAustralia,Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNSWAustralia
| | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideSAAustralia
| | - Kym Slater
- Tharawal Aboriginal CorporationAirdsNSWAustralia
| | - Natalie Smith
- Riverina Medical and Dental Aboriginal CorporationWagga WaggaNSWAustralia
| | | | | | - Kirsten Howard
- Sydney School of Public HealthThe University of SydneySydneyNSWAustralia
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20
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Macniven R, Simon A, Wilson R, Howie A, Stewart G, Ma T, Turner NJ, Cairnduff S, Coombes J. Ironbark: Developing a healthy community program for older Aboriginal people. Health Promot J Austr 2022; 33 Suppl 1:128-133. [PMID: 35148452 PMCID: PMC9790301 DOI: 10.1002/hpja.581] [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: 08/18/2020] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
ISSUE ADDRESSED Programs by, with and for Aboriginal older people must be culturally safe and relevant. Successful elements include being Aboriginal specific and group based. Co-design with Aboriginal people and stakeholders is essential. We describe the co-design process of developing the Ironbark: Healthy Community program. METHODS Aboriginal ways of knowing, being and doing and yarning conversational methods guided the development process, during 2018. A desktop review provided details of current group characteristics and key community stakeholders. Stakeholder engagement regarding views about group operations, participants and benefits also occurred. Aboriginal Elders views of their groups were gathered through yarning circles in New South Wales (NSW). Grounded theory approach was used to ascertain key themes. RESULTS Initial engagement occurred with 13 different community stakeholders and organisations in three Australian states (NSW, South Australia (SA), Western Australia (WA)). Three yarning circles occurred with Elders from urban (N = 10), regional coastal (N = 10) and regional country (N = 4) groups. Six key themes were organised in three groups according to an Aboriginal ontology. 1. Knowing: groups provide opportunities to share knowledge and connect socially. Adequate program resourcing and sustainability are valued. 2. Being: groups strengthen culture, providing important social, emotional and other forms of support to age well. 3. Doing: previous program experiences inform perceptions for new program operations. Group venues and operational aspects should be culturally safe, acknowledging diversity among Elders, their preferences and community control. Themes were used to develop the program and its resource manual that were finalised with stakeholders, including steering committee approval. CONCLUSIONS Stakeholder feedback at multiple stages and Aboriginal Elders' perspectives resulted in a new co-designed community program involving weekly yarning circles and social activities. So what?: Co-design, guided by Aboriginal ways of knowing, being and doing, can develop programs relevant for Aboriginal people.
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Affiliation(s)
- Rona Macniven
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia,Faculty of Health, Medicine and Human SciencesMacquarie UniversityNew South WalesAustralia
| | | | - Roland Wilson
- Southgate Institute for Health, Society, and EquityFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Adam Howie
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Georgia Stewart
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research InstituteThe University of WollongongWollongongNew South WalesAustralia
| | - Tracey Ma
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia,The George Institute for Global HealthSydneyNew South WalesAustralia
| | - Norma Jean Turner
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Sallie Cairnduff
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia,The George Institute for Global HealthSydneyNew South WalesAustralia
| | - Julieann Coombes
- The George Institute for Global HealthSydneyNew South WalesAustralia
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21
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Casas Cruz HM, Pelcastre-Villafuerte BE, Arenas-Monreal L, Ruiz-Rodríguez M. Concerted Model of Healthcare for Awá Indigenous of Nariño, Colombia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12250. [PMID: 36231547 PMCID: PMC9566783 DOI: 10.3390/ijerph191912250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Indigenous communities in Colombia are facing a critical health situation; alternative health care models based on the vision of the communities themselves are needed. The objective of this research was to create a health care model that decreases health inequities for the Indigenous Awá population of Nariño, Colombia. This study was guided by the paradigm of community-based participatory action research; the process was carried out in 2015 and 2016. The proposed Intercultural Health Care Model is essentially based on health promotion, disease prevention, community empowerment, social participation in health, decentralized health care and coordination between the two medicines (traditional and allopathic). Strategies such as those reported herein, with concerted efforts rather than imposition, maintain human rights and respect for the sovereignty and autonomy of Indigenous people.
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Affiliation(s)
| | | | - Luz Arenas-Monreal
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Myriam Ruiz-Rodríguez
- Department of Public Health, Medicine School, Universidad Industrial de Santander-UIS, Bucaramanga 680002, Colombia
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22
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Wei H, Daniels S, Whitfield CA, Han Y, Denning DW, Hall I, Regan M, Verma A, van Tongeren M. Agility and Sustainability: A Qualitative Evaluation of COVID-19 Non-pharmaceutical Interventions in the UK Logistics Sector. Front Public Health 2022; 10:864506. [PMID: 35719658 PMCID: PMC9198245 DOI: 10.3389/fpubh.2022.864506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background The emergence of SARS-CoV-2 triggered a chain of public health responses that radically changed our way of living and working. Non-healthcare sectors, such as the logistics sector, play a key role in such responses. This research aims to qualitatively evaluate the non-pharmaceutical interventions (NPIs) implemented in the UK logistics sector during the COVID-19 pandemic. Methods We conducted nine semi-structured interviews in July-August 2020 and May-June 2021. In total 11 interviewees represented six companies occupying a range of positions in the UK's logistics sector, including takeaway food delivery, large and small goods delivery and home appliance installation, and logistics technology providers. Thematic analysis was completed using NVivo12. Codes relevant to NPIs were grouped into themes and mapped deductively onto an adapted Hierarchy of Control (HoC) framework, focusing on delivery workers. Codes relevant to the implementation process of NPIs were grouped into themes/subthemes to identify key characteristics of rapid responses, and barriers and facilitators. Results HoC analysis suggests the sector has implemented a wide range of risk mitigation measures, with each company developing their own portfolio of measures. Contact-free delivery was the most commonly implemented measure and perceived effective. The other implemented measures included social distancing, internal contact tracing, communication and collaboration with other key stakeholders of the sector. Process evaluation identified facilitators of rapid responses including capacity to develop interventions internally, localized government support, strong external mandates, effective communication, leadership support and financial support for self-isolation, while barriers included unclear government guidance, shortage of testing capacity and supply, high costs and diversified language and cultural backgrounds. Main sustainability issues included compliance fatigue, and the possible mental health impacts of a prolonged rapid response. Conclusions This research identified drivers and obstacles of rapid implementation of NPIs in response to a respiratory infection pandemic. Existing implementation process models do not consider speed to respond and the absence or lack of guidance in emergency situations such as the COVID-19. We recommend the development of a rapid response model to inform the design of effective and sustainable infection prevention and control policies and to focus future research priorities.
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Affiliation(s)
- Hua Wei
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sarah Daniels
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Carl A. Whitfield
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Yang Han
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - David W. Denning
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Division of Evolution, Infection & Genomics, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Ian Hall
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
- Public Health, Advice, Guidance and Expertise, UK Health Security Agency, London, United Kingdom
| | - Martyn Regan
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National COVID-19 Response Centre, UK Health Security Agency, London, United Kingdom
| | - Arpana Verma
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Martie van Tongeren
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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23
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Meursinge Reynders R, Ter Riet G, Di Girolamo N, Malički M. Honorary authorship in health sciences: a protocol for a systematic review of survey research. Syst Rev 2022; 11:57. [PMID: 35379330 PMCID: PMC8978359 DOI: 10.1186/s13643-022-01928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Honorary authorship refers to the practice of naming an individual who has made little or no contribution to a publication as an author. Honorary authorship inflates the output estimates of honorary authors and deflates the value of the work by authors who truly merit authorship. This manuscript presents the protocol for a systematic review that will assess the prevalence of five honorary authorship issues in health sciences. METHODS Surveys of authors of scientific publications in health sciences that assess prevalence estimates will be eligible. No selection criteria will be set for the time point for measuring outcomes, the setting, the language of the publication, and the publication status. Eligible manuscripts are searched from inception onwards in PubMed, Lens.org , and Dimensions.ai. Two calibrated authors will independently search, determine eligibility of manuscripts, and conduct data extraction. The quality of each review outcome for each eligible manuscript will be assessed with a 14-item checklist developed and piloted for this review. Data will be qualitatively synthesized and quantitative syntheses will be performed where feasible. Criteria for precluding quantitative syntheses were defined a priori. The pooled random effects double arcsine transformed summary event rates of five outcomes on honorary authorship issues with the pertinent 95% confidence intervals will be calculated if these criteria are met. Summary estimates will be displayed after back-transformation. Stata software (Stata Corporation, College Station, TX, USA) version 16 will be used for all statistical analyses. Statistical heterogeneity will be assessed using Tau2 and Chi2 tests and I2 to quantify inconsistency. DISCUSSION The outcomes of the planned systematic review will give insights in the magnitude of honorary authorship in health sciences and could direct new research studies to develop and implement strategies to address this problem. However, the validity of the outcomes could be influenced by low response rates, inadequate research design, weighting issues, and recall bias in the eligible surveys. SYSTEMATIC REVIEW REGISTRATION This protocol was registered a priori in the Open Science Framework (OSF) link: https://osf.io/5nvar/ .
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Affiliation(s)
- Reint Meursinge Reynders
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (Amsterdam UMC) Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. .,Studio di Ortodonzia, Via Matteo Bandello 15, 20123, Milan, Italy.
| | - Gerben Ter Riet
- Urban Vitality Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam University Medical Center (Amsterdam UMC) Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Nicola Di Girolamo
- Center for Veterinary Health Sciences, Oklahoma State University, 2065 W, Farm Road, Stillwater, Oklahoma, 74078, USA.,EBMVet, Via Sigismondo Trecchi 20, 26100, Cremona, CR, Italy
| | - Mario Malički
- Meta-research Innovation Center a Stanford (METRICS), Stanford University, Stanford, USA
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24
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Cossar RD, Stewart AC, Wilkinson AL, Dietze P, Ogloff JRP, Aitken C, Butler T, Kinner SA, Curtis M, Walker S, Kirwan A, Stoové M. Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103532. [PMID: 34871944 DOI: 10.1016/j.drugpo.2021.103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rates of emergency department (ED) use are higher among people released from prison than in the general population. However, little is known about ED presentations specifically among people with a history of injecting drug use (IDU) leaving prison. We measured the incidence of ED presentation in the three months following release from prison, among a cohort of men with histories of IDU, and determined pre-release characteristics associated with presenting to an ED during this period. METHODS We analysed linked survey and administrative data from the Prison and Transition Health (PATH) study (N = 400) using multiple-failure survival analysis. RESULTS Twenty-one percent (n = 81/393) of the cohort presented to an ED at least once within the three months after release from prison. The incidence of ED presentation was highest in the first six days after release. Cox proportional hazards modelling showed that a history of in-patient psychiatric admission and housing instability were associated with increased hazard of an ED presentation, and identifying as Aboriginal and Torres Strait Islander was associated with decreased hazard. CONCLUSIONS In our study, ED presentations following release from prison among people with a history of IDU was linked to acute health risks related to known mental health and social vulnerabilities in this population. Greater collaboration and systems integration between prison and community health and support services is needed to reduce presentations to ED and associated morbidities among people with a history of IDU after release from prison.
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Affiliation(s)
- Reece David Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia.
| | - Ashleigh Cara Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anna Lee Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, QLD, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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25
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Conigrave JH, Conigrave KM, Wilson S, Lee KSK. Indigenous Australian drinking risk: Comparing risk categorisations based on recall of recent drinking occasions to AUDIT-C screening in a representative sample. Drug Alcohol Rev 2021; 41:616-624. [PMID: 34750926 PMCID: PMC9299218 DOI: 10.1111/dar.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/23/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander (Indigenous) Australians have identified alcohol consumption as an area of concern. Accurate screening tools are required to help detect and assist at-risk drinkers, and to provide accurate data to policy makers. The Finnish method (determining drinking patterns based on the last two to four drinking occasions), has been proposed as a culturally appropriate and effective screening tool for detecting Indigenous Australians at risk from alcohol consumption. While it has been found to be valid and acceptable for use with Indigenous Australians, the Finnish method has not been compared to the three-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) which is currently recommended by the Australian government for use in Aboriginal community-controlled health services. METHODS We compared the performance of the AUDIT-C and Finnish method as screening tools for detecting harms experienced from alcohol in a representative, cross-sectional, sample of Indigenous Australians. RESULTS AUDIT-C was substantially faster for participants to complete than the Finnish method. Metrics derived from both the AUDIT-C and Finnish method were similarly linked to the frequency of self-reported International Classification of Diseases, 11th revision dependence symptoms and harms. DISCUSSION AND CONCLUSIONS The AUDIT-C is likely most appropriate for use in clinical settings due to its speed and ease of use. The Finnish method provides relatively detailed information about drinking and is better suited to population surveys.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Drug Health Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,Aboriginal Drug and Alcohol Council SA Aboriginal Corporation, Adelaide, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia.,Burnet Institute, Melbourne, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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26
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Harding T, Oetzel J, Simpson M, Nock S. Identifying the Facilitators and Barriers in Disseminating and Adopting a Health Intervention Developed by a Community-Academic Partnership. HEALTH EDUCATION & BEHAVIOR 2021; 49:724-731. [PMID: 34697952 DOI: 10.1177/10901981211033228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The literature regarding implementation science of evidence-based health interventions in Māori communities is limited, and there is a push for new and innovative delivery methods of health interventions in New Zealand. The purpose of the study was to identify the facilitators and barriers in implementing a health intervention designed by others and was framed by the Consolidated Framework for Implementation Research (CFIR). This study explored general perceptions of the implementation process and also included a case study, the Kaumātua Mana Motuhake (older people's autonomy and self-actualization) project; a codesigned peer education intervention for older Māori. Semistructured interviews (N = 17) were conducted via face-to-face, phone, or Zoom with health and social service professionals with experience working with Māori communities. Thematic analysis was used to analyze the data. The facilitators included community engagement, program structure, program adaptability and creators' experience. The barriers consisted of funding access, funding constraints and organizational constraints. The findings support key elements within the CFIR, highlighting the importance of community engagement and adaptability. Additionally, this study identified nuanced aspects of funding and resources that constrain organisations in employing health interventions designed by others.
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Affiliation(s)
| | - John Oetzel
- University of Waikato, Hamilton, New Zealand
| | | | - Sophie Nock
- University of Waikato, Hamilton, New Zealand
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27
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Harfield S, Davy C, Dawson A, Mulholland E, Braunack-Mayer A, Brown A. Building Indigenous health workforce capacity and capability through leadership - the Miwatj health leadership model. Prim Health Care Res Dev 2021; 22:e52. [PMID: 34615567 PMCID: PMC8515491 DOI: 10.1017/s1463423621000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/07/2022] Open
Abstract
AIM In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj). BACKGROUND The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally divergent approaches to management and leadership. METHODS Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model. FINDINGS The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities; it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas; and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety. CONCLUSIONS Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.
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Affiliation(s)
- Stephen Harfield
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- UQ Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Carol Davy
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Anna Dawson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Eddie Mulholland
- Miwatj Aboriginal Health Service, Nhulunbuy, Northern Territory, Australia
| | - Annette Braunack-Mayer
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Melariri HI, Kalinda C, Chimbari MJ. Enablers and hindrances to health promotion and disease prevention practices among healthcare workers in Nelson Mandela Bay Municipality, South Africa. Prev Med Rep 2021; 23:101462. [PMID: 34258174 PMCID: PMC8254112 DOI: 10.1016/j.pmedr.2021.101462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/16/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Health promotion (HP) and disease prevention (DP) practices among healthcare workers (HCWs) are key to achieving universal health coverage. This study identified HP and DP enablers and hindrances and compared them at different healthcare levels in Nelson Mandela Bay Municipality, South Africa. An exploratory cross-sectional study using a structured questionnaire was conducted among HCWs (n = 501) from 23 hospitals. Bivariate and multinomial regression were used to analyze the data. The highest number of participants (70.46%; n = 353) were from tertiary hospitals. Thirteen and Eight categories of enablers and hindrances respectively were identified. Of these, eleven enablers and six hindrances of HP and DP were associated with tertiary hospitals; no enabler was identified at both primary and secondary while one hindrance was associated with primary level of health care. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28-3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23-0.62) were the predictors of HP and DP among medical doctors, while staff induction training (Coeff: 0.62, 95% CI: 0.40-0.95) and performance appraisal (Coeff: 1.86, 95% CI: 1.16-2.98) were the enablers among allied health workers. On the other hand, 'facility promoting treatment more than prevention' (Coeff: 2.03, 95% CI: 1.30-3.14) and 'practice guidelines incorporating HP' (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers respectively. Our work indicates the need for an operational strategy designed considering enabling and hindering factors to HP and DP practices for empowering HCWs and enhancing health outcomes.
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Affiliation(s)
- Herbert I. Melariri
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- Eastern Cape Department of Health, South Africa
| | - Chester Kalinda
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- University of Namibia, Faculty of Agriculture, Engineering and Natural Sciences, School of Science, Katima Mulilo Campus, P/Bag 1096, Katima Mulilo, Namibia
| | - Moses J. Chimbari
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
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29
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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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Nicolaidis C, Zhen KY, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J, Scharer M. Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:786-799. [PMID: 33103457 PMCID: PMC8068734 DOI: 10.1177/1362361320967178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient-provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Kelly Y Zhen
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | | | - Dora M Raymaker
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Steven K Kapp
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- University of Portsmouth, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- RMIT University, Australia
| | - Joelle Maslak
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Mirah Scharer
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
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Power T, East L, Gao Y, Usher K, Jackson D. A mixed-methods evaluation of an urban Aboriginal diabetes lifestyle program. Aust N Z J Public Health 2021; 45:143-149. [PMID: 33749953 DOI: 10.1111/1753-6405.13092] [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: 10/01/2020] [Revised: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate an Aboriginal-led diabetes lifestyle program catering to urban Aboriginal people in an Aboriginal organisation. METHODS Mixed-methods study that employed routinely collected physiological data and audio-recorded focus group sessions. Physiological data were analysed using a multi-level model to account for participant clustering. Qualitative data were subject to thematic analysis. RESULTS Participants were overwhelmingly positive about the program. They lost weight and improved their diastolic blood pressure and glycaemic control; however, it was the feelings of belonging and optimism about their ability to improve their health that they most valued. Qualitative analysis revealed three main themes. These were: 'With the Mob', 'For the Mob' and 'Program Elements. The strengths of the program lay in its indigeneity, low-cost and easy-to-prepare diet, and cultural and communication skills of the director. CONCLUSIONS Recommendations for improvement included educating participants on the pathophysiology of diabetes, the refinement of online elements and the introduction of face-to-face group exercise. Implications for public health: Programs of this nature should be expanded and evaluated longitudinally with multiple cohorts.
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Affiliation(s)
- Tamara Power
- Susan Wakil School of Nursing and Midwifery, University of Sydney, New South Wales
| | - Leah East
- School of Health, University of New England, New South Wales
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Queensland
| | - Kim Usher
- School of Health, University of New England, New South Wales
| | - Debra Jackson
- Susan Wakil School of Nursing and Midwifery, University of Sydney, New South Wales
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Access to healthcare system of indigenous communities with musculoskeletal disorders and rheumatic disease in Chaco, Argentina: a qualitative study. Clin Rheumatol 2020; 40:2407-2417. [PMID: 33231776 PMCID: PMC7685194 DOI: 10.1007/s10067-020-05513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022]
Abstract
Introduction/objectives The objective of this study is to describe the local healthcare system from the perspective of the health professionals, community health workers, and local representatives of the qom community living in the province of Chaco, Argentina. Methods A qualitative study, with an ethnographic approach, was carried out using two techniques: non-participant observations and semi-structured interviews. A guide for the interviews was designed and developed by a multidisciplinary group of GLADERPO researchers. The main aspects included were the following: reference into the local healthcare system and accessibility to the system. Andersen’s base conceptual model of health service utilization was applied for the analysis and for structuring the results. Results A total of 21 people were interviewed, twelve women and nine men with an age ranging between 25 and 60 years old. The main findings were different barriers (communication and cultural) between the community and the healthcare system; “navigation” within the health system carried out by the qom community; and migration and bureaucratization of the health system. Conclusions These findings should be incorporated into educational strategies to improve access to healthcare system and adherence to medical treatment, establishing an interaction between the different levels of the local care system and providing community health workers with an appropriate training with the support of the community representatives.Key Points • The different barriers between the community and the healthcare system were described. • The “navigation” within the health system carried out by the qom community and the migration were relevant points. • The bureaucratization of the health system and the need to design and implement educational strategies in the future were highlighted. |
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Lord H, MacPhail C, Cherry J, Fernandez R. Perceptions of Aboriginal and Torres Strait Islander Australians toward cardiovascular primary prevention programs: A qualitative systematic review. Public Health Nurs 2020; 38:197-211. [PMID: 33216386 DOI: 10.1111/phn.12837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/22/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To synthesize the best available qualitative evidence on the perceptions of Aboriginal and Torres Strait Islander Australians (hereafter, respectfully referred to as Indigenous Australians) toward participation in cardiovascular primary prevention programs. BACKGROUND In 2017, cardiovascular disease was the leading cause of premature mortality in Indigenous Australians, accounting for 11.5% of all deaths. Health risk behaviors such as smoking, physical inactivity, poor nutrition, and obesity largely contribute to this burden of disease. METHODS A search using MEDLINE, CINAHL, EMBASE, PubMed, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Data extraction and meta-aggregation were conducted in accordance with JBI methodology. RESULTS Eleven studies were included. Three synthesized findings were developed (a) social and community support affect participants' experiences of prevention programs; (b) structural drivers and social determinants influence Indigenous Australians experiences and participation in prevention programs and health risk behavioral change; and (c) a personal desire to change behaviors and participate in prevention programs requires development of knowledge regarding healthy lifestyles and creation of new social norms. CONCLUSIONS Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants, and personal desire. Future programs need to tackle the structural drivers and facilitate a supportive environment to assist in health risk behavior change.
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Affiliation(s)
- Heidi Lord
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Wollongong, NSW, Australia
| | - Catherine MacPhail
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Julie Cherry
- Budyari Aboriginal Community Health Centre, Primary and Community Health, Miller, NSW, Australia
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Wollongong, NSW, Australia
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Beks H, Ewing G, Charles JA, Mitchell F, Paradies Y, Clark RA, Versace VL. Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review. Int J Equity Health 2020; 19:201. [PMID: 33168029 PMCID: PMC7652411 DOI: 10.1186/s12939-020-01306-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mobile clinics have been used to deliver primary health care to populations that otherwise experience difficulty in accessing services. Indigenous populations in Australia, Canada, New Zealand, and the United States experience greater health inequities than non-Indigenous populations. There is increasing support for Indigenous-governed and culturally accessible primary health care services which meet the needs of Indigenous populations. There is some support for primary health care mobile clinics implemented specifically for Indigenous populations to improve health service accessibility. The purpose of this review is to scope the literature for evidence of mobile primary health care clinics implemented specifically for Indigenous populations in Australia, Canada, New Zealand, and the United States. METHODS This review was undertaken using the Joanna Brigg Institute (JBI) scoping review methodology. Review objectives, inclusion criteria and methods were specified in advance and documented in a published protocol. The search included five academic databases and an extensive search of the grey literature. RESULTS The search resulted in 1350 unique citations, with 91 of these citations retrieved from the grey literature and targeted organisational websites. Title, abstract and full-text screening was conducted independently by two reviewers, with 123 citations undergoing full text review. Of these, 39 citations discussing 25 mobile clinics, met the inclusion criteria. An additional 14 citations were snowballed from a review of the reference lists of included citations. Of these 25 mobile clinics, the majority were implemented in Australia (n = 14), followed by United States (n = 6) and Canada (n = 5). No primary health mobile clinics specifically for Indigenous people in New Zealand were retrieved. There was a pattern of declining locations serviced by mobile clinics with an increasing population. Furthermore, only 13 mobile clinics had some form of evaluation. CONCLUSIONS This review identifies geographical gaps in the implementation of primary health care mobile clinics for Indigenous populations in Australia, Canada, New Zealand, and the United States. There is a paucity of evaluations supporting the use of mobile clinics for Indigenous populations and a need for organisations implementing mobile clinics specifically for Indigenous populations to share their experiences. Engaging with the perspectives of Indigenous people accessing mobile clinic services is imperative to future evaluations. REGISTRATION The protocol for this review has been peer-reviewed and published in JBI Evidence Synthesis (doi: 10.11124/JBISRIR-D-19-00057).
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Geraldine Ewing
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - James A. Charles
- National Indigenous Knowledges Education Research Innovation (NIKERI) Institute, Deakin University, Geelong, Victoria Australia
| | - Fiona Mitchell
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Burwood, Victoria Australia
| | - Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
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Sarkies M, Long JC, Pomare C, Wu W, Clay-Williams R, Nguyen HM, Francis-Auton E, Westbrook J, Levesque JF, Watson DE, Braithwaite J. Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes. Implement Sci 2020; 15:91. [PMID: 33087147 PMCID: PMC7579904 DOI: 10.1186/s13012-020-01049-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022] Open
Abstract
Background Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. Methods An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. Results The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Conclusions Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. Trial registration PROSPERO 162812
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Affiliation(s)
- Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia.
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Wendy Wu
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Hoa Mi Nguyen
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emilie Francis-Auton
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Agency for Clinical Innovation, New South Wales, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Diane E Watson
- Bureau of Health Information, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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Masters-Awatere B, Rarere M, Gilbert R, Manuel C, Scott N. He aha te mea nui o te ao? He tāngata! (What is the most important thing in the world? It is people!). Aust J Prim Health 2020; 25:435-442. [PMID: 32171366 DOI: 10.1071/py19027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022]
Abstract
This paper highlights the importance of people as a central factor in improving health for Māori (Indigenous people of New Zealand). How whānau (family) relationships, connections, values and inspiration are integral to achieving Indigenous health goals is explained. Descriptions of how community researchers, healthcare staff, consumers and academics worked together to design interventions for two health services (in the Waikato and Bay of Plenty regions) is included. Through highlighting the experiences of health consumers, the potential for future interventions to reduce the advancement of pre-diabetes among whānau is described. Evidence from the study interviews reinforces the importance of whānau and whakapapa (heritage) as enabling factors for Indigenous people to improve health. Specifically, the positive effect of whānau enhancing activities that support peoples' aspirations of tino rangatiratanga (self-determination) in their lives when engaging with health care has been observed. This study highlights the many positives that have emerged, and offers an opportunity for taking primary health to the next level by placing whānau alongside Indigenous primary care providers at the centre of change strategies.
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Affiliation(s)
| | - Moana Rarere
- University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
| | - Rewa Gilbert
- Te Kohao Health Services Ltd, 951 Wairere Drive, Hamilton 3216, New Zealand
| | - Carey Manuel
- Poutiri Charitable Trust, PO Box 148, Te Puke 3119, New Zealand
| | - Nina Scott
- Waikato District Health Board, Private Bag 3200, Hamilton 3240, New Zealand
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Rarere M, Oetzel J, Masters-Awatere B, Scott N, Wihapi R, Manuel C, Gilbert R. Critical reflection for researcher-community partnership effectiveness: the He Pikinga Waiora process evaluation tool guiding the implementation of chronic condition interventions in Indigenous communities. Aust J Prim Health 2020; 25:478-485. [PMID: 31506161 DOI: 10.1071/py19022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022]
Abstract
Critically reflecting on researcher-community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research-community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege.
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Affiliation(s)
- Moana Rarere
- The University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand; and Corresponding author.
| | - John Oetzel
- The University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
| | | | - Nina Scott
- Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand
| | - Ray Wihapi
- Poutiri Trust, 35 Commerce Lane, Te Puke 3119, New Zealand
| | - Carey Manuel
- Poutiri Trust, 35 Commerce Lane, Te Puke 3119, New Zealand
| | - Rewa Gilbert
- Te Kohao Health Services Ltd, 951 Wairere Drive, Hamilton 3216, New Zealand
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Shukla N, Pradhan B, Dikshit A, Chakraborty S, Alamri AM. A Review of Models Used for Investigating Barriers to Healthcare Access in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4087. [PMID: 32521710 PMCID: PMC7312585 DOI: 10.3390/ijerph17114087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
Understanding barriers to healthcare access is a multifaceted challenge, which is often highly diverse depending on location and the prevalent surroundings. The barriers can range from transport accessibility to socio-economic conditions, ethnicity and various patient characteristics. Australia has one of the best healthcare systems in the world; however, there are several concerns surrounding its accessibility, primarily due to the vast geographical area it encompasses. This review study is an attempt to understand the various modeling approaches used by researchers to analyze diverse barriers related to specific disease types and the various areal distributions in the country. In terms of barriers, the most affected people are those living in rural and remote parts, and the situation is even worse for indigenous people. These models have mostly focused on the use of statistical models and spatial modeling. The review reveals that most of the focus has been on cancer-related studies and understanding accessibility among the rural and urban population. Future work should focus on further categorizing the population based on indigeneity, migration status and the use of advanced computational models. This article should not be considered an exhaustive review of every aspect as each section deserves a separate review of its own. However, it highlights all the key points, covered under several facets which can be used by researchers and policymakers to understand the current limitations and the steps that need to be taken to improve health accessibility.
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Affiliation(s)
- Nagesh Shukla
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
- Department of Energy and Mineral Resources Engineering, Sejong University, Choongmu-gwan, 209 Neungdong-ro, Gwangjin-gu, Seoul 05006, Korea
| | - Abhirup Dikshit
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Subrata Chakraborty
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Abdullah M. Alamri
- Department of Geology & Geophysics, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
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Groot G, Waldron T, Barreno L, Cochran D, Carr T. Trust and world view in shared decision making with indigenous patients: A realist synthesis. J Eval Clin Pract 2020; 26:503-514. [PMID: 31750600 PMCID: PMC7154772 DOI: 10.1111/jep.13307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION How shared decision making (SDM) works with indigenous patient values and preferences is not well understood. Colonization has affected indigenous peoples' levels of trust with institutions, and their world view tends to be distinct from that of nonindigenous people. Building on a programme theory for SDM, the present research aims to refine the original programme theory to understand how the mechanisms of trust and world view might work differently for indigenous patients. DESIGN We used a six-step iterative process for realist synthesis: preliminary programme theory development, search strategy development, selection and appraisal of literature, data extraction, data analysis and synthesis, and formation of a revised programme theory. DATA SOURCES Searches were through Medline, CINAHL, and the University of Saskatchewan iPortal for grey literature. Medline and CINAHL searches included the University of Alberta Canada-wide indigenous peoples search filters. DATA SYNTHESIS Following screening 731 references, 90 documents were included for data extraction (53 peer reviewed and 37 grey literature). Documents from countries with similar colonization experiences were included. RESULTS A total of 518 context-mechanism-outcome (CMO) configurations were identified and synthesized into 21 CMOs for a revised programme theory. Demographics, indigenous world view, system and institutional support, language barriers, and the macro-context of discrimination and historical abuse provided the main contexts for the programme theory. These inspired mechanisms of reciprocal respect, perception of world view acceptance, and culturally appropriate knowledge translation. In turn, these mechanisms influenced the level of trust and anxiety experienced by indigenous patients. Trust and anxiety were both mechanisms and intermediate outcomes and determined the level of engagement in SDM. CONCLUSION This realist synthesis provides clinicians and policymakers a deeper understanding of the complex configurations that influence indigenous patient engagement in SDM and offers possible avenues for improvement.
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Affiliation(s)
- Gary Groot
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tamara Waldron
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Leonzo Barreno
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - David Cochran
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tracey Carr
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
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Hendrickx D, Amgarth-Duff I, C Bowen A, R Carapetis J, Chibawe R, Samson M, Walker R. Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E808. [PMID: 32012972 PMCID: PMC7037003 DOI: 10.3390/ijerph17030808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Abstract
In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers (n = 16), healthcare practitioners (n = 15) and other community service providers (n = 25). We used Andersen's health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities.
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Affiliation(s)
- David Hendrickx
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
| | - Ingrid Amgarth-Duff
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Asha C Bowen
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
| | - Robby Chibawe
- Puntukurnu Aboriginal Medical Service Unit 5, 15, Iron Ore Parade, Newman, WA 6753, Australia
| | - Margaret Samson
- Jigalong Community Council, Pmb 8, Newman, WA 6753, Australia
| | - Roz Walker
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
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Maple-Brown L, Lee IL, Longmore D, Barzi F, Connors C, Boyle JA, Moore E, Whitbread C, Kirkwood M, Graham S, Hampton V, Simmonds A, Van Dokkum P, Kelaart J, Thomas S, Chitturi S, Eades S, Corpus S, Lynch M, Lu ZX, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown ADH, Shaw JE. Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study-an observational birth cohort. Int J Epidemiol 2020; 48:307-318. [PMID: 30508095 DOI: 10.1093/ije/dyy245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. METHODS This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. RESULTS Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. CONCLUSIONS Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
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Affiliation(s)
- Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Christine Connors
- Remote Primary Health Care, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Jacqueline A Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance, Darwin, NT, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula Van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sujatha Thomas
- Division of Maternal and Child Health, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Zhong X Lu
- Biochemistry Department, Melbourne Pathology, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alex D H Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
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Utzumi FC, Bernardino E, Lacerda MR, Santos JLGD, Peres AM, Andrade SRD. ACCESS VERSUS CARE CONTINUITY IN HEALTH NETWORK SERVICES: EXPERIENCING POSSIBILITIES AND CONTRADICTIONS. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2018-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to understand the meaning of access to health services with a view to care continuity in the care network for users and professionals. Method: qualitative research, which used the methodological steps of Grounded Theory, carried out from November 2015 to April 2017. The theoretical sampling was obtained with 33 participants from a hospital institution and a Family Health Strategy unit. The participants were organized into three sample groups according to circular and continuous orientation of data collection and Grounded Theory analysis. The analysis was conducted according to the guidelines of the methodological framework which was composed of the open, axial and integrative coding phases. Results: four central concepts emerged from the data that demonstrate how participants experience access with a view to care continuity. These range from the first contact with the health network, through limitations and alternatives found to achieve perspectives to the care continuity in health actions and services. Conclusion: possibilities and contradictions were identified in the experience of care, with regard to access to health services and actions for the continuity of care, understanding them as feasible in health services, but divergent from the ideal advocated by the literature on the theme, as well as by the norms and prerogatives in force in the Unified Health System.
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Social contributors to cardiometabolic diseases in indigenous populations: an international Delphi study. Public Health 2019; 176:133-141. [PMID: 31796166 DOI: 10.1016/j.puhe.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 06/11/2018] [Accepted: 08/30/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to identify priority social factors contributing to indigenous cardiometabolic diseases. STUDY DESIGN A three-round Delphi process was used to consolidate and compare the opinions of 60 experts in indigenous cardiometabolic health from Australia, New Zealand and the United States. METHODS Round one: three open-ended questions: (i) historical, (ii) economic and (iii) sociocultural factor contributors to cardiometabolic disease risk. Round two: a structured questionnaire based on the results from the first round; items were ranked according to perceived importance. Final round: the items were reranked after receiving the summary feedback. RESULTS Several key findings were identified: (i) an important historical factor is marginalisation and disempowerment; (ii) in terms of economic and sociocultural factors, the panellists came to the consensus that the socio-economic status and educational inequalities are important; and (iii) while consensus was not reached, economic and educational factors were also perceived to be historically influential. CONCLUSION These findings support the need for multilevel health promotion policy. For example, tackling financial barriers that limit the access to health-promoting resources, combined with improving literacy skills to permit understanding of health education.
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Fazelipour M, Cunningham F. Barriers and facilitators to the implementation of brief interventions targeting smoking, nutrition, and physical activity for indigenous populations: a narrative review. Int J Equity Health 2019; 18:169. [PMID: 31690340 PMCID: PMC6833184 DOI: 10.1186/s12939-019-1059-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/23/2019] [Indexed: 01/02/2023] Open
Abstract
Objective This narrative review aimed to identify and categorize the barriers and facilitators to the provision of brief intervention and behavioral change programs that target several risk behaviors among the Indigenous populations of Australia, Canada, and New Zealand. Methods A systematic database search was conducted of six databases including PubMeD, Embase, CINAHL, HealthStar, PsycINFO, and Web of Science. Thematic analysis was utilized to analyze qualitative data extracted from the included studies, and a narrative approach was employed to synthesize the common themes that emerged. The quality of studies was assessed in accordance with the Joanna Briggs Institute’s guidelines and using the software SUMARI – The System for the Unified Management, Assessment and Review of Information. Results Nine studies were included. The studies were classified at three intervention levels: (1) individual-based brief interventions, (2) family-based interventions, and (3) community-based-interventions. Across the studies, selection of the intervention level was associated with Indigenous priorities and preferences, and approaches with Indigenous collaboration were supported. Barriers and facilitators were grouped under four major categories representing the common themes: (1) characteristics of design, development, and delivery, (2) patient/provider relationship, (3) environmental factors, and (4) organizational capacity and workplace-related factors. Several sub-themes also emerged under the above-mentioned categories including level of intervention, Indigenous leadership and participation, cultural appropriateness, social and economic barriers, and design elements. Conclusion To improve the effectiveness of multiple health behavior change interventions among Indigenous populations, collaborative approaches that target different intervention levels are beneficial. Further research to bridge the knowledge gap in this topic will help to improve the quality of preventive health strategies to achieve better outcomes at all levels, and will improve intervention implementation from development and delivery fidelity, to acceptability and sustainability.
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Affiliation(s)
- Mojan Fazelipour
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Frances Cunningham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Level 10, 410 Ann Street, Brisbane, QLD, 4000, Australia
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Reina Bolaños CA, Tobar Blandón MF. Barreras y facilitadores en la implementación de la estrategia de atención primaria en salud en Palmira, Colombia. Rev Salud Publica (Bogota) 2019. [DOI: 10.15446/rsap.v21n6.74723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Conocer las barreras y facilitadores para la continuidad en la implementación de la estrategia de Atención Primaria en Salud en Palmira.Métodos Se tomó la experiencia de Atención Primaria en Salud (APS) del ente territorial de salud del Municipio de Palmira, Colombia, un territorio de aproximadamente 283 431 habitantes. Se usó el enfoque metodológico cualitativo mediante el análisis de contenido temático. La población objeto fueron los informantes clave, individuos con un papel potencialmente significativo en la formulación y desarrollo de la estrategia de APS, elegidos con un enfoque no probabilístico por conveniencia. La información se obtuvo de fuentes primarias y secundarias y se utilizó el software informático de análisis cualitativo Atlas Ti V7, como herramienta de apoyo para el manejo de datos.Resultados El análisis de barreras y facilitadores para la continuidad de la estrategia de APS identificó las principales características de la estrategia y una serie de temas recurrentes al momento de analizar las posibles barreras y facilitadores en los componentes de proceso, actores, contenido y contexto. Cada uno de estos temas presentó comportamientos diversos según la percepción de los participantes. Algunos temas fueron percibidos como facilitadores, barreras o como ambos.Conclusión Al comparar las barreras y facilitadores, se encontró que, a nivel global, son mayores las barreras que los facilitadores, comportamiento reflejado en la teoría, que indica que la población con algún tipo de vulnerabilidad presenta mayor cantidad de barreras frente a los servicios de salud y que la estrategia de APS hace especial énfasis en este tipo de población.
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Harding T, Oetzel J. Implementation effectiveness of health interventions for indigenous communities: a systematic review. Implement Sci 2019; 14:76. [PMID: 31382994 PMCID: PMC6683565 DOI: 10.1186/s13012-019-0920-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION Not registered.
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Affiliation(s)
- Truely Harding
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - John Oetzel
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
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Laird P, Walker R, Lane M, Chang AB, Schultz A. We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children. Respirology 2019; 25:383-392. [DOI: 10.1111/resp.13642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/03/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Pamela Laird
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
- Departments of Respiratory Medicine and Physiotherapy, Perth Children's Hospital Perth WA Australia
| | - Roz Walker
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service Broome WA Australia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health ResearchCharles Darwin University Darwin NT Australia
| | - André Schultz
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
- Departments of Respiratory Medicine and Physiotherapy, Perth Children's Hospital Perth WA Australia
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Laycock A, Bailie J, Matthews V, Bailie R. Using developmental evaluation to support knowledge translation: reflections from a large-scale quality improvement project in Indigenous primary healthcare. Health Res Policy Syst 2019; 17:70. [PMID: 31324251 PMCID: PMC6642555 DOI: 10.1186/s12961-019-0474-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Developmental evaluation is a growing area of evaluation practice, advocated for informing the adaptive development of change initiatives in complex social environments. The utilisation focus, complexity perspective and systems thinking of developmental evaluation suggest suitability for evaluating knowledge translation initiatives in primary healthcare. However, there are few examples in the literature to guide its use in these contexts and in Indigenous settings. In this paper, we reflect on our experience of using developmental evaluation to implement a large-scale knowledge translation research project in Australian Aboriginal and Torres Strait Islander primary healthcare. Drawing on principles of knowledge translation and key features of developmental evaluation, we debate the key benefits and challenges of applying this approach to engage diverse stakeholders in using aggregated quality improvement data to identify and address persistent gaps in care delivery. DISCUSSION The developmental evaluation enabled the team to respond to stakeholder feedback and apply learning in real-time to successfully refine theory-informed research and engagement processes, tailor the presentation of findings to stakeholders and context, and support the project's dissemination and knowledge co-production aim. It thereby contributed to the production of robust, useable research findings for informing policy and system change. The use of developmental evaluation appeared to positively influence stakeholders' use of the project reports and their responses to the findings. Challenges included managing a high volume of evaluation data and multiple evaluation purposes, balancing facilitative sense-making processes and change with task-focused project management, and lack of experience in using this evaluation approach. Use of an embedded evaluator with facilitation skills and background knowledge of the project helped to overcome these challenges, as did similarities observed between features of developmental evaluation and continuous quality improvement. CONCLUSION Our experience of developmental evaluation confirmed our expectations of the potential value of this approach for strengthening improvement interventions and implementation research, and particularly for adapting healthcare innovations in Indigenous settings. In our project, developmental evaluation successfully encompassed evaluation, project adaptation, capacity development and knowledge translation. Further work is warranted to apply this approach more widely to improve primary healthcare initiatives and outcomes, and to evaluate implementation research.
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Affiliation(s)
- Alison Laycock
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia. .,The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia.
| | - Jodie Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia
| | - Veronica Matthews
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia
| | - Ross Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia
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Lin IB, Bunzli S, Mak DB, Green C, Goucke R, Coffin J, O'Sullivan PB. Unmet Needs of Aboriginal Australians With Musculoskeletal Pain: A Mixed-Method Systematic Review. Arthritis Care Res (Hoboken) 2019; 70:1335-1347. [PMID: 29245188 DOI: 10.1002/acr.23493] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Musculoskeletal pain (MSP) conditions are the biggest cause of disability, and internationally, indigenous peoples experience a higher burden. There are conflicting reports about Aboriginal Australians and MSP. We conducted a systematic review to describe the prevalence, associated factors, impacts, care access, health care experiences, and factors associated with MSP among Aboriginal Australians. METHODS We used a systematic search of quantitative and qualitative scientific and grey literature (PROSPERO# CRD42016038342). Articles were appraised using the Mixed Methods Appraisal Tool. Due to study heterogeneity, a narrative synthesis was conducted. RESULTS Of 536 articles identified, 18 were included (14 quantitative, 4 qualitative), of high (n = 11), medium (n = 2), and low (n = 5) quality. Prevalence of MSP in Aboriginal populations was similar to or slightly higher than the non-Aboriginal population (prevalence rate ratio 1.1 for back pain, 1.2-1.5 for osteoarthritis [OA], and 1.0-2.0 for rheumatoid arthritis). Aboriginal people accessed primary care for knee or hip OA at approximately half the rate of non-Aboriginal people, and were less than half as likely to have knee or hip replacement surgery. Communication difficulties with health practitioners were the main reason why Aboriginal people with MSP choose not to access care. No articles reported interventions. CONCLUSION Findings provide preliminary evidence of an increased MSP burden among Aboriginal Australians, and particularly for OA, a mismatch between the disease burden and access to health care. To increase accessibility, health services should initially focus on improving Aboriginal patients' experiences of care, in particular by improving patient-practitioner communication. Implications for care and research are outlined.
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Affiliation(s)
- Ivan B Lin
- University of Western Australia, Geraldton, Western Australia, Australia
| | | | - Donna B Mak
- University of Notre Dame Australia School of Medicine, Fremantle, Western Australia, Australia
| | - Charmaine Green
- University of Western Australia, Geraldton, Western Australia, Australia
| | - Roger Goucke
- Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - Juli Coffin
- University of Notre Dame Australia, Broome, Western Australia, Australia
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Canuto K, Harfield S, Wittert G, Brown A. Listen, understand, collaborate: developing innovative strategies to improve health service utilisation by Aboriginal and Torres Strait Islander men. Aust N Z J Public Health 2019; 43:307-309. [PMID: 31287939 DOI: 10.1111/1753-6405.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kootsy Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, South Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, South Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, South Australia
| | - Stephen Harfield
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, South Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, South Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, South Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, South Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, South Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, South Australia.,Sansom Institute for Health Research, University of South Australia
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