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Meharg DP, Dennis SM, McNab J, Gwynne KG, Jenkins CR, Maguire GP, Jan S, Shaw T, McKeough Z, Rambaldini B, Lee V, McCowen D, Newman J, Longbottom H, Eades S, Alison JA. A Qualitative Study of Aboriginal Peoples' Health Care Experiences With Chronic Obstructive Pulmonary Disease. QUALITATIVE HEALTH RESEARCH 2024:10497323241259891. [PMID: 39117016 DOI: 10.1177/10497323241259891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Aboriginal Australians experience a high prevalence of chronic obstructive pulmonary disease (COPD), with high rates of potentially preventable hospitalisations. However, little is known about Aboriginal peoples' experiences of living with COPD and how they navigate health care systems. This study used thematic analysis and Aboriginal methodology to explore Aboriginal peoples' lived experiences of COPD, their health care journey from receiving a diagnosis of COPD to the clinical management, and the impact of COPD on their daily lives. We conducted in-depth semi-structured interviews over a 6-month period with 18 Aboriginal adults diagnosed with COPD from four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. Reflexive thematic analysis was employed to ensure rigour. The findings revealed deeply personal and reflective stories shaped by historical, social, and cultural realities of Aboriginal peoples living with COPD. Four themes were identified characterising their experiences. Based on the findings, the following guidance is provided on future COPD care for Aboriginal peoples: Better alignment of existing COPD management with Aboriginal peoples' cultural contexts and perspectives to improve access to culturally safe care; Increased funding for ACCHS to enhance COPD management, such as early detection through case finding and access to ACCHS-led pulmonary rehabilitation; Engaging family members in COPD management and providing culturally centred COPD education that facilitates discussions and builds health literacy and self-management skills; Implementing health promotion initiatives to increase awareness and counteract fear and shame to improve early COPD detection.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Justin McNab
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- University of New South Wales, Sydney, Kensington, NSW, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, Australia
| | - Hayley Longbottom
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, NSW, Australia
| | - Sandra Eades
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Centre for Epidemiology and Biostatistics, The School of Population and Global Health, The University of Melbourne, Carlton South, VIC, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Sydney Local Health District, Camperdown, NSW, 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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3
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Howarth TP, Jersmann HPA, Majoni SW, Mo L, Ben Saad H, Ford LP, Heraganahally SS. The 'ABC' of respiratory disorders among adult Indigenous people: asthma, bronchiectasis and COPD among Aboriginal Australians - a systematic review. BMJ Open Respir Res 2023; 10:e001738. [PMID: 37451702 PMCID: PMC10351270 DOI: 10.1136/bmjresp-2023-001738] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Aboriginal Australians are reported to have higher presence of chronic respiratory diseases. However, comprehensive evidence surrounding this is sparse. Hence, a systematic review was undertaken to appraise the current state of knowledge on respiratory health in the adult Aboriginal Australians, in particular among the three most common respiratory disorders: asthma, bronchiectasis and chronic obstructive pulmonary disease (COPD). METHODS A systematic review of primary literature published between January 2012 and October 2022, using the databases PubMed and Scopus, was conducted. Studies were included if they reported adult Aboriginal Australian prevalence's or outcomes related to asthma, bronchiectasis or COPD, and excluded if adult data were not reported separately, if Aboriginal Australian data were not reported separately or if respiratory disorders were combined into a single group. Risk of bias was assessed by both Joanne Briggs Institute checklists and Hoys' bias assessment. Summary data pertaining to prevalence, lung function, symptoms, sputum cultures and mortality for each of asthma, bronchiectasis and COPD were extracted from the included studies. RESULTS Thirty-seven studies were included, involving approximately 33 364 participants (71% female). Eighteen studies reported on asthma, 21 on bronchiectasis and 30 on COPD. The majority of studies (94%) involved patients from hospitals or respiratory clinics and were retrospective in nature. Across studies, the estimated prevalence of asthma was 15.4%, bronchiectasis was 9.4% and COPD was 13.7%, although there was significant geographical variation. Only a minority of studies reported on clinical manifestations (n=7) or symptoms (n=4), and studies reporting on lung function parameters (n=17) showed significant impairment, in particular among those with concurrent bronchiectasis and COPD. Airway exacerbation frequency and hospital admission rates including mortality are high. DISCUSSION Although risk of bias globally was assessed as low, and study quality as high, there was limited diversity of studies with most reporting on referred populations, and the majority originating from two centres in the Northern Territory. The states with the greatest Aboriginal Australian population (Victoria and New South Wales) reported the lowest number of studies and patients. This limits the generalisability of results to the wider Aboriginal Australian population due to significant environmental, cultural and socioeconomic variation across the population. Regardless, Aboriginal Australians appear to display a high prevalence, alongside quite advanced and complex chronic respiratory diseases. There is however significant heterogeneity of prevalence, risk factors and outcomes geographically and by patient population. Further collaborative efforts are required to address specific diagnostic and management pathways in order to close the health gap secondary to respiratory disorders in this population.
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Affiliation(s)
- Timothy P Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
- Darwin Respiratory and Sleep Health, Darwin private Hospital, Tiwi, Darwin, Northern Territory, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Hubertus P A Jersmann
- Department of Respiratory and sleep Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia
- Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lin Mo
- College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Helmi Ben Saad
- University of Sousse, Farhat HACHED Hospital, Heart Failure (LR12SP09) Research Laboratory, Sousse, Tunisia
| | - Linda P Ford
- Northern Institute, Faculty of Arts & Society, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin private Hospital, Tiwi, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Meharg DP, Dennis SM, McNab J, Gwynne KG, Jenkins CR, Maguire GP, Jan S, Shaw T, McKeough Z, Rambaldini B, Lee V, McCowen D, Newman J, Monaghan S, Longbottom H, Eades SJ, Alison JA. A mixed methods study of Aboriginal health workers' and exercise physiologists' experiences of co-designing chronic lung disease 'yarning' education resources. BMC Public Health 2023; 23:612. [PMID: 36997963 PMCID: PMC10063331 DOI: 10.1186/s12889-023-15508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management. AIM To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management. METHODS AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework '8 Ways of learning', which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise is important; Managing breathlessness; Healthy eating; Managing anxiety and depression. After each session, AHWs with support from EPs, co-designed education 'yarning' resources using Aboriginal ways of learning to ensure topics were culturally safe for the local Aboriginal community and practiced delivering this at the following session. At the end of the program participants completed an anonymous online survey (5-point Likert scale) to assess satisfaction, and a semi-structured interview about their experience of the online education. RESULTS Of the 12 participants, 11 completed the survey (7 AHWs, 4 EPs). Most (90%) participants strongly agreed or agreed that the online sessions increased knowledge and skills they needed to support Aboriginal patients with COPD. All (100%) participants felt: their cultural perspectives and opinions were valued and that they were encouraged to include cultural knowledge. Most (91%) reported that delivering their own co-designed yarning scripts during the online sessions improved their understanding of the topics. Eleven participants completed semi-structured interviews about participating in online education to co-design Aboriginal 'yarning' resources. Themes identified were: revealing the Aboriginal lung health landscape; participating in online learning; structuring the online education sessions; co-designing with the facilitators. CONCLUSIONS Online education using co-design and 8 Ways of learning was rated highly by AHWs and EPs for improving COPD knowledge and valuing cultural perspectives. The use of co-design principles supported the cultural adaptation of COPD resources for Aboriginal people with COPD. TRIAL REGISTRATION PROSPERO (registration number: CRD42019111405).
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia.
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Justin McNab
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
- University of New South Wales, Sydney, Kensington, NSW, 2052, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Stephen Jan
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, 2800, Australia
| | - Scott Monaghan
- Bulgarr Ngaru Medical Aboriginal Corporation, Grafton, NSW, 2460, Australia
| | - Hayley Longbottom
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, NSW, 2541, Australia
| | - Sandra J Eades
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
- Centre for Epidemiology and Biostatistics, The School of Population and Global Health, The University of Melbourne, Carlton South, Victoria, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
- Sydney Local Health District, Camperdown, NSW, 2050, Australia
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5
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Heerema J, Hug S, Bear N, Hill K. Characterising hospitalisation risk for chronic obstructive pulmonary disease exacerbations: Bedside and outpatient clinic assessments of easily measured variables. Chron Respir Dis 2023; 20:14799731231211852. [PMID: 37934787 PMCID: PMC10631319 DOI: 10.1177/14799731231211852] [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: 06/05/2023] [Accepted: 10/15/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To identify the characteristics of people with chronic obstructive pulmonary disease (COPD) who require hospitalisation for exacerbations. METHODS People with COPD were recruited either during hospitalisation or from out-patient respiratory medicine clinics. Hospital admissions were tracked throughout the 5-months recruitment period. For participants who were admitted, hospital readmissions were tracked for at least 30 days following discharge. Participants were grouped as either needing; (i) no hospital admission during the study period (no admission; ø-A), (ii) one or more hospital admissions during the study period but no readmission within 30 days of discharge (no rapid readmission; ø-RR) or (iii) one or more hospital admissions with a readmission within 30 days of discharge (rapid readmission; RR). RESULTS Compared with the ø-A group (n=211), factors that independently increased the risk of ø-RR (n=146) and/or RR (n=57) group membership were being aged >60 years, identifying as an Indigenous person (relative risk ratio, 95% confidence interval 7.8 [1.8 to 34.0]) and the use of a support person or community service for activities of daily living (1.5 [1.0 to 2.4]. A body mass index ≥25 kg/m2 was protective. CONCLUSIONS Variables recorded at the bedside or in clinic provided information on hospitalisation risk.
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Affiliation(s)
- Joshua Heerema
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Sarah Hug
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | - Natasha Bear
- Institute of Health Sciences, Notre Dame University, Perth, Australia
| | - Kylie Hill
- Curtin School of Allied Health, Curtin University, Perth, Australia
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6
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Pal A, Howarth TP, Rissel C, Messenger R, Issac S, Ford L, Connors C, Heraganahally S. COPD disease knowledge, self-awareness and reasons for hospital presentations among a predominately Indigenous Australian cohort: a study to explore preventable hospitalisation. BMJ Open Respir Res 2022; 9:9/1/e001295. [PMID: 35944944 PMCID: PMC9367193 DOI: 10.1136/bmjresp-2022-001295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of chronic obstructive pulmonary disease (COPD) is higher among Indigenous Australians than that of non-Indigenous Australians. However, no studies have investigated COPD disease awareness and knowledge among Indigenous Australians. In this study, we assessed the COPD disease awareness among Indigenous and non-Indigenous patients in the Top End Health Service region of the Northern Territory of Australia. Methods Of a total convenience sample of 100 adults, 86 patients consented to participate in this study over a 15-month period. A structured interview was conducted to identify participant’s level of knowledge about COPD, medications, self-management, healthcare interaction and utilisations. Results Most (69%) participants were Indigenous and men (52%). Indigenous patients were significantly younger (mean 56 vs 68 years p<0.001), with a higher proportion of remote residence and current smoking. COPD knowledge across the cohort was low, with 68% of Indigenous and 19% of non-Indigenous participants reporting they ‘know nothing/had never heard of COPD’. Most patients self-reported use of puffers/inhalers and were able to identify medication used; however, adherence to therapy was observed in only 18%. Shortness of breath was the most common symptom for hospital presentation (83%) and 69% of Indigenous patients reported seeking medical attention during an exacerbation. Self-management and COPD action plans were poorly implemented. A significant proportion (49%) reported ≥2 hospital admissions in the preceding 12 months. During exacerbation, although the majority of Indigenous patients were transferred to a tertiary centre from remote communities, patient’s preference was to be managed in their respective local communities. Conclusions Awareness and understanding of COPD are low in this cohort on several domains. Tailored and culturally appropriate initiatives for both patients and health professionals alike are required to improve COPD disease management among Indigenous population. This will not only improve quality of life but also reduce recurrent hospitalisation, healthcare cost and utilisation.
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Affiliation(s)
- Arijeet Pal
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Timothy P Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Raelene Messenger
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Siji Issac
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Linda Ford
- College of Indigenous Futures, Education & Arts, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Christine Connors
- Department of Health & Community Services, Top End Health Service, Darwin, Northern Territory, Australia
| | - Subash Heraganahally
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia .,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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7
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Meharg DP, Jenkins CR, Maguire GP, Jan S, Shaw T, Dennis SM, McKeough Z, Lee V, Gwynne KG, McCowen D, Rambaldini B, Alison JA. Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol). BMC Pulm Med 2022; 22:239. [PMID: 35729525 PMCID: PMC9210710 DOI: 10.1186/s12890-022-02033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD. METHODS Multi-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program. OUTCOMES AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests. DISCUSSION Pulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Kensington, NSW, 2052, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Stephan Jan
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia.
- Sydney Local Health District, Camperdown, NSW, 2050, Australia.
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8
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Gardiner L, Singh S. Inequality in Pulmonary Rehabilitation - The challenges magnified by the COVID-19 pandemic. Chron Respir Dis 2022; 19:14799731221104098. [PMID: 35687527 PMCID: PMC9189169 DOI: 10.1177/14799731221104098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic has served to expose and amplify existing inequalities in chronic respiratory disease and the social determinants of health. In this article, we summarise evidence of existing disparities associated with chronic obstructive pulmonary disease and pulmonary rehabilitation; highlighting limitations of existing data. To reduce health inequalities in pulmonary rehabilitation, there is a need to identify and target factors influencing fair access and personal agency to engage. With consideration of the influence of culture on beliefs, expectations and health behaviours, we propose a renewed approach toward progressively achieving health equity in pulmonary rehabilitation based on principles of cultural safety and adaptation. This is a key priority in improving the quality of life of people living with chronic respiratory disease. Building comprehensive pulmonary rehabilitation service delivery models based on an understanding of the holistic needs of the local population should be a priority for service providers and researchers.
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Affiliation(s)
- Lucy Gardiner
- School of Sport, Exercise and Rehabilitation Sciences, 1724University of Birmingham, Birmingham, UK
| | - Sally Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
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