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Jessop S, Hill S, Bicanin K, Day T, Turner J, O'Connell M, Highfold R, Revesz T. Aboriginal children with cancer: The patient and healthcare worker perspective. Pediatr Blood Cancer 2024; 71:e30747. [PMID: 37880841 DOI: 10.1002/pbc.30747] [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] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
There are inequitable health outcomes for Aboriginal children with cancer. A quality improvement audit performed at our institution through interviews with families and healthcare workers has highlighted individual, systematic and cultural barriers to equitable and culturally safe healthcare for Aboriginal patients, in addition to facilitators and recommendations for improvements.
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Affiliation(s)
- Sophie Jessop
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- University of Adelaide, North Adelaide, South Australia, Australia
| | - Shandelle Hill
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Kon Bicanin
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Tanya Day
- Aboriginal Health Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jess Turner
- Taikurrinthi Aboriginal Liaison Office, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Megan O'Connell
- Taikurrinthi Aboriginal Liaison Office, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Rose Highfold
- Taikurrinthi Aboriginal Liaison Office, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Tom Revesz
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- University of Adelaide, North Adelaide, South Australia, 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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Brew B, Gibberd A, Marks GB, Strobel N, Allen CW, Jorm L, Chambers G, Eades S, McNamara B. Identifying preventable risk factors for hospitalised asthma in young Aboriginal children: a whole-population cohort study. Thorax 2021; 76:539-546. [PMID: 33419952 DOI: 10.1136/thoraxjnl-2020-216189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population. AIM To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1-4 years of age). METHODS Birth, hospital and emergency data for all Aboriginal children born 2003-2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life. RESULTS There were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at <33 weeks' gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight <1500 g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%-7%. We did not observe a higher risk of asthma in those children who were from remote areas. CONCLUSION Improving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.
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Affiliation(s)
- Bronwyn Brew
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia .,School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
| | - Alison Gibberd
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Clare Wendy Allen
- Children's Hospital Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgina Chambers
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
| | - Sandra Eades
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Bridgette McNamara
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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McCalman J, Bainbridge R, James YC, Bailie R, Tsey K, Matthews V, Ungar M, Askew D, Fagan R, Visser H, Spurling G, Percival N, Blignault I, Doran C. Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach. BMC Public Health 2020; 20:1810. [PMID: 33246445 PMCID: PMC7694265 DOI: 10.1186/s12889-020-09885-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4-17 years). This paper outlines a protocol for implementing such complex community-driven research. METHODS/DESIGN Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children's social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. DISCUSSION The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.
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Affiliation(s)
- Janya McCalman
- Centre for Indigenous Health Equity Research, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia.
- School of Health, Medical and Applied Sciences, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia.
| | - Roxanne Bainbridge
- School of Health, Medical and Applied Sciences, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia
| | - Yvonne Cadet James
- Apunipima Cape York Health Council, 186 McCoombe St, Cairns, QLD, 4870, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, 61 Uralba St, Lismore, NSW, 2480, Australia
| | - Komla Tsey
- The Cairns Institute, James Cook University, McGregor Rd, Cairns, QLD, 4878, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, 61 Uralba St, Lismore, NSW, 2480, Australia
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, 6420 Coburg Rd, Halifax, NS, B3H 4R2, Canada
| | - Deborah Askew
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Qld, 4072, Australia
- Southern Queensland Health Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, Building 2/37 Wirraway Parade, Inala, QLD, 4077, Australia
| | - Ruth Fagan
- Gurriny Yealamucka Health Service, Bukki Rd, Yarrabah, QLD, 4871, Australia
| | - Hannah Visser
- Bulgarr Ngaru Medical Aboriginal Corporation, 153 Canterbury St, Casino, NSW, 2470, Australia
| | - Geoffrey Spurling
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Qld, 4072, Australia
- Southern Queensland Health Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, Building 2/37 Wirraway Parade, Inala, QLD, 4077, Australia
| | - Nikki Percival
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia
| | - Ilse Blignault
- Translational Health Research Institute, University of Western Sydney, School of Medicine, Campbelltown Campus, NSW, 2560, Australia
| | - Chris Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia
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