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Cullen T, Griffith M, Damodaran A, Lewis E, McMillan F, Sammel A, Honeysette R, Biles B, Beadman K, Nathan S. The First Nations experience of accessing rheumatology services in a metropolitan hospital: A qualitative study. Health Expect 2024; 27:e14049. [PMID: 38623822 PMCID: PMC11019439 DOI: 10.1111/hex.14049] [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: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE First Nations Australians experience a higher burden and severity of Rheumatic Disease with poorer outcomes than the general population. Despite a widely acknowledged need to improve health outcomes, there has been minimal research assessing existing models of care from a First Nations perspective in Australia. The objective of this study was to describe First Nations experiences and barriers and enablers to accessing a hospital-based adult Rheumatology service in Sydney. METHODS A qualitative study using semi-structured interviews was undertaken. Patients who self-identified as First Nations attending the Prince of Wales Hospital Rheumatology Clinic in 2021 were invited to participate. Interviews were conducted face-to-face or by telephone using culturally-appropriate Yarning methods with an Aboriginal Health Worker (AHW) at the request of participants. Thematic analysis was done in consultation with an Aboriginal Reference Group (ARG). RESULTS Four categories, which encapsulated 11 themes were identified. Participants reported barriers to care such as logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments and health worker behaviours, inadequate cultural support and community perceptions of the specialty. Enabling factors included family member involvement, AHW support and telehealth consultation. CONCLUSION The current model of care perpetuates access challenges for First Nations Australians within rheumatology. Barriers to care include the delayed referral process, limited cultural responsivity in the clinic environment and poor cross-cultural communication. There is a need for models of care that are co-designed with First Nations Peoples to address these barriers. PATIENT AND PUBLIC CONTRIBUTION Participants were First Nations Australians with lived experience attending the rheumatology clinic. All interviewees were offered the opportunity to review their transcripts to ensure trustworthiness of the data. Preliminary thematic analysis was conducted in partnership with the AHW who has over 20 years experience. Following preliminary coding, a list of themes were presented to the ARG for iterative discussion and refinement. The ARG provided community representation and ensured that First Nations voices were privileged in the analysis. It's intended that the findings of this study will support the upcoming co-design of a First Nations health service for Rheumatology patients.
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Affiliation(s)
- Taylor Cullen
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
- Department of RheumatologyPrince of Wales HospitalSydneyAustralia
| | - Miki Griffith
- Aboriginal and Torres Strait Islander Community ServicesPrince of Wales HospitalSydneyAustralia
| | - Arvin Damodaran
- Department of RheumatologyPrince of Wales HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSWSydneyAustralia
| | - Ebony Lewis
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
| | - Faye McMillan
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
- School of Public HealthUniversity of TechnologySydneyAustralia
| | - Anthony Sammel
- Department of RheumatologyPrince of Wales HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSWSydneyAustralia
| | - Rhiana Honeysette
- Aboriginal and Torres Strait Islander Community ServicesPrince of Wales HospitalSydneyAustralia
| | - Brett Biles
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
| | | | - Sally Nathan
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
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Howard K, Garvey G, Anderson K, Dickson M, Viney R, Ratcliffe J, Howell M, Gall A, Cunningham J, Whop LJ, Cass A, Jaure A, Mulhern B. Development of the What Matters 2 Adults (WM2A) wellbeing measure for Aboriginal and Torres Strait Islander adults. Soc Sci Med 2024; 347:116694. [PMID: 38569315 DOI: 10.1016/j.socscimed.2024.116694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE As wellbeing is culturally bound, wellbeing measures for Aboriginal and Torres Strait Islander peoples must be culturally relevant and grounded in Aboriginal and Torres Strait Islander values and preferences. We describe the development of a nationally-relevant and culturally grounded wellbeing measure for Aboriginal and Torres Strait Islander adults: the What Matters to Adults (WM2A) measure. METHODS We used a mixed methods approach to measure development, combining Indigenist methodologies and psychometric methods. Candidate items were derived through a large national qualitative study. Think-aloud interviews (n = 17) were conducted to assess comprehension, acceptability, and wording of candidate items. Two national surveys collected data on the item pool (n = 312, n = 354). Items were analysed using exploratory factor analysis (EFA), and item response theory (IRT) to test dimensionality, local dependence and item fit. A Collaborative Yarning approach ensured Aboriginal and Torres Strait Islander voices were privileged throughout. RESULTS Fifty candidate items were developed, refined, and tested. Using EFA, an eight factor model was developed. All items met pre-specified thresholds for maximum endorsement frequencies, and floor and ceiling effects; no item redundancy was identified. Ten items did not meet thresholds for aggregate adjacent endorsement frequencies. During Collaborative Yarning, six items were removed based on low factor loadings (<0.4) and twelve due to conceptual overlap, high correlations with other items, endorsement frequencies, and/or low IRT item level information. Several items were retained for content validity. The final measure includes 32 items across 10 domains (Balance & control; Hope & resilience; Caring for others; Culture & Country; Spirit & identity; Feeling valued; Connection with others; Access; Racism & worries; Pride & strength). CONCLUSIONS The unique combination of Indigenist and psychometric methodologies to develop WM2A ensures a culturally and psychometrically robust measure, relevant across a range of settings and applications.
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Affiliation(s)
- K Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia.
| | - G Garvey
- The First Nations Cancer & Wellbeing Research Team, The School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane Qld 4072, Australia
| | - K Anderson
- The First Nations Cancer & Wellbeing Research Team, The School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane Qld 4072, Australia
| | - M Dickson
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia; The Poche Centre for Indigenous Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - R Viney
- The Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - J Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5001, Australia
| | - M Howell
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - A Gall
- The First Nations Cancer & Wellbeing Research Team, The School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane Qld 4072, Australia
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin NT, Australia
| | - L J Whop
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, 2600, Australia
| | - A Cass
- Menzies School of Health Research, Charles Darwin University, Darwin NT, Australia
| | - A Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - B Mulhern
- The Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Ultimo, NSW, 2007, Australia
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Rungan S, Liu HM, Smith-Merry J, Eastwood J. Kalgal Burnbona: An Integrated Model of Care Between the Health and Education Sector. Int J Integr Care 2024; 24:14. [PMID: 38706536 PMCID: PMC11067974 DOI: 10.5334/ijic.7745] [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: 09/10/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Kalgal Burnbona is a framework developed for applying school-based integrated care (SBIC) across Sydney Local Health District (SLHD). Description Kalgal Burnbona is an innovative and integrative framework developed to provide holistic, integrated, multidisciplinary child and family centred care to school-aged children from priority populations within SLHD, such as those belonging to the Aboriginal community. The expected outcomes include improved health, behavioural, education and social outcomes. This article contextualises the development of the Kalgal Burnbona framework from its beginnings as a pilot site called Ngaramadhi Space (NS) within the Healthy Homes and Neighbourhoods (HHAN) initiative, through to its evolution to an integrated partnership between the New South Wales (NSW) health and education sector. An example of how the framework can be implemented in other settings within SLHD is described. Discussion A tiered approach to integrated care across SLHD is postulated based on evidence from a mixed methods evaluation of NS and in line with the Rainbow Model of Integrated Care (RMIC). Kalgal Burnbona is an example of a community-driven response through collaborative partnerships to improve health, education and social outcomes. The framework described provides structure for multisector teams to work within, recognising that each community and school has its own history and needs. Conclusion The Kalgal Burnbona model can be scaled up to serve a wider network of students across SLHD. The initial successes of the model, which include improving access and engagement for children with unmet physical health, mental health and social needs while being accepted by communities provide evidence for policy changes and advocacy that centre on collaborative cross-sector partnerships.
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Affiliation(s)
- Santuri Rungan
- Croydon Health Centre, 24 Liverpool Road, Croydon, NSW, 2132, Australia
| | - Huei Ming Liu
- Menzies Centre for Health Policy, University of Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, Australia
| | - John Eastwood
- School of Population Health, University of New South Wales, Kensington, NSW, 2050, Australia
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
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Schilstra CE, Ellis SJ, Cohen J, Gall A, Diaz A, Clarke K, Dumlao G, Chard J, Cumming TM, Davis E, Dhillon H, Burns MA, Docking K, Koh ES, O'Reilly J, Sansom-Daly UM, Shaw J, Speers N, Taylor N, Warne A, Fardell JE. Exploring Web-Based Information and Resources That Support Adolescents and Young Adults With Cancer to Resume Study and Work: Environmental Scan Study. JMIR Cancer 2024; 10:e47944. [PMID: 38526527 PMCID: PMC11002739 DOI: 10.2196/47944] [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: 04/09/2023] [Revised: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) diagnosed with cancer experience physical, cognitive, and psychosocial effects from cancer treatment that can negatively affect their ability to remain engaged in education or work through cancer treatment and in the long term. Disengagement from education or work can have lasting implications for AYAs' financial independence, psychosocial well-being, and quality of life. Australian AYAs with cancer lack access to adequate specialist support for their education and work needs and report a preference for web-based support that they can access from anywhere, in their own time. However, it remains unclear what web-based resources exist that are tailored to support AYAs with cancer in reaching their educational or work goals. OBJECTIVE This study aimed to determine what web-based resources exist for Australian AYAs with cancer to (1) support return to education or work and (2) identify the degree to which existing resources are age-specific, cancer-specific, culturally inclusive, and evidence-based; are co-designed with AYAs; use age-appropriate language; and are easy to find. METHODS We conducted an environmental scan by searching Google with English search terms in August 2022 to identify information resources about employment and education for AYAs ever diagnosed with cancer. Data extraction was conducted in Microsoft Excel, and the following were assessed: understandability and actionability (using the Patient Education and Materials Tool), readability (using the Sydney Health Literacy Laboratory Health Literacy Editor), and whether the resource was easy to locate, evidence-based, co-designed with AYAs, and culturally inclusive of Aboriginal and Torres Strait Islander peoples. The latter was assessed using 7 criteria previously developed by members of the research team. RESULTS We identified 24 web-based resources, comprising 22 written text resources and 12 video resources. Most resources (21/24, 88%) were published by nongovernmental organizations in Australia, Canada, the United States, and the United Kingdom. A total of 7 resources focused on education, 8 focused on work, and 9 focused on both education and work. The evaluation of resources demonstrated poor understandability and actionability. Resources were rarely evidence-based or co-designed by AYAs, difficult to locate on the internet, and largely not inclusive of Aboriginal and Torres Strait Islander populations. CONCLUSIONS Although web-based resources for AYAs with cancer are often available through the websites of hospitals or nongovernmental organizations, this environmental scan suggests they would benefit from more evidence-based and actionable resources that are available in multiple formats (eg, text and audio-visual) and tailored to be age-appropriate and culturally inclusive.
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Affiliation(s)
- Clarissa E Schilstra
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Randwick, Australia
| | - Sarah J Ellis
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Randwick, Australia
| | - Jennifer Cohen
- Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Kensington, Australia
- Canteen Australia, Newtown, Australia
| | - Alana Gall
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia
| | - Abbey Diaz
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Gadiel Dumlao
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Randwick, Australia
| | - Jennifer Chard
- Western Sydney Youth Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Therese M Cumming
- Faculty of Arts, Design and Architecture, University of New South Wales Sydney, Kensington, Australia
- Disability Innovation Institute, University of New South Wales Sydney, Kensington, Australia
| | | | - Haryana Dhillon
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
| | - Mary Anne Burns
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
| | - Kimberley Docking
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Eng-Siew Koh
- South West Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales Sydney, Liverpool, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | | | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Randwick, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
| | - Nicole Speers
- Cancer survivor representative, New South Wales, Australia
| | - Natalie Taylor
- Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Kensington, Australia
| | - Anthea Warne
- Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Kensington, Australia
| | - Joanna E Fardell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Faculty of Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Randwick, Australia
- Western Sydney Youth Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
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Anderson K, Elder-Robinson E, Ferguson M, Fredericks B, Sherriff S, Dickson M, Howard K, Garvey G. Pathways between foodways and wellbeing for first nations Australians. BMC Public Health 2024; 24:502. [PMID: 38365753 PMCID: PMC10873965 DOI: 10.1186/s12889-024-18005-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: 06/27/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Supporting the health and wellbeing of Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as First Nations peoples) is a national priority for Australia. Despite immense losses of land, language, and governance caused by the continuing impact of colonisation, First Nations peoples have maintained strong connections with traditional food culture, while also creating new beliefs, preferences, and traditions around food, which together are termed foodways. While foodways are known to support holistic health and wellbeing for First Nations peoples, the pathways via which this occurs have received limited attention. METHODS Secondary data analysis was conducted on two national qualitative datasets exploring wellbeing, which together included the views of 531 First Nations peoples (aged 12-92). Thematic analysis, guided by an Indigenist research methodology, was conducted to identify the pathways through which foodways impact on and support wellbeing for First Nations peoples. RESULTS AND CONCLUSIONS Five pathways through which wellbeing is supported via foodways for First Nations peoples were identified as: connecting with others through food; accessing traditional foods; experiencing joy in making and sharing food; sharing information about food and nutrition; and strategies for improving food security. These findings offer constructive, nationally relevant evidence to guide and inform health and nutrition programs and services to harness the strengths and preferences of First Nations peoples to support the health and wellbeing of First Nations peoples more effectively.
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Affiliation(s)
- Kate Anderson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Elaina Elder-Robinson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Megan Ferguson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Bronwyn Fredericks
- Office of the Deputy Vice Chancellor (Indigenous Engagement), The University of Queensland, St. Lucia, QLD, Australia
- The Poche Centre for Indigenous Health, Faculty of Health and Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Simone Sherriff
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Sax Institute, Sydney, NSW, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Davison N, Stanzel K, Hammarberg K. The Impact of Social Determinants of Health on Australian Women's Capacity to Access and Understand Health Information: A Secondary Analysis of the 2022 National Women's Health Survey. Healthcare (Basel) 2024; 12:207. [PMID: 38255095 PMCID: PMC10815356 DOI: 10.3390/healthcare12020207] [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: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
The ability to access, understand, judge, and use health information is crucial for making informed decisions about health and optimal health outcomes. This secondary data analysis investigated associations between social determinants of health and Australian women's ability to access and understand health information using data from 10,652 women who responded to the 2022 National Women's Health Survey. A score (0-5) was created based on five questions assessing the participants' ability to access and understand health information, which was dichotomised into low (≤3) and high (≥4) scores. The data were analyzed using descriptive statistics, univariate comparisons, and multivariable binary logistic regression. Almost a quarter of the women had a low score. Non-native English speakers were approximately four times more likely to have low health literacy than native English speakers. Additionally, women without tertiary education, financially disadvantaged women, and First Nations women were almost twice as likely to have lower health literacy than other women. These findings suggest that social determinants of health decrease the capacity to access and understand health information. To reduce health inequalities, healthcare systems and health professionals must consider the factors that reduce women's capacity to access and understand health information and address the health information needs of socioeconomically disadvantaged women.
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Affiliation(s)
| | - Karin Stanzel
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (N.D.); (K.H.)
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Rungan S, Gardner S, Liu HM, Woolfenden S, Smith-Merry J, Eastwood J. Ngaramadhi Space: An Integrated, Multisector Model of Care for Students Experiencing Problematic Externalising Behaviour. Int J Integr Care 2023; 23:19. [PMID: 38107833 PMCID: PMC10723013 DOI: 10.5334/ijic.7612] [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: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Behavioural and emotional disorders are a significant cause of morbidity for young people aged 10-19 years. School-based health care (SBHC) provides an innovative approach to addressing these issues within Australia. Description We describe an innovative and integrative SBHC model called Ngaramadhi Space (NS) based at a specialised behavioural school called Yudi Gunyi school (YGS) in metropolitan Sydney, Australia. NS was developed in partnership with the Aboriginal community to provide holistic, integrated, multidisciplinary child and family centred care to students experiencing problematic externalising behaviour. We contextualise the historical factors leading to the development of NS, highlighting the importance of effective partnerships between sectors, and providing the theoretical framework and key components underpinning the model of care. Discussion In Australia, schools are an under-utilised resource for the delivery of health and support alongside education. Collaboration between sectors can be challenging but allows a more coordinated approach to the management of complex social and health issues. By forming effective partnerships with schools and communities, the health sector has an opportunity to improve access to health and social care in a culturally safe and acceptable way. This is in line with national and international frameworks for improving health service delivery and addressing inequity. Conclusion The health sector can play a pivotal role in improving the wellbeing of children by forming effective partnerships with schools and communities. The NS model is a practice-based example of this.
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Affiliation(s)
- Santuri Rungan
- Sydney Local Health District, University of Sydney, Sydney Institute for Women, Children & their Families, AU
| | | | - Huei-Ming Liu
- The George Institute for Global Health, University of New South Wales, AU
| | - Susan Woolfenden
- Sydney Local Health District, University of Sydney, AU
- Sydney Institute Women, Children and their Families, University of New South Wales, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, AU
| | - John Eastwood
- University of New South Wales, Sydney, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- University of Sydney, Sydney Institute for Women, Children and their Families and Sydney Local Health District, AU
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Scholes‐Robertson N, Blazek K, Tong A, Gutman T, Craig JC, Essue BM, Howard K, Wong G, Howell M. Financial toxicity experienced by rural Australian families with chronic kidney disease. Nephrology (Carlton) 2023; 28:456-466. [PMID: 37286370 PMCID: PMC10947551 DOI: 10.1111/nep.14192] [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: 02/05/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
AIM Chronic kidney disease (CKD) and its treatment places a financial burden on healthcare systems and households worldwide, yet little is known of its financial impact, on those who reside in rural settings. We aimed to quantify the financial impacts and out-of-pocket expenditure experienced by adult rural patients with CKD in Australia. METHODS A web based structured survey was completed between November 2020 and January 2021. English speaking participants over 18 years of age, diagnosed with CKD stages 3-5, those receiving dialysis or with a kidney transplant, who lived in a rural location in Australia. RESULTS In total 77 (69% completion rate) participated. The mean out of pocket expenses were 5056 AUD annually (excluding private health insurance costs), 78% of households experienced financial hardship with 54% classified as experiencing financial catastrophe (out-of-pocket expenditure greater than 10% of household income). Mean distances to access health services for all rural and remote classifications was greater than 50 kilometres for specialist nephrology services and greater than 300 kilometres for transplanting centres. Relocation for a period greater than 3 months to access care was experienced by 24% of participants. CONCLUSION Rural households experience considerable financial hardship due to out-of-pocket costs in accessing treatment for CKD and other health-related care, raising concerns about equity in Australia, a high-income country with universal healthcare.
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Affiliation(s)
- Nicole Scholes‐Robertson
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Katrina Blazek
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Allison Tong
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Talia Gutman
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Beverley M. Essue
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Kirsten Howard
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Menzies Centre for Health Policy and Economics, Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Germaine Wong
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Martin Howell
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
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Nash K, Macniven R, Clague L, Coates H, Fitzpatrick M, Gunasekera H, Gwynne K, Halvorsen L, Harkus S, Holt L, Lumby N, Neal K, Orr N, Pellicano E, Rambaldini B, McMahon C. Ear and hearing care programs for First Nations children: a scoping review. BMC Health Serv Res 2023; 23:380. [PMID: 37076841 PMCID: PMC10116763 DOI: 10.1186/s12913-023-09338-2] [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: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs. METHOD A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services. RESULTS Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases. CONCLUSION The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
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Affiliation(s)
- Kai Nash
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia.
| | - Rona Macniven
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Liesa Clague
- Thurru Indigenous Unit, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Harvey Coates
- The University of Western Australia, Perth, Australia
| | | | | | - Kylie Gwynne
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | - Luke Halvorsen
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Leanne Holt
- Department of Indigenous Studies, Macquarie University, Sydney, Australia
| | - Noeleen Lumby
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Neil Orr
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Boe Rambaldini
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | - Catherine McMahon
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
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Sharp VL, Chapman JE, Gardner B, Ponsford JL, Giummarra MJ, Lannin NA, Olver J, Stolwyk RJ. Perspectives of major traumatic injury survivors on accessibility and quality of rehabilitation services in rural Australia. Disabil Rehabil 2023; 45:1379-1388. [PMID: 35417290 DOI: 10.1080/09638288.2022.2060345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE For the 30% of Australians who live in rural areas, access to rehabilitation services after sustaining a major traumatic injury can be challenging. This study aimed to explore the experience of rural major traumatic injury survivors accessing rehabilitation services. MATERIALS AND METHODS Semi-structured interviews were conducted with 21 rural major traumatic injury survivors (Mage = 47.86; SD = 11.35; Range: 21-61) who were an average of seven years post-injury (SD = 3.10; Range: 3.25-13.01). Transcribed interviews were thematically analysed. RESULTS Four themes were identified: (1) Managing the transition back to local services, (2) Independence and determination to get better, (3) Rehabilitation is an ongoing process, and (4) Limited service access and quality. While injury-related symptoms persisted for many participants, they expressed strong determination for independence and self-management of their recovery. Barriers to accessing rehabilitation services included poor knowledge of local services, travel burden, financial costs, and a lack of local practitioners experienced in major traumatic injury rehabilitation. Facilitating factors included financial, psychological, community, and informal supports. CONCLUSIONS To support recovery, future rural service models should improve consideration of factors resulting from living at a distance to services and harness independence to self-manage.IMPLICATIONS FOR REHABILITATIONRural major traumatic injury survivors need support to navigate numerous barriers to accessing rehabilitation services.Rural participants expressed their preference for greater involvement in planning their transition back home following hospitalisation and help to link with available services in their local area.Specialist training and support for rural rehabilitation practitioners is needed, to effectively treat impairments related to major traumatic injury, particularly psychological and cognitive difficulties.Future service delivery models should incorporate methods to locate rural services; facilitate telehealth access and client self-management; and provide financial and mental health support to both rural survivors of major traumatic injury and their carers.
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Affiliation(s)
- Vanessa L Sharp
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Jodie E Chapman
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Betina Gardner
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Melita J Giummarra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Alfred Health, Melbourne, Australia
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - John Olver
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Research Unit, Monash University, Melbourne, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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11
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Hu H, Xu Y, Shao Y, Liang Y, Wang Q, Luo S, Lu H, Meng H, Liu C. A latent profile analysis of residents' knowledge, attitude, and practice toward common chronic diseases among ethnic minority area in China. Front Public Health 2022; 10:940619. [PMID: 35958853 PMCID: PMC9357989 DOI: 10.3389/fpubh.2022.940619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHealth literacy plays an important role in preventing and managing chronic diseases, while low levels of health literacy among ethnic minorities are a major manifestation of health inequities. We believe that before effective health literacy intervention strategies, it is preferable to understand the features of health literacy among ethnic minorities. The present study firstly updated insights on health literacy among ethnic minorities by investigating the knowledge, attitude, and practice (KAP) profile of common chronic diseases in ethnic minority areas, and secondly discussed the KAP profiles in detail to inspire future health education interventions.MethodsA cross-sectional, health-literacy-sensitive study was conducted in China's typical ethnic minority area. Participants included 801 adult residents who lived in the ethnic minority area. The primary outcome was participant scores on the KAP questionnaire of common chronic diseases, followed by latent profile analysis to identify participants with similar KAP score patterns and determine whether membership in specific groups was associated with demographic or clinical characteristics.ResultsThe participants included 496 ethnic minorities (61.9%) and 305 Han Chinese (38.1%). Three-profile solution was determined after the latent profile analysis: incomplete transfer [I.T.] (n = 215), better practice [B.P.] (n = 301), and average [A.V.] (n = 285). IT group (26.84%) was characterized by the highest level of knowledge and attitude toward common chronic diseases and below average level for practice. Participants in B.P. group performed poorly in both knowledge and attitude toward common chronic diseases but had the highest level of practice. A.V. group reflected average knowledge, attitude, and practice toward common chronic diseases among three subgroups. Ethnic minorities were the dominant population in A.V. group (68.8%). Compared with other groups, the A.V. group contained the largest proportions of married participants (84.2%), participants with no formal education (46.7%), and high annual out-of-pocket medical expense (33.3%).ConclusionA more specific and nuanced understanding of minority health literacy can enable service providers to provide more effective health education to their recipients, thereby improving health inequities.
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Affiliation(s)
- Huaqin Hu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihua Xu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yihua Xu
| | - Yingshan Shao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaxin Liang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Shunmei Luo
- Lincang Second People's Hospital, Lincang, China
| | - Heyun Lu
- Lincang Second People's Hospital, Lincang, China
| | - Heng Meng
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Chenxi Liu
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Scholes-Robertson NJ, Gutman T, Howell M, Craig J, Chalmers R, Dwyer KM, Jose M, Roberts I, Tong A. Clinicians' perspectives on equity of access to dialysis and kidney transplantation for rural people in Australia: a semistructured interview study. BMJ Open 2022; 12:e052315. [PMID: 35177446 PMCID: PMC8860044 DOI: 10.1136/bmjopen-2021-052315] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES People with chronic kidney disease requiring dialysis or kidney transplantation in rural areas have worse outcomes, including an increased risk of hospitalisation and mortality and encounter many barriers to accessing kidney replacement therapy. We aim to describe clinicians' perspectives of equity of access to dialysis and kidney transplantation in rural areas. DESIGN Qualitative study with semistructured interviews. SETTING AND PARTICIPANTS Twenty eight nephrologists, nurses and social workers from 19 centres across seven states in Australia. RESULTS We identified five themes: the tyranny of distance (with subthemes of overwhelming burden of travel, minimising relocation distress, limited transportation options and concerns for patient safety on the roads); supporting navigation of health systems (reliance on local champions, variability of health literacy, providing flexible models of care and frustrated by gatekeepers); disrupted care (without continuity of care, scarcity of specialist services and fluctuating capacity for dialysis); pervasive financial distress (crippling out of pocket expenditure and widespread socioeconomic disadvantage) and understanding local variability (lacking availability of safe and sustainable resources for dialysis, sensitivity to local needs and dependence on social support). CONCLUSIONS Clinicians identified geographical barriers, dislocation from homes and financial hardship to be major challenges for patients in accessing kidney replacement therapy. Strategies such as telehealth, outreach services, increased service provision and patient navigators were suggested to improve access.
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Affiliation(s)
- Nicole Jane Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Rachel Chalmers
- Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Karen M Dwyer
- School of Medicine, Faculty of Health, Deakin University-Geelong Campus at Waurn Ponds, Geelong, Victoria, Australia
| | - Matthew Jose
- Hobart Clinical School, University of Tasmania School of Medicine, Hobart, Tasmania, Australia
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Ieyesha Roberts
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Biles J, Deravin L, Seaman CE, Alexander N, Damm A, Trudgett N. Learnings from a mentoring project to support Aboriginal and Torres Strait Islander nurses and midwives to remain in the workforce. Contemp Nurse 2021; 57:327-337. [PMID: 34618664 DOI: 10.1080/10376178.2021.1991412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: This article provides the findings of a research project which explored the experiences of participants in a mentoring programme designed to support Aboriginal and Torres Strait Islander nurses and midwives in a rural health district.Aims: It seeks to understand how a mentoring programme achieved its aims and anticipated outcomes that would ultimately inform future Aboriginal and Torres Strait Islander workforce support programmes.Design: The research project used a hermeneutic phenomenological philosophical framework to conduct Aboriginal and Torres Strait Islander people's methods of yarning, which engaged in conversation around key topics with participants, followed by the research team's analysis of yarns.Methods: A qualitative study utilising purposive sampling to select participants. Participants were drawn from those who had undertaken the cultural mentoring programme and could have been either mentors or mentees. Interviews were conducted once the 12-month mentoring programme had ceased.Results: The five main themes that were drawn from the data were cultural safety, motivations, relationships, learning and support.Conclusion: Participant experiences indicate that mentoring can be an avenue for providing appropriate clinical and cultural support and a safe space for Aboriginal and Torres Strait Islander nurses and midwives. They also show that identified support roles and Aboriginal-led projects can have larger impacts; fostering organisational connections and broader feelings of cultural respect amongst Aboriginal and Torres Strait Islander staff beyond programme participation.
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Affiliation(s)
- Jessica Biles
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Wiradjuri Country, Albury, NSW 2640, Australia
| | - Linda Deravin
- Wiradjuri Nation, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Wiradjuri Country, Bathurst, NSW, Australia
| | - Claire Ellen Seaman
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Nathaniel Alexander
- Ngunnawal Nation, NSW Health, Murrumbidgee Local Health District, Wiradjuri Country, Wagga Wagga, NSW, Australia
| | - Angela Damm
- Ngunnawal Nation, NSW Health, Murrumbidgee Local Health District, Wiradjuri Country, Wagga Wagga, NSW, Australia
| | - Nikki Trudgett
- Wiradjuri Nation, Aboriginal Health and Wellbeing, Western NSW Primary Health Network, Wiradjuri Country, Bathurst, NSW, Australia
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Garvey G, Anderson K, Gall A, Butler TL, Whop LJ, Arley B, Cunningham J, Dickson M, Cass A, Ratcliffe J, Tong A, Howard K. The Fabric of Aboriginal and Torres Strait Islander Wellbeing: A Conceptual Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157745. [PMID: 34360037 PMCID: PMC8345714 DOI: 10.3390/ijerph18157745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
Wellbeing is culturally bound and is shaped by many aspects of life, including experiences, beliefs and values. As such, in order to accurately measure wellbeing for a specific cultural group, it is necessary to understand the experiences, beliefs and values that influence the conception and experience of wellbeing of that group. This paper presents a conceptual model of wellbeing for Aboriginal and Torres Strait Islander people, which was developed from a large national qualitative study that explored the views of 359 Aboriginal and Torres Strait Islander adults. An Aboriginal- and Torres Strait Islander-led research team used an Indigenist research approach to iteratively develop this conceptual model, called the Fabric of Aboriginal and Torres Strait Islander Wellbeing model, which takes inspiration from Aboriginal and Torres Strait Islander weaving traditions whereby individual strands are twined to create fabrics that are both beautiful and strong. This reflects our findings that the parts of life that are most important to wellbeing for many Aboriginal and Torres Strait Islander people are interwoven with their families, communities and culture.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- School of Public Health, University of Queensland, Brisbane 4000, Australia
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- Correspondence:
| | - Alana Gall
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Tamara L. Butler
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
| | - Brian Arley
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide 5042, Australia;
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kirsten Howard
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney 2006, Australia
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15
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Coyle M, Sandover S, Poobalan A, Bullen J, Cleland J. Meritocratic and fair? The discourse of UK and Australia's widening participation policies. MEDICAL EDUCATION 2021; 55:825-839. [PMID: 33346380 DOI: 10.1111/medu.14442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Globally, people with the academic and personal attributes to successfully study medicine experience disadvantages associated with sociodemographic factors. Governments have attempted to address this issue via macrolevel policies aimed at widening participation (WP) to medicine. These policies differ by country, suggesting much can be learned from examining and comparing international policy discourses of WP. Our question was: How are discourses of WP to higher and medical education positioned in the UK and Australia? METHODS A systematic search strategy was guided by five a priori themes inspired by United Nations Sustainability Goals (2015). Seventeen policy documents (UK n = 9, Australia n = 8) published between 2008 and 2018 were identified. Analysis involved two over-arching, iterative stages: a document analysis then a Foucauldian critical discourse analysis, the latter with the aim of unveiling the power dynamics at play within policy-related discourses. RESULTS Discourses of social mobility and individual responsibility within a meritocracy are still paramount in the UK. In contrast, the dominant discourse in Australia is social accountability in achieving equity and workforce diversity, prioritising affirmative action and community values. Similarities between the two countries in terms of WP policy and policy levers have changed over time, linked to the divergence of internal drivers for societal change. Both nations recognise tensions inherent in striving to achieve both local and global goals, but Australia appears to prioritise community values in working towards 'nation building' whereas in the UK the focus on individuality and meritocracy at times seems at odds with achieving parity for disadvantaged individuals. DISCUSSION WP policies and practices are situated and contextual so caution must be taken when extrapolating lessons from one context to another. The history of a country and the nature of marginalisation in that country must be scrutinised when trying to understand what drives WP policy.
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Affiliation(s)
- Maeve Coyle
- Institute of Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Amudha Poobalan
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Jennifer Cleland
- Nanyang Technological University Singapore, Singapore, Singapore
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What Matters 2 Adults (WM2Adults): Understanding the Foundations of Aboriginal and Torres Strait Islander Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126193. [PMID: 34201090 PMCID: PMC8226989 DOI: 10.3390/ijerph18126193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Aboriginal and Torres Strait Islander people experience a greater range of health and social disadvantages compared to other Australians. Wellbeing is a culturally-bound construct, and to date, a national evidence base around the components of wellbeing for Aboriginal and Torres Strait Islander people is lacking. Understanding and measurement of wellbeing for this population is critical in achieving health equity. This paper aims to identify and describe the foundations of wellbeing for Aboriginal and Torres Strait Islander adults. This national qualitative study was underpinned by an Indigenist research approach which privileges the voices of Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander adults were purposively recruited from around Australia between September 2017 and September 2018 to participate in Yarning Circles, led by Aboriginal and Torres Strait Islander researchers. Yarning Circles were audio recorded, transcribed and analyzed. A Collaborative Yarning Methodology was used, which incorporated reflexive thematic analysis to identify and describe the foundations of wellbeing reported by participants. A total of 359 Aboriginal and Torres Strait Islander adults participated. Our analysis revealed five foundations of wellbeing: belonging and connection; holistic health; purpose and control; dignity and respect; and basic needs. These foundations were deeply interwoven by three interconnected aspects of Aboriginal and Torres Strait Islander life: family, community and culture. The findings of this study will substantially aid our efforts to develop a new wellbeing measure for Aboriginal and Torres Strait Islander adults. The iterative Indigenist methods used in this study provide a robust research methodology for conducting large-scale, nationally-relevant qualitative research with Aboriginal and Torres Strait Islander people. Policies and practices that are informed by our results have the potential to address outcomes that are meaningful for Aboriginal and Torres Strait Islander people.
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Belita E, Schofield R, Currie G, Dietrich Leurer M, Dosani A, Cusack C, Danaher A, Dilworth K, Etowa J, Filion F, Joseph C, Lukewich J, MacDonald JA, Reid-Haughian C. Advancing Excellence in Community Health Nursing Through Evidence-Based National Standards of Practice. J Contin Educ Nurs 2021; 52:168-175. [PMID: 34038234 DOI: 10.3928/00220124-20210315-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current standards of practice are necessary to ensure safe nursing practice in Canada and across the world. This article aimed to describe and present findings from the rigorous review process undertaken to update the 2011 Canadian Community Health Nursing Standards of Practice. METHOD A revision process included a scoping review of the literature, focus groups, and a modified Delphi method. RESULTS Through the inclusive consultation process, 495 community health nurses enhanced the content of the standards with respect to cultural safety, cultural humility, Indigenous health and ways of knowing, health equity, and evidence-informed practice. CONCLUSION This comprehensive revision process can guide other nursing specialty groups developing or revising specialized practice standards in Canada and across the world. [J Contin Educ Nurs. 2021;52(4):168-175.].
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Missel M, Bernild C, Dagyaran I, Christensen SW, Berg SK. A stoic and altruistic orientation towards their work: a qualitative study of healthcare professionals' experiences of awaiting a COVID-19 test result. BMC Health Serv Res 2020; 20:1031. [PMID: 33176771 PMCID: PMC7656225 DOI: 10.1186/s12913-020-05904-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/05/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Extensive measures to reduce person-to-person transmission of COVID-19 are required to control the current outbreak. Special attention is directed at healthcare professionals as reducing the risk of infection in healthcare is essential. The purpose of this study was to explore healthcare professionals' experiences of awaiting a test result for a potential COVID-19 infection. METHODS Qualitative interviews with 15 healthcare professionals were performed, underpinned by a phenomenological hermeneutical analytical framework. RESULTS The participating healthcare professionals' experiences of awaiting a COVID-19 test result were found to be associated with a stoic and altruistic orientation towards their work. These healthcare professionals presented a strong professional identity overriding most concerns about their own health. The result of the coronavirus test was a decisive parameter for whether healthcare professionals could return to work. The healthcare professionals were aware that their family and friends were having a hard time knowing that the COVID-19 infection risk was part of their jobs. This concern did not, however, cause the healthcare professionals to falter in their belief that they were doing the right thing by focusing on their core area. The threat to own health ran through the minds of the healthcare professionals occasionally, which makes access to testing particularly important. CONCLUSION The participating healthcare professionals had a strong professional identity. However, a discrepancy between an altruistic role as a healthcare professional and the expectations that come from the community was illuminated. A mental health coronavirus hotline for healthcare professionals is suggested.
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Affiliation(s)
- Malene Missel
- Clinical nurse specialist at the Department of Cardiothoracic Surgery, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Camilla Bernild
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilkay Dagyaran
- Clinical nurse specialist at Department of Infectious Diseases, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Westh Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ferdinand A, Lambert M, Trad L, Pedrana L, Paradies Y, Kelaher M. Indigenous engagement in health: lessons from Brazil, Chile, Australia and New Zealand. Int J Equity Health 2020; 19:47. [PMID: 32731870 PMCID: PMC7393707 DOI: 10.1186/s12939-020-1149-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/27/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Given the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination. Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world's Indigenous people. AIM This paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems. METHODS For each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat. FINDINGS Each of the four countries have adopted international agreements regarding the engagement of Indigenous peoples in health. However, there is significant variation in the extent to which the principles laid out in these agreements are reflected in national policy, legislation and practice. Brazil and New Zealand both have established national policies to facilitate engagement. In contrast, national policy to enable engagement is relatively lacking in Australia and Chile. Australia, Brazil and New Zealand each have significant initiatives and policy structures in place to address Indigenous health. However, in Brazil this is not necessarily reflected in practice and although New Zealand has national policies these have been recently reported as insufficient and, in fact, may be contributing to health inequity for Māori. In comparison to the other three countries, Chile has relatively few national initiatives or policies in place to support Indigenous engagement or recognise the distinct health needs of Indigenous communities. CONCLUSIONS The adoption of international policy frameworks forms an important step in ensuring that Indigenous peoples are able to participate in the formation and implementation of health policy and programs. However, without the relevant principles being reflected in national legislature, international agreements hold little weight. At the same time, while a national legislative framework facilitates the engagement of Indigenous peoples, such policy may not necessarily translate into practice. Developing multi-level approaches that improve cohesion between international policy, national policy and practice in Indigenous engagement in health is therefore vital. Given that each of the four countries demonstrate strengths and weaknesses across this causal chain, cross-country policy examination provides guidance on strengthening these links.
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Affiliation(s)
- Angeline Ferdinand
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Australia.
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Leny Trad
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Leo Pedrana
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Burwood, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Australia
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Re-Evaluating Expertise: Principles for Food and Nutrition Security Research, Advocacy and Solutions in High-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040561. [PMID: 30769953 PMCID: PMC6406792 DOI: 10.3390/ijerph16040561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/02/2022]
Abstract
Drawing on examples from Australia and the United States, we outline the benefits of sharing expertise to identify new approaches to food and nutrition security. While there are many challenges to sharing expertise such as discrimination, academic expectations, siloed thinking, and cultural differences, we identify principles and values that can help food insecurity researchers to improve solutions. These principles are critical consciousness, undoing white privilege, adopting a rights framework, and engaging in co-creation processes. These changes demand a commitment to the following values: acceptance of multiple knowledges, caring relationships, humility, empathy, reciprocity, trust, transparency, accountability, and courage.
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