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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Urquhart L, Roberts K, Duncanson K, Brown LJ, Fisher K. Sustaining an Aboriginal wellbeing program: Informing health promotion practice and policy. Health Promot J Austr 2024; 35:457-469. [PMID: 37466162 DOI: 10.1002/hpja.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
ISSUE ADDRESSED Aboriginal and Torres Strait Islander Peoples' holistic concepts of wellbeing are inadequately represented in the health promotion discourse. The aim of this article was to explore what sustains an Aboriginal wellbeing program, to inform critical reflection and reorientation to empower Aboriginal wellbeing approaches in health promotion practice and policy. METHODS Aboriginal and non-Indigenous researchers collaboratively designed a critically framed, strengths-based research approach with Aboriginal Community Controlled Health Service staff and wellbeing program participants. Data from Individual Yarning (n = 15) with program participants and staff inspired co-researchers to co-develop interpretations over two half-day Collaborative Yarning sessions (n = 9). RESULTS Co-researchers depicted five lifeworld qualities that sustain an Aboriginal wellbeing program: love, connection, respect, culture and belonging. The lifeworld qualities are relational, communicative and involve the dynamics of identity, power and self-determination. CONCLUSIONS The five qualities support a lifeworld approach to an Aboriginal wellbeing program, opening communicative and relational opportunities to mediate culturally responsive interactions. The qualities mediated interactions between people in the lifeworld including program participants and coordinators, and systems representatives including health service providers. A lifeworld approach provides a way to empower Aboriginal self-determination and leadership through embedment of cultural determinants of health in wellbeing programs. SO WHAT?: Health service providers and policy makers can use lifeworld approaches to guide critical reflection and reorient practice and policy related to Aboriginal health. The lifeworld qualities that encompass this approach in wellbeing programs are communicative and relational, centred on local community voices and co-produced with community for Aboriginal identity, empowerment and self-determination.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Coffs Harbour, New South Wales, Australia
| | - Karen Roberts
- Galambila Aboriginal Health Service, Coffs Harbour, New South Wales, Australia
| | - Kerith Duncanson
- Centre of Research Excellence in Digestive Health, University of Newcastle, Callaghan, New South Wales, Australia
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Leanne J Brown
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
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Thapa S, Gibbs P, Ross N, Newman J, Allan J, Dalton H, Mahmood S, Kalinna BH, Ross AG. Are adverse childhood experiences (ACEs) the root cause of the Aboriginal health gap in Australia? BMJ Glob Health 2024; 9:e014901. [PMID: 38442985 DOI: 10.1136/bmjgh-2023-014901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Peter Gibbs
- Regional Enterprise Development Institute (REDI.E), Dubbo, New South Wales, Australia
| | - Nancy Ross
- School of Social Work, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, New South Wales, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Hazel Dalton
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Shakeel Mahmood
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Bernd H Kalinna
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Allen G Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
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Masquillier C, Cosaert T. Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual model. BMC Prim Care 2023; 24:281. [PMID: 38114909 PMCID: PMC10731868 DOI: 10.1186/s12875-023-02214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Inspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care. METHODS The qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. The transcripts and the observation notes were analysed in accordance with the abductive analysis procedures described by Timmermans and Tavory. RESULTS The qualitative results show that the CHWs' outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care - as conceptualised in the theoretical access-to-care framework of (Levesque et al. Int J Equity Health. 12:18, 2013). Building on the theoretical access-to-care framework described by (Levesque et al. Int J Equity Health. 12:18, 2013), the conceptual model outlines first the underlying mechanisms of CHW-facilitated access to primary care: (I) outreaching and pro-active way of working; (II) building trust; (III) providing unbiased support and guidance in a culturally sensitive manner; and (IV) tailoring the CHWs' approach to the unique interplay of barriers at the individual and health system level along the access-to-care continuum as experienced by the individual. Further disentangling how CHWs provide support to the barriers in access to care across the continuum and at each step is outlined further in the process characteristics of this conceptual model. Furthermore, the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW. DISCUSSION The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances.
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Affiliation(s)
- Caroline Masquillier
- Department of Family Medicine and Population Health, Faculty of Medicine and Heath Sciences & Department of Sociology, Centre for Population, Family and Health, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium.
| | - Theo Cosaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Bourke S, Munira SL, Parkinson A, Lancsar E, Desborough J. Exploring the barriers and enablers of diabetes care in a remote Australian context: A qualitative study. PLoS One 2023; 18:e0286517. [PMID: 37498850 PMCID: PMC10373998 DOI: 10.1371/journal.pone.0286517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/17/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE This qualitative study explored the current barriers and enablers of diabetes care in the Indian Ocean Territories (IOT). METHODS A constructivist grounded theory approach that incorporated semi-structured telephone interviews was employed. Initial analysis of the interview transcripts used a line-by-line approach, to identify recurring themes, connections, and patterns, before they were re-labelled and categorised. This was followed by axial coding, categorisation refinement, and mapping of diabetes triggers in the IOT. PARTICIPANTS AND SETTING The IOT, consisting of Christmas Island and the Cocos (Keeling) Islands, are some of the most remote areas in Australia. When compared with mainland Australia, the prevalence of type 2 diabetes in the IOT is disproportionately higher. There were no known cases of type 1 diabetes at the time of the study. Like other remote communities, these communities experience difficulties in accessing health services to prevent and manage diabetes. Twenty health care professionals and health service administrators in the IOT took part in semi-structured telephone interviews held during April-June 2020. Participants included GPs, nurses, dietitians, social and community services workers, school principals, and administrators. The interview questions focused on their perceptions of the current diabetes care in place in the IOT and their views on the challenges of providing diabetes care in the IOT. RESULTS We identified four main barriers and two main enabling factors to the provision of effective diabetes care in the IOT. The barriers were: (i) societal influences; (ii) family; (iii) changing availability of food; (v) sustainability and communication. The two main enablers were: (i) tailoring interventions to meet local and cultural needs and values; and (ii) proactive compliance with the medical model of care. CONCLUSION Due to the cultural and linguistic diversity within the IOT, many of the identified barriers and enablers are unique to this community and need to be considered and incorporated into routine diabetes care to ensure successful and effective delivery of services in a remote context.
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Affiliation(s)
- Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Syarifah Liza Munira
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Sommers IJ, Gunter KE, McGrath KJ, Wilkinson CM, Kuther SM, Peek ME, Chin MH. Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study. J Gen Intern Med 2023;:1-7. [PMID: 36864268 DOI: 10.1007/s11606-022-07921-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities. OBJECTIVE This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho. DESIGN This is a qualitative study based on in-person, semi-structured interviews. PARTICIPANTS We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15). APPROACH Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews. KEY RESULTS CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process. CONCLUSIONS CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system.
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Topp SM, Tully J, Cummins R, Graham V, Yashadhana A, Elliott L, Taylor S. Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia. Int J Health Policy Manag 2022; 11:2951-2963. [PMID: 35569001 PMCID: PMC10105169 DOI: 10.34172/ijhpm.2022.6750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation. METHODS The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n=51), clinicians (n=19) community members (n=8) and administrators (n=5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it. RESULTS Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs. CONCLUSION Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role.
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Affiliation(s)
- Stephanie M. Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Josslyn Tully
- Torres and Cape Hospital and Health Services (TCHSS), Cairns, QLD, Australia
| | - Rachel Cummins
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Veronica Graham
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, UNSW, Sydney, NSW, Australia
- School of Social Sciences, UNSW, Sydney, NSW, Australia
| | - Lana Elliott
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Sean Taylor
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- NT Health, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
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Govender V, Topp SM, Tunçalp Ö. Rethinking trust in the context of mistreatment of women during childbirth: a neglected focus. BMJ Glob Health 2022; 7:e009490. [PMID: 35606016 PMCID: PMC9125697 DOI: 10.1136/bmjgh-2022-009490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Veloshnee Govender
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Özge Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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