RESUMO
OBJECTIVE: To describe the frequency of hospitalisation and in-hospital death following moderate to severe traumatic brain injury (TBI) in Australia, both overall and by patient demographic characteristics and the nature and severity of the injury. DESIGN, SETTING: Cross-sectional study; analysis of Australia New Zealand Trauma Registry data. PARTICIPANTS: People with moderate to severe TBI (Abbreviated Injury Score [head] greater than 2) who were admitted to or died in one of the twenty-three major Australian trauma services that contributed data to the ATR throughout the study period, 1 July 2015 - 30 June 2020. MAJOR OUTCOME MEASURES: Primary outcome: number of hospitalisations with moderate to severe TBI; secondary outcome: number of deaths in hospital following moderate to severe TBI. RESULTS: During 2015-20, 16 350 people were hospitalised with moderate to severe TBI (mean, 3270 per year), of whom 2437 died in hospital (14.9%; mean, 487 per year). The mean age at admission was 50.5 years (standard deviation [SD], 26.1 years), and 11 644 patients were male (71.2%); the mean age of people who died in hospital was 60.4 years (SD, 25.2 years), and 1686 deaths were of male patients (69.2%). The overall number of hospitalisations did not change during 2015-20 (per year: incidence rate ratio [IRR], 1.00; 95% confidence interval [CI], 0.99-1.02) and death (IRR, 1.00; 95% CI, 0.97-1.03). CONCLUSION: Injury prevention and trauma care interventions for people with moderate to severe TBI in Australia reduced neither the incidence of the condition nor the associated in-hospital mortality during 2015-20. More effective care strategies are required to reduce the burden of TBI, particularly among younger men.
Assuntos
Lesões Encefálicas Traumáticas , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Mortalidade Hospitalar , Austrália/epidemiologia , Estudos Transversais , Lesões Encefálicas Traumáticas/epidemiologia , Hospitalização , Sistema de Registros , Análise de DadosRESUMO
BACKGROUND: Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. METHODS: A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. RESULTS: Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. CONCLUSION: Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. REGISTRATION: This study was prospectively registered in PROSPERO (ID CRD42021254718).
Assuntos
Serviços de Saúde do Indígena , Alta do Paciente , Humanos , Assistência ao Convalescente , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Austrália , Doença CrônicaRESUMO
BACKGROUND: Traumatic brain injury (TBI) is the largest contributor to death and disability in people who have experienced physical trauma. There are no national data on outcomes for people with moderate to severe TBI in Australia. OBJECTIVES: To determine the incidence and key determinants of outcomes for patients with moderate to severe TBI, both for Australia and for selected population subgroups, including Aboriginal and Torres Strait Islander Australians. METHODS AND ANALYSIS: The Australian Traumatic Brain Injury National Data (ATBIND) project will analyse Australia New Zealand Trauma Registry (ATR) data and National Coronial Information Service (NCIS) deaths data. The ATR documents the demographic characteristics, injury event description and severity, processes of care, and outcomes for people with major injury, including TBI, assessed and managed at the 27 major trauma services in Australia. We will include data for people with moderate to severe TBI (Abbreviated Injury Scale [AIS] (head) score higher than 2) who had Injury Severity Scores [ISS] higher than 12 or who died in hospital. People will also be included if they died before reaching a major trauma service and the coronial report details were consistent with moderate to severe TBI. The primary research outcome will be survival to discharge. Secondary outcomes will be hospital discharge destination, hospital length of stay, ventilator-free days, and health service cost. ETHICS APPROVAL: The Alfred Ethics Committee approved ATR data extraction (project reference number 670/21). Further ethics approval has been sought from the NCIS and multiple Aboriginal health research ethics committees. The ATBIND project will conform with Indigenous data sovereignty principles. DISSEMINATION OF RESULTS: Our findings will be disseminated by project partners with the aim of informing improvements in equitable system-level care for all people in Australia with moderate to severe TBI. STUDY REGISTRATION: Not applicable.
Assuntos
Lesões Encefálicas Traumáticas , Serviços de Saúde do Indígena , Austrália/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/terapia , Humanos , Escala de Gravidade do Ferimento , Havaiano Nativo ou Outro Ilhéu do PacíficoRESUMO
BACKGROUND: Quality and safety in Australian healthcare is inequitably distributed, highlighted by gaps in the provision of quality care for Aboriginal and Torres Strait Islander children. Burns have potential for long-term adverse outcomes, and quality care, including culturally safe care, is critical to recovery. This study aimed to develop and apply an Aboriginal Patient Journey Mapping (APJM) tool to investigate the quality of healthcare systems for burn care with Aboriginal and Torres Strait Islander children. STUDY DESIGN: Interface research methodology, using biomedical and cultural evidence, informed the modification of an existing APJM tool. The tool was then applied to the journey of one family accessing a paediatric tertiary burn care site. Data were collected through yarning with the family, case note review and clinician interviews. Data were analysed using Emden's core story and thematic analysis methods. Reflexivity informed consideration of the implications of the APJM tool, including its effectiveness and efficiency in eliciting information about quality and cultural safety. RESULTS: Through application of a modified APJM tool, gaps in quality care for Aboriginal and Torres Strait Islander children and families were identified at the individual, service and system levels. Engagement in innovative methodology incorporating more than biomedical standards of care, uncovered critical information about the experiences of culturally safe care in complex patient journeys. CONCLUSION: Based on our application of the tool, APJM can identify and evaluate specific aspects of culturally safe care as experienced by Aboriginal and Torres Strait Islander peoples and be used for quality improvement.
Assuntos
Queimaduras , Assistência à Saúde Culturalmente Competente , Disparidades em Assistência à Saúde , Povos Indígenas , Criança , Humanos , Austrália , Instalações de Saúde , Qualidade da Assistência à Saúde , Grupos RaciaisRESUMO
INTRODUCTION: Process evaluations examining programme implementation are often conducted in conjunction with effectiveness studies. Their inclusion in studies with Aboriginal participants can give an understanding of programme delivery in Aboriginal community contexts. The Ironbark: Standing Strong and Tall programme was codesigned with Aboriginal communities and includes exercise and facilitated 'yarning' discussion about fall risk and prevention strategies. The programme pilot showed favourable outcomes and acceptability for Aboriginal people aged 45 years and over. The Ironbark: Standing Strong and Tall programme is now being compared with a 'Healthy Community' programme in a cluster randomised controlled trial within Aboriginal health and community services. An embedded process evaluation aims to explore relationships between participation and programme outcomes and the quality of programme implementation. METHODS AND ANALYSIS: The process evaluation will use a mixed methods design, guided by Indigenous research methodology. It will evaluate quantitative data (number of completed sessions, site coaching checklist tool, participant and facilitator questionnaire data and a participant habit formation scale), as well as qualitative data (open-ended responses from project and site staff and semistructured interviews using yarning with study participants and site managers). A programme logic model was developed to explain the intended inputs, activities, outputs and outcomes, which guided this process evaluation design. CONCLUSION: This process evaluation of a fall prevention programme for older Aboriginal people using a mixed methods design and data triangulation will allow for a comprehensive understanding of study findings. Multiple study sites allow for generalisability of findings and exploration of variation across sites. TRIAL REGISTRATION NUMBER: ACTRN12619000349145.
RESUMO
BACKGROUND: With increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment. METHODS: Driving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data. RESULTS: From 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%). Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22-5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27-2.33, p < 0.001) to gain an independent licence than those from urban areas. There was no difference in employment outcomes (OR: 1.2, 95% CI: 0.53-2.52, p = 0.719) for clients from urban compared to regional areas. CONCLUSION: The Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians.
Assuntos
Condução de Veículo , Austrália/epidemiologia , Emprego , Feminino , Humanos , Licenciamento , Masculino , Havaiano Nativo ou Outro Ilhéu do PacíficoRESUMO
BACKGROUND: Road traffic collisions contribute a significant burden of mortality and morbidity to children globally. The improper or non-use of child restraints can result in children sustaining significant injuries in the event of a collision. Systematic reviews on the effectiveness of various interventions to increase the use of child restraints already exist but to the best of our knowledge, there has been no qualitative evidence syntheses on the facilitators and barriers to child restraint usage. This review aims to fill that gap. METHODS: We searched for qualitative studies, which focused on perceptions, values and experiences of children, parents/caregivers or any other relevant stakeholders on the use of restraints for children travelling in motor vehicles in PubMed, EMBASE and Global Health and screened reference lists of all included studies. We assessed the quality of included studies with the Critical Appraisal Skills Programme (CASP) checklist and used the PROGRESS Plus lens for an equity focused analysis. RESULTS: We identified a total of 335 records from searching the databases and five records from other sources. After screening, we identified 17 studies that met our inclusion criteria. All but one study (which had children as participants) focused on the perceptions, attitudes and barriers of parents or caregivers. The included studies were from three high-income (n=14) and one upper-middle income (n=3) country. In addition, although many focused exclusively on participants from culturally and linguistically diverse minorities, the issue of equity was not well addressed. Five major themes emerged from the analysis. (1) perceived risk for injuries and perceived safety benefits of child restraint usage varies in different settings and between different types of caregivers; (2) practical issues around the use of child restraints is a major barrier to its uptake as a child safety measure; (3) restraint use is considered as a mechanism to discipline children rather than as a safety device by parents and as children became older they actively seek opportunities to negotiate the non-usage of restraints; (4) adoption and enforcement of laws shape perceptions and usage in all settings and (5) perceptions and norms of child safety differ among culturally and linguistically diverse groups. CONCLUSION: The results of this systematic review should be considered when designing interventions to promote the uptake of child restraints. However, there is a need to conduct qualitative research around the facilitators and barriers to child restraint usage in low-income and middle-income countries. Furthermore, there is a need for more evidence conducted in semiurban and rural areas and to involve fathers, policy-makers, implementers and enforcement agencies in such studies.
Assuntos
Atitude , Veículos Automotores , Cuidadores , Criança , Feminino , Humanos , Pais , Gravidez , Pesquisa QualitativaRESUMO
OBJECTIVE: This study aimed to describe road user behaviour, attitudes and crashes in Aboriginal and Torres Strait Islander people in four urban, regional and remote communities located in New South Wales (NSW) and South Australia (SA). METHODS: Face-to-face surveys were administered to clients (n=625) in Aboriginal Community Controlled Health Services (ACCHS). All Aboriginal and Torres Strait Islander clients attending the ACCHS for any reason were approached to participate over a 2-week period. Surveys included questions on sociodemographic factors, crash involvement, road behaviours and road safety attitudes drawn from tools used in national surveys. RESULTS: The participation rate was high (69%-75%). Seat belt wearing rates were very high, particularly in the front of a car, although rear seat belt wearing rates in SA (77%) were substantially lower than in NSW (93%). Among drivers, 11% reported always or mostly driving 10 km/hour over the speed limit, and this was higher among drivers in SA (13.4%). Drivers aged 55 years and over and/or women were more likely to report that they do not drink at any time or restricted what they drank when driving. These results enable comparison with the Community Attitude to Road Safety survey conducted Australia-wide in 2013. CONCLUSIONS: This study confirms that Aboriginal and Torres Strait Islander people are inclined to report attitudes or road safety behaviours similar to the rest of the population; however, rear restraint use was lower and self-reported speeding was higher. These issues are likely attributable to transport options and geography in remote communities, which can contribute to overcrowding and unsafe driving practices.
Assuntos
Atitude Frente a Saúde/etnologia , Condução de Veículo/psicologia , Adolescente , Adulto , Condução de Veículo/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico/genética , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Austrália do Sul/etnologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Incorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored. METHODS: We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial. RESULTS: There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p<0.001). The mean error percentage in the control group was 23% (95% CI 16% to 31%) compared with 14% in the intervention group (95% CI 8% to 20%, p=0.056). For every one point increase in comprehension, there was an almost 2% (95% CI -2.7% to -1.0%) reduction in errors (y=45.5-1.87x, p value for slope <0.001). CONCLUSIONS: Consumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.
Assuntos
Sistemas de Proteção para Crianças , Criança , Humanos , Projetos PilotoRESUMO
BACKGROUND: Access to ongoing multidisciplinary healthcare services for children who have sustained a burn injury is critical for optimal recovery. This paper reports on barriers and facilitators to culturally safe and appropriate burn aftercare for Australia's First Nations children. The voices of First Nations families whose child had sustained a serious burn are central to this paper. METHODS: Eighteen families, which consisted of 59 family members, of children younger than 16 years who had sustained a burn injury were asked to describe their own journey in accessing appropriate burn aftercare. Interviews were conducted in the families' homes using yarning (dialogue) and Dadirri (deep listening) as Indigenous research methods. Data was gathered in South Australia, the Northern Territory, Queensland and New South Wales, Australia. Using a cyclic process, transcripts and emerging themes were sent back to participants, and a collaborative approach was used to conduct the final analysis. RESULTS: Lack of culturally safe communication between service providers and family members, in addition to institutionalised racism, were found to be the major barriers to accessing healthcare services. Distance to medical treatment also impacted children's access to aftercare. Involvement of First Nations Health Workers and/or Liaison Officers working with health providers, the child and family members, was found to be an important facilitator in reducing miscommunication and alleviating fear and anxiety in the children and families. CONCLUSION: There are significant barriers to access to aftercare following a serious burn including miscommunication, lack of cultural safety, distance to medical treatment and racism. However, these can be largely mitigated when First Nations families have input into the care received and the care needed for ongoing burn care to be effective and are supported by First Nations Health/Liaison Officers support.
Assuntos
Assistência ao Convalescente/organização & administração , Queimaduras/etnologia , Queimaduras/terapia , Acessibilidade aos Serviços de Saúde , Povos Indígenas/psicologia , Austrália , Criança , Humanos , Povos Indígenas/estatística & dados numéricos , Pesquisa QualitativaRESUMO
BACKGROUND: With long-standing and widespread high rates of errors in child restraint use, there is a need to identify effective methods to address this problem. Information supplied with products at the point of sale may be a potentially efficient delivery point for such a countermeasure. The aim of this study is to establish whether product materials developed using a consumer-driven approach reduce errors in restraint use among purchasers of new child restraint systems. METHODS: A cluster randomised controlled trial (cRCT) will be conducted. Retail stores (n=22) in the greater Sydney area will be randomised into intervention sites (n=11) and control sites (n=11), stratified by geographical and socioeconomic indicators. Participants (n=836) will enter the study on purchase of a restraint. Outcome measures are errors in installation of the restraint as observed by a trained researcher during a 6-month follow-up home assessment, and adjustment checks made by the parent when the child is placed into the restraint (observed using naturalistic methods). Process evaluation measures will also be collected during the home visit. An intention-to-treat approach will be used for all analyses. Correct use and adjustment checks made by the parent will be compared between control and intervention groups using a logistic regression model. The number of installation errors between groups will be compared using Poisson regression. DISCUSSION: This cRCT will determine the effectiveness of targeted, consumer-driven information on actual error rates in use of restraints. More broadly, it may provide a best practice model for developing safety product information. TRIAL REGISTRATION NUMBER: ACTRN12617001252303p; Pre-results.
Assuntos
Acidentes de Trânsito/prevenção & controle , Sistemas de Proteção para Crianças , Informação de Saúde ao Consumidor , Qualidade de Produtos para o Consumidor , Condução de Veículo , Pré-Escolar , Comportamento do Consumidor , Desenho de Equipamento , Humanos , Lactente , Recém-Nascido , PaisRESUMO
ISSUE ADDRESSED: To assess web-based information about sport opportunities for people with physical disabilities and to explore barriers and potential solutions to offering such opportunities from the perspective of sporting organisations. METHODS: A mixed method study was conducted in 2 stages focusing on 26 high-participation sports. Stage One involved conducting web-based searches of sporting organisations at national (Australia), state (NSW) and local club levels and auditing the websites to identify the mention of sport opportunities for people with disabilities. Stage Two involved conducting semi-structured phone interviews with 25 sport providers identified from Stage One to discuss barriers and potential solutions to providing these opportunities. Data from interviews were transcribed verbatim and thematically analysed. RESULTS: Across 26 sports, 138 organisations (43 national, 33 states, 62 local clubs) were identified. Information about sport opportunities for people with disabilities decreased from national (86% of websites mentioned such opportunities) to state (76%) to club (37%) level. Barriers identified included funding, awareness, lack of coordination between organisations and people's attitudes. Potential solutions included fostering working partnerships and increasing understanding. CONCLUSION: Greater awareness within sporting organisations of the role of sport for people with disabilities is needed. Finding information on what disability sport opportunities are available particularly at a local participation level is currently challenging. SO WHAT?: Organisations need to work in partnership within and between sports and with other sectors to provide accessible information and appropriate opportunities. This should be supported by government policy and funding and informed by the needs of people with disabilities.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Esportes/estatística & dados numéricos , Austrália , Humanos , Internet , Entrevistas como AssuntoRESUMO
BACKGROUND: Access to multidisciplinary health care services for First Nation children with a chronic condition is critical for the child's health and well-being, but disparities and inequality in health care systems have been almost impossible to eradicate for First Nation people globally. The objective of this review is to identify the factors that impact access and ongoing care for First Nation children globally with a chronic condition. METHODS: An extensive systematic search was conducted of nine electronic databases to identify primary studies that explored factors affecting access to ongoing services for First Nation children with a chronic disease or injury. Due to the heterogeneity of included studies the Mixed Method Appraisal Tool (MMAT) was used to assess study quality. RESULTS: A total of six studies from Australia, New Zealand and Canada were identified and included in this review. Four studies applied qualitative approaches using in-depth semi structured interviews, focus groups and community fora. Two of the six studies used quantitative approaches. Facilitators included the utilisation of First Nation liaison workers or First Nation Health workers. Key barriers that emerged included lack of culturally appropriate health care, distance, language and cultural barriers, racism, the lack of incorporation of First Nation workers in services, financial difficulties and transport issues. CONCLUSION: There are few studies that have identified positive factors that facilitate access to health care for First Nation children. There is an urgent need to develop programs and processes to facilitate access to appropriate health care that are inclusive of the cultural needs of First Nation children.
Assuntos
Doença Crônica/terapia , Serviços de Saúde do Indígena/normas , Serviços de Saúde/normas , Austrália/etnologia , Canadá/etnologia , Criança , Saúde da Criança/etnologia , Saúde da Criança/normas , Saúde da Criança/estatística & dados numéricos , Doença Crônica/etnologia , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Feminino , Grupos Focais , Pessoal de Saúde , Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Nova Zelândia , Pesquisa Qualitativa , Racismo/estatística & dados numéricosRESUMO
The Driving Change programme was developed to facilitate access to licensing in Aboriginal communities in Australia. This process evaluation aimed to explore whether Driving Change was implemented as intended and was addressing the needs of the communities. A mixed methods approach was used, with triangulation of client data (n = 984), semi-structured interviews (n = 18) and client discussion groups (n = 21). Descriptive and regression analyses of quantitative and thematic analysis of qualitative data were drawn together to develop an integrated understanding of implementation barriers and facilitators. The programme reached 984 clients, with the majority from the target age group 16-24 years (56-89%). In multivariate analysis, clients who had supervised driving practice were 2.4 times more likely to attain a licence (95% CI: 1.9-3.1) and clients who received a high level of case management were 1.8 times more likely to progress to attain a licence than those who received low levels of case management (95% CI: 1.3-2.6). Implementation was facilitated by community partnerships and this was attributed to local delivery, Aboriginal leadership, connections with community networks and community ownership of solutions. Driving Change is engaging communities and reaching clients with a high level of need for licensing support. The programme is working with communities, benefiting from the input of cultural values and sharing ownership of local solutions. Community partnerships were critical to successfully supporting clients to overcome challenging barriers to participation. The learnings from this programme are relevant to complex community programme implementation and evaluation, particularly with diverse or hard to reach populations.
Assuntos
Condução de Veículo/estatística & dados numéricos , Condução de Veículo/normas , Licenciamento/estatística & dados numéricos , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Adolescente , Adulto , Austrália , Relações Comunidade-Instituição , Feminino , Humanos , Entrevistas como Assunto , Licenciamento/legislação & jurisprudência , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , New South Wales , Análise de Regressão , Rede Social , Apoio Social , Adulto JovemRESUMO
ISSUE ADDRESSED: Aboriginal Australian children experience higher rates of injury than other Australian children. However, few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of New South Wales. Delivered by Aboriginal Family Workers (AFWs), the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This study reports on the qualitative interviews which explored the ways in which clients, IAMS staff and external service providers experienced the program and assessed its delivery by the AFWs. METHODS: A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. RESULTS: The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. CONCLUSIONS: Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by AFWs to vulnerable families. Clients, IAMS staff and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. SO WHAT&QUEST: This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children.
Assuntos
Visita Domiciliar , Havaiano Nativo ou Outro Ilhéu do Pacífico , Poder Familiar , Segurança , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , New South Wales , Avaliação de Programas e Projetos de Saúde , População Urbana , Populações VulneráveisRESUMO
INTRODUCTION: Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. METHODS: Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. RESULTS: Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. CONCLUSIONS: Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.
Assuntos
Doença Crônica/etnologia , Doença Crônica/terapia , Serviços de Saúde do Indígena/organização & administração , Telemedicina/organização & administração , Atitude do Pessoal de Saúde , Competência Cultural , Saúde Global , Nível de Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Qualidade de VidaRESUMO
INTRODUCTION: Aboriginal and Torres Strait Islander people are overrepresented in transport-related morbidity and mortality. Low rates of licensure in Aboriginal communities and households have been identified as a contributor to high rates of unlicensed driving. There is increasing recognition that Aboriginal people experience challenges and adversity in attaining a licence. This systematic review aims to identify the barriers to licence participation among Aboriginal people in Australia. METHOD: A systematic search of electronic databases and purposive sampling of grey literature was conducted, two authors independently assessed publications for eligibility for inclusion. RESULTS: Twelve publications were included in this review, of which there were 11 reporting primary research (qualitative and mixed methods) and a practitioner report. Barriers identified were categorised as individual and family barriers or systemic barriers relating to the justice system, graduated driver licensing (GDL) and service provision. A model is presented that depicts the barriers within a cycle of licensing adversity. DISCUSSION: There is an endemic lack of licensing access for Aboriginal people that relates to financial hardship, unmet cultural needs and an inequitable system. This review recommends targeting change at the systemic level, including a review of proof of identification and fines enforcement policy, diversionary programs and increased provision for people experiencing financial hardship. CONCLUSION: This review positions licensing within the context of barriers to social inclusion that Aboriginal people frequently encounter. Equitable access to licensing urgently requires policy reform and service provision that is inclusive, responsive to the cultural needs of Aboriginal people and accessible to regional and remote communities.
Assuntos
Condução de Veículo/estatística & dados numéricos , Licenciamento/estatística & dados numéricos , Havaiano Nativo ou Outro Ilhéu do Pacífico , Austrália/epidemiologia , Humanos , Licenciamento/economiaRESUMO
Issue addressed: Aboriginal people face significant barriers to accessing the driver licensing system in New South Wales (NSW). Low rates of licence participation contribute to transport disadvantage and impede access to employment, education and essential health services. The Driving Change program has been piloted in three communities to increase licensing rates for young Aboriginal people. This brief report reviews implementation to determine whether Driving Change is being delivered as intended to the target population.Methods: Descriptive analysis of routinely collected program data collected between April 2013 and October 2014 to monitor client demographics (n = 194) and program-specific outcomes.Results: The target population is being reached with the majority of clients aged 16-24 years (76%) and being unemployed (53%). Licensing outcomes are being achieved at all pilot sites (learner licence 19%; provisional or unrestricted licence 16%). There is variation in program delivery across the three pilot sites demonstrating the intended flexibility of the program.Conclusions: Driving Change is delivering all aspects of the program as intended at the three pilot sites. The program is reaching the target population and providing a sufficiently flexible program that responds to community and client identified need.So what?: Reviewing implementation of community pilot programs is critical to ensure that the intervention is being delivered as intended to the target population. This brief report indicates that Driving Change is assisting young Aboriginal people to access licensing services in NSW. This review of program implementation will assist the subsequent expansion of the program to a further nine communities in NSW.
Assuntos
Exame para Habilitação de Motoristas , Havaiano Nativo ou Outro Ilhéu do Pacífico , Adolescente , Adulto , Condução de Veículo/normas , Feminino , Humanos , Masculino , New South Wales , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVES: We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints. METHODS: In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly. RESULTS: This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR]=3.66; 95% confidence interval [CI]=1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR=0.14; 95% CI=0.07, 0.30) or being from a family with more than 2 children (AOR=0.34; 95% CI=0.17, 0.67). CONCLUSIONS: Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.
Assuntos
Sistemas de Proteção para Crianças/normas , Pais/educação , Segurança/normas , Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Fatores Etários , Creches , Sistemas de Proteção para Crianças/estatística & dados numéricos , Pré-Escolar , Implementação de Plano de Saúde , Humanos , Modelos Logísticos , New South Wales , Avaliação de Programas e Projetos de Saúde , Escolas Maternais , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Despite known inequalities, little is understood about the burden and healthcare experiences of Aboriginal and Torres Strait Islander children who sustain a burn injury and their families. METHODS: The Coolamon Study recruited parents and carers whose children (aged <16 years) were Aboriginal and / or Torres Strait Islander children and had presented to burn units across four Australian states, New South Wales (Sydney), Northern Territory (Darwin), Queensland (Brisbane, Townsville) and South Australia (Adelaide), between 2015 and 2018. Consent was obtained and carers completed baseline and subsequent interviews at 3, 6, 12 and 24 months. Data were collected on the injury event, patient care and safety, sociodemographic factors, health related quality of life (PedsQual), and psychological distress (Kessler K-5). RESULTS: Of the 208 participants, 64 % were male; 26 % were aged less than 2 years and 37 % aged 2-4 years. The most common burn mechanisms were scalds (37 %), contact (33 %) and flame burns (21 %), with more severe burns and flame burns occurring in rural and remote settings. Most carers rated their child's care as either excellent or very good (82 %). Family distress, measured by the K-5, lessened over the 24 months, however the changes were not statistically significant. While 77 % of carers reported that they received enough information, 18 % reported they would have liked more, and 3 % reported no information was provided before treatment. Parents described mixed access to information about the types of support available to them, such as accommodation, meals, travel or cultural support. CONCLUSION: Data from this cohort provide rich new information about risk factors and care received from point of injury through to rehabilitation for Aboriginal and Torres Strait Islander children with burns, providing unique insights into what is needed for appropriate, culturally safe care.