Creating "a Safe Place to Go": Yarning With Health Workers About Stroke Recovery Care for Aboriginal Stroke Survivors-A Qualitative Study.

Stroke affects Aboriginal people at disproportionate rates compared to other populations in Australia. Aboriginal peoples are less likely to receive a timely stroke diagnosis, or timely culturally responsive treatment, as there are very few stroke resources and recovery plans that have been developed by Aboriginal peoples for Aboriginal peoples. Understanding how to develop and implement culturally responsive stroke care requires research approaches that are informed by and with Aboriginal people. A qualitative Indigenous research methodology including "yarning" was undertaken to understand the experiences of both Aboriginal and non-Aboriginal health workers from nine health services providing stroke rehabilitation and recovery support to Aboriginal people living within the participating communities. Data were analyzed using an inductive approach driven by an Indigenous research approach. Yarns revealed three themes: (i) the role of culturally safe health environments to support stroke survivors, their family, and health workers; and how (ii) complicated, under-resourced systems impede the capacity to support stroke survivors; and (iii) collaborative and adaptive practices prevent people "falling through the cracks." This study highlights the need to scrutinize the cultural safety of health care, current health systems, workforce, and culture and how these influence the capacity of health workers to provide care that is responsive to the individual needs of Aboriginal stroke survivors and their families. These learnings will inform the co-design of a culturally responsive stroke recovery care strategy to improve the recovery experience and health and well-being of Aboriginal people and their families living with stroke.

Preventative health assessments and indigenous people of Australia: a scoping review.

Given that Indigenous populations globally are impacted by similar colonial global legacies, their health and other disaprities are usually worse than non-indigenous people. Indigenous peoples of Australia have been seriously impacted by colonial legacies and as a result, their health has negatively been affected. If Indigenous health and wellbeing are to be promoted within the existing Australian health services, a clear understanding of what preventive health means for Indigenous peoples is needed. The aim of this scoping review was to explore the available literature on the uptake/engagement in health assessments or health checks by Indigenous Australian peoples and to determine the enablers and barriers and of health assessment/check uptake/engagement. Specifically, we aimed to: investigate the available evidence reporting the uptake/engagement of health checks/assessments for Australian Indigenous; assess the quality of the available evidence on indigenous health checks/assessments; and identify the enablers or barriers affecting Indigenous persons' engagement and access to health assessment/health checks. A systematic search of online databases (such as Cinhl, Scopus, ProQuest health and medicine, PubMed, informit, google scholar and google) identified 10 eligible publications on Indigenous preventive health assessments. Reflexive thematic analysis identified three major themes on preventive health assessments: (1) uptake/engagement; (2) benefits and limitations; and (3) enablers and barriers. Findings revealed that Indigenous peoples' uptake and/or engagement in health assessments/check is a holistic concept varied by cultural factors, gender identity, geographical locations (living in regional and remote areas), and Indigenous clinical leadership/staff's motivational capacity. Overall, the results indicate that there has been improving rates of uptake of health assessments by some sections of Indigenous communities. However, there is clearly room for improvement, both for aboriginal men and women and those living in regional and remote areas. In addition, barriers to uptake of health asessments were identified as length of time required for the assessment, intrusive or sensitive questions and shame, and lack of access to health services for some. Indigenous clinical leadership is needed to improve services and encourage Indigenous people to participate in routine health assessments.

Meaningful Engagement With Aboriginal Communities Using Participatory Action Research to Develop Culturally Appropriate Health Resources.

Introduction: This article outlines the processes used to meaningfully and authentically engage Australian Aboriginal communities in Northern New South Wales, Australia, to develop culturally appropriate stroke health resources. Methodology: Participatory action research using the research topic yarning framework is a collaborative, culturally safe way to uncover vital information and concepts. There were two stages in the participatory action research project: community engagement and evaluation of the processes involved in developing the localised, culturally appropriate health resources. Results: Establishing relationships built on trust, mutual sharing of knowledge, and bringing together the wider community, enabled the health message to be embedded within the community, ensuring the message was culturally appropriate and sustainable. Discussion: The stroke education resource is a tangible outcome and a major achievement; however, the process of authentic engagement to achieve the final product was the ultimate accomplishment.

Investigating the processes used to develop and evaluate the effectiveness of health education resources for adult Indigenous people: A literature review.

Purpose: Aboriginal and Torres Strait Islander communities need to participate in the development of health education material to gain connection with and ownership of concepts. This review extracted and synthesized evidence to answer the question: what processes are used to develop health education resources for adult Aboriginal and Torres Strait Islander people, and what makes them effective?Design: A review was conducted using the PRISMA guidelines. Five databases were searched (OvidSP Medline, CINAHL, Informit, OvidSP Embase and ProQuest) and 438 non duplicate records were screened.Findings: Twenty-two articles were identified; 18 reporting qualitative studies, two reporting mixed-method studies and two discussion papers. No quantitative studies met the inclusion criteria. Synthesis of the evidence revealed five themes: collaborative relationships, community ownership, lack of evaluation, cultural sensitivity, and health literacy.Discussions/Conclusions: Limitations identified include barriers due to distance, time, and funding, and a need for cultural competency in mainstream health.

Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance.

INTRODUCTION: Contrast-enhanced spectral mammography (CESM) may have similar diagnostic performance to Contrast-enhanced MRI (CEMRI) in the diagnosis and staging of breast cancer. To date, research has focused exclusively on diagnostic performance when comparing these two techniques. Patient experience is also an important factor when comparing and deciding on which of these modalities is preferable. The aim of this study is to compare patient experience of CESM against CEMRI during preoperative breast cancer staging. METHODS: Forty-nine participants who underwent both CESM and CEMRI, as part of a larger trial, completed a Likert questionnaire about their preference for each modality according to the following criteria: comfort of breast compression, comfort of intravenous (IV) contrast injection, anxiety and overall preference. Participants also reported reasons for preferring one modality to the other. Quantitative data were analysed using a Wilcoxon sign-rank test and chi-squared test. Qualitative data are reported descriptively. RESULTS: A significantly higher overall preference towards CESM was demonstrated (n = 49, P < 0.001), with faster procedure time, greater comfort and lower noise level cited as the commonest reasons. Participants also reported significantly lower rates of anxiety during CESM compared with CEMRI (n = 36, P = 0.009). A significantly higher rate of comfort was reported during CEMRI for measures of breast compression (n = 49, P = 0.001) and the sensation of IV contrast injection (n = 49, P = 0.003). CONCLUSION: Our data suggest that overall, patients prefer the experience of CESM to CEMRI, adding support for the role of CESM as a possible alternative to CEMRI for breast cancer staging.