Identifying barriers and facilitators for the effective diagnosis and provision of primary health care for otitis media from the perspective of carers of Aboriginal children.

AIM: To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children. METHODS: A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development. Data underwent thematic analysis using NVivo software. RESULTS: Thirty-two carers of Aboriginal children participated. Key barriers identified for the detection of OM were limited information about OM provided to carers and carers feeling disempowered to express their concerns. Key facilitators identified were the provision of health information through health promotion and the use of culturally secure resources. Having a culturally secure clinical environment was identified as essential, with Aboriginal Health Workers playing a vital role in clinical care. No barriers to management of OM in primary care were reported. Facilitators included health care practitioners (HCPs) emphasising the importance of completing antibiotic course and the clinic providing necessary medications. CONCLUSIONS: A culturally secure health promotion strategy with health promotion teams, campaigns and resources is needed to increase community awareness of OM signs and symptoms and facilitate appropriate health seeking. It is essential that the local Aboriginal community co-lead and co-develop these initiatives to ensure the unique wisdom and knowledge of Aboriginal people are captured. HCPs and the clinic effectively facilitate management of OM by providing medications and emphasising completion of antibiotics.

Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership.

OBJECTIVE: To describe how a novel program of diabetic retinopathy screening was conceived, refined and sustained in a remote region over 10 years, and to evaluate its activities and outcomes. DESIGN: Program description; analysis of regional screening database; audit of electronic client registers of Aboriginal community controlled health services (ACCHSs). SETTING AND PARTICIPANTS: 1318 Aboriginal and 271 non-Aboriginal individuals who underwent retinal screening in the 5 years to September 2004 in the Kimberley region of north-west Australia; 11 758 regular local Aboriginal clients of Kimberley ACCHSs as at January 2005. MAIN OUTCOME MEASURES: Characteristics of clients and camera operators, prevalence of retinopathy, photograph quality, screening intervals and coverage. RESULTS: Among Aboriginal clients, 21% had diabetic retinopathy: 19% with non-proliferative retinopathy, 1.2% with proliferative retinopathy, and 2.8% with maculopathy. Corresponding figures for non-Aboriginal clients were 11%, 11%, 0 and 0.4%, respectively. Photograph quality was generally high, and better for non-Aboriginal clients, younger Aboriginal clients and from 2002 (when mydriatic use became universal). Quality was not related to operator qualifications, certification or experience. Of 718 regular Aboriginal clients with diabetes on local ACCHS databases, 48% had a record of retinal screening within the previous 18 months, and 65% within the previous 30 months. CONCLUSIONS: Screening for diabetic retinopathy performed locally by Aboriginal health workers and nurses with fundus cameras can be successfully sustained with regional support. Formal certification appears unnecessary. Data sharing across services, client recall and point-of-care prompts generated by electronic information systems, together with policies making primary care providers responsible for care coordination, support appropriate timely screening.