Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families.

INTRODUCTION: Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay, than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which includes additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals. METHODS: Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data. RESULTS: A total of seven yarning sessions were conducted with 10 participants. Seven themes were identified: travel, barriers to health care, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets and not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden. CONCLUSION: Aboriginal families are significantly burdened by OOPHE when needing to travel for health care. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access that does not create additional financial hardship in communities already experiencing economic disadvantage.

Agency in change: Learning experiences of international midwifery students in South Australia.

PROBLEM: While literature reports broadly on the experiences of international students of health professions in higher education, the experience of students undertaking an undergraduate midwifery program outside their country of origin has not previously been reported. BACKGROUND: Midwifery studies incorporate distinct clinical practice and discipline-specific therapeutic relationships which can challenge students familiar with the health system, so it is necessary to understand their impact on the learning needs of international students, who contribute to the diversity of our workforce. AIM: To explore learning experiences of international students of an undergraduate midwifery program to identify their perceptions and personal strategies which impacted their participation in the program. METHODS: A qualitative descriptive study, with a purposive sample of nine current international students and recent graduates of a midwifery program at a South Australian university. Participants attended a focus group or individual phone interview to explore their learning experiences, and data were thematically analysed. FINDINGS: Five themes and sub-themes were identified, built around a core concept of the international midwifery student experience as agency in change: language and culture, teaching and learning, isolation and integration, services and support, and motivation and resilience. Studying abroad was associated with personal and professional growth. Continuity of care for women presented challenges and produced learnings unique to this cohort. CONCLUSION: Tailored support, such as specialized clinical facilitation and organized peer networking, is required for international midwifery students in Australia. Additionally, effective approaches to facilitate bilingualism to support language concordant care are needed.

Community Engagement and Psychometric Methods in Aboriginal and Torres Strait Islander Patient-Reported Outcome Measures and Surveys-A Scoping Review and Critical Analysis.

(1) Background: In healthcare settings, patient-reported outcome measures (PROMs) and surveys are accepted, patient-centered measures that provide qualitative information on dimensions of health and wellbeing. The level of psychometric assessment and engagement with end users for their design can vary significantly. This scoping review describes the psychometric and community engagement processes for PROMs and surveys developed for Aboriginal and Torres Strait Islander communities. (2) Methods: The PRISMA ScR guidelines for scoping reviews were followed, aimed at those PROMs and surveys that underwent psychometric assessment. The Aboriginal and Torres Strait Islander Quality Appraisal Tool and a narrative synthesis approach were used. (3) Results: Of 1080 articles, 14 were eligible for review. Most articles focused on a validity assessment of PROMs and surveys, with reliability being less common. Face validity with Aboriginal and Torres Strait Islander communities was reported in most studies, with construct validity through exploratory factor analyses. Methodological design risks were identified in the majority of studies, notably the absence of explicit Indigenous knowledges. Variability existed in the development of PROMs and surveys for Aboriginal and Torres Strait Islander communities. (4) Conclusions: Improvement in inclusion of Indigenous knowledges and research approaches is needed to ensure relevance and appropriate PROM structures. We provide suggestions for research teams to assist in future design.

Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study.

PURPOSE: To investigate the successful strategies of health workers who support and regularly communicate with Aboriginal and Torres Strait Islander people about cancer and its treatment. METHODS: Semi-structured interviews were conducted face-to face or via telephone and audio-recorded with twenty-three health professionals (medical and radiation oncologists, oncology nurses and Aboriginal Health Workers), 5 identifying as Aboriginal or Torres Strait Islander in the Northern Territory and South Australia. When data saturation was reached, thematic analysis using a bottom up, essentialist/realist approach was used. RESULTS: Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves considering the physical environment and allowing time in interviews to establish a relationship. (2) Employ specific communication strategies to explain cancer, treatment and its side effects through language choices and employing visual aids such as drawings, metaphors and relatable analogies. (3) Obtain support from Aboriginal and Torres Strait Islander staff and patient escorts who can assist in communication. (4) Consider culture which involves collective decision making, strong connection to country and community, with cultural obligations and a unique understanding of cancer. (5) Anticipate the contextual complexities of conflicts between Western medicine and Aboriginal culture, practitioner bias and difficulty maintaining contact with patients. (6) Develop personal qualities of good communicators, including being patient-centred, showing respect, patience, empathy and honesty. CONCLUSION: These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal and Torres Strait Islander people with cancer.

The learning experiences of international students in nursing and midwifery programs: A literature review.

Globally, education continues to diversify, with a growing body of literature that describes the experiences of international higher education students. While the research includes representation from the health sciences, nursing and midwifery programs are underrepresented; understanding the experiences of international students therein may assist in determining whether discipline-specific teaching, learning and support is required. This review aims to summarise international nursing and midwifery students' perceptions of challenge and enablement when undertaking an undergraduate or baccalaureate program. A total of 408 articles were identified and after duplicates were removed and inclusion/exclusion criteria applied, eight primary studies were included. No papers were identified that reported on the experiences of international midwifery students. For international nursing students, five themes emerged: language and culture, isolation and segregation, teaching and learning, services and support, and resilience and growth. This review concludes that the available data both affirms the existing body of knowledge around international students and illuminates unique challenges and opportunities for nursing students undertaking clinical placements. There is a need for increased language and peer support, socialisation and specially educated support staff. Research is required to identify best practice in teaching methodology for an increasingly diverse cohort and importantly, to provide a midwifery perspective.

Love the way you're teaching us': A purpose-developed clinical communication workshop for first year midwifery students.

Preparing students for communication in clinical healthcare settings can be challenging, particularly given it may be the first time they have considered how and why they communicate. The challenge is to find an effective process for the development of clinical communication skills in a highly content-driven curriculum. The objective of this study was to empower first-year midwifery students to reflect on their experiences of communication to inform and expand their clinical communication by drawing on two distinct disciplines - midwifery and linguistics. This paper reports on the findings of a study that examined the implementation of innovative, preparatory workshops for first-year midwifery students. Data from quantitative and qualitative surveys were collected pre- and post-workshop, and post-clinical placement, and analysed using linguistic mapping and thematic analysis. Perceptible shifts in self-evaluation of competence were noted post the workshop and clinical placement. Students developed and used metalanguage appropriately to describe and evaluate communication while demonstrating increased awareness of the complexity of professional communication. They were able to find a balance between the vital technical information, and the interpersonal aspects of communication. This impacted positively on their perception of women as partners.

How language shapes psychiatric case formulation.

The aim of this paper is to describe, analyse, and discuss the process of formulation in the specific context of mental health (MH). Formulation is a fundamental element of the work of psychiatrists and other MH clinicians that is expected to be mastered during training. The literature, however, shows that formulation is rarely explicitly addressed in the psychiatric curriculum; rather, it is implicitly developed through modelling, and/or clinical practice. This paper focuses on case formulation in one MH context in Australia. It tracks the iterative formulation of one patient in a hospital emergency department. The analysis uses resources from systemic functional linguistics (SFL) situated within a broader framework of discourse analysis. It highlights patterns of lexical relations and nominalisation as well as the range of conjunctions. These make explicit how the clinicians talk about the patient's illness and shape their developing understanding into a logical formulation. We see applications of this work for the training of mental health professionals. These data make explicit the ways in which the participating clinicians use language in the process of formulation. By bringing this process to the level of consciousness, it can be discussed and evaluated and become a pedagogic resource.