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1.
Implement Sci ; 14(1): 76, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382994

RESUMO

BACKGROUND: Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS: A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS: Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS: The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION: Not registered.


Assuntos
Doença Crônica/terapia , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Doença Crônica/etnologia , Acesso aos Serviços de Saúde , Humanos
2.
Women Birth ; 32(5): 412-426, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262706

RESUMO

BACKGROUND: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. METHODS: Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA; care was provided anytime during the perinatal period, in an urban area; and cultural security (or variations of this term) were used. RESULTS: 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15); New Zealand (4/15); and Canada (3/15); while theses were from Canada (7/9) and Australia (2/9). CONCLUSION: The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.


Assuntos
Assistência à Saúde Culturalmente Competente , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Tocologia/métodos , Assistência Perinatal , Austrália , Canadá , Competência Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Nova Zelândia , Parto , Gravidez , População Urbana
3.
Women Birth ; 32(5): 466-475, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279713

RESUMO

BACKGROUND: Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing. QUESTION: How can we implement Birthing on Country services for Aboriginal and/or Torres Strait Islander families across Australia? METHODS: We have developed a framework from theoretical, policy and research literature on Birthing on Country; Aboriginal and Torres Strait Islander voices from across Australia; reviews exploring programs that have improved outcomes for Indigenous mothers and infants; and the retrospective synthesis of learnings from two empirical studies that have redesigned maternal infant health services and improved outcomes for Aboriginal and Torres Strait Islander families. RESULTS: The RISE Framework has four pillars to drive important reform: (1) Redesign the health service; (2) Invest in the workforce; (3) Strengthen families; and, (4) Embed Aboriginal and/or Torres Strait Islander community governance and control. We present the evidence base for each pillar and practical examples of moving from the standard 'western' model of maternity care towards Birthing on Country services. CONCLUSIONS: Application of the RISE framework to plan, develop and monitor Birthing on Country services is likely to result in short and long-term health gains for Aboriginal and Torres Strait Islander families.


Assuntos
Fortalecimento Institucional , Serviços de Saúde do Indígena/organização & administração , Mão de Obra em Saúde , Serviços de Saúde Materna/organização & administração , Grupo com Ancestrais Oceânicos , Austrália , Feminino , Humanos , Lactente , Gravidez
4.
Women Birth ; 32(5): 437-448, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326383

RESUMO

BACKGROUND: Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM: To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS: This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS: No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION: A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Cuidado Pré-Natal/métodos , Adulto , Austrália , Feminino , Pessoal de Saúde , Disparidades em Assistência à Saúde , Humanos , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
6.
BMC Public Health ; 19(1): 768, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208402

RESUMO

BACKGROUND: In Canada, there is a growing need to develop community-based, culturally appropriate palliative care for Indigenous people living in First Nations communities. The public health approach to palliative care, which emphasizes community-based initiatives, is especially relevant in First Nations communities because care is grounded in their distinct social and cultural context. Central to the public health approach are educational strategies that strengthen communities' capacity to care for their vulnerable members as they die. This paper presents community-based research conducted with First Nations communities in Canada that aimed to assess and address local palliative care educational needs to improve community capacity in palliative care. METHODS: Participatory action research (PAR) was conducted with four First Nations communities in Canada over a six-year period (2010-2016). The research occurred in three phases. Phase 1: focus groups, interviews and surveys were employed to assess community specific needs and resources. Phase 2: recommendations were developed to guide the PAR process. Phase 3: educational resources were created to address the identified educational needs. These resources were implemented incrementally over 4 years. Ongoing process evaluation was employed, and revisions were made as required. RESULTS: Educational needs were identified for patients, families, community members and internal and external health care providers. A wide and comprehensive range of educational resources were created to address those needs. Those culturally appropriate educational resources are available in a very accessible and useable workbook format and are available for use by other Indigenous people and communities. CONCLUSIONS: This research provides an example of the public health approach and offers implementation strategies around palliative care education. This paper contributes to the international literature on the public health approach to palliative care by presenting a case study from Canada that includes: conducting a culturally appropriate assessment of educational needs, creating recommendations, facilitating development and implementation of educational resources in the community to improve community capacity in palliative care.


Assuntos
Adaptação Psicológica , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Índios Norte-Americanos/psicologia , Cuidados Paliativos/psicologia , Adulto , Canadá , Fortalecimento Institucional/métodos , Feminino , Educação em Saúde , Pesquisa sobre Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Saúde Pública
7.
Int J Equity Health ; 18(1): 70, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092262

RESUMO

INTRODUCTION: Aboriginal Health and Wellbeing staff are crucial for successful primary health care for Aboriginal communities. However, they are often affected by high rates of stress, burnout, and staff turn-over, which can impact primary health care delivery to Aboriginal peoples. The aim of this review was to identify organisational factors that help support the retention of Aboriginal Health and Wellbeing staff in Aboriginal Health services. METHODS: A comprehensive literature review was undertaken. Eleven electronic databases were searched for papers published between 2002 and 2017 and supplemented by hand searching. Papers were included if they were in English, full text, peer-reviewed, and had a focus on retention of Aboriginal Health and Wellbeing staff, or health staff in comparable roles working in Aboriginal health services. Twenty-six papers were included in the final review. RESULTS: Five key themes were identified as being important to the retention of Aboriginal Health and Wellbeing staff in Aboriginal Health Services: feeling culturally safe and secure within the workplace; teamwork and collaboration; supervision and strong managerial leadership and support from peers (to debrief, reflect, receive emotional support and strengthen coping mechanisms); professional development (the opportunity for skill development and role progression); and recognition (of work load, quality of work performed, being trusted to work autonomously, and financial remuneration that reflected the high pressure of the role). CONCLUSION: Aboriginal Health and Wellbeing staff are fundamental to successful primary health care for Aboriginal peoples. State and Federal Governments should consider formalising recognition of the significant cultural knowledge that Aboriginal Health and Wellbeing staff bring to their roles. Formal recognition could also pave the way to revise remuneration as well as ensure adequate support mechanisms are put in place to improve retention and reduce stress and burnout affecting Aboriginal Health and Wellbeing staff.


Assuntos
Serviços de Saúde do Indígena/organização & administração , Lealdade ao Trabalho , Humanos
8.
BMC Womens Health ; 19(1): 53, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943958

RESUMO

BACKGROUND: Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women's Circles) in a population with significant need but no access to mental health services. METHODS: A parallel group pilot randomised study was undertaken in five rural Mam and three periurban K'iche' communities. Participants included 84 women (12 per community, in seven of the communities) randomly allocated to intervention and 71 to control groups; all were pregnant and/or within 2 years postpartum. The intervention consisted of 10 sessions co-designed with and facilitated by 16 circle leaders. Main outcome measures were: maternal psychosocial distress (HSCL-25), wellbeing (MHC-SF), self-efficacy and engagement in early infant stimulation activities. In-depth interviews also assessed acceptability and feasibility. RESULTS: The intervention proved feasible and well accepted by circle leaders and participating women. 1-month post-intervention, wellbeing scores (p-value 0.008) and self-care self-efficacy (0.049) scores were higher among intervention compared to control women. Those women who attended more sessions had higher wellbeing (0.007), self-care and infant-care self-efficacy (0.014 and 0.043, respectively), and early infant stimulation (0.019) scores. CONCLUSIONS: The pilot demonstrated acceptability, feasibility and potential efficacy to justify a future definitive randomised controlled trial. Co-designed women's groups provide a safe space where indigenous women can collectively improve their functioning and wellbeing. TRIAL REGISTRATION: ISRCTN13964819 . Registered 26 June 2018, retrospectively registered.


Assuntos
Redes Comunitárias/organização & administração , Serviços de Saúde do Indígena/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Feminino , Guatemala , Humanos , Lactente , Serviços de Saúde Materna/organização & administração , Projetos Piloto , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Adulto Jovem
9.
N Z Med J ; 132(1491): 38-45, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30845127

RESUMO

AIM: As part of a project developing cancer service capability, the National Health Service (NHS) Cancer patient experience survey was used to assess the currently available services at Waitemata District Health Board (WDHB). METHODS: Patients presenting with cancer to WDHB in the previous 12 months were mailed a copy of the survey, to the initial cohort in 2013 and to the second in 2015. Results were compared between survey periods and with the 2015 NHS Cancer Patient Experience Survey. RESULTS: In 2013, 329 patients completed the survey while 319 responded in 2015. Over 90% of patients classed their experience as good or excellent in both survey periods and comparison showed significant overall improvement (p=0.001) in patient experience between 2013 and 2015. Overall, WDHB benchmarked with the NHS experience but the NHS performed better than WDHB in cancer nurse specialist contact for ongoing support and information related to eligibility for financial assistance. CONCLUSION: The results of these confirm that the NHS Cancer Patient Experience Survey provides meaningful data within New Zealand and that WDHB cancer patient experience has improved over the survey period. This data has assisted WDHB in prioritising patient information resources and treatment planning in developing services.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Neoplasias/terapia , Serviços de Saúde Rural/organização & administração , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Nova Zelândia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Regionalização/organização & administração
10.
N Z Med J ; 132(1492): 61-66, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30921312

RESUMO

Upholding te Tiriti o Waitangi should eliminate institutional racism against Maori and contribute to the achievement of health equity. Given the Waitangi Tribunal is investigating health-related breaches of te Tiriti o Waitangi, we argue institutional racism, a key determinant of health inequalities, needs to be acknowledged and addressed within the health sector. Historically the Crown response can be characterised by denial and inaction. The Crown has the power and resources to take action through mechanisms such as those they are currently applying to child poverty and gender pay inequity. Anti-racism literature recommends planned, systems-based approaches to eradicate the problem. We need the government to uphold our Tiriti responsibilities and we require a plan to end racism in the New Zealand health system.


Assuntos
Equidade em Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Racismo/prevenção & controle , Características Culturais , Política de Saúde/tendências , Humanos , Nova Zelândia
11.
Aust N Z J Public Health ; 43(3): 294-299, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30908804

RESUMO

OBJECTIVE: Rheumatic fever (RF) recurrence prevention requires secondary prophylaxis for at least ten years. However, recurrences of rheumatic fever (RRF) persist disproportionately affecting Maori and Pacific youth. Reasons for recurrence rates are not well understood and commonly attributed to patient non-adherence. This research explored Maori and Pacific family experiences of RRF to better understand barriers to accessing secondary prophylaxis to inform health service improvements. METHODS: Participants were Maori and Pacific patients who had RRF or unexpected rheumatic heart disease and their family; and health professionals working in RF contexts. Kaupapa Maori, Talanga and Kakala Pacific qualitative methodologies were employed. Data were thematically analysed using a general inductive approach. RESULTS: Data collection included 38 interviews with patients and families (n=80), six focus group interviews and nine interviews with health providers (n=33) from seven geographic regions. Three key themes were identified where mismatches occurred between services and community needs: 1. Model of delivery; 2. Interpersonal approaches to care; and 3. Adolescent care. Conclusions and Public health implications: Successful RRF prevention requires interventions to address structural causes of inequity, appropriate clinical guidelines and quality health services. Service-delivery models should provide regular prophylaxis in an accessible manner through culturally-safe, community-based, age-appropriate care.


Assuntos
Atitude Frente a Saúde/etnologia , Assistência à Saúde/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Febre Reumática/prevenção & controle , Cardiopatia Reumática/prevenção & controle , Prevenção Secundária , Adolescente , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Nova Zelândia/epidemiologia , Pesquisa Qualitativa , Febre Reumática/diagnóstico , Febre Reumática/etnologia , Cardiopatia Reumática/diagnóstico
12.
Aust N Z J Public Health ; 43(3): 228-235, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30908846

RESUMO

OBJECTIVE: Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS: A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS: One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS: The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.


Assuntos
Antivirais/uso terapêutico , Serviços de Saúde do Indígena/organização & administração , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Hepatite C/tratamento farmacológico , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Austrália/epidemiologia , Criança , Feminino , Hepacivirus/isolamento & purificação , Hepatite C Crônica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
Global Health ; 15(1): 16, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786901

RESUMO

The objective of this article is to describe the state of North, Central, South American and Caribbean (Pan-American) indigenous health. The second objective is to identify recommendations for optimal healthcare and research strategies to achieve indigenous health equity. Current health disparities continue to present between indigenous populations and general populations. Research foci of Pan-American indigenous health center on health outcomes for chronic and acute disease as well as presence of indigenous in data sets. Research is both qualitative and quantitative. Recommendations to improve indigenous health in effort of health equity are variable yet feasible. Stronger epidemiology, continued cohesive Pan-American global strategies, better research alignment with emphasis to quality and comprehensive metric analyses in healthcare delivery are all avenues to improve the health of the indigenous. Research and healthcare delivery on the Pan-American indigenous must be maximized for optimal results, must be representative of the indigenous communities, must be implemented in best practice and must introduce sustainable healthcare delivery for Pan-American indigenous health equity.


Assuntos
Equidade em Saúde , Serviços de Saúde do Indígena/organização & administração , Grupos Populacionais , Região do Caribe , América Central , Humanos , América do Norte , América do Sul
14.
Rural Remote Health ; 19(1): 4625, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30744384

RESUMO

INTRODUCTION: All healthcare providers can influence the delivery and outcome of a palliative approach to care, ensuring that everyone has 'equitable access to quality care based on assessed need as they approach and reach the end-of-life'. This study mapped the delivery of palliative care in far west New South Wales (NSW), Australia, with objectives to: identify who was involved in providing such care in the Far West Local Health District (FWLHD), how they connect, and any gaps in the network describe what care was provided and identify any challenges to care provision. The mapping process and outcomes can be used to guide the implementation of new models of care by building on the localised knowledge of current networks, provision of care and challenges. METHODS: Semi-structured interviews were undertaken with members of the specialist palliative care service and generalist healthcare providers within the FWLHD. Fifteen interviews were conducted over 7 months. Content analyses of interview transcripts identified processes and challenges as well as improvements for care. A network analysis was conducted to identify unidirectional connections and 'map' the services. RESULTS: The vast network demonstrates extensive long-term involvement in palliative care as well as established connections and opportunities for improving communication between the services and providers involved in palliative care. Palliative practice is varied and challenging within the network; challenges include communication, early identification and education. Mapping the existing networks, resources and relationships proved invaluable to guide the implementation of a palliative approach to care. CONCLUSION: The implementation of a palliative approach, as with any service model, requires agreement and engagement across relevant healthcare organisations, services and providers. Mapping and understanding the network of providers (and organisations) that support healthcare delivery before implementing new models of care will identify strengths and gaps within the network. This knowledge will then support new and integrated connections that enhance the provision of care so that it is acceptable, fit for purpose and regionally responsive.


Assuntos
Redes Comunitárias/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Cuidados Paliativos/organização & administração , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde , Assistência à Saúde/organização & administração , Humanos , New South Wales , Serviços de Saúde Rural/organização & administração
15.
Aust N Z J Public Health ; 43(2): 156-162, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30786129

RESUMO

OBJECTIVE: To investigate the effectiveness and cultural relevance of Quitskills training tailored for health professionals working with Aboriginal and Torres Strait Islander people who smoke. METHODS: A retrospective analysis was conducted with data collected from 860 participants (54% Aboriginal and Torres Strait Islander participants) in tailored Quitskills training from 2012 to 2016. Course participants took part in a survey at pre-training, post-training and four-six weeks post-training to assess confidence in skills to address tobacco, and perceptions of the strengths, areas for improvement and cultural relevance of the training. RESULTS: Confidence in skills and knowledge to address tobacco increased significantly from pre- to post-training (all indicators of confidence in skills increased p<0.001) and remained high at follow-up. Tailored Quitskills training was perceived as being culturally relevant by Aboriginal and Torres Strait Islander participants, and the training facilitators were the most commonly cited strength of the training. CONCLUSIONS: Quitskills is an appropriate course for increasing skills and confidence among health professionals working with Aboriginal and Torres Strait Islander people who smoke. Implications for public health: Training courses that are tailored for Aboriginal and Torres Strait Islander people can build the capacity of the health workforce in a culturally relevant manner.


Assuntos
Competência Cultural , Pessoal de Saúde/educação , Serviços de Saúde do Indígena/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Austrália , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos
16.
Int J Equity Health ; 18(1): 3, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30612567

RESUMO

BACKGROUND: Type 2 Diabetes (T2D) is a common long-term condition affecting the health and wellbeing of New Zealanders; one in every four New Zealanders is pre-diabetic. Maori, the Indigenous people of New Zealand, are at an increased risk of developing pre-diabetes and T2D and there are significant inequities between Maori and non-Maori for T2D complications. The purpose of this study was to explore the questions of how the strengths of Maori heath organisations may be leveraged, and how the barriers and constraints experienced by Maori health organisations may be negotiated, for the benefit of Maori; and from a systems perspective, to identify strategic opportunities that may be considered and applied by Maori health organisations, funders and policy makers to respond more effectively to pre-diabetes and reduce health inequities between Maori and non-Maori. METHODS: Utilising case study methodology, a range of data sources were triangulated including nine semi-structured interviews, documents, and a diabetes system map to identify possible strategic opportunities for key stakeholders to respond more effectively to pre-diabetes. RESULTS: Key themes and possible actions to improve health outcomes for Maori with pre-diabetes include: (1) Recognising Maori health organisations as conduits for the community voice and influential partners in the community to effect change; (2) Strengthened partnerships with Maori health organisations for community benefit and to support measurable, evidence-based change and service delivery, particularly when Maori knowledge systems are viewed alongside a Western scientific approach; and (3) Intersectoral integration of health and social services to support provision of whanau-centred care and influence the social determinants of health and local environment. CONCLUSIONS: Maori health organisations are important actors in systems seeking to improve outcomes and eliminate health inequities. Support from funders and policy makers will be required to build on the strengths of these organisations and to overcome system challenges. To realise improved health outcomes for Maori, the value placed on whanau and community perspectives not only needs to be acknowledged in the implementation of health interventions, health and social policies and funding arrangements, but performance measures, service design and delivery must evolve to accommodate these perspectives in practice.


Assuntos
Doença Crônica/terapia , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos , Estado Pré-Diabético/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia
17.
Aust N Z J Public Health ; 43(1): 24-26, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30690842

RESUMO

OBJECTIVE: To undertake a descriptive analysis of the Aboriginal and Torres Strait Islander Health Worker workforce to quantify the changes from 2006-2016. METHOD: We analysed data on Indigenous Health Workers from three waves of Australian Census: 2006, 2011 and 2016. We described the workforce by gender, age and state/territory. RESULTS: There has been overall growth in the number of Indigenous Health Workers (from 1,009 in 2006 to 1,347 in 2016), but this is not commensurate with Aboriginal and Torres Strait Islander population growth (221 Indigenous Health Workers per 100,000 people in 2006 to 207 Indigenous Health Workers per 100,000 people in 2016). The growth is in Indigenous Health Workers aged ≥45 years, with declines in the proportion of Indigenous Health Workers aged ≤44 years. There was growth in workers in two states only, Queensland (increase 4.2 percentage points) and New South Wales (increase 6.6 percentage points). CONCLUSION: There are pressing concerns regarding the lack of growth and the ageing workforce of Aboriginal and Torres Strait Islander Health Workers. We remain concerned that little is being done to increase the retention and recruitment of this workforce. Implications for public health: Greater effort is needed to improve the recruitment and retention of Aboriginal and Torres Strait Islander Health Workers, particularly for younger age groups and males. A National Aboriginal and Torres Strait Islander Health Workforce Strategy needs to be implemented.


Assuntos
Competência Cultural , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde do Indígena/tendências , Mão de Obra em Saúde/tendências , Grupo com Ancestrais Oceânicos/psicologia , Adulto , Austrália , Feminino , Previsões , Conhecimentos, Atitudes e Prática em Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos
18.
Aust J Rural Health ; 27(1): 88-92, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30694000

RESUMO

OBJECTIVE: To evaluate the acceptability of a cancer care team based at an Australian Aboriginal medical service in supporting patients' cancer journeys and to assess improvements in access to cancer care. DESIGN: The cancer care team consisted of an Australian Aboriginal health worker, counsellor and enrolled nurse employed for 2 days a week, supported by a general practitioner. The cancer care team supported patients from prediagnosis while investigations were being undertaken, at diagnosis and through treatment, such as surgery, chemotherapy and radiotherapy, and follow-up, including to palliative care and grief support where these were required. They coordinated preventive programs, such as cervical smear and mammogram recall registers, and coordinated health promotion activities to promote prevention and early detection of other cancers, such as bowel cancer, skin cancer, liver cancer and prostate cancer. The program was evaluated qualitatively using semistructured interviews with current clients of the cancer care team and stakeholders, using grounded theory to analyse emerging themes. SETTING: An Australian Aboriginal community-controlled health service in New South Wales. PARTICIPANTS: The cancer care team provided care for 79 clients. MAIN OUTCOME MEASURES: Acceptability and accessibility of cancer care services. RESULTS: The evaluation involved recruitment of eight Australian Aboriginal clients of the cancer care team and eight stakeholders. The main themes to emerge included improved accessibility of cancer care services, including availability of home visits, transport and accompaniment to tertiary settings. The service was viewed as being culturally safe. CONCLUSION: A primary care-based cancer care team in an Australian Aboriginal medical service provided a culturally safe and accessible service for clients.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Competência Cultural/organização & administração , Serviços de Saúde do Indígena/organização & administração , Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos
19.
BMC Health Serv Res ; 18(1): 960, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541540

RESUMO

BACKGROUND: For Indigenous Australians, health transcends the absence of disease, and includes the health and wellbeing of their community and Country: their whole physical, cultural and spiritual environment. Stronger relationships with Country and greater involvement in cultural practices enhance the wellbeing of Indigenous Australians, and those in more remote regions have greater access to their Country and higher levels of wellbeing. However this does not translate into improvements in clinical indicators, and Indigenous Australians in more remote regions suffer higher levels of morbidity and mortality than Indigenous people in non-remote areas, and other Australians. The Interplay research project aimed to explore how Indigenous Australians in remote regions experience high levels of wellbeing despite poor health statistics, and how services could more effectively enhance both health and wellbeing. METHODS: Indigenous Australians in remote regions, together with researchers and government representatives developed a wellbeing framework, comprising government and community priorities: education, employment and health, and community, culture and empowerment respectively. To explore these priorities Indigenous community researchers recruited participants from diverse Indigenous organizations, including Indigenous land management, art, business development, education, employment, health and municipal services. Fourteen focus groups and seven interviews, involving 75 Indigenous and ten non-Indigenous service providers and users were conducted. These were recorded, transcribed and analyzed, using thematic analysis, based on the wellbeing framework. RESULTS: Research participants highlighted Indigenous land management as a source of wellbeing, through strengthened identity and empowerment, access to traditional food sources, enjoyable physical activity, and escape from communities where high levels of alcohol are consumed. Participants described how collaboration and partnerships between services, and recognition of Indigenous languages could enhance wellbeing, while competition between services undermines wellbeing. Indigenous land management programs work across different sectors and promote collaboration between services, serving as a source of comprehensive primary health care. CONCLUSIONS: Developing primary health care to reflect distinctive health needs of Indigenous Australians will enhance their health and wellbeing, which includes their communities and Country. Indigenous land management consolidates aspects of comprehensive primary health care, providing both clinical benefits and wellbeing, and can provide a focus for service collaboration.


Assuntos
Conservação dos Recursos Naturais , Assistência à Saúde Culturalmente Competente , Serviços de Saúde do Indígena/organização & administração , Nível de Saúde , Grupo com Ancestrais Oceânicos , Atenção Primária à Saúde/organização & administração , Austrália , Grupos Focais , Humanos , Colaboração Intersetorial , Entrevistas como Assunto , Pesquisa Qualitativa
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