Aboriginal and Torres Strait Islander people in Australia, education and health literacy

Health literacy is a vital tool to build health knowledge and enable empowerment in health decision making at a community and individual level. There are different views of what constitutes health literacy with the most inclusive addressing broadly the skills and competencies required “to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life” (Zarcadoolas 2005). Poor health literacy has been shown to impact health seeking behaviour, access and awareness to preventive health campaigns and adherence with treatment. Populations at risk of poor health have lower health literacy and this is compounded by lower socioeconomic status, lower education levels and, where language and cultural differences exist, these disparities may be magnified (Shaw 2008). Health literacy needs to consider both preventative health practices as well as treatment of identified conditions. While we know that poor health literacy does impact health seeking behaviour, access and awareness to preventive health campaigns and adherence with treatment, we seek and advocate solutions to improving health literacy, which are culturally appropriate and also support Indigeniety. We recognise the need to do both; otherwise gains in one area may be countered by lost ground in other areas with overall adverse consequences for Indigenous people and Australians as a whole. To do otherwise, produces a more unwell, inequitable Australian society

Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes

Aim: To understand enablers and barriers influencing postpartum screening for type 2 diabetes following gestational diabetes in Australian Indigenous women and how screening might be improved. Background: Australian Indigenous women with gestational diabetes mellitus (GDM) are less likely than other Australian women to receive postpartum diabetes screening. This is despite a fourfold higher risk of developing type 2 diabetes within eight years postpartum. Methods: We conducted interviews with seven Indigenous women with previous GDM, focus groups with 20 Indigenous health workers and workshops with 24 other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data were analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of ‘capability’, ‘motivation’ and ‘opportunity’. Enabling strategies are presented under ‘intervention’ and ‘policy’ headings. Findings: Participants generated 28 enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Understanding Indigenous women’s perspectives, developing strategies with health workers and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. Importantly, we need evidence which can demonstrate whether the strategies are effective

Paths to improving postpartum care in Aboriginal Australian and Torres Strait Islander women after gestational diabetes

What was this research project about? We aimed to understand why there are low rates of postpartum screening after gestational diabetes (GDM) among Aboriginal and Torres Strait Islander women, and what might help to improve this. 1. We interviewed seven (7) women who had gestational diabetes to understand barriers and enablers to postpartum screening. 2. Twenty (20) Aboriginal and Torres Strait Islander health workers came to focus groups to identify strategies to improve postpartum care. 3. Twenty-four (24) other service providers (doctors, nurses, midwives) attended workshops to discuss strategies and how to implement them

Improving models of care for diabetes in pregnancy: Experience of current practice in Far North Queensland, Australia

Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24-28 weeks gestation was reported as routine with 87% using a 75g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened < 24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusion: Communication, information technology systems, coordination of care and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland