‘It’s got to be another approach’: an Aboriginal Health Worker perspective on cardiovascular risk screening and education

This study provides a new perspective from Aboriginal Health Workers (AHWs) working in the area of heart health in the Aboriginal community of western Sydney. Discussion AHWs are well placed and keen to be a part of the team that assesses cardiovascular risk. However, lack of recognition of the AHWs’ skills and lack of access to formal training are current barriers to enhancing their role in the heart health team. Cardiovascular disease (CVD) is a major health concern in the Aboriginal population and contributes to the significant life expectancy gap between Aboriginal and non-Aboriginal Australians. Conventional risk factors alone do not account for the excess CVD mortality, which has foundations in the economic, social, physiological, psychological and educational disadvantage of the Aboriginal population. There is a lack of progress in reducing the disparities in health outcomes between Aboriginal and non-Aboriginal Australians. This may be because of a focus, to date, on acute care and patient responsibility rather than addressing underlying determinants of health such as living conditions and socioeconomic factors. In Aboriginal communities, Aboriginal Health Workers (AHWs) fulfil a variety of roles, depending on personal interests and the needs of the community. Unfortunately, a lack of understanding of the diverse expertise of AHWs persists. A universal role is that of a cultural broker through which communication between Aboriginal people and non-Aboriginal healthcare providers are enhanced, thereby increasing the effectiveness of their interaction. Recognition of AHWs as an important part of the healthcare team has been suggested as a means of delivering improved healthcare to the Aboriginal population. The aim of this study was to study the perspectives of Aboriginal health professionals (nurses and AHWs) regarding cardiovascular risk and heart health, including their understanding of cardiovascular risk assessment. Qualitative research methods can improve the understanding of perceptions of health across cultures and lead to improved health outcomes. This study was undertaken with AHWs and Aboriginal nurses from the Aboriginal Medical Service Western Sydney (AMSWS) and Western Sydney Local Health District, all of whom are working in the area of chronic disease management or heart health. AMSWS is a large Aboriginal community controlled health organisation that provides multidisciplinary primary healthcare, including cardiovascular screening, healthy lifestyle education and case management to clients with heart disease

Perceptions of shared care among survivors of colorectal cancer from non-English-speaking and English-speaking backgrounds: A qualitative study

Background: Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Culturally and Linguistically Diverse (CALD) groups are known to have poorer outcomes following cancer treatment but little is known about their perceptions of shared care following surgery for CRC. This study aimed to explore how non-English-speaking and English-speaking patients perceive care to be coordinated amongst various health practitioners. Methods: This was a qualitative study using data from face to face semi-structured interviews and one focus group in a culturally diverse area of Sydney with non-English-speaking and English-speaking CRC survivors. Participants were recruited in community settings and were interviewed in English, Spanish or Vietnamese. Interviews were recorded, transcribed, and analysed by researchers fluent in those languages. Data were coded and analysed thematically. Results: Twenty-two CRC survivors participated in the study. Participants from non-English-speaking and English-speaking groups described similar barriers to care, but non-English-speaking participants described additional communication difficulties and perceived discrimination. Non-English-speaking participants relied on family members and bilingual GPs for assistance with communication and care coordination. Factors that influenced the care pathways used by participants and how care was shared between the specialist and GP included patient and practitioner preference, accessibility, complexity of care needs, and requirements for assistance with understanding information and navigating the health system, that were particularly difficult for non-English-speaking CRC survivors. Conclusions: Both non-English-speaking and English-speaking CRC survivors described a blend of specialist-led or GP-led care depending on the complexity of care required, informational needs, and how engaged and accessible they perceived the specialist or GP to be. Findings from this study highlight the role of the bilingual GP in assisting CALD participants to understand information and to navigate their care pathways following CRC surgery

Supporting Primary Health Care Providers in Western Sydney areas of socioeconomic disadvantage

General Practitioners working with socially disadvantaged populations face challenges in trying to solve complex health issues and social problems, often in time pressured visits. Western Sydney includes some of the most disadvantaged postcodes in Australia and has some of the highest rates of disease prevalence as well as lowest GP to population ratios. This project is describing the needs of primary health care providers (PHCPs) in these areas, to develop a support model and to evaluate early implementation of this model in order to inform funding bids for ongoing research and support. The longer term aim is to build sustainability of the primary care workforce in order to improve health outcomes and inform the Australian health reform agenda particularly regarding workforce shortages in outer urban disadvantaged areas.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences

Background: Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives. Methods: We used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives. Results: In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities. Conclusions: The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation

Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: a data linkage study

OBJECTIVES Australian Aboriginal children experience earlier, more frequent and more severe otitis media, particularly in remote communities, than non-Aboriginal children. Insertion of ventilation tubes is the main surgical procedure for otitis media. Our aim was to quantify inequalities in ventilation tube insertion (VTI) procedures between Australian Aboriginal and non-Aboriginal children, and to explore the influence of birth characteristics, socioeconomic background and geographical remoteness on this inequality. DESIGN Retrospective cohort study using linked hospital and mortality data from July 2000 to December 2008. SETTING AND PARTICIPANTS A whole-of-population cohort of 653 550 children (16 831 Aboriginal and 636 719 non-Aboriginal) born in a New South Wales hospital between 1 July 2000 and 31 December 2007 was included in the analysis. OUTCOME MEASURE First VTI procedure. RESULTS VTI rates were lower in Aboriginal compared with non-Aboriginal children (incidence rate (IR), 4.3/1000 person-years; 95% CI 3.8 to 4.8 vs IR 5.8/1000 person-years; 95% CI 5.7 to 5.8). Overall, Aboriginal children were 28% less likely than non-Aboriginal children to have ventilation tubes inserted (age-adjusted and sex-adjusted rate ratios (RRs) 0.72; 95% CI 0.64 to 0.80). After adjusting additionally for geographical remoteness, Aboriginal children were 19% less likely to have ventilation tubes inserted (age-adjusted and sex-adjusted RR 0.81; 95% CI 0.73 to 0.91). After adjusting separately for private patient/health insurance status and area socioeconomic status, there was no significant difference (age-adjusted and sex-adjusted RR 0.96; 95% CI 0.86 to 1.08 and RR 0.93; 95% CI 0.83 to 1.04, respectively). In the fully adjusted model, there were no significant differences in VTI rates between Aboriginal and non-Aboriginal children (RR 1.06; 95% CI 0.94 to 1.19). CONCLUSIONS Despite a much higher prevalence of otitis media, Aboriginal children were less likely to receive VTI procedures than their non-Aboriginal counterparts; this inequality was largely explained by differences in socioeconomic status and geographical remoteness.This work was supported by the National Health and Medical Research Council (NHMRC; grant number 573113). KF was supported by an NHMRC Early Career Fellowship (#1016475) and an NHMRC capacity building grant (#573122). EB was supported by an NHMRC Senior Research Fellowship (#1042717)

Integrating health care in Australia : a qualitative evaluation

With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses. We aimed to investigate the WSICP’s effectiveness through a qualitative evaluation focused on the 10 WSICP strategies. The combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research

Experiences of primary healthcare professionals and patients from an area of urban disadvantage : a qualitative study

Background: The health disadvantage in socioeconomically marginalised urban settings can be challenging for health professionals, but strong primary health care improves health equity and outcomes. Aim: To understand challenges and identify needs in general practices in a socioeconomically marginalised Australian setting. Design & setting: Qualitative methodology with general practices in a disadvantaged area of western Sydney. Method: Semi-structured interviews with healthcare professionals and their patients were transcribed and analysed thematically under the guidance of a reference group of stakeholder representatives. Results: A total of 57 participants from 17 practices (comprising 16 GPs, five GP registrars [GPRs], 15 practice staff, 10 patients, and 11 allied health professionals [AHPs]), provided a rich description of local communities and patients, and highlighted areas of satisfaction and challenges of providing high quality health care in this setting. Interviewees identified issues with health systems impacting on patients and healthcare professionals, and recommended healthcare reform. Team-based, patient-centred models of primary health care with remuneration for quality of care rather than patient throughput were strongly advocated, along with strategies to improve patient access to specialist care. Conclusion: The needs of healthcare professionals and patients working and living in urban areas of disadvantage are not adequately addressed by the Australian health system. The authors recommend the implementation of local trials aimed at improving primary health care in areas of need, and wider health system reform in order to improve the health of those at socioeconomic and health disadvantage

Ngaa-bi-nya-nhumi-nya (to test first) : piloting the feasibility of using the growth and empowerment measure with Aboriginal pregnant women who smoke

Introduction. Aboriginal pregnant women who smoke experience barriers to quitting, including challenges to social and emotional well-being, but these are infrequently quantified. Finding an appropriate measurement tool in this setting is crucial to increase knowledge for holistic smoking cessation interventions. Aims. To pilot the Growth and Empowerment Measure (GEM) with a sample of pregnant Aboriginal women who smoke. Methods. Aboriginal women participating in the step-wedge ICAN QUIT in Pregnancy pilot study completed the GEM comprised of 14-item Emotional Empowerment Scale (EES14), 12 Scenarios (12S), and K6 items at baseline, 4 weeks, and 12 weeks. Qualitative interviews with service staff were held at the end of the study to assess feasibility. Results. 15 pregnant Aboriginal women took part between November 2016 and July 2017. At 12 weeks, n=8/12 (67%) of women reported an increase in both the EES14 and 12S scores. Total 12S scores were significantly higher at 12 weeks (p=0.0186). Total K6 had a nonsignificant trend for reduction (p=0.0547). Staff reported that the length of the survey presents challenges in this setting. Conclusions. A shortened, modified GEM is recommended in this setting. We recommend the GEM to be tested in a larger study, powered to assess its associations with smoking behaviours

Using community based research frameworks to develop and implement a church-based program to prevent diabetes and its complications for Samoan communities in South Western Sydney

Pasifika communities bear a disproportionate burden of diabetes compared to the general Australian population. Community-based participatory research (CBPR), which involves working in partnership with researchers and communities to address local health needs, has gained prominence as a model of working with underserved communities. This paper describes how Le Taeao Afua (LTA) Samoan diabetes prevention program was underpinned by two CBPR frameworks to develop a culturally tailored church-based lifestyle intervention to prevent diabetes and its complications in the Australian Samoan community. The name LTA, which means ‘a new dawn,’ was chosen by the community to signify a new dawn without diabetes in the Australian Samoan community. Strategies for engaging with the Australian Samoan community in South Western Sydney are discussed mapped to the key principles from the CBPR frameworks. In particular, this paper highlights the steps involved in building relationships with Samoan community leaders and the vital role of community activators and peer support facilitators in the success of delivering the program. Lessons learnt, such as the importance of church and maintaining a Samoan way of life in daily activities, and processes to build effective partnerships and maintain long-term relationships with the Australian Samoan community, are also discussed. Our paper, through providing a case example of how to apply CBPR frameworks, will help guide future community-based health promotion programs for underserved communities

Developing indicators and measures of high-quality for Australian general practice

Background: Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. Methods: We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. Results: A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. Conclusions: The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally