A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care.
More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations.
We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to "Aboriginal and Torres Strait Islander peoples," "Chronic Disease," and "Primary Health Care". Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches.
Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery.
Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.
Yadav UN
,Davis JM
,Bennett-Brook K
,Coombes J
,Wyber R
,Pearson O
... -
《-》
Students' experiences of placements in urban indigenous health contexts: developing a culturally responsive workforce.
A culturally responsive health workforce is essential to ensure the delivery of culturally safe health services that meet Aboriginal and Torres Strait Islander Peoples needs. In partnership with universities, placement providers play an essential role in creating opportunities for immersive experiences that enable students to develop their cultural responsiveness. This study evaluated students' experiences of an innovative student placement model embedded within an urban Aboriginal and Torres Strait Islander Community-Controlled Health Organisation.
Students completed pre and post placement surveys administered using a web-based interface. The surveys involved five-point Likert and open-ended response items exploring students' perceptions of their knowledge, skills development, awareness and self-development, and overall placement experience. Frequencies were calculated for the variables of interest and compared between pre and post surveys. The sign test for matched pairs was used to calculate differences between pre and post surveys, and a one-sided hypothesis test was utilised to determine if the level of agreement increased from pre to post survey. Qualitative data obtained for seven questions were thematically analysed using Groundwater Method, an Indigenous data analysis technique.
Between January 1, 2017, and June 30, 2019, 938 students from 32 disciplines were placed within the organisation and its Member services. Survey responses were received from 338 participants pre-placement, and 158 participants post-placement. The matched pre-post group contained 81 students. The results indicate significant positive changes in cultural responsiveness, skills development, awareness, and self-development when comparing pre- and post-placement responses. Students' overall satisfaction with the quality of their placement was positively associated with their intention to work in Aboriginal and Torres Strait Islander health contexts in the future. Key pre-placement themes included competence, cultural skills, support and fear, and key post-placement themes included expertise, cultural responsiveness, learning environment and challenges.
Indigenous-led, regionally coordinated placements in urban Indigenous health contexts can support transformative learning and the development of a culturally responsive workforce. Universities should aim to develop reciprocal relationships with Indigenous-led organisations to support students to develop their cultural responsiveness and improve the provision of culturally safe care for Aboriginal and Torres Strait Islander Peoples. Future research should explore the longer-term impacts of student placements on cultural responsiveness, attitudes, values, and behaviours, as well as the experiences of Aboriginal and Torres Strait Islander Peoples interfacing with university students on placement in urban settings. NOTE: We will predominantly use the term 'Aboriginal and Torres Strait Islander Peoples', as opposed to 'Indigenous' or 'First Nations'. When the term 'Indigenous' is used, it largely relates to government policy - except when referring to Indigenisation of curriculum and Indigenous Knowledges - and where 'First Nations' is used, it is in a global context. In addition, we use the term 'Peoples' to signify that Aboriginal and Torres Strait Islander Peoples are not one People or Nation, but a collective of Peoples and Nations.
Odgers-Jewell K
,Nelson A
,Brown R
,Hunter N
,Atkins T
,Menzel K
... -
《BMC Medical Education》