A Qualitative Study on the Transition Support Needs of Indigenous Australians Following Traumatic Brain Injury

Abstract

Objective:A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced.Methods and Procedure:Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis.Results:Five major themes were identified within the data. These were labelled ‘hospital experiences’, ‘engaging with medical and community-based supports’, ‘health and wellbeing impacts from the injury’, ‘everyday living’ and ‘family adjustments post-injury’.Conclusions:While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an individualised, coordinated transition support, may reduce the risks for re-admission with further head injuries.

Clinical profile of Aboriginal and Torres Strait Islander adults with stroke and traumatic brain injury at a regional Australian hospital: a retrospective chart audit

“…Health care needs may also differ across urban, remote and discrete Aboriginal and Torres Strait Islander communities (Queensland Health, 2010, 2014. Health professionals must recognise and acknowledge these aspects of diversity and tailor their services to ensure culturally secure practice and that the unique values, cultural needs and rights of Aboriginal and Torres Strait Islander peoples are met (Armstrong et al, 2019;Fitts et al, 2019;Hersh et al, 2019;Queensland Health, 2010, 2014Taylor & Guerin, 2014). Failure to do so may lead to patient dis-engagement in the health service, negative emotions and poorer health outcomes for Aboriginal and Torres Strait Islander peoples, particularly those who experience stroke and TBI, and subsequent acquired communication disorders (Armstrong et al, 2019;Fitts et al, 2019;Hersh et al, 2019;Katzenellenbogen et al, 2013).…”

“…Additionally, Aboriginal patients preferred to have access to a familiar interpreter, such as a family member or known health worker (Kelly et al, 2012). Poor intercultural communication may compromise patient's health and health outcomes due to miscommunication and inappropriate information to make informed decisions, particularly those who have experienced stroke or TBI (Armstrong et al, 2019;Fitts et al, 2019;Katzenellenbogen et al, 2013;Queensland Health, 2014). Language and cultural difference between the patient and the health professional, along with culturally insensitive practices, have been identified by Australian Aboriginal and Torres Strait Islander patients as having a negative effect on their well-being and health outcomes (Armstrong et al, 2019;Aspin, Brown, Jowsey, Yen, & Leeder, 2012;Fitts et al, 2019;Hersh et al, 2019).…”

The development of aboriginal brain injury coordinator positions: a culturally secure rehabilitation service initiative as part of a clinical trial

“…Acquired brain injury, as a result of stroke and traumatic brain injury, affects Australia's First Peoples (hereafter referred to as Aboriginal people) at a significant rate (Esterman et al, 2018, Katzenellenbogen et al, 2018, Katzenellenbogen et al, 2016, You et al, 2015 and the impact is felt by individuals, families and communities (Armstrong et al, 2015(Armstrong et al, , 2019a(Armstrong et al, , 2019b. However, access to brain injury rehabilitation services for Aboriginal people is reported to be often limited, and there is very little support outside of the hospital environment for the person involved, extended family or community (Armstrong et al, 2015, 2019a, 2019b, Fitts et al, 2019. Our recent research involving Aboriginal brain injury survivors and their families revealed that people often manage 'on their own' following such events.…”

“You felt like a prisoner in your own self, trapped”: the experiences of Aboriginal people with acquired communication disorders

“…Access to services is reported as problematic for many Aboriginal people, with barriers identified as communication breakdowns, racism and distance from established services in regional and remote contexts [12,13,14,15]. However, with the exception of a small number of studies [12,16,17,18,19,20] most have investigated Aboriginal and non-Aboriginal health professionals' perspectives on the issues involved rather than that of Aboriginal patients themselves. The importance of obtaining the Aboriginal perspective is increasingly acknowledged as part of service focus on client-centred and family-centred care.…”