Aboriginal health workers and diabetes care in remote community health centres: a mixed method analysis

Abstract

Objective: To assess the effect of employing Aboriginal health workers (AHWs) on delivery of diabetes care in remote community health centres, and to identify barriers related to AHWs’ involvement in diabetes and other chronic illness care. Design, setting and participants: Three‐year follow‐up study of 137 Aboriginal people with type 2 diabetes in seven remote community health centres in the Northern Territory. Main outcome measures: Delivery of guideline‐scheduled diabetes services; intermediate outcomes (glycated haemoglobin [HbA1c] and blood pressure levels); number and sex of AHWs at health centres over time; barriers to AHWs’ involvement in chronic illness care. Results: There was a positive relationship between the number of AHWs per 1000 residents and delivery of guideline‐scheduled diabetes services (but not intermediate health outcomes). Presence of male AHWs was associated with higher adherence to the guidelines. Barriers to AHWs’ involvement in chronic illness care included inadequate training, lack of clear role divisions, lack of stable relationships with non‐Aboriginal staff, and high demands for acute care. Conclusions: Employing AHWs is independently associated with improved diabetes care in remote communities. AHWs have potentially important roles to play in chronic illness care, and service managers need to clearly define and support these roles.

The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review

“…Two of these studies (Morisky et al. 2002, Si et al. 2006) were graded as yielding high quality evidence as indicated by the number of positive outcomes.…”

“…The issue of gender was a consideration for bi‐lingual CHWs (Si et al. 2006), at least among Indigenous people with diabetes.…”

Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service

“…Interventions targeting health providers (such as the AHC) may need to be accompanied by systematic efforts to increase patients' knowledge, skills and confidence to manage their own conditions [29,30]. In the challenging setting of remote Aboriginal communities, specific strategies may be required to: (i) involve family members in care [19,31], (ii) train and retain a skilled medical and nursing workforce to provide high quality chronic illness care [8,19,26] and (iii) improve Aboriginal participation in the delivery of chronic disease care [8,31,32]. These remain the ongoing challenges for PHC practitioners, policy makers, health administrators and health researchers.…”

Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population

“…However, AHP require support to participate in patient decision‐making processes and to carry out their work . The number of AHP per patient population as well as accessibility to AHP of the same gender may impact the delivery of diabetes care and achievement of scheduled assessment of cardio‐metabolic risk . We have mentored and supported AHP to complete successfully postgraduate certification in diabetes education, and non‐Indigenous staff of our multidisciplinary team have benefited enormously from exchange of information and learnings with AHP.…”