Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples

Abstract

Objective: Given the high prevalence of chronic disease, it is of concern that access to and sustained engagement with primary healthcare services by Aboriginal and Torres Strait Islander Australians is often far lower than would be expected. This study sought to explore ways in which relationships can support sustained engagement with healthcare services. Methods: Semi‐structured interviews were conducted with 126 Aboriginal and Torres Strait Islander participants with and without chronic disease and 97 Aboriginal and Torres Strait Islander and non‐Indigenous healthcare providers, healthcare service managers or administrative staff. Results: Our findings indicate that when faced with acute health issues, Aboriginal and Torres Strait Islander participants did prioritise care, provided that the service was both physically and emotionally welcoming. Trustworthiness of healthcare providers and strong relationships with patients were the most important factors for encouraging sustained engagement overtime. Conclusions: Responsibility for sustaining relationships does not rest solely with Aboriginal and Torres Strait Islander patients. Rather, healthcare providers need to commit to the process of building and maintaining relationships. Implications: First and foremost healthcare providers should take time to establish and then maintain relationships. Healthcare services can also contribute by ensuring facilities are welcoming for Aboriginal and Torres Strait Islander peoples.

Multimorbidity among Aboriginal people in New South Wales contributes significantly to their higher mortality

“…These challenges are exacerbated for Aboriginal and Torres Strait Islander people by discrimination and prejudice in mainstream care and difficulties in accessing culturally safe and appropriate care 22 . A qualitative study found that sustained engagement of Indigenous people with health care providers was most likely when they felt that the health care service was part of the community and the staff were Indigenous Australians or had a willingness to understand the cultural, community and kinship contexts of the community 23 . Providing high quality care and evidence‐based interventions, particularly interventions targeting alcohol and other substance use disorders, is crucial to reducing multimorbidity among Aboriginal and Torres Strait Islander Australians.…”

“…22 A qualitative study found that sustained engagement of Indigenous people with health care providers was most likely when they felt that the health care service was part of the community and the staff were Indigenous Australians or had a willingness to understand the cultural, community and kinship contexts of the community. 23 Strait Islander Australians. Unfortunately, there have been few quality evaluations of interventions for substance use disorders in these populations.…”

What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence

“…Inadequate access to primary health care (PHC) services responsive to Indigenous clients' holistic needs, modifiable socioeconomic factors including low income, poor education, poor living conditions and social exclusion are principal contributors to the higher chronic disease burden in the Indigenous population 1–3 . Increasing Indigenous Australian engagement with effective PHC, conceived in the comprehensive Indigenous Australian sense, is critical to reduce chronic disease in Indigenous communities and mitigate the disparities in health 3,4 . Australia's culturally diverse Indigenous peoples' understanding of accessible, appropriate, quality PHC is different and broader than Western notions 3,5 .…”

The evaluation of nurse navigators in chronic and complex care

“…Additionally, an inequity‐responsive, contextually‐tailored, culturally‐competent care approach (Browne et al, ), provides a guideline for ensuring that the care delivered is tailored to the patient. The model aligns with culturally tailored care, for example Kaupapa Māori theory where self‐determination and culturally acceptable care is important (Forrest et al, ; Jackson, ) and Aboriginal and Torres Strait Islander peoples as consumers of chronic care services focusing on relationships and cultural sensitivity (Coombe, Haswell‐Elkins, & Hill, ; Davy et al, ).…”

“…• Improved patient and carer satisfaction and quality of life (RQ 1,2,3,4) • The development of a model of care for navigation services (RQ 3, 4) • Provision of a sustainable model of nurse-led co-ordination that works across all services within a multidisciplinary team (RQ 6) • Social impact outcomes measured as social return on investment. (RQ 6) • Measurement of well-being and resilience in the navigator cohort (RQ 5) • Improved health literacy, health promotion and prevention practices (RQ 3, 4) care, for example Kaupapa Māori theory where self-determination and culturally acceptable care is important (Forrest et al, 2016;Jackson, 2015) and Aboriginal and Torres Strait Islander peoples as consumers of chronic care services focusing on relationships and cultural sensitivity (Coombe, Haswell-Elkins, & Hill, 2008;Davy et al, 2016).…”