Non‐clinical eye care support for Aboriginal and Torres Strait Islander Australians: a systematic review

Abstract

Objectives To describe research into non‐clinical support eye health care for Aboriginal and Torres Strait Islander (Indigenous) Australians, the people who provide such care, and its impact on eye health outcomes. Study design Systematic review and qualitative analysis of peer‐reviewed research publications. Data sources Peer‐reviewed research articles published between January 2000 and July 2018 and included in MEDLINE/EMBASE, Web of Science, Informit, EBSCO (CINAHL and Anthropology Plus), or ProQuest Central. Study selection We included English language, peer‐reviewed articles reporting empirical data on non‐clinical support for eye health for Indigenous Australians. Two authors independently assessed the titles and abstracts of 1678 unique articles for inclusion in a full text review; the full texts of 104 publications were reviewed, of which 77 were excluded and 27 included in our qualitative analysis. Data synthesis Qualitative analysis identified five key areas of non‐clinical support for Indigenous eye health: coordination of eye care, integrating and linking services, cultural support, health promotion, and social and emotional support. People who provide non‐clinical support include eye health coordinators, Aboriginal Health Workers, primary care clinicians, family members, carers, and community‐based liaison workers. The availability of non‐clinical support is associated with increased patient attendance at eye care services, higher visual acuity examination and cataract surgery rates, broader eye health knowledge, and greater cultural responsivity. Conclusion Non‐clinical support is critical for facilitating attendance at appointments by patients and ensuring that preventive, primary, and tertiary eye care services are accessible to Indigenous Australians. Greater financial investment is needed to support key providers of non‐clinical support, especially eye health coordinators, community‐based liaison officers, and family members and carers.

Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia

“…CBRs proposed that a disjuncture in cultural and clinical understandings of diabetic eye disease may be prevented with the introduction of specific Indigenous cultural brokerage roles; that aim to bridge cultural and language gaps, through a combination of interpreting, clinical appointment coordination assistance and family/community engagement. A non-clinical role such as this would support, rather than replicate the work performed by Indigenous health workers or eye health coordinators who are often overburdened by clinical and administrative responsibilities, limiting their capacity to provide cultural brokerage 28…”

“…In comparison, Western biomedical understandings of health and illness place emphasis on identifying and treating standard disease entities within individual bodies, and tend to individualise the problem of poor health,32 despite widespread recognition that the social (and structural) determinants of health shape disease causation more than individual agency. The epistemological differences between these systems both directly and indirectly contribute to persisting poor eye health outcomes for Indigenous Australians 13…”

“…A detailed account of the methodology is documented elsewhere,13 however, a summary is provided here for context. The study was undertaken in four rural communities, two in the Katherine Region, NT, and two in north-western NSW; and was grounded in the principles of Indigenist15 16 decolonising,17 and participatory action research (PAR)18 methodologies.…”

“…Data were collected as part of a broader research project named the Patient Experience in Eye Care study,13 which was undertaken in close collaboration with Aboriginal Community Controlled Health Services (ACCHS) in the Northern Territory (NT) and New South Wales (NSW), Australia. ACCHS are governed by an Indigenous board, and aim to deliver holistic and culturally responsive primary health services that are primarily managed and provided by Indigenous staff.…”

Updating the model of eye care for Aboriginal populations in remote Central Australia

“…Prior studies have also shown the superiority of peer encouragement in engaging patients, compared to encouragement from trained health professionals. 30 A recent review outlined the importance of non-clinical patient support from family members, carers and community liaison workers in increasing attendance at specialist care appointments 35 ; including escorting and sitting with patients while attending appointments, 36,37 and providing postoperative home care support like meal delivery. 38…”