A qualitative evaluation of a mentoring program for Aboriginal health workers and allied health professionals

Objective: Effective partnerships between Aboriginal Health Workers and non‐Aboriginal health professionals are essential to achieve Aboriginal health outcomes. This study aimed to evaluate a mentoring workforce development strategy for Aboriginal Health Workers and non‐Aboriginal allied health professionals. Methods: Thirty‐four Aboriginal Health Workers and non‐Aboriginal health professionals were recruited to the mentoring program where they were paired and established a learning relationship for approximately six months. A qualitative evaluation with thirty of the participants was undertaken involving in‐depth interviews at the completion of the program. Results: A total of 18 mentoring partnerships were formed across Victoria. The data revealed three key themes in relation to the evaluation of the program: (1) The mentoring program facilitated two‐way learning, (2) The Aboriginal Health Workers and non‐Aboriginal health professional participants reported being able to meet their identified learning needs through the partnership, (3) The capacity to improve practice was facilitated through readiness to learn and change practice and personal attributes of the participants, as well as organisation and management support. Conclusions: Peer mentoring between Aboriginal and non‐Aboriginal health workforce was found to be a powerful mechanism to promote two‐way learning that has the capacity to meet learning needs and promote practice improvement. Implications: Peer mentoring may be part of a multi‐strategy approach to the development of the Aboriginal health workforce.     

Evaluation of an intervention to train health professionals working with Aboriginal and Torres Strait Islander people to provide smoking cessation advice

Objective : To investigate the effectiveness and cultural relevance of Quitskills training tailored for health professionals working with Aboriginal and Torres Strait Islander people who smoke. Methods : A retrospective analysis was conducted with data collected from 860 participants (54% Aboriginal and Torres Strait Islander participants) in tailored Quitskills training from 2012 to 2016. Course participants took part in a survey at pre‐training, post‐training and four‐six weeks post‐training to assess confidence in skills to address tobacco, and perceptions of the strengths, areas for improvement and cultural relevance of the training. Results : Confidence in skills and knowledge to address tobacco increased significantly from pre‐ to post‐training (all indicators of confidence in skills increased p<0.001) and remained high at follow‐up. Tailored Quitskills training was perceived as being culturally relevant by Aboriginal and Torres Strait Islander participants, and the training facilitators were the most commonly cited strength of the training. Conclusions : Quitskills is an appropriate course for increasing skills and confidence among health professionals working with Aboriginal and Torres Strait Islander people who smoke. Implications for public health : Training courses that are tailored for Aboriginal and Torres Strait Islander people can build the capacity of the health workforce in a culturally relevant manner.     

Aboriginal health: agreement between general practitioners and patients on their health risk status and screening history

Objective: To examine agreement between patients’ self‐report and general practitioners’ perception of their patients’ health risk status and screening history. Methods: Patients attending an Aboriginal Community Controlled Health Service self‐reported via survey their health risk status and screening history, while waiting to see their general practitioner (GP). Following the consultation the GP completed a corresponding survey. Prevalence rates and rates of agreement using the kappa statistic were calculated for both self‐reported and GP‐reported risk status for smoking, at‐risk alcohol consumption and physical inactivity; and screening history for blood pressure, cholesterol, diabetes and cervical cancer. Results: Prevalence rates of health risks were similar from self‐report versus GP‐reported, yet differed on screening history. Patients who identified themselves as being at risk were often not the same as those identified by GPs. Agreement between patient and doctor was substantial for smoking, yet poor for at‐risk alcohol consumption and physical inactivity. Agreement was fair for cholesterol and cervical cancer screening, and slight for blood pressure and diabetes screening. Conclusions and implications: This study suggests that for effective preventive care, using self‐report for some health risks may be reliable, but less so for screening history. Greater assistance is needed in primary health care settings to identify patients who are at risk.     

Urban Aboriginal mobility in Canada: Examining the association with health care utilization

In recent decades, Indigenous peoples across the globe have become increasingly urbanized. Growing urbanization has been associated with high rates of geographic mobility between rural areas and cities, as well as within cities. In Canada, over 54 percent of Aboriginal peoples are urban and change their place of residence at a higher rate than the non-Aboriginal population. High rates of mobility may affect the delivery and use of health services. The purpose of this paper is to examine the association between urban Aboriginal peoples' mobility and conventional (physician/nurse) as well as traditional (traditional healer) health service use in two distinct Canadian cities: Toronto and Winnipeg. Using data from Statistics Canada's 2006 Aboriginal Peoples Survey, this analysis demonstrates that mobility is a significant predisposing correlate of health service use and that the impact of mobility on health care use varies by urban setting. In Toronto, urban newcomers were more likely to use a physician or nurse compared to long-term residents. This was in direct contrast to the effect of residency on physician and nurse use in Winnipeg. In Toronto, urban newcomers were less likely to use a traditional healer than long-term residents, indicating that traditional healing may represent an unmet health care need. The results demonstrate that distinct urban settings differentially influence patterns of health service utilization for mobile Aboriginal peoples. This has important implications for how health services are planned and delivered to urban Aboriginal movers on a local, and potentially global, scale.     

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations

Objective : Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. Methods : Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. Results : While most ACCHOs had delivered post‐release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. Conclusion : A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs’ role in primary health care delivery to people inside or leaving prison. Implications for public health : ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.     

Relation of child,caregiver, and environmental characteristics to childhood injury in an urban Aboriginal cohort in New South Wales,Australia

Objective : Despite being disproportionately affected by injury, little is known about factors associated with injury in Aboriginal children. We investigated factors associated with injury among urban Aboriginal children attending four Aboriginal Community Controlled Health Services in New South Wales, Australia. Methods : We examined characteristics of caregiver‐reported child injury, and calculated prevalence ratios of ‘ever‐injury’ by child, family, and environmental factors. Results : Among children in the cohort, 29% (n=373/1,303) had ever broken a bone, been knocked out, required stitches or been hospitalised for a burn or poisoning; 40–78% of first injuries occurred at home and 60–91% were treated in hospital. Reported ever‐injury was significantly lower (prevalence ratio ≤0.80) among children who were female, younger, whose caregiver had low psychological distress and had not been imprisoned, whose family experienced few major life events, and who hadn't experienced alcohol misuse in the household or theft in the community, compared to other cohort members. Conclusions : In this urban Aboriginal child cohort, injury was common and associated with measures of family and community vulnerability. Implications for public health : Prevention efforts targeting upstream injury determinants and Aboriginal children living in vulnerable families may reduce child injury. Existing broad‐based intervention programs for vulnerable families may present opportunities to deliver targeted injury prevention.     

Aboriginal peoples, health and healing approaches: the effects of age and place on health

For demographic reasons and as a result of a number of high profile health incidents in recent years, much of the health research and policy focus is on the younger cohorts of Aboriginal peoples in Canada. A critical examination of recent demographic trends reveals, however, that older cohorts of the Aboriginal population are increasing at a faster rate than younger cohorts, primarily due to improvements in life expectancy and declining fertility rates. Yet, there are surprisingly few health studies that have recognized the aging of the Aboriginal population. The overall goal of this paper is to examine differences in health status, use of conventional health care and traditional approaches to healing between older and younger cohorts of the Aboriginal population as well as to examine the importance of age as a determinant of health and health care use. Using data from the 2001 Statistics Canada Aboriginal Peoples Survey and contingency tables and logistic regression, the results demonstrate that older Aboriginal people face unique challenges - e.g. loss of traditional approaches to healing, geographic isolation, identity politics, constitutional and legal divisions within the Aboriginal community - with respect to their health and access to health services. These outcomes result from a colonial past and contemporary policies that affect all Aboriginal people.     

Aboriginal Australians' experience of social capital and its relevance to health and wellbeing in urban settings

Social capital has been linked to physical and mental health. While definitions of social capital vary, all include networks of social relationships and refer to the subsequent benefits and disadvantages accrued to members. Research on social capital for Aboriginal Australians has mainly focused on discrete rural and remote Aboriginal contexts with less known about the features and health and other benefits of social capital in urban settings. This paper presents findings from in-depth interviews with 153 Aboriginal people living in urban areas on their experiences of social capital. Of particular interest was how engagement in bonding and bridging networks influenced health and wellbeing. Employing Bourdieu's relational theory of capital where resources are unequally distributed and reproduced in society we found that patterns of social capital are strongly associated with economic, social and cultural position which in turn reflects the historical experiences of dispossession and disadvantage experienced by Aboriginal Australians. Social capital was also found to both reinforce and influence Aboriginal cultural identity, and had both positive and negative impacts on health and wellbeing.     

Over‐the‐counter analgesic use by urban Aboriginal people in South Australia

Despite recent health gains for Australian Aboriginal people their significantly poorer health status compared with that of non‐Aboriginal Australians remains significant. Within the context of high levels of mortality and morbidity, research highlights significant barriers to timely health‐care, access and safe use of prescribed and over‐the‐counter medicines. The risks to Aboriginal people's health due to unsafe medication use are preventable. The purpose of this article is to present the findings from qualitative research focused on Aboriginal people's knowledge, use and experience of over‐the‐counter analgesics. The study was conducted in the north‐western metropolitan area of Adelaide, which has the largest urban Aboriginal population in South Australia. The employment of an Aboriginal Elder as Cultural Advisor enabled engagement with Aboriginal participants. Purposive ‘snow ball’ sampling was used to recruit participants for four focus groups [n = 30] and one participant opting for a personal semi‐structured interview. Participants worked with the researchers to develop the findings and formulate recommendations. The 25 women and 6 men, aged 20–80 years reported various chronic medical conditions. Focus groups/interview elicited accounts of critical issues concerning safe selection and use of over‐the‐counter analgesics. Serious health risks were evident due to limited knowledge about safe analgesic use and over‐reliance on information from family, friends and advertising. Extremely poor access was reported by participants to culturally and linguistically appropriate information, education and advice from a range of doctors and other health professionals including Aboriginal health workers.     

Estimating tobacco consumption in remote Aboriginal communities using retail sales data: some challenges and opportunities

Objective: To describe and discuss challenges and opportunities encountered when estimating tobacco consumption in six remote Aboriginal communities using tobacco sales data from retail outlets. Approach: We consider tobacco sales data collected from retail outlets selling tobacco to six Aboriginal communities in two similar but separate studies. Despite challenges – including: not all outlets provided data; data not uniform across outlets (sales and invoice data); change in format of data; personnel change or management restructures; and anomalies in data and changes in community populations – tobacco consumption was estimated and returned through project newsletters and community feedback sessions. Amounts of tobacco sold were returned using graphs in newsletters and pictures of items common to the community in community feedback sessions. Conclusions: Despite inherent limitations of estimating tobacco consumption using tobacco sales data, returning the amount of tobacco sold to communities provided an opportunity to discuss tobacco consumption and provide a focal point for individual and community action. Using this method, however, may require large and sustained changes be observed over time to evaluate whether initiatives to reduce tobacco consumption have been effective. Implications: Estimating tobacco consumption in remote Aboriginal communities using tobacco sales data from retail outlets requires careful consideration of many logistical, social, cultural and geographic challenges.     

A rapid review of interventions to improve medicine self-management for older people living at home

Background

As people age, they are more likely to develop multiple long-term conditions that require complicated medicine regimens. Safely self-managing multiple medicines at home is challenging and how older people can be better supported to do so has not been fully explored.

Aim

This study aimed to identify interventions to improve medicine self-management for older people living at home and the aspects of medicine self-management that they address.

Design

A rapid review was undertaken of publications up to April 2022. Eight databases were searched. Inclusion criteria were as follows: interventions aimed at people 65 years of age or older and their informal carers, living at home. Interventions needed to include at least one component of medicine self-management. Study protocols, conference papers, literature reviews and articles not in the English language were not included. The results from the review were reported through narrative synthesis, underpinned by the Resilient Healthcare theory.

Results

Database searches returned 14,353 results. One hundred and sixty-seven articles were individually appraised (full-text screening) and 33 were included in the review. The majority of interventions identified were educational. In most cases, they aimed to improve older people's adherence and increase their knowledge of medicines. Only very few interventions addressed potential issues with medicine supply. Only a minority of interventions specifically targeted older people with either polypharmacy, multimorbidities or frailty.

Conclusion

To date, the emphasis in supporting older people to manage their medicines has been on the ability to adhere to medicine regimens. Most interventions identify and target deficiencies within the patient, rather than preparing patients for problems inherent in the medicine management system. Medicine self-management requires a much wider range of skills than taking medicines as prescribed. Interventions supporting older people to anticipate and respond to problems with their medicines may reduce the risk of harm associated with polypharmacy and may contribute to increased resilience in the system.

Patient or Public Contribution

A patient with lived experience of medicine self-management in older age contributed towards shaping the research question as well as the inclusion and exclusion criteria for this review. She is also the coauthor of this article. A patient advisory group oversaw the study.     

UNRESOLVED HEALTHCARE ISSUES IN RURAL AND REMOTE AUSTRALIA: PRELIMINARY FINDINGS FROM A NATIONAL RURAL HEALTH UNIT SURVEY

ABSTRACT: A preliminary analysis of a survey answered by 317 health practitioners with interests in heath in rural and remote Australia is described. The most important unresolved issues in rural health were service delivery problems, difficulties experienced with attracting and retaining staff, continuing education, Aboriginal health and shortage of finance.     

皮革企业接触二甲基甲酰胺作业工人健康监护结果

目的探讨接触二甲基甲酰胺（DMF）对作业工人肝功能的影响,提出预防职业病危害的有关建议。方法根据工厂近几年车间空气中DMF的监测数据,将作业工人分为对照组、低浓度组及高浓度组。收集2010年度4家皮革企业共236名作业工人的健康检查报告涵盖各组研究对象的基本情况：年龄、性别、工龄等）,体重、吸烟、饮酒和作业时间等另行问卷调查,对结果进行分析。结果高浓度组消化道症状出现率明显高于对照组,且有从对照组、低浓度组向高浓度组逐渐升高的趋势;低浓度组和高浓度组血清中丙氨酸转氨酶（ALT）及γ-谷氨酰转肽酶（γ-GT）水平明显高于对照组,高浓度组血清天冬氨酸转氨酶（AST）水平高于低浓度组;高浓度组肝脏指数（L iVer index）明显高于对照组和低浓度组。结论接触DMF浓度与时间对人体肝功能影响较大,应通过做好作业岗位通风排毒、限制接触时间来保护作业工人身体健康,同时,根据DMF作用机制,建议规范职业健康监护（周期、项目）,做好员工的预防性用药。     

Cancer-related health behaviours and health service use among Inuit and other residents of Canada's north

This article identifies the extent to which demographic, socio-economic and geographic factors account for differences between Inuit and other Northern Canadian residents in health-related behaviours and health service use related to cancer incidence and diagnosis. The study population includes Inuit, Métis, First Nation and non-Aboriginal residents aged 21–65 who live in Nunavut, Northwest Territories, Labrador, Nunavik and Jamésie in northern Quebec, and the northern regions of Saskatchewan and Manitoba. Data are drawn from confidential versions of the 2000–2001 and 2004–2005 Canadian Community Health Surveys and the 2001 Aboriginal People's Survey produced by Statistics Canada. Multivariate Logistic regression analysis is applied to a set of health-related behaviours including cigarette smoking, binge drinking and obesity, and a set of basic health service use measures including consultation with a physician, consultation with a nurse, Pap smear testing and mammography.     

Pragmatic indicators for remote Aboriginal maternal and infant health care: why it matters and where to start

Objective: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory (NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to inform a set of pragmatic indicators for reporting improvement in remote MIH care. Methods: Scientific databases and grey literature (organisational websites and Google Scholar) were searched using the terms ‘Aboriginal/maternal/infant/remote health/monitoring performance’. Key stakeholders identified omitted indicators sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme. Results: Forty‐two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000 individual indicators. Of these, 656 were relevant for our purpose and were subsequently organised into 300 topics and 16 themes for antenatal, birth and postpartum, and infant care by indicator type. Conclusion: There are many measures for monitoring health care delivery to mothers and infants. Few are framed around remote MIH services, despite poorer health outcomes of remote mothers and infants and the specific challenges with providing care in this setting. Establishing relevant indicators is vital to support relevant data collection and the development of appropriate policy for remote Aboriginal maternal and infant care.