Culturally Appropriate Measures for Addressing the Health Needs of the Aboriginal and/or Torres Strait Islander Community

Executive Summary

This study recognizes that the Aboriginal and/or Torres Strait Islander communities face numerous challenges in accessing health care services, and it seeks to discuss culturally appropriate measures that can be used to address these issues. Therefore, it looked at culturally appropriate measures for providing enhanced access to health services that are responsive to the Aboriginal and/or Torres Strait Islander community world view; improving existing mental health services tailored to Aboriginal and Torres Strait Islander people; and improving understanding in health service providers about intergenerational trauma. Each section discusses the challenges being faced by the people under consideration, measures that can be used to address such challenges, and justification for the recommended measures.

Introduction

It is established in studies that providing primary health care facilities aids in improving health outcomes in the general community (Davy et al., 2016; Grad, 2002). When it involves the Aboriginal and/or Torres Strait Islander community, this importance is further increased, as they are known to be reluctant to access mainstream health care due to a number of social issues (racism, discrimination, and traumatic experiences induced by the government) which they have been through over the years. As such, it is highly important that studies consider the influence of their reluctance to access mainstream health care on their overall health outcomes and discuss possible ways of improving their experience in the health sector. This is the main objective of this research, which is based on existing findings from other related studies, as it seeks to highlight the challenges faced by the Aboriginal and/or Torres Strait Islander community in accessing health care and discuss culturally responsive measures that can be used to address these challenges. The importance lies in the fact that such an understanding can help improve overall health outcomes for the people under consideration.

Provide access to health services that are responsive to the Aboriginal and/or Torres Strait Islander community's world view.

Studies have established that access to health care improves the overall health outcomes of the general public (Davy et al., 2016; Grad, 2002). This importance becomes more pronounced in cases where it involves indigenous people that have been living with different chronic diseases (World Health Organisation, 2008), as even the most minute health care service can improve the overall outcome overtime. This is also the case even in developed economies, as studies have shown that the deaths of indigenous people brought about by cardiovascular diseases are 1.5 times more likely than their non-indigenous counterparts (Hoy, 2014). Notwithstanding the need for improved health care service provisions, indigenous people are usually denied access to the right health care services because of the numerous barriers like racism, experience of discrimination, high cost of accessing such health care services, and poor communication between health participants and service providers (Aspin et al., 2015).

A culturally appropriate measure for improving the access of indigenous people to health care services and facilities would be one that can tailor the said services to their indigenous needs or is owned and managed by the indigenous communities themselves (Reibel et al., 2015; Hayman, 2010; Yashadhana et al., 2020). This is because indigenous health care services, being owned and offered by the indigenous people, will likely be free of racism, and they are generally considered to be more culturally appropriate than mainstream health care services because both the service providers and health participants understand each other, their values, and norms (Khoury, 2015; Jongen et al., 2019). It is established that such hospitals normally employ the services of indigenous staff who can better communicate in the local language and are usually known by the participants coming for their service (Reeve et al., 2015; Coombes et al., 2018), bridging the gap created through poor communication streams.

Furthermore, access to primary health care is more complex than just locating the service provider within the domain of the indigenous communities (Davy et al., 2010; Fogarty et al., 2018). However, for any given population, means of access seem to be confined mainly to special factors like location and distance. Therefore, accessing health care facilities and services within the community, in a way that is considered culturally appropriate, will help in addressing issues related to access because the people now live closer to these facilities and it will eventually lead to better health outcomes. As such, it will guarantee improved responsiveness for the Aboriginal and/or Torres Strait Islander community.

In conclusion, a culturally appropriate measure for increasing access to health care facilities for indigenous people is one that recognizes the numerous access issues relevant to these indigenous communities, like the ability of the services to accommodate their cultural and social needs, providing the services through indigenous staff in an indigenous-friendly space, and taking into consideration the vital roles that families and communities normally play (Gibson et al., 2015; Trivedi & Kelaher, 2020).

improve existing mental health services tailored to Aboriginal and Torres Strait Islander people.

Aborigines are known to experience several barriers while seeking conventional health treatment. Transportation issues, an unwelcoming hospital environment, mistrust of mainstream health care, rigid treatment alternatives, and a sense of isolation are among them. The result has been a general aversion among this demographic to attending healthcare appointments and using mainstream healthcare services (Shahid et al., 2009; Macniven et al., 2019). Poor communication between Aboriginal patients and healthcare providers has also been found to increase these problems in studies (Durey et al., 2012; Isaacs et al., 2012; Dixit & Sambasivan, 2018). The importance of treating this issue is evident in the case of those suffering from mental illnesses, when a lack of sufficient attention might potentially worsen their condition.

As a result, in order to improve existing mental health care services tailored to Aboriginal and Torres Strait Islander people, health care service providers must commit to developing respectful partnerships with local Aboriginal communities and increasing overall service capacity in order to meet the needs of these Aboriginal people (Taylor et al., 2013; Taylor & Thompson, 2011; HealthInfoNet, 2021). It all boils down to achieving effective contact with the Aboriginal community.

Communication, consultation, education, partnership, participation, empowerment, and cooperation are all terms that have been used to define community engagement (Council of Australian Governments, 2009; Medhora, 2016). Mooney & Blackwell (2004), which necessitates the development of competency and partnerships (Mooney & Blackwell, 2004; Gwynne et al., 2018). A study conducted in Queensland reveals the enablers and hurdles for Aboriginal individuals participating in health promotion programs, such as those designed for mentally challenged people. The familiarity with the local Aboriginal community, the recognition of the relevance of local Aboriginal knowledge and cultural traditions, and the development of a local leadership network are examples of enablers. They are critical in strengthening the region's existing health-care services. The reason is that these variables not only aid in the development of trust and acceptance but are also beneficial prior to the implementation of any medical intervention for mentally ill people. Similarly, the success of community involvement is determined by whether or not members of the Aboriginal community believe that the advantages of intervention outweigh the time-cost of participating in such medical care (Brookhart, 2013; Hay et al., 2017). Through adequate involvement with members of the Aboriginal community, barriers generated by unpleasant contacts with medical professionals, a lack of proper knowledge of cultural differences, and a narrow notion of health can be overcome (Barnett & Kendall, 2011; Campbell et al., 2017).

Improved understanding in health service providers about intergenerational trauma.

Child maltreatment and other adverse childhood experiences (ACEs) are widely recognized as international health priorities (Sara & Lappin, 2017; Chamberlain et al., 2019), and they contribute to a wide range of long-term social, physical, and emotional health issues (Sara & Lappin, 2017; Chamberlain et al., 2019). (Sara & Lappin, 2017; McCrory et al., 2010; De Bellis & Zisk, 2014; Brent & Silverstein, 2013). The need to understand the various clusters of distress symptoms that people may have as a result of childhood exposure to extreme threats, known as complex post-traumatic stress disorder (PTSD), is gaining traction (complex trauma). This classification is used to characterize the set of symptoms that typically follow a long-term traumatic experience or events that have a recurring negative impact that is difficult to separate from the individual's daily life (Sara & Lappin, 2017). These traumatic events usually include interpersonal violations and are associated with institutional caregiving systems or childhood families (for example, severe domestic violence, childhood abuse, torture, or slavery) (Sara & Lappin, 2017). Broader sociocultural influences can amplify or mitigate the impact of these traumatic experiences. Because of the legacy of historical trauma (Sara & Lappin, 2017), Aboriginal and Torres Strait Islander people in Australia are particularly affected by these complex traumatic experiences. These include state-sanctioned acts that systematically removed Aboriginal children from their families and the ongoing discrimination they experience in mainstream services (Sara & Lappin, 2017).

Despite these clear risks and opportunities, it is argued that there are few available interventions for people with specific trauma histories, and there are no systematic, culturally induced processes or evidence of effective strategies for identifying and supporting Aboriginal people who are experiencing complex trauma (McCrory et al., 2010; De Bellis & Zisk, 2014). As a result, improving healthcare providers' understanding of intergenerational trauma in this group is critical. This can be accomplished through regular scheduled contracts with health care providers prior to and after receiving health care services, particularly after childbirth and for the first two years after childbirth, because it allows for comprehensive system-based support for people who are experiencing trauma in the course of this period. The importance of this is based on the fact that it might be the first time many of these patients, especially the predominantly young childbearing population, have had contact with global health service providers since their childhood. The significance of this is that it gives the healthcare service providers sufficient room and time to assess and understand the intergenerational traumatic experience of these people and deliver informed care. 

Conclusion

It is evident from this entry that the Aboriginal and/or Torres Strait Islander communities face numerous challenges in the course of assessing mainstream health care services. These challenges revolve around discrimination, racism, poor communication and transportation, and improper understanding of intergenerational traumatic experiences of these groups of people. The effect is that it makes them reluctant to access mainstream health care services, and even when they do, they are not accorded proper care. Therefore, it is necessary that culturally-informed measures be developed and implemented to address these challenges. This can be done by bringing the health care services closer to the communities, engaging members of the communities, and employing members of the communities in the health care service sector. By so doing, the patients will gain higher trust because they will be attended to by people from the same clan, and it can effectively improve the overall health of the Aboriginal and/or Torres Strait Islander community members.

References

Aspin, C., Brown, N., Jowsey, T., Yen, L., & Leeder, S. (2012). Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study 1-9 in BMC health services research, 12(1).

Barnett, L., & Kendall, E. (2011). Culturally appropriate methods for enhancing the participation of Aboriginal Australians in health-promoting programs Health Promotion Journal of Australia, 22 (1), 27-32.

Brent, D. A., & Silverstein, M. (2013). Shedding light on the long shadow of childhood adversity 309 (17), 1777-1778 in JAMA.

S. Brookhart (2013).Chapter 1. What are rubrics and why are they important? How to create and use rubrics for formative assessment and grading. Alexandria: ASCD.

Campbell, M. A., Hunt, J., Scrimgeour, D. J., Davey, M., & Jones, V. (2017). An Evidence Review of the Contribution of Aboriginal Community-Controlled Health Services to Improving Aboriginal Health Australian Health Review, 42(2), 218-226.

Chamberlain, C., Gee, G., Brown, S. J., Atkinson, J., Herrman, H., Gartland, D., & Nicholson, J. (2019). Healing the Past by Nurturing the Future: co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study. BMJ open, 9(6), e028397, doi:10.1136/bmjopen-2018-028397.

Coombes, J., Hunter, K., Mackean, T., Holland, A. J., Sullivan, E., & Ivers, R. (2018). Factors that impact access to ongoing health care for First Nation children with a chronic condition 1-9 in BMC Health Services Research, 18(1).

Council of Australian Governments, 2009.National partnership agreement on closing the gap in Indigenous health outcomes

Davy, C. P., Sicuri, E., Ome, M., Lawrence-Wood, E., Siba, P., Warvi, G.,... & Conteh, L. (2010). Seeking treatment for symptomatic malaria in Papua New Guinea Malaria journal, 9(1), pp. 1-12.

Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown (2016). Access to primary health care services for Indigenous peoples: A framework synthesis International Journal for Equity in Health, 15, 163. https://doi.org/10.1186/s12939-016-0450-5

De Bellis, M. D., & Zisk, A. (2014). The biological effects of childhood trauma Child and Adolescent Psychiatric Clinics, 23 (2), 185-222.

Dixit, S. K., & Sambasivan, M. (2018). A review of the Australian healthcare system: A policy perspective 2050312118769211, SAGE Open Medicine, 6.

Durey, A., Thompson, S. C., & Wood, M. (2012). Time to bring down the twin towers of poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Journal of Internal Medicine, 42(1), pp. 17-22.

Fogarty, W., Lovell, M., Langenberg, J., & Heron, M. J. (2018). Deficit discourse and strengths-based approaches Changing the Narrative of Aboriginal and Torres Strait Islander Health and Wellbeing Melbourne: The Lowitja Institute

Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C.,... & Brown, A. (2015). Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review 1-11 in Implementation Science, 10(1).

Gra, F. P. (2002). The preamble of the constitution of the World Health Organization Bulletin of the World Health Organization, 80, 981-981.

Gwynne, K., Jeffries, T., & Lincoln, M. (2018). Improving the efficacy of healthcare services for Aboriginal Australians. Australian Health Review, 43(3), 314-322.

Hay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., & Ciobanu, L. G. (2017). Global, regional, and national disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) for 333 diseases and injuries in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.1260–1344, The Lancet, 390(10100).

N. Hayman (2010).Strategies to improve indigenous access to health services for urban and regional populations Heart, Lung, and Circulation, vol. 19, no. 5–6, pp. 367–371.

HealthInfoNet, A. I. (2021). An Overview of Aboriginal and Torres Strait Islander health status, 2020

Hoy, W. E. (2014). Cardiovascular disease, diabetes, and chronic kidney disease: Australian facts: prevalence and incidence.

Isaacs, A. N., Maybery, D., & Gruis, H. (2012). Mental health services for Aboriginal men: Mismatches and solutions 400-408 in International Journal of Mental Health Nursing, 21(5).

Jongen, C., McCalman, J., Campbell, S., & Fagan, R. (2019). Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector 1-12 in BMC health services research, 19(1).

Khoury, P. (2015). Beyond the biomedical paradigm: The formation and development of Indigenous community-controlled health organizations in Australia. 471-494 in International Journal of Health Services.

Macniven, R., Hunter, K., Lincoln, M., O’Brien, C., Jeffries, Jr., T. L., Shein, G.,... & Gwynne, K. (2019). Accessibility of Primary, Specialist, and Allied Health Services for Aboriginal People Living in Rural and Remote Communities: Protocol for a Mixed-Methods Study. e11471 in JMIR Research Protocols, 8(2).

McCrory, E., De Brito, S. A., & Viding, E. (2010). Research Review: The Neurobiology and Genetics of Maltreatment and Adversity. Child Psychology and Psychiatry, 51(10), pp. 1079–1095.

S. Medhora (2016).Closing the Gap 2016 report: Indigenous infant mortality is down, but no change in most targets. The Australian Guardian.

Mooney, G. H., & Blackwell, S. H. (2004). Whose health service is it anyway? Community values in healthcare The Medical Journal of Australia, 180 (2), 76-78.

Reeve, C., Humphreys, J., Wakerman, J., Carter, M., Carroll, V., & Reeve, D. (2015). Strengthening primary health care: achieving health gains in a remote region of Australia. 483–487 in the Medical Journal of Australia, 202(9).

Reibel, T., Morrison, L., Griffin, D., Chapman, L., & Woods, H. (2015). Young Aboriginal women's voices on pregnancy care: Factors encouraging antenatal engagement. Women and Birth, 28 (1), 47-53.

Sara, G., & Lappin, J. (2017). Childhood trauma: psychiatry's greatest public health challenge? e300-e301 in The Lancet Public Health.

Shahid, S., Finn, L. D., & Thompson, S. C. (2009). Barriers to the participation of Aboriginal people in cancer care: communication in the hospital setting. 190(10), pp. 575-579.

Taylor, K. P., and Thompson, S. C. (2011). Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services Australian Health Review, 35(3), 297-308.

Taylor, K. P., Bessarab, D., Hunter, L., & Thompson, S. C. (2013). Aboriginal-mainstream partnerships: exploring the challenges and enhancers of a collaborative service arrangement for Aboriginal clients with substance use issues. 1-8 in BMC health services research, 13(1).

Trivedi, A. N., & Kelaher, M. (2020). A Study of Government-sponsored Subsidies to Reduce Prescription Drug Copayments Among Indigenous Australians After 2010: A Study of government-sponsored subsidies to reduce prescription drug copayments among Indigenous Australians. 289–296 in Health Affairs.

The World Health Organization.Primary health care is more important than ever, according to the World Health Report 2008.Geneva, WHO

Yashadhana, A., Fields, T., Blitner, G., Stanley, R., & Zwi, A. B. (2020). Trust, culture, and communication: determinants of eye health and care among Indigenous people with diabetes in Australia. e001999, BMJ Global Health, 5(1).