Aboriginal and Torres Strait Islander family access to continuity of health care services in the first 1000 days of life: a systematic review of the literature

Abstract

Background: Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective and appropriate maternal and child healthcare can contribute to reducing these existing health disparities. However, accessing mainstream healthcare services often results in high levels of fear and anxiety, and low attendance at subsequent appointments among Aboriginal women, due to inefficient communication, poor service coordination and a lack of continuity of care. Methods: This integrative literature review sought to explore factors that contribute to continuity of care and consider service features that contribute to positive care experiences and satisfaction with care received by Aboriginal women and their infants. In total, 28 studies were included in the review and were thematically analysed using Braun and Clarke's six steps of thematic analysis. This was followed by a collaborative, computer-assisted qualitative analysis, which resulted in the emergence of five key themes: lack of continuity of care, impact of lack of continuity of care, continuity of care interventions, impact of continuity of care interventions, and strategies to improve continuity of care. Results: Most studies focused on health services in rural or remote Aboriginal communities and there was a lack of documented evidence of continuity of care (or lack thereof) for Aboriginal women living and birthing in regional and metropolitan areas. The majority of studies focused explicitly on continuity of care during the antenatal, birthing and immediate postnatal period, with only two studies considering continuity through to an infant's first 1000 days. Conclusion: The review highlights a lack of studies exploring continuity of care for Aboriginal families from the antenatal period through to an infants' first 1000 days of life. Included studies identified a lack of continuity in the antenatal, peri-and postnatal periods in both regional and metropolitan settings. This, along with identified strategies for enhancing continuity, have implications for communities, and healthcare services to provide appropriate and culturally safe care. It also marks an urgent need to incorporate and extend continuity of care and carer through to the first 1000 days for successful maternal and infant health outcomes for Aboriginal peoples.

Aboriginal Health Workers Promoting Oral Health among Aboriginal and Torres Strait Islander Women during Pregnancy: Development and Pilot Testing of the Grinnin’ Up Mums & Bubs Program

“…Further, the MIOH training program is widely used by midwives who provide services in mainstream services. However, some Aboriginal and Torres Strait Islander women may choose to access non-mainstream antenatal services for more culturally appropriate care and may subsequently miss out on receiving the MIOH model of care [ 23 ]. To create a culturally safe model of care, a more collaborative approach to designing, pilot testing, and implementing the MIOH model needed to be undertaken.…”

Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin

“…Reasons for lower OGTT uptake in Aboriginal women were not directly explored in the ORCHID study. As inferenced from qualitative explorations of antenatal care with Aboriginal women, social disadvantage, lack of culturally safe healthcare, lack of continuity of care, and challenges travelling for care in remote settings could be significant contributors [29][30][31]. Our findings warrant additional co-designed strategies for improving screening for diabetes during and after pregnancy, including evaluation of alternative tests to the OGTT.…”

Pregnancy and birth characteristics of Aboriginal twins in two Australian states: a data linkage study

“…Finally, Aboriginal women often access antenatal and postnatal care through primary health care organisations operated by local Aboriginal communities. Births in a distant hospital may require a transfer of care from midwives at these local Aboriginal services to a large, mainstream hospital which may be perceived as less culturally safe and disrupt continuity of care [ 47 ].…”