Re-examining the gap: A critical realist analysis of eye health inequity among Aboriginal and Torres Strait Islander Australians

Yashadhana, Aryati; Fields, Ted; Burnett, Anthea; Zwi, Anthony B.

doi:10.1016/j.socscimed.2021.114230

Cited by 20 publications

(20 citation statements)

References 27 publications

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“…Prioritising the maintenance and practice of First Nations cultures is at a tension with dominant values and norms. 49 As our review revealed, the practice and preservation of culture and cultural identity is a priority to older First Nations peoples, suggesting that efforts to support this through the mechanisms of policy and service delivery are necessary.…”

Section: Discussionmentioning

confidence: 94%

Experiences and perceptions of ageing among older First Nations Australians: A rapid review

et al. 2021

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Objective: To identify and describe articles reporting the experiences and perceptions of ageing among older First Nations Australians.Methods: Following rapid review and PRISMA guidelines, we searched five databases for peer-reviewed articles published prior to October 2019 that reported qualitative accounts of ageing among older (≥ 45 years) First Nations Australians.Data were extracted and synthesised thematically. Results: Twenty-one articles were included in the final synthesis. Priorities in ageing highlighted the role of Elders, family, community, culture and connection to ancestral lands. Experiences and perceptions of ageing reflected cultural marginalisation in aged and health care services, and highlighted the importance of cultural identity, resilience and survival as key to ageing well. Conclusions:Our review suggests that mainstream ageing frameworks do not fully reflect the priorities of older First Nations Australians. This has important implications for ageing policy and the design and delivery of culturally safe aged and health care services.

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Section: Discussionmentioning

confidence: 94%

Experiences and perceptions of ageing among older First Nations Australians: A rapid review

et al. 2021

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“…This will require significant hard work on the part of non-Indigenous leaders and health professionals who benefit, whether knowingly or not, from the present system. Acknowledgement of their role in co-creating the current work culture; willingness to build knowledge and respect of diverse medical and cultural knowledges 7,69,70 and critical self-reflection well beyond what individually performed one-off cultural awareness courses can provide are all needed. 58,[71][72][73] Meanwhile, ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs in this study, and others, 5,74,75 signals the scale of the challenge likely to be faced to enact such transformation.…”

Section: Discussionmentioning

confidence: 99%

Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia

Topp

Tully²,

Cummins

et al. 2022

Int J Health Policy Manag

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Background: In northern Australia, Aboriginal and/or Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation. Methods: The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n=51), clinicians (n=19) community members (n=8) and administrators (n=5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it. Results: Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs with race and racism at its core. Conclusion: Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role.

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“…Our study produced evidence that an initiative like '10,000 Lives' can effectively increase the uptake of those programs and reduce the disparities in different population groups.In Australia, referrals to and uptake of Quitline among Aboriginal and Torres Strait Islander peoples are lower than non-Indigenous people. Finding culturally appropriate ways to improve access to smoking cessation support is crucial to increase equitable provision of health services [28,29]. Australian Quitlines offer counselling by Aboriginal and Torres Strait Islander counsellors to provide culturally safe smoking cessation assistance.…”

Section: Discussionmentioning

confidence: 99%

Impact of the ‘10,000 lives’ program on Quitline referrals, use and outcomes by demography and Indigenous status

Khan

Green²,

Medlin³

et al. 2022

Drug and Alcohol Review

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Introduction: In November 2017, Central Queensland Public Health Unit launched the '10,000 Lives' initiative to reduce smoking prevalence in Central Queensland. The program partnered with local champions and other programs (e.g. 'Deadly Choices') to promote the use of smoking cessation services (e.g. Quitline) in Central Queensland. This study assesses the program's impact on Quitline use by participant demographics and Indigenous status. Methods: We compared the number of referred individuals who participated in and completed the Quitline program, and quit smoking during 26-months before (July 2015 to August 2017) and after (November 2017 to December 2019) the '10,000 Lives' launch. We conducted an interrupted time series analysis of monthly referrals to and use of Quitline for Aboriginal and Torres Strait Islander peoples. Results: Overall, 3207 individuals were referred to Quitline during the 26-monthspost-launch compared to 1594 during 26-months-pre-launch period of '10,000 Lives'. The number of referred individuals who completed Quitline program increased by 330.7% and quit smoking by 308.3% in post-launch period. The increase was substantially higher among aged 45+ years, females and Aboriginal and Torres Strait Islander peoples. The result for referrals and use of Quitline was validated by interrupted time series analysis for Aboriginal and Torres Strait Islander peoples.Discussion and Conclusions: The '10,000 Lives' collaborative approach to partner with local champions and targeted smoking cessation programs was effective in increasing the use of Quitline and smoking cessation among all demographic groups, including Aboriginal and Torres Strait Islander peoples. This approach can be used in other regions to address higher smoking prevalence.

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Re-examining the gap: A critical realist analysis of eye health inequity among Aboriginal and Torres Strait Islander Australians

Cited by 20 publications

References 27 publications

Experiences and perceptions of ageing among older First Nations Australians: A rapid review

Experiences and perceptions of ageing among older First Nations Australians: A rapid review

Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia

Impact of the ‘10,000 lives’ program on Quitline referrals, use and outcomes by demography and Indigenous status

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