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

Abstract

IntroductionOur study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.MethodsIn collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11.ResultsMore than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care.DiscussionWe outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.

Indigenous Australians at increased risk of COVID-19 due to existing health and socioeconomic inequities

“…The socioeconomic, and physical, mental, and environmental health inequities discussed, are reflective of the cultural marginalisation faced by Indigenous Australians, all of which culminate as key factors in COVID-19 susceptibility. Cultural and linguistic marginalisation from health information and services, directly affect health care accessibility and outcomes among Indigenous Australians [7] . The impact of racism, which has been named by Indigenous Australian leaders as a public health emergency, and in- ternationally as the 'second pandemic', is a central factor in health and social outcomes.…”

“…We emphasise concerns as to how this will disproportionately impact Indigenous Australians, given existing over-policing, and a poor understanding of Indigenous family systems among law enforcement. Indigenous cultural identity is a two-fold determinant, as its maintenance and expression can lead to discrimination in the context of health and social systems that reflect the values of the dominant culture [7] , yet it is also evidenced as a protective factor against the health harming impact of racism [8] . The Australian government's Emergency Response Plan for COVID-19 and the management and operational plans for Indigenous communties [9] , places considerable responsibility on Indigenous run health services known as Aboriginal Community Controlled Health Organisations (ACCHOs) including whole-ofcommunity preparedness, provision of COVID-19 clinics, and communication of cases to government health departments.…”

Action needed to improve equity and diversity in global eye health leadership

“…Women in LMICs tend to have poorer access to eye care due to socially constructed gender norms that limit their mobility and financial decision-making power [ 5 – 7 ]. In high-income countries (HIC), services are less accessible to ethnic-minority groups [ 8 , 9 ] and Indigenous peoples [ 10 ], and subsequently these groups are disproportionately afflicted by vision impairment and blindness [ 1 , 3 , 5 ].…”

Healthcare and Health Problems from the Perspective of Indigenous Population of the Peruvian Amazon: A Qualitative Study

“…Current studies with indigenous populations confirm the results of this study on the use of official health services. Limited access to health information, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, are determining factors in health and care [ 38 ]. Good strategies to minimize the cultural differences between indigenous persons and health personnel are the use of local materials in the construction of health facilities, the use of indigenous language to alert people to these spaces and the provision of specific spaces for the practice of traditional medicine [ 39 ].…”