Question

Describe how nurse work in indigenous community collaborating with multidisciplinary team using strength based approach to address health issues on obesity in Australia. Write 2000 words essay

Answer 1

Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services.

To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague’s accessibility framework.

Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs.

Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples.

Ensuring access to primary health care is widely accepted as key to improving health outcomes .In the case of Indigenous populations living with high rates of chronic disease, access to these services is even more crucial . Even in developed countries such as Australia, the number of Indigenous peoples dying from cardiovascular disease is 1.5 times that of their non-Indigenous counterparts.Despite this, Indigenous peoples are often prevented from accessing these types of services due to a range of barriers including the high cost of health care, experiences of discrimination and racism and poor communication with health care professionals .Evidence suggests that access to primary health care can be improved when services are tailored to the needs of, or owned and managed by Indigenous communities themselves This is because Indigenous health care services are more likely to be free of racism and are generally more culturally appropriate than mainstream services .They also tend to employ Indigenous staff who are able to speak the local language and are often known by people accessing the service .

Accessing primary health care is therefore far more complex than simply locating a service within or close to Indigenous communities . Nevertheless, measures of access at a population level are often confined to spatial factors including location and distance, using primarily quantitative data. In Australia, for example, a rural index of access combines system measures such as the number of health services within a given area and the population-provider ratio, with measures including the type and degree of identified health needs, distance to the nearest service and a mobility score. Others have used less complex scores focusing on distance travel time and supply and demand ratio Quantitative measures of socioeconomic status with indicators of disadvantage have also been included clearly these quantitative perspectives ignore many of the access issues relevant to Indigenous peoples such as the ability of the service to accommodate the social and cultural needs of Indigenous peoples, the provision of health care by Indigenous staff in an Indigenous friendly space and considering the important role that communities and families often play within the care process

Problems associated with defining access have contributed to the complexity about what should be measured. Early research defined access in terms of how well available services are able to meet the health needs of the populations they serve or alternatively how well patients are able to access health care given their particular capacity to seek and obtain care.These types of definitions tend to place responsibility for access on either the health service or the potential user. Not all researchers agree with this dichotomy.suggested that both provider and patient factors are important, suggesting that the term ‘access’ best refers to the ability of the population to obtain appropriate health care services, while ‘accessibility’ best refers to the ability of the health care service or system to respond to those needs. Other frameworks have exemplied the importance of the user/service interface .suggesting that access to health care is jointly negated between the patient and the health care service

built upon this earlier research by developing a more holistic conceptual framework based around broader definitions of access to and accessibility of health care services. Both user and health care service characteristics are incorporated within the five stage linear framework. The strength of Levesque et al’s framework is that their model of access does not stop at the user reaching the health care service but instead considers important access issues in relation to Indigenous peoples engaging with and remaining engaged with care overtime Stage one, Perception of Needs and Desire for Health Care, is influenced by the ability of people to recognise a need to seek care (Ability to Perceive) and by the degree to which the health care service is known to exist (Approachability). Stage two, Health Care Seeking, focuses on the ability of people to freely seek out services when needed (Ability to Seek) and the appropriateness of health care services relating to, for example, the social and cultural norms that underpin the communities they serve (Acceptability). Stage three, Health Care Reaching, focuses on how easy it is for individuals to get to the service when needed (Ability to Reach) and whether health care services can be reached in a timely manner (Availability and Accommodation). Step four, Health Care Utilisation, encompasses the cost to patients accessing services (Ability to Pay) and the expenses incurred in running a health care service (Affordability). Stage five, Consequences of Accessing Health Care, considers how well the individual is able to engage with the care that is offered and the extent to which the care provided meets the needs of the communities they serve

del of access to health care reprinted with permission

A recently completed scoping review identified and described the characteristics (values, principles, components and suggested practical applications) of models of service delivery implemented within primary health care services that predominantly provide care for Indigenous people worldwide. One of the key characteristics which underpinned these models of service delivery was access. In particular, these initial findings suggested that community needed to be aware of the service and that services in turn need to ensure that they provided affordable, available and acceptable care. The primary objective of the framework synthesis presented in this paper was to systematically re-examine literature included within the previous scoping review in order to identify and better understand factors that influenced access to and accessibility of these Indigenous health services.

Our framework synthesis primarily aimed to identify the challenges faced by Indigenous peoples attempting to access care and then explore how Indigenous health care services addressed those challenges using the more holistic framework developed by Levesque et al. . Identifying both the challenges and the ways in which they have been addressed will assist mainstream services to improve the accessibility of their health care. We also sought to explore whether the framework developed by Levesque and colleagues was useful for exploring access to and the accessibility of Indigenous health care services in particular. To our knowledge this is the first synthesis to look at the issues of both access and accessibility of Indigenous health care services using Levesque et al’s framework.

The focus and design of the original scoping review and this framework synthesis were guided by a Leadership Group comprising 24 senior members of the Aboriginal Community Controlled Health Sector. The original scoping review research team, led by an Aboriginal Research Fellow was also involved in this new framework synthesis. While all of the authors were experienced in synthesising data, we believe our findings were strengthened by the involvement of Indigenous researchers who guided the interpretation of data.

The original scoping review summarised below aimed to identify the characteristics (values, principles and components) of Indigenous primary health care service delivery models. Further information on the methods used and the design for the scoping review can be found in the published protocol

Concepts of interests included characteristics (values, principles, components and suggested practical applications) of models of service delivery implemented within an Indigenous primary health service. Within the literature a number of different terms such as service delivery models of care and service frameworks have been used interchangeably to articulate the way in which services are or should be operationalised.