Putting Policy into Practice: How Three Cancer Services Perform against Indigenous Health and Cancer Frameworks

Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.

Health service providers’ perspectives on the influence of modern health systems on adolescents’ sexual health practices in Umguza and Mberengwa districts of Zimbabwe

Background Health service providers play a significant role in crafting and implementing health policies and programs that manage adolescent sexual health-related issues at different health system levels. These influence adolescent sexual behaviours and practices. Aim This study explored the roles of health service providers in managing adolescent sexual issues and how this impacts their sexual behaviours and practices. The study further probed the health service providers on how the indigenous health system could be integrated into the modern health system for effective management of adolescent sexual health related issues. Methods A qualitative cross-sectional survey was conducted on purposively selected health service providers in health facilities in Mberengwa and Umguza districts. Data was collected using unstructured interviews that were recorded, transcribed verbatim, and thematically analysed. Findings were presented as clearly defined as superordinate and subordinate themes. Results A total of five superordinate themes and 19 subordinate themes emerged from the interrogated data. The superordinate themes were: overview of adolescent sexual health issues, role of modern health system in adolescent sexual health issues, challenges encountered, indigenous health system factors that could be factored into modern health systems, and strategies to foster the integration of indigenous health system and modern health system. The subordinate themes explored in-depth the findings of the key stakeholders under the five superordinate themes. Conclusions From the findings, it can be concluded that health service providers play an essential role in shaping and providing adolescent sexual health services that adolescents utilise despite challenges that have reduced demand for these services. Therefore, there is a need to point out that there is a window of opportunity to foster collaborations between the indigenous health system and the modern health system as they strive to serve the adolescents to the best of their ability though in different contextual settings.

Moving with the times: evolution of Buttabean Motivation – a community-based, Pacific-centred approach to health

Buttabean Motivation (BBM) is a grassroot initiative aiming to improve Pasifika and M?ori health through free community bootcamps offering exercise, motivation and nutritional advices, and with online programmes of workouts and meal plans. It is a dynamic organisation, responding to community needs, providing practical solutions to issues such as food insecurity and influenza vaccination while maintaining its core focus of reducing obesity among Pasifika and M?ori through nutrition and physical activity.. BBM forms active and changing relationships with numerous organisations that offer support. They would like to work with the government and the district health boards, but the structure and changing nature of their organisation does not fit traditional funding models. To show that BBM is effective for Pacific people beyond anecdotal evidence, BBM has partnered with University of Auckland researchers. The research team are using a kaupapa M?ori and co-design approach to explore how BBM might benefit the community and reduce health inequities, especially whether BBM’s model of social collectivism enables sustainable weight loss for Pasifika and M?ori in the current obesogenic environment. Weight reduction programmes typically find that after initial success, participants have reverted to pre-programme weight by five years. BBM’s “whole of life change” approach may lead to sustained weight loss not demonstrated by other programmes. Using co-design, a BBM/University of Auckland partnership is evaluating the effectiveness of the BBM programme for sustained health and wellbeing. BBM is grounded in the Pacific/indigenous health frameworks fonofale, te whare tapa wh? and fa’afaletui addressing physical, mental, spiritual, family and social health in the context of people’s lives. The research will use a longitudinal cohort approach study design, using metrics and outcomes of relevance to its participants and the programme. A systems analysis will facilitate understanding of the strengths and challenges to delivering a holistic and sustained service for the community. BBM provides much promise in reducing health inequities for Pasifika and M?ori, however the model creates challenges for ongoing funding, business structure and evaluation. The goal is to find ways that both the programme and social institutions, including funders and evaluators, can adapt to meet these real-world challenges.

Culturally safe health care practice for Indigenous Peoples in Australia: A systematic meta-ethnographic review

Objectives Culturally safe health care services contribute to improved health outcomes for Aboriginal and Torres Strait Islander Peoples in Australia. Yet there has been no comprehensive systematic review of the literature on what constitutes culturally safe health care practice. This gap in knowledge contributes to ongoing challenges providing culturally safe health services and policy. This review explores culturally safe health care practice from the perspective of Indigenous Peoples as recipients of health care in Western high-income countries, with a specific focus on Australian Aboriginal and Torres Strait Islander Peoples. Methods A systematic meta-ethnographic review of peer-reviewed literature was undertaken across five databases: Ovid MEDLINE, Scopus, PsychINFO, CINAHL Plus and Informit. Eligible studies included Aboriginal and Torres Strait Islander Peoples receiving health care in Australia, had a focus on exploring health care experiences, and a qualitative component to study design. Two authors independently determined study eligibility (5554 articles screened). Study characteristics and results were extracted and quality appraisal was conducted. Data synthesis was conducted using meta-ethnography methodology, contextualised by health care setting. Results Thirty-four eligible studies were identified. Elements of culturally safe health care identified were inter-related and included personable two-way communication, a well-resourced Indigenous health workforce, trusting relationships and supportive health care systems that are responsive to Indigenous Peoples’ cultural knowledge, beliefs and values. Conclusions These elements can form the basis of interventions and strategies to promote culturally safe health care practice and systems in Australia. Future cultural safety interventions need to be rigorously evaluated to explore their impact on Indigenous Peoples’ satisfaction with health care and improvements in health care outcomes.

Health Systems Responsiveness in Addressing Indigenous Residents' Health and Mental Health Needs Following the 2016 Horse River Wildfire in Northern Alberta, Canada: Perspectives From Health Service Providers

Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Métis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.

Cultural Safety within the Indigenous Health Context: Findings from a Review of Reviews

First Nations, Inuit, and Métis older adults often face systemic barriers to accessing culturally safe and equitable healthcare, including racism, structural injustice, and a historical legacy of colonialism. However, there is a paucity of knowledge on cultural safety interventions and implementation strategies in care for older adults. This presentation aims to: 1) explore persistent barriers to achieving health equity and advancing cultural safety in healthcare; and 2) identify cultural safety interventions to improve healthcare for Indigenous older adults. Guided by Arksey and O’Malley’s scoping review framework, we conducted a review of reviews published between January 2010 to December 2020 on Indigenous cultural safety in healthcare. We searched five databases (CINAHL, PubMed, Scopus, Web of Science, and Google Scholar) and hand-searched reference lists of relevant articles. We conducted a thematic analysis to identify patterns and themes in the literature. Key barriers to achieving health equity and advancing cultural safety in healthcare included care providers lacking knowledge of Indigenous culture, power imbalances, racism, and discrimination. A range of cultural safety interventions were identified, from education and training initiatives for healthcare providers (emergency physicians and occupational therapists) to collaborative partnerships with First Nations, Inuit, and Métis communities. As First Nations, Inuit, and Métis populations age, there is a growing need for safe healthcare services for Indigenous older adults, and these findings suggest focusing on healthcare providers knowledge and attitudes is key. Research is necessary to develop, implement, and evaluate cultural safety interventions aimed at healthcare providers to improve healthcare for Indigenous older adults.