Introduction: Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation.
Methods: The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting.
Results: A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems.
Conclusion: The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and right
导言:Māori(新西兰奥特亚罗瓦的土著居民)在心血管疾病(CVD)患病率、发病率和死亡率中的比例过高,而且不太可能获得循证的心血管疾病医疗保健服务。与生活在城市地区的非毛利人和毛利人相比,农村毛利人在获得治疗方面面临更多障碍,健康状况更差,心血管疾病风险因素的负担也更重。重要的是,受殖民化影响的其他国家的土著居民也同样经历着这些不平等。鉴于现有文献稀缺,我们对农村地区的 Māori 和其他受殖民化影响国家的原住民在获得心血管疾病医疗保健方面的障碍和促进因素的文献进行了系统性的范围界定综述:该研究以 Kaupapa Māori 研究方法为基础,采用 Arksey 和 O'Malley(2005 年)的方法框架进行。数据库搜索包括 MEDLINE (OVID)、PubMed、Embase、SCOPUS、CINAHL Plus、澳大利亚/新西兰参考资料中心和 NZResearch.org,以探索实证研究文献。此外,还进行了灰色文献检索。所有为成年人提供心血管疾病治疗的医疗机构中的文献均被包括在内。新西兰、澳大利亚、加拿大和美国的农村或偏远地区的原住民也包括在内。如果文献涉及心血管疾病,并报告了在任何医疗机构中获得医疗服务的障碍和促进因素,则也包括在内:通过数据库搜索,共发现了 363 篇文章。在灰色文献检索中还发现了另外 19 篇报告。经过筛选,16 篇文章被数据库检索收录,5 篇文章被灰色文献检索收录。文献总结采用了 Te Tiriti o Waitangi(《威坦哲条约》)框架原则:tino rangatiratanga(自决)、伙伴关系、积极保护、公平和选择。文献中阐明的主题被描述为农村原住民获得心血管疾病医疗保健的关键驱动因素。关键驱动因素主题包括:农村原住民对医疗保健服务设计和提供的投入、为土著和农村医疗保健服务提供充足的资源和支持、解决系统性种族主义和历史创伤问题、提供文化上适当的医疗保健、农村原住民获得家庭和福利支持、农村原住民获得更广泛的健康社会决定因素的机会不同、有效的服务间联系和沟通,以及公平驱动和一致的数据系统:结论:研究结果与其他探讨农村原住民获得医疗保健的文献一致。本综述提供了一种新颖的方法,通过将主题置于土著人民的公平和权利的背景下来总结文献。本综述还强调,有必要在新西兰奥特亚罗瓦(Aotearoa New Zealand)的背景下进一步开展该领域的研究。
{"title":"Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.","authors":"Tāria Tane, Vanessa Selak, Kyle Eggleton, Matire Harwood","doi":"10.22605/RRH8674","DOIUrl":"10.22605/RRH8674","url":null,"abstract":"<p><strong>Introduction: </strong>Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation.</p><p><strong>Methods: </strong>The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting.</p><p><strong>Results: </strong>A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems.</p><p><strong>Conclusion: </strong>The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and right","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-05-22DOI: 10.22605/RRH8555
Kirsty van Stormbroek, Lisa O'Brien, Tania Rauch van der Merwe, Hellen Myezwa
Introduction: Healthcare practitioners delivering services in rural and underserved areas need timely access to appropriate knowledge to optimise the care they deliver. Novice generalist occupational therapists in South Africa experience this need as they respond to a high demand for hand therapy. Embedded within a study aimed at identifying their support and development needs, this article describes participants' experience of a virtual community of practice.
Methods: A qualitative case study design was employed. Nine occupational therapists participated in a virtual community of practice that met fortnightly for meetings and interacted on WhatsApp. Data were collected through photo elicitation, facilitated reflection, and case discussions. An online survey questionnaire was used to evaluate participants' experience of this virtual community. Thematic analysis was applied to the anonymous responses submitted by participants (n=7). A number of strategies were employed to ensure the trustworthiness of results including prolonged engagement, member checking, peer examination, reflexive reading and writing, triangulation, and a dense description of participants to enable readers to evaluate the transferability of results.
Results: Three themes were generated from analysis. The first theme, versatile support, describes participants' experience of being helped and supported, appreciating the immediacy of support, and being able to share resources. A vehicle for learning captures participants' experience of mutual learning, opportunity to reflect, to acquire knowledge and skills, and develop their clinical reasoning. Finally, the community of practice was grounding: learning opportunities were contextually relevant and participants were able to consolidate their professional values and identity. Participants raised the importance of using online platforms that were accessible, recommended a group size of 5-10 members, and proposed 60-90-minute meetings held weekly or fortnightly.
Conclusion: A virtual community of practice provided both support and professional development opportunities for therapists delivering hand therapy. Careful planning and implementation to upscale this intervention are recommended for rehabilitation personnel delivering care to underserved communities in South Africa. The logistics of virtual communities need to mitigate for connectivity difficulties, and online platforms should enable real-time support. Participant satisfaction and the evaluation of implementation outcomes should be considered in the design of virtual communities of practice.
{"title":"Virtual communities of practice for novice occupational therapists: a vehicle for learning, support and professional identity strengthening?","authors":"Kirsty van Stormbroek, Lisa O'Brien, Tania Rauch van der Merwe, Hellen Myezwa","doi":"10.22605/RRH8555","DOIUrl":"https://doi.org/10.22605/RRH8555","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare practitioners delivering services in rural and underserved areas need timely access to appropriate knowledge to optimise the care they deliver. Novice generalist occupational therapists in South Africa experience this need as they respond to a high demand for hand therapy. Embedded within a study aimed at identifying their support and development needs, this article describes participants' experience of a virtual community of practice.</p><p><strong>Methods: </strong>A qualitative case study design was employed. Nine occupational therapists participated in a virtual community of practice that met fortnightly for meetings and interacted on WhatsApp. Data were collected through photo elicitation, facilitated reflection, and case discussions. An online survey questionnaire was used to evaluate participants' experience of this virtual community. Thematic analysis was applied to the anonymous responses submitted by participants (n=7). A number of strategies were employed to ensure the trustworthiness of results including prolonged engagement, member checking, peer examination, reflexive reading and writing, triangulation, and a dense description of participants to enable readers to evaluate the transferability of results.</p><p><strong>Results: </strong>Three themes were generated from analysis. The first theme, versatile support, describes participants' experience of being helped and supported, appreciating the immediacy of support, and being able to share resources. A vehicle for learning captures participants' experience of mutual learning, opportunity to reflect, to acquire knowledge and skills, and develop their clinical reasoning. Finally, the community of practice was grounding: learning opportunities were contextually relevant and participants were able to consolidate their professional values and identity. Participants raised the importance of using online platforms that were accessible, recommended a group size of 5-10 members, and proposed 60-90-minute meetings held weekly or fortnightly.</p><p><strong>Conclusion: </strong>A virtual community of practice provided both support and professional development opportunities for therapists delivering hand therapy. Careful planning and implementation to upscale this intervention are recommended for rehabilitation personnel delivering care to underserved communities in South Africa. The logistics of virtual communities need to mitigate for connectivity difficulties, and online platforms should enable real-time support. Participant satisfaction and the evaluation of implementation outcomes should be considered in the design of virtual communities of practice.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Lowell, Yomei Jones, Robyn Aitken, Dikul R Baker, Judith Lovell, Samantha Togni, Dianne Gon D Arra, Beth Sometimes, Margaret Smith, Julie Anderson, Rachael Sharp, Maria Karidakis, Sarita Quinlivan, Mandy Truong, Paul Lawton
INTRODUCTION Health services collect patient experience data to monitor, evaluate and improve services and subsequently health outcomes. Obtaining authentic patient experience information to inform improvements relies on the quality of data collection processes and the responsiveness of these processes to the cultural and linguistic needs of diverse populations. This study explores the challenges and considerations in collecting authentic patient experience information through survey methods with Australians who primarily speak First Nations languages. METHODS First Nations language experts, interpreters, health staff and researchers with expertise in intercultural communication engaged in an iterative process of critical review of two survey tools using qualitative methods. These included a collaborative process of repeated translation and back translation of survey items and collaborative analysis of video-recorded trial administration of surveys with languages experts (who were also receiving dialysis treatment) and survey administrators. All research activities were audio- or video-recorded, and data from all sources were translated, transcribed and inductively analysed to identify key elements influencing acceptability and relevance of both survey process and items as well as translatability. RESULTS Serious challenges in achieving equivalence of meaning between English and translated versions of survey items were pervasive. Translatability of original survey items was extensively compromised by the use of metaphors specific to the cultural context within which surveys were developed, English words that are familiar but used with different meaning, English terms with no equivalent in First Nations languages and grammatical discordance between languages. Discordance between survey methods and First Nations cultural protocols and preferences for seeking and sharing information was also important: the lack of opportunity to share the 'full story', discomfort with direct questions and communication protocols that preclude negative or critical responses constrained the authenticity of the information obtained through survey methods. These limitations have serious implications for the quality of information collected and result in frustration and distress for those engaging with the survey. CONCLUSION Profound implications for the acceptability of a survey tool as well as data quality arise from differences between First Nations cultural and communication contexts and the cultural context within which survey methods have evolved. When data collection processes are not linguistically and culturally congruent there is a risk that patient experience data are inaccurate, miss what is important to First Nations patients and have limited utility for informing relevant healthcare improvement. Engagement of First Nations cultural and language experts is essential in all stages of development, implementation and evaluation of culturally safe and effe
{"title":"Why surveys are 'very hard': exploring challenges and insights for collection of authentic patient experience information with speakers of Australian First Nations languages.","authors":"Anne Lowell, Yomei Jones, Robyn Aitken, Dikul R Baker, Judith Lovell, Samantha Togni, Dianne Gon D Arra, Beth Sometimes, Margaret Smith, Julie Anderson, Rachael Sharp, Maria Karidakis, Sarita Quinlivan, Mandy Truong, Paul Lawton","doi":"10.22605/RRH8380","DOIUrl":"https://doi.org/10.22605/RRH8380","url":null,"abstract":"INTRODUCTION\u0000Health services collect patient experience data to monitor, evaluate and improve services and subsequently health outcomes. Obtaining authentic patient experience information to inform improvements relies on the quality of data collection processes and the responsiveness of these processes to the cultural and linguistic needs of diverse populations. This study explores the challenges and considerations in collecting authentic patient experience information through survey methods with Australians who primarily speak First Nations languages.\u0000\u0000\u0000METHODS\u0000First Nations language experts, interpreters, health staff and researchers with expertise in intercultural communication engaged in an iterative process of critical review of two survey tools using qualitative methods. These included a collaborative process of repeated translation and back translation of survey items and collaborative analysis of video-recorded trial administration of surveys with languages experts (who were also receiving dialysis treatment) and survey administrators. All research activities were audio- or video-recorded, and data from all sources were translated, transcribed and inductively analysed to identify key elements influencing acceptability and relevance of both survey process and items as well as translatability.\u0000\u0000\u0000RESULTS\u0000Serious challenges in achieving equivalence of meaning between English and translated versions of survey items were pervasive. Translatability of original survey items was extensively compromised by the use of metaphors specific to the cultural context within which surveys were developed, English words that are familiar but used with different meaning, English terms with no equivalent in First Nations languages and grammatical discordance between languages. Discordance between survey methods and First Nations cultural protocols and preferences for seeking and sharing information was also important: the lack of opportunity to share the 'full story', discomfort with direct questions and communication protocols that preclude negative or critical responses constrained the authenticity of the information obtained through survey methods. These limitations have serious implications for the quality of information collected and result in frustration and distress for those engaging with the survey.\u0000\u0000\u0000CONCLUSION\u0000Profound implications for the acceptability of a survey tool as well as data quality arise from differences between First Nations cultural and communication contexts and the cultural context within which survey methods have evolved. When data collection processes are not linguistically and culturally congruent there is a risk that patient experience data are inaccurate, miss what is important to First Nations patients and have limited utility for informing relevant healthcare improvement. Engagement of First Nations cultural and language experts is essential in all stages of development, implementation and evaluation of culturally safe and effe","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haylee Fox, Allison Hempenstall, Pelista Pilot, Emily Callander, Simon Smith, Malcolm I McDonald, Josh Hanson
INTRODUCTION Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery. METHODS The research team conducted a retrospective, de-identified audit of health records for a 2-year period, 2018-2019. The aim was to define health service utilisation, episodes of outpatient care, emergency department care, inpatient care and aeromedical retrieval services for SSTIs. RESULTS Across 2018 - 2019, there were 3509 outpatient episodes of care for SSTIs as well as 507 emergency department visits and 100 hospitalisations. For individuals with an SSTI, the mean outpatient clinic episode cost $240; the mean emergency department episode cost $400.85, the mean inpatient episode cost $8403.05 while an aeromedical retrieval service cost $18,670. The total costs to the health system for all services accessed for SSTI management was $6,169,881 per year, 3% of the total annual health service budget. CONCLUSION Healthcare costs associated with SSTIs in the Torres Strait are substantial. The implementation of effective preventative and primary care interventions may enable resources to be reallocated to address other health priorities in the Torres Strait.
{"title":"Significant healthcare resource utilisation in the management of skin and soft tissue infections in the Torres Strait, Australia.","authors":"Haylee Fox, Allison Hempenstall, Pelista Pilot, Emily Callander, Simon Smith, Malcolm I McDonald, Josh Hanson","doi":"10.22605/RRH8572","DOIUrl":"https://doi.org/10.22605/RRH8572","url":null,"abstract":"INTRODUCTION\u0000Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery.\u0000\u0000\u0000METHODS\u0000The research team conducted a retrospective, de-identified audit of health records for a 2-year period, 2018-2019. The aim was to define health service utilisation, episodes of outpatient care, emergency department care, inpatient care and aeromedical retrieval services for SSTIs.\u0000\u0000\u0000RESULTS\u0000Across 2018 - 2019, there were 3509 outpatient episodes of care for SSTIs as well as 507 emergency department visits and 100 hospitalisations. For individuals with an SSTI, the mean outpatient clinic episode cost $240; the mean emergency department episode cost $400.85, the mean inpatient episode cost $8403.05 while an aeromedical retrieval service cost $18,670. The total costs to the health system for all services accessed for SSTI management was $6,169,881 per year, 3% of the total annual health service budget.\u0000\u0000\u0000CONCLUSION\u0000Healthcare costs associated with SSTIs in the Torres Strait are substantial. The implementation of effective preventative and primary care interventions may enable resources to be reallocated to address other health priorities in the Torres Strait.","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay, than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which includes additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals.
Methods: Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data.
Results: A total of seven yarning sessions were conducted with 10 participants. Seven themes were identified: travel, barriers to health care, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets and not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden.
Conclusion: Aboriginal families are significantly burdened by OOPHE when needing to travel for health care. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access that does not create additional financial hardship in communities already experiencing economic disadvantage.
{"title":"Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families.","authors":"Courtney Ryder, Shane D'Angelo, Patrick Sharpe, Tamara Mackean, Nayia Cominos, Julieann Coombes, Keziah Bennett-Brook, Darryl Cameron, Emily Gloede, Shahid Ullah, Jacqueline Stephens","doi":"10.22605/RRH8328","DOIUrl":"10.22605/RRH8328","url":null,"abstract":"<p><strong>Introduction: </strong>Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay, than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which includes additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals.</p><p><strong>Methods: </strong>Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data.</p><p><strong>Results: </strong>A total of seven yarning sessions were conducted with 10 participants. Seven themes were identified: travel, barriers to health care, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets and not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden.</p><p><strong>Conclusion: </strong>Aboriginal families are significantly burdened by OOPHE when needing to travel for health care. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access that does not create additional financial hardship in communities already experiencing economic disadvantage.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Farmersâ perceptions about the risk of suicide and the available help schemes: a qualitative study in France","authors":"Priour, Delalande, Ricono, Chapron, Fiquet","doi":"10.22605/rrh8534","DOIUrl":"https://doi.org/10.22605/rrh8534","url":null,"abstract":"","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-03-19DOI: 10.22605/RRH8281
Morten Nikolaisen, Cathrine Arntzen, Marianne Eliassen, Astrid Gramstad
<p><strong>Introduction: </strong>Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas.</p><p><strong>Methods: </strong>A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion.</p><p><strong>Results: </strong>Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level.</p><p><strong>Conclusion: </strong>The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowled
导言:融入社区(CI)被认为是后天性脑损伤(ABI)患者康复的首要目标。然而,患有较轻后天性脑损伤的成年人在出院或住院康复后回到家中时,尽管仍有持续的损伤和需求,却往往缺乏支持。生活在农村地区的人在这一时期获得充分支持的可能性更小,因为这一阶段往往充满挑战和不确定性。本综述旨在对研究文献进行梳理和探索,以确定现有的康复服务提供模式,从而促进农村地区居家成人缺血性脑损伤患者的CI:方法:对研究文献进行了范围界定。研究遵循了乔安娜-布里格斯研究所(Joanna Briggs Institute)的范围界定综述指南和范围界定综述的 PRISMA 扩展指南。检索的数据库包括 MEDLINE、Embase、AMED、CINAHL、Web of Science、Cochrane Library、PsycInfo 和 Google Scholar。对研究设计、发表时间或来源国不做限制,但只考虑纳入英语、丹麦语、挪威语或瑞典语的文献:结果:共收录了 27 篇文章。结果:共收录了 27 篇文章,全部来自四个以英语为主的西方国家:澳大利亚、加拿大、英国和瑞典:澳大利亚、加拿大、英国和美国。专题分析确定了六个模式类别,这些类别反映了为促进农村地区患有 ABI 的成人的 CI 而提供康复的不同策略。将模式类别分为微观(个人、人际)、中观(组织、社区)和宏观(政策、社会)三个层面,突出显示了所收录的大部分文献都集中在个人或人际层面的微观问题上。微观层面的模式类别包括自我管理和教育、导航员的使用以及将日常生活活动纳入康复。涉及农村地区服务发展或包容性农村社区发展等中观层面问题的文章要少得多,只有一篇文章涉及宏观层面的政策发展:收录的文章数量相对较少,且研究的地理分布有限,这表明需要对旨在促进农村地区患有 ABI 的成人 CI 的康复模式进行更多的研究。尽管我们发现了几种在农村地区提供康复服务的现有方法,但仍有必要开发能充分考虑到缺血性脑损伤后 CI 的复杂性和长期性的模式。研究结果还表明,农村地区的 CI 不仅取决于针对 ABI 患者提供的专业服务,还可以通过支持重要他人、发展包容性社区和改善政策来促进 CI 的发展。对这些问题有更多的了解可能会促进护理系统的更广泛重组,以加强农村地区有注意力缺损成人的 CI。不过,这需要开展更多的研究,研究范围要比微观层面的服务提供更为广泛。
{"title":"Rehabilitation models for community integration of adults with acquired brain injury in rural areas: a scoping review.","authors":"Morten Nikolaisen, Cathrine Arntzen, Marianne Eliassen, Astrid Gramstad","doi":"10.22605/RRH8281","DOIUrl":"10.22605/RRH8281","url":null,"abstract":"<p><strong>Introduction: </strong>Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas.</p><p><strong>Methods: </strong>A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion.</p><p><strong>Results: </strong>Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level.</p><p><strong>Conclusion: </strong>The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowled","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-03-18DOI: 10.22605/RRH8687
Daniel R Terry, Blake Peck, Hoang Phan, Danny Hills, Jaclyn Bishop, Mark Kirschbaum, Kehinde O Obamiro, Ed Baker, David Schmitz
Introduction: Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities.
Methods: The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention.
Results: The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns.
Discussion: The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities als
{"title":"Understanding rural pharmacists' perspectives: lived experiences and insights associated with rural recruitment and retention.","authors":"Daniel R Terry, Blake Peck, Hoang Phan, Danny Hills, Jaclyn Bishop, Mark Kirschbaum, Kehinde O Obamiro, Ed Baker, David Schmitz","doi":"10.22605/RRH8687","DOIUrl":"10.22605/RRH8687","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities.</p><p><strong>Methods: </strong>The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention.</p><p><strong>Results: </strong>The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns.</p><p><strong>Discussion: </strong>The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities als","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-03-21DOI: 10.22605/RRH8364
Kyle Eggleton, Jonathan Watts-Henwood, Felicity Goodyear-Smith
Introduction: Health disparities between rural and urban areas in Aotearoa New Zealand are exacerbated by rural workforce issues. Traditionally, undergraduate medical programs are urban-based, and reconfiguring the curriculum to meet the needs of rural communities is challenging. The aim of this project is explore how urban-located universities might develop and implement a rural strategy. Evaluation of a rural strategy may lead to the strategy's ongoing improvements designed to increase the rural workforce.
Methods: This is a qualitative study involving semi-structured interviews with purposively selected key stakeholders. Enquiry included the systematic identification of processes required to develop a rural strategy, including possible facilitators and challenges to be addressed. Qualitative analysis of de-identified data was conducted using a thematic approach.
Results: Fourteen stakeholders were interviewed: four rural GPs, two rural hospital doctors, four administrators involved in placing students, and four senior medical academics with involvement in the regional and rural programs. Five overarching themes were identified: (1) developing rural pathways into medical school, (2) improving and expanding rural exposures, (3) developing rural GP pathways, (4) implementing interprofessional education and (5) having a social mission.
Conclusion: These findings align with the literature relating to developing rural strategies for universities. However, this study also suggested that rural health interprofessional programs may have a role. A key finding was that the social mission of a university may not be visible to rural stakeholders. Reorientating an urban-located university to having a rural strategy requires moving past having policy around social accountability to operationalising it.
{"title":"Development of a rural strategy for an urban-based medical program: a pragmatic reality.","authors":"Kyle Eggleton, Jonathan Watts-Henwood, Felicity Goodyear-Smith","doi":"10.22605/RRH8364","DOIUrl":"10.22605/RRH8364","url":null,"abstract":"<p><strong>Introduction: </strong>Health disparities between rural and urban areas in Aotearoa New Zealand are exacerbated by rural workforce issues. Traditionally, undergraduate medical programs are urban-based, and reconfiguring the curriculum to meet the needs of rural communities is challenging. The aim of this project is explore how urban-located universities might develop and implement a rural strategy. Evaluation of a rural strategy may lead to the strategy's ongoing improvements designed to increase the rural workforce.</p><p><strong>Methods: </strong>This is a qualitative study involving semi-structured interviews with purposively selected key stakeholders. Enquiry included the systematic identification of processes required to develop a rural strategy, including possible facilitators and challenges to be addressed. Qualitative analysis of de-identified data was conducted using a thematic approach.</p><p><strong>Results: </strong>Fourteen stakeholders were interviewed: four rural GPs, two rural hospital doctors, four administrators involved in placing students, and four senior medical academics with involvement in the regional and rural programs. Five overarching themes were identified: (1) developing rural pathways into medical school, (2) improving and expanding rural exposures, (3) developing rural GP pathways, (4) implementing interprofessional education and (5) having a social mission.</p><p><strong>Conclusion: </strong>These findings align with the literature relating to developing rural strategies for universities. However, this study also suggested that rural health interprofessional programs may have a role. A key finding was that the social mission of a university may not be visible to rural stakeholders. Reorientating an urban-located university to having a rural strategy requires moving past having policy around social accountability to operationalising it.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-03-07DOI: 10.22605/RRH8045
Deborah Magee, Marguerite Bramble, Holly Randell-Moon, Jola Stewart-Bugg, Julian Grant
Introduction: This scoping review was undertaken to obtain conceptual clarification about how racism and cultural safety are understood by interdisciplinary health professionals globally in the aged care sector in regional, rural and remote areas. There is evidence in Australia and internationally that racism is a factor impacting significantly on the health of First Peoples and other racialised minorities. Recent policy changes in Australia have required health professionals to integrate cultural safety into their practice to mitigate racism and improve the health of older First Nations Australians and older people from diverse ethnic and cultural groups.
Methods: This review consisted of literature published in English from 1990, including published primary studies; systematic, integrative and narrative reviews; meta-analyses; theses; policy documents; guidelines; position statements; and government literature. Ovid (MEDLINE), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health Database, and Informit were used in the full search. The most recent search of all databases was undertaken on 9 May 2022. Ten papers were included in the review, following the exclusion of 376 papers. A title and abstract search of the reference lists of papers included in the review identified no additional papers.
Results: Ten papers were included in the review from Australia, Canada, the US, Norway and England. The literature reviewed suggests that health professionals in the aged care sector in regional, rural and remote areas in Australia, Canada, the US, Norway and England use alternative terms to 'racism' and 'racist', such as 'institutional marginalisation'.
Discussion: The absence of explicit reference to racism aligns with critical race research that argues implicit bias and institutional racism are often separated from an individualised understanding of racism. That is, practitioners may understand racism as something that is perpetrated by individuals in an otherwise 'neutral' health setting. There is also a lack of clarity on how culturally safe care is understood, even though individual care plans are viewed as instrumental in establishing the needs and preferences of the consumers. Within the literature surveyed, barriers to providing quality and culturally inclusive care include disengaged management, insufficient human and material resources, language barriers and a lack of education focused on the needs of older individuals and groups with various cultural and spiritual needs. Additionally, the review does not clearly illuminate what health professionals understand to be racist thinking or behaviour and how it is responded to in practice. Likewise, there is limited information about health professionals' understanding of cultural safety and how to provide culturally inclusive care.
Conclusion: While work is beginning on dev
简介本次范围界定审查旨在从概念上澄清全球区域、农村和偏远地区老年护理部门的跨学科卫生专业人员是如何理解种族主义和文化安全的。澳大利亚和国际上都有证据表明,种族主义是严重影响原住民和其他少数民族健康的一个因素。澳大利亚最近的政策变化要求医疗专业人员将文化安全融入到他们的实践中,以减轻种族主义并改善澳大利亚原住民老年人以及来自不同种族和文化群体的老年人的健康状况:本综述包括 1990 年以来发表的英文文献,其中包括已发表的主要研究;系统性、综合性和叙述性综述;荟萃分析;论文;政策文件;指南;立场声明;以及政府文献。全面检索使用了 Ovid (MEDLINE)、CINAHL Plus with Full Text、Scopus、Proquest Nursing and Allied Health Database 和 Informit。对所有数据库的最新检索是在 2022 年 5 月 9 日进行的。在排除 376 篇论文后,有 10 篇论文被纳入综述。对纳入综述的论文参考文献目录进行了标题和摘要检索,未发现其他论文:共有 10 篇来自澳大利亚、加拿大、美国、挪威和英国的论文被纳入综述。综述的文献表明,在澳大利亚、加拿大、美国、挪威和英国的地区、农村和偏远地区,养老护理部门的卫生专业人员使用 "种族主义 "和 "种族歧视 "的替代术语,如 "机构边缘化":没有明确提及种族主义与批判性种族研究的观点一致,即隐性偏见和制度性种族主义往往与对种族主义的个人化理解相分离。也就是说,从业人员可能会将种族主义理解为个人在 "中立 "的医疗环境中实施的行为。尽管个人护理计划被认为有助于确定消费者的需求和偏好,但对于如何理解文化安全护理也缺乏清晰的认识。在所调查的文献中,提供高质量和文化包容性护理的障碍包括管理层不参与、人力和物力资源不足、语言障碍以及缺乏针对具有各种文化和精神需求的老年人和群体的教育。此外,审查没有明确说明卫生专业人员对种族主义思想或行为的理解,以及在实践中是如何应对的。同样,关于卫生专业人员对文化安全的理解以及如何提供文化包容性护理的信息也很有限:结论:澳大利亚正在着手制定文化安全培训标准,同时也有机会考虑如何将这些标准应用或调整到养老院和社区养老护理中,以最大限度地满足多样化的消费者群体和劳动力的需求。
{"title":"Understanding and responding to racism and the provision of culturally safe care by interdisciplinary health professionals in the aged care sector in regional, rural and remote areas: a scoping review.","authors":"Deborah Magee, Marguerite Bramble, Holly Randell-Moon, Jola Stewart-Bugg, Julian Grant","doi":"10.22605/RRH8045","DOIUrl":"10.22605/RRH8045","url":null,"abstract":"<p><strong>Introduction: </strong>This scoping review was undertaken to obtain conceptual clarification about how racism and cultural safety are understood by interdisciplinary health professionals globally in the aged care sector in regional, rural and remote areas. There is evidence in Australia and internationally that racism is a factor impacting significantly on the health of First Peoples and other racialised minorities. Recent policy changes in Australia have required health professionals to integrate cultural safety into their practice to mitigate racism and improve the health of older First Nations Australians and older people from diverse ethnic and cultural groups.</p><p><strong>Methods: </strong>This review consisted of literature published in English from 1990, including published primary studies; systematic, integrative and narrative reviews; meta-analyses; theses; policy documents; guidelines; position statements; and government literature. Ovid (MEDLINE), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health Database, and Informit were used in the full search. The most recent search of all databases was undertaken on 9 May 2022. Ten papers were included in the review, following the exclusion of 376 papers. A title and abstract search of the reference lists of papers included in the review identified no additional papers.</p><p><strong>Results: </strong>Ten papers were included in the review from Australia, Canada, the US, Norway and England. The literature reviewed suggests that health professionals in the aged care sector in regional, rural and remote areas in Australia, Canada, the US, Norway and England use alternative terms to 'racism' and 'racist', such as 'institutional marginalisation'.</p><p><strong>Discussion: </strong>The absence of explicit reference to racism aligns with critical race research that argues implicit bias and institutional racism are often separated from an individualised understanding of racism. That is, practitioners may understand racism as something that is perpetrated by individuals in an otherwise 'neutral' health setting. There is also a lack of clarity on how culturally safe care is understood, even though individual care plans are viewed as instrumental in establishing the needs and preferences of the consumers. Within the literature surveyed, barriers to providing quality and culturally inclusive care include disengaged management, insufficient human and material resources, language barriers and a lack of education focused on the needs of older individuals and groups with various cultural and spiritual needs. Additionally, the review does not clearly illuminate what health professionals understand to be racist thinking or behaviour and how it is responded to in practice. Likewise, there is limited information about health professionals' understanding of cultural safety and how to provide culturally inclusive care.</p><p><strong>Conclusion: </strong>While work is beginning on dev","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}