Essay on diabetes in indigenous people

Others have used less complex scores focusing on distance [ 11 ], travel time [ 12 ] and supply and demand ratios [ 13 ].

Diabetes in Indigenous Australians: possible ways forward

Quantitative measures of socioeconomic status with indicators of disadvantage have also been included [ 14 , 15 ]. 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 [ 16 ].

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 [ 17 ], or alternatively how well patients are able to access health care given their particular capacity to seek and obtain care [ 18 , 19 ].

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. For example Haggerty et al. Levesque et al. Both user and health care service characteristics are incorporated within the five stage linear framework. 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.

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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 Ability to Engage and the extent to which the care provided meets the needs of the communities they serve Appropriateness Fig. A recently completed scoping review [ 25 ] 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.

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 [ 25 ].

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. Service delivery models implemented within settings where primary health care services were provided predominantly for Indigenous peoples were included in the original scoping review. Indigenous peoples were defined as:. They generally maintain cultural and social identities, and social, economic, cultural and political institutions, separate from the mainstream or dominant society or culture.

Comprehensive primary health care includes health promotion, illness prevention, treatment and care of the sick, community development, and advocacy and rehabilitation. All qualitative, quantitative, economic and mixed methods studies were considered for inclusion in the original scoping review. In addition reviews and systematic literature reviews of programs that meet the inclusion criteria were also retrieved.

Only literature published in English from September were considered in the original scoping review as this is the date that the Declaration of Alma Ata which outlined primary health care was adopted at the International Conference on Primary Health Care.

An Essay on Indigenous Health

Initial search terms used in the original scoping review included Aboriginal, Aborigine, Indigenous, first nation, Maori, Inuit, American Indian, primary health care, comprehensive primary health care, medical service, health service, community care, community health care, model. A three-step search strategy was utilized in the original scoping review. An initial limited search of PubMed and CINAHL was undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article.

Third, the reference list of all identified reports and articles was searched for additional studies. In addition, academics from universities with expertise in Indigenous health services were contacted and asked to identify literature particularly grey literature that meets the review inclusion criteria.

Articles were assessed for inclusion in the initial scoping review by title and abstract. Full text of the articles were retrieved if they meet the inclusion criteria or if further examination was required. Two reviewers independently confirmed that the full text article meet the inclusion criteria. Any disagreements was decided by a third reviewer. To be considered for this new framework synthesis, papers must have been included in the previous scoping review and present findings related to one or more of the five stages included in Levesque et al.

Prevalence Of Diabetes Among Indigenous People – ✔️Essay and Paper Writers Handcraft

Findings from these papers were firstly extracted and then imported into NVivo A framework synthesis [ 29 ] was used to aid in the analyse and the interpretation of the extracted findings. Of the 62 papers included in the original scoping review, 50 met the inclusion criteria for this framework synthesis [see Additional file 1 : Table S1]. However, findings suggest two additional improvements, at least in relation to access to health care services for Indigenous peoples. First, the broader health care system rather than a particular service or the user also appeared to influence access to and acceptability of care.

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Funding was the most obvious system issue identified by this framework synthesis. For example, we found a closer relationship between the ability to pay and the ability to reach than was suggested by the original linear framework.

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For example, studies demonstrated that the cost of transport to the health care service was as prohibitive as the cost of health care. We also found that the ability to engage was as relevant to health care acceptability as it was to appropriateness. A non-linear representation which provides space for factors relating to health care system systems more broadly Fig. The primary aim of this framework synthesis was to explore access to factors related to Indigenous patients, their families and communities and accessibility of factors relating to services Indigenous health care services using the Levesque et al.

Poverty was a prominent social determinant of health issue with some Indigenous peoples finding it difficult to afford either transportation to, or the costs of, obtaining services. This review also found that a lack of basic communication infrastructure within communities such as telephones prevented access to health care guidance and advice. Despite limited funding, Indigenous health care services also subsidised these costs for Indigenous peoples on low incomes.

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Health care services that are both cognisant of and able to address the social determinants of health relevance within their particular context will be crucial for improving access to health care services for Indigenous communities. In this framework synthesis we found that community acceptance was key to both seeking and engaging with health care services. The acceptability of services depends on health care providers understanding the cultural, historical and social fabric of the communities they serve [ 31 ].

However, simply understanding is not sufficient. Instead a deeper level of interaction and thoughtful practice that ensures culturally safe services, as defined by those who receive services, is required [ 32 ]. To support this view, we found that Indigenous health care staff, particularly those from local communities, were associated with increased Indigenous health care engagement. Indigenous health care services included in this review also actively sought to engage with and learn from local Indigenous peoples.

In some instances Indigenous health care services were owned and managed by local Indigenous peoples resulting in a sense of community ownership and promoting the use of culturally safe models of health care. Indigenous health care services may therefore provide the best opportunity to address access because they are in a better position to address the types of social and cultural determinants of health faced by Indigenous communities. They are, for example, generally situated within or at least near to the communities they serve and are more likely to be aware of local values, norms as well as health care needs.

Indigenous health care services are also more willing to work with communities in order to respond to local needs. Importantly, Indigenous services owned and managed by Indigenous peoples are more likely to develop culturally safe models of care [ 33 ]. In contrast, mainstream services are generally set up to cater for dominant often non-Indigenous cultures and may not have the resources required to respond to the needs of others.