Julieann Coombes

Understanding burn injuries in Aboriginal and Torres Strait Islander children: Protocol for a prospective cohort study

Introduction Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. Methods and analysis All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. Ethics and dissemination The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals.

Risk factors, incidence, consequences and prevention strategies for falls and fall-injury within older indigenous populations: a systematic review

Objective: To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall‐related injury in older indigenous people.

Fall-related hospitalisations of older Aboriginal and Torres Strait Islander people and other Australians

Objectives: To compare the socio‐demographic characteristics and type of injury sustained, the use of hospital resources and rates of hospitalisation by injury type, and survival following fall injuries to older Aboriginal people and non‐Indigenous Australian people hospitalised for fall‐related injuries.

Risk factors for falls among older Aboriginal and Torres Strait Islander people in urban and regional communities

To examine associations between fall risk factors identified previously in other populations and falls among Aboriginal people aged 60 years and older, living in New South Wales, Australia.

Participant preferences for an Aboriginal-specific fall prevention program: Measuring the value of culturally-appropriate care

Background Culturally-specific services are central to efforts to improve the health of Aboriginal Australians. Few empirical studies have demonstrated the value of such services relative to mainstream alternatives. Objective To assess the preferences and willingness to pay (WTP) of participants for attending a class and the relative importance of transport, cost and cultural-appropriateness in the choices made by participants. Design A discrete choice experiment (DCE) was conducted alongside a study of a culturally-specific fall-prevention service. Attributes that were assessed were out-of-pocket costs, whether transport was provided and whether the class was Aboriginal-specific. Choices of participants were modelled using panel-mixed logit methods. Results 60 patients completed the DCE. Attending a service was strongly preferred over no service (selected 99% of the time). Assuming equivalent efficacy of fall-prevention programs, participants indicated a preference for services that were culturally-specific (OR 1.25 95% CI: 1.00–1.55) and incurred lower out-of-pocket participant costs (OR 1.19 95% CI 1.11–1.27). The provision of transport did not have a statistically significant influence on service choice (p = 0.57). Discussion and conclusions This represents the first published DCE in the health field examining preferences amongst an Aboriginal population. The results empirically demonstrate the value of the culturally-specific element of a program has to this cohort and the potential that stated-preference methods can have in incorporating the preferences of Aboriginal Australians and valuing cultural components of health services. Note on terminology As the majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (97.2%), this population will be referred to as ‘Aboriginal’ in this manuscript.

Factors that impact access to ongoing health care for First Nation children with a chronic condition

BackgroundAccess to multidisciplinary health care services for First Nation children with a chronic condition is critical for the child’s health and well-being, but disparities and inequality in health care systems have been almost impossible to eradicate for First Nation people globally. The objective of this review is to identify the factors that impact access and ongoing care for First Nation children globally with a chronic condition.MethodsAn extensive systematic search was conducted of nine electronic databases to identify primary studies that explored factors affecting access to ongoing services for First Nation children with a chronic disease or injury. Due to the heterogeneity of included studies the Mixed Method Appraisal Tool (MMAT) was used to assess study quality.ResultsA total of six studies from Australia, New Zealand and Canada were identified and included in this review. Four studies applied qualitative approaches using in-depth semi structured interviews, focus groups and community fora. Two of the six studies used quantitative approaches. Facilitators included the utilisation of First Nation liaison workers or First Nation Health workers. Key barriers that emerged included lack of culturally appropriate health care, distance, language and cultural barriers, racism, the lack of incorporation of First Nation workers in services, financial difficulties and transport issues.ConclusionThere are few studies that have identified positive factors that facilitate access to health care for First Nation children. There is an urgent need to develop programs and processes to facilitate access to appropriate health care that are inclusive of the cultural needs of First Nation children.

First Nation Elders’ perspectives on healthy ageing in NSW, Australia

Objectives: Healthy ageing has been unattainable for many of Australia’s First Nation people, driven by an earlier onset of chronic disease when compared to the general Australian population. Our objective was to examine the perspectives of Australian First Nation people about healthy ageing.

PA 15-4-1813 Evaluation of a culturally appropriate fall prevention program for older aboriginal people

Fall-related injury amongst older Aboriginal people is a growing health issue yet our recent audit of services identified few Aboriginal-specific fall prevention programs. Informed by stakeholder interviews and Yarning Circles with over 70 older Aboriginal people, a fall prevention program was developed in partnership with Aboriginal community groups. The aim of this study was to evaluate a culturally appropriate fall prevention program for older Aboriginal people. The Ironbark Program is an on-going, weekly, group-based, strength and balance exercise class with an education component held within Yarning Circles. The program was delivered in 6 communities in NSW over a 6 month period from June 2015. A mixed methods approach was used for evaluation; measures of strength and balance were collected to measure changes in physical outcomes, and participants completed questionnaires and interviews to assess program acceptability. Ninety-eight participants (mean age=64, 71% women) registered for the program; 77 (85%) completed baseline and follow-up measurements. Positive ongoing feedback was received, and attendance was good. On average across all sites, there was significant improvement in participant leg strength (time to complete 5 repetition sit-to-stand: 14 s to 11 s, p<0.01), balance (timed single-leg stance: 5.6 s to 7.8 s, p<0.01) and gait speed (timed 4 meter walk: 0.51 m/s to 0.94 m/s, p<0.01), and a significant decrease in BMI (p<0.01). Participants reported both the exercise and yarning components of the program were enjoyable and valuable. The Ironbark program was effective in improving fall-related measures; funding has now been received for a large scale cluster randomized trial to test its effectiveness in preventing falls. Collaboration between Aboriginal community leaders, Aboriginal health and community service providers facilitated development of a unique, culturally appropriate program that addressed a variety of health, social and cultural needs, translating knowledge into action for positive change.