战略性方法以提高慢性病的澳式原住民和托雷斯海峡岛民的健康服务提供：一项定性研究。
Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study.
机构信息
Poche Centre for Indigenous Health, University of Sydney, Sydney, Australia.
出版信息
BMC Health Serv Res. 2012 Jun 8;12:143. doi: 10.1186/1472-6963-12-143.
BACKGROUND
Aboriginal and Torres Strait Islander people with chronic illness confront multiple challenges that contribute to their poor health outcomes, and to the health disparities that exist in Australian society. This study aimed to identify barriers and facilitators to care and support for Aboriginal and Torres Strait Islander people with chronic illness.
METHODS
Face-to-face in-depth interviews were conducted with Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease (n-16) and family carers (n = 3). Interviews were transcribed verbatim and the transcripts were analysed using content analysis. Recurrent themes were identified and these were used to inform the key findings of the study.
RESULTS
Participants reported both negative and positive influences that affected their health and well-being. Among the negative influences, they identified poor access to culturally appropriate health services, dislocation from cultural support systems, exposure to racism, poor communication with health care professionals and economic hardship. As a counter to these, participants pointed to cultural and traditional knowledge as well as insights from their own experiences. Participants said that while they often felt overwhelmed and confused by the burden of chronic illness, they drew strength from being part of an Aboriginal community, having regular and ongoing access to primary health care, and being well-connected to a supportive family network. Within this context, elders played an important role in increasing people's awareness of the impact of chronic illness on people and communities.
CONCLUSIONS
Our study indicated that non-Indigenous health services struggled to meet the needs of Aboriginal and Torres Strait Islander people with chronic illness. To address their complex needs, health services could gain considerably by recognising that Aboriginal and Torres Strait Islander patients have a wealth of cultural knowledge at their disposal. Strategies to ensure that this knowledge is integrated into care and support programs for Aboriginal and Torres Strait Islander people with chronic illness should achieve major improvements.
背景
患有慢性病的澳大利亚原住民和托雷斯海峡岛民面临着多种挑战，这些挑战导致他们的健康状况不佳，并导致澳大利亚社会存在健康差距。本研究旨在确定影响患有慢性病的澳大利亚原住民和托雷斯海峡岛民的护理和支持的障碍和促进因素。
方法
对患有糖尿病、慢性心力衰竭或慢性阻塞性肺疾病的澳大利亚原住民和托雷斯海峡岛民（n=16）及其家庭照顾者（n=3）进行了面对面的深入访谈。采访记录被逐字转录，并使用内容分析法对转录内容进行分析。确定了反复出现的主题，并将这些主题用于告知研究的主要发现。
结果
参与者报告了对他们的健康和福祉既有负面影响也有积极影响的因素。在负面影响方面，他们确定了获得文化上适当的卫生服务的机会有限、与文化支持系统脱节、遭受种族主义、与卫生保健专业人员沟通不畅以及经济困难。作为对此的回应，参与者指出了文化和传统知识以及他们自己的经验见解。参与者表示，尽管他们常常因慢性病的负担而感到不知所措和困惑，但他们从作为一个原住民社区的一部分、定期和持续获得初级卫生保健以及与支持性家庭网络的紧密联系中获得了力量。在这种情况下，长辈在提高人们对慢性病对个人和社区的影响的认识方面发挥了重要作用。
结论
我们的研究表明，非原住民卫生服务机构难以满足患有慢性病的澳大利亚原住民和托雷斯海峡岛民的需求。为了满足他们的复杂需求，卫生服务机构可以通过认识到澳大利亚原住民和托雷斯海峡岛民患者拥有丰富的文化知识来获得巨大的收益。确保将这种知识纳入针对患有慢性病的澳大利亚原住民和托雷斯海峡岛民的护理和支持计划的策略应该会取得重大改善。
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