School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Vision Cooperative Research Centre, Sydney, New South Wales, Australia.
BMJ Glob Health. 2020 Jan 9;5(1):e001999. doi: 10.1136/bmjgh-2019-001999. eCollection 2020.
Our study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.
In collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11.
More than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care.
We outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.
本研究旨在确定影响澳大利亚偏远地区糖尿病原住民获得眼科护理和眼健康结果的因素。
本研究与原住民社区参与式研究人员（CBR）和原住民社区控制的医疗服务机构（ACCHS）合作，采用定性、参与式行动研究方法，借鉴原住民主义和去殖民化方法。该研究在澳大利亚北领地凯瑟琳地区和新南威尔士州西北部的四个偏远社区进行。对≥40 岁的糖尿病原住民成年人（n=110）和在 ACCHS 工作的初级保健临床医生（n=37）进行了访谈和焦点小组讨论。在数据收集之前和之后，与 CBR 进行了一系列访谈（n=13），以增加文化见解并验证参与者的说法。使用扎根理论、深入讨论和 NVivo V.11 对数据进行了归纳分析。
超过三分之一的患者对糖尿病如何影响眼睛健康知之甚少。获取健康信息和口译员的机会有限、语言障碍、对卫生提供者和服务的不信任、以及非原住民临床医生的文化反应能力有限，这些都是影响眼睛健康和护理的决定因素。
我们概述了需要通过增加对原住民语言口译员和文化经纪人的获取和资源、可理解的和具有文化敏感性的糖尿病眼健康信息以及对非原住民临床医生的文化反应能力培训来解决信任和沟通方面的差距。将原住民文化置于医疗保健实践的中心，将使临床医生和原住民患者之间能够达成共识，从而获得更公平的眼健康结果。
