Brodie Tina, Pearson Odette, Cantley Luke, Cooper Peita, Westhead Seth, Brown Alex, Howard Natasha J
Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
Prim Health Care Res Dev. 2021 Jun 29;22:e35. doi: 10.1017/S1463423621000402.
Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently 'do what it takes' to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being.The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.
原住民及托雷斯海峡岛民的整体健康体现了社会、情感、精神和文化因素对健康与幸福的相互联系。社会因素（教育、就业、住房、交通、食品和金融安全）在国际上被描述并公认为健康的社会决定因素。据估计，健康的社会决定因素在原住民及托雷斯海峡岛民所经历的总体疾病负担中占34%。目前，初级卫生保健服务“竭尽所能”满足社会和情感幸福需求，包括健康的社会决定因素，并且需要具有文化相关性的工具和流程来实施协调一致的整体应对措施。基于一项研究背景的试点项目，本手稿概述了基于优势方法的关键要素，旨在解决原住民及托雷斯海峡岛民的整体社会和情感幸福问题。文化途径项目是对社区确定需求的回应，由原住民及托雷斯海峡岛民设计和主导，并以整体健康观为依据。该项目旨在将原住民及托雷斯海峡岛民的整体需求确定为应对健康社会决定因素的行动起点。协调员采用基于优势的做法来确定社会和文化需求（如文化和社区联系、食品和金融安全、住房、心理健康、交通），参与目标设定过程，并促成与社会和卫生服务机构的联系。一个综合的、符合文化背景的临床监督模式通过反思性实践和共同决策来加强项目的实施。这些内在方法能够从项目和参与者的角度进行持续审查和改进。一项发展性评估为项目实施提供支持，所提议的具有文化相关性的要素可进一步调整，以便在初级卫生保健服务中作为常规护理的一部分提供服务，以加强对社会和情感幸福需求的系统识别和应对。
