Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, 0811, Australia.
George Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales, 2042, Australia.
BMC Health Serv Res. 2021 Oct 20;21(1):1127. doi: 10.1186/s12913-021-07159-9.
In Australia's north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF); driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education. Our aim is to determine how the model was experienced by study participants.
This is a two-year, outreach-to-household, pragmatic intervention implemented by Aboriginal Community Workers in three remote communities. The qualitative component was shaped by Participatory Action Research. Yarning sessions and semi-structured interviews were conducted with 14 individuals affected by, or working with, ARF/RHD. 31 project field reports were collated. We conducted a hybrid inductive-deductive thematic analysis guided by critical theory.
Aboriginal Community Workers were best placed to support two of the six domains: housing and environmental health support and health navigation. This was due to trusting relationships between ACWs and families and the authority attributed to ACWs through the project. ACWs improved health literacy and supported awareness and empowerment; but this was limited by disease complexities. Consequently, ACWs requested more training to address knowledge gaps and improve knowledge transfer to families. ACWs did not have skills to provide health professionals with education or ensure health and education services participated in ARF/RHD. Where knowledge gain among participant family members was apparent, motivation or structural capability to implement behaviour change was lacking in some domains, even though the model was intended to support structural changes through care navigation and housing fixes.
This is the first multi-site effort in northern Australia to strengthen primordial and primary prevention of RHD. Community-led programs are central to the overarching strategy to eliminate RHD. Future implementation should support culturally safe relationships which build the social capital required to address social determinants of health and enable holistic ways to support sustainable individual and community-level actions. Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD.
在澳大利亚北部，原住民人群的风湿性心脏病（RHD）及其前身急性风湿热（ARF）发病率居世界之首；这些疾病是由健康的社会和环境决定因素所驱动的。我们开展了一项工作方案，使用涵盖六个领域的模型来加强 RHD 的初级预防和一级预防：住房和环境支持、社区意识和赋权、健康素养、卫生和教育服务整合、卫生导航和卫生提供者教育。我们的目标是确定研究参与者对该模型的体验。
这是一项为期两年的、面向家庭的、以实用主义为导向的干预措施，由原住民社区工作者在三个偏远社区实施。定性部分由参与式行动研究形成。与 14 名受 ARF/RHD 影响或与之合作的个人进行了交谈会议和半结构化访谈。共收集了 31 份项目现场报告。我们根据批判理论进行了混合归纳演绎主题分析。
原住民社区工作者最适合支持六个领域中的两个：住房和环境卫生支持以及卫生导航。这是因为原住民社区工作者与家庭之间建立了信任关系，并且由于该项目，原住民社区工作者被赋予了权威。原住民社区工作者提高了健康素养，并支持了意识和赋权；但这受到疾病复杂性的限制。因此，原住民社区工作者要求进行更多培训，以解决知识差距并提高向家庭传递知识的能力。原住民社区工作者没有技能为卫生专业人员提供教育，也不能确保卫生和教育服务参与 ARF/RHD。尽管该模型旨在通过护理导航和住房修复来支持结构变化，但在某些领域，尽管参与者家庭成员的知识有所提高，但缺乏实施行为改变的动机或结构能力。
这是澳大利亚北部首次在多个地点开展的加强 RHD 初级预防的工作。社区主导的计划是消除 RHD 的总体战略的核心。未来的实施应支持建立文化安全关系，这些关系可以建立解决健康的社会决定因素所需的社会资本，并为支持可持续的个人和社区层面的行动提供整体方式。政府和服务部门必须与社区合作，解决限制原住民消除 RHD 能力的系统性、结构性问题。
