School of Population & Global Health, University of Western Australia.
Menzies School of Health Research, Charles Darwin University, Northern Territory.
Aust N Z J Public Health. 2022 Oct;46(5):588-594. doi: 10.1111/1753-6405.13219. Epub 2022 Jul 19.
To examine the views of senior health system knowledge holders, including Aboriginal experts, regarding the spaces where elimination strategies for rheumatic heart disease take place: Aboriginal and Torres Strait Islander ways of knowing, being and doing; and biomedical healthcare models. We aimed to support the implementation of the RHD Endgame Strategy by providing some of the 'how'.
In-depth interviews were undertaken with 23 participants. The design of the interview questions and analysis of the data used strengths-based approaches as directed by Aboriginal researchers.
Given the dominance of the biomedical worldview, and the complex trajectory of RHD, there is significant tension in the intersection of worldviews. Tensions that limit productive dialogue are juxtaposed with suggestions on how to reduce tension through reflexivity, power shifting and endorsing Aboriginal leadership and governance. Evidence supported cultural safety for RHD care, prevention and elimination as the key action.
Recommendations include addressing power imbalances between dominant and minority populations throughout the health system; reform that both supports and is supported by Non-Indigenous and Aboriginal and Torres Strait Islander leadership.
Increased understanding of and support for Indigenous leadership and cultural safety will enable implementation of the new RHD strategy.
探讨资深卫生系统知识持有者（包括原住民专家）对风湿性心脏病消除策略发生的空间的看法：原住民和托雷斯海峡岛民的认知、存在和实践方式；以及生物医学医疗模式。我们旨在通过提供一些“方法”来支持《风湿性心脏病终结战略》的实施。
对 23 名参与者进行了深入访谈。访谈问题的设计和数据分析采用了原住民研究人员指导的基于优势的方法。
鉴于生物医学世界观的主导地位，以及风湿性心脏病的复杂轨迹，世界观的交汇处存在着巨大的紧张关系。限制富有成效对话的紧张关系与如何通过反思、权力转移以及支持原住民领导和治理来减少紧张关系的建议形成鲜明对比。证据支持将风湿性心脏病护理、预防和消除的文化安全作为关键行动。
建议包括在整个卫生系统中解决主导和少数群体之间的权力不平衡问题；改革既要得到非原住民和原住民及托雷斯海峡岛民领导的支持，也要得到他们的支持。
增加对原住民领导和文化安全的理解和支持，将使新的风湿性心脏病战略得以实施。
