Field Patricia, Franklin Richard C, Barker Ruth, Ring Ian, Leggat Peter, Canuto Karla
College of Public health, Medicine and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia.
Aust J Rural Health. 2023 Feb;31(1):152-158. doi: 10.1111/ajr.12932. Epub 2022 Oct 10.
To focus on the needs, challenges and opportunities to improve access to cardiac rehabilitation (CR) (Heart: Road to health [HRH]) for Aboriginal and Torres Strait Islander peoples in rural and remote (R&R) areas of North Queensland.
It is known that there is insufficient access to HRH for Aboriginal and Torres Strait Islander peoples in R&R areas of NQ, who have the highest rates of heart disease and socioeconomic disadvantage mainly due to poor social determinants of health. However, at least in part due to the impact of colonialism and predominantly western medicalised approach to health care, few gains have been made.
This commentary draws on recent research and literature and reflects on cultural issues that impact on improving access to an HRH for Aboriginal and Torres Strait Islander peoples in R&R areas. The underutilisation of the skills of Aboriginal and Torres Strait Islander Health Workers (ATSIHW) and a lack of a defined process to ensure access to culturally responsive HRH are discussed. Finally, a way forward is proposed that includes the development of policies, pathways and guidelines to ensure that appropriate support is available in the client's home community.
It is proposed that culturally responsive, accessible and effective HRH is achievable through the reorientation of current health systems that include a continuous client-centred pathway from hospital to home. In this model, ATSIHW will take a lead or partnership role in which their clinical, cultural brokerage and health promotion skills are fully utilised.
关注北昆士兰农村和偏远地区原住民及托雷斯海峡岛民改善心脏康复（CR，即“心脏：健康之路”[HRH]）服务可及性方面的需求、挑战和机遇。
众所周知，北昆士兰农村和偏远地区的原住民及托雷斯海峡岛民获得HRH服务的机会不足，他们的心脏病发病率最高，且主要由于不良的健康社会决定因素而处于社会经济劣势。然而，至少部分由于殖民主义的影响以及主要是西方医学化的医疗保健方式，进展甚微。
本评论借鉴了近期的研究和文献，并思考了影响改善农村和偏远地区原住民及托雷斯海峡岛民获得HRH服务可及性的文化问题。讨论了原住民及托雷斯海峡岛民卫生工作者（ATSIHW）技能利用不足以及缺乏确保获得具有文化响应性的HRH服务的明确流程的问题。最后，提出了一条前进的道路，包括制定政策、途径和指南，以确保在客户的家乡社区能够获得适当的支持。
建议通过重新调整当前的卫生系统来实现具有文化响应性、可及且有效的HRH服务，该系统应包括从医院到家庭的以客户为中心的连续途径。在这个模式中，ATSIHW将发挥主导或伙伴作用，充分利用他们的临床、文化中介和健康促进技能。
