Models of care for Indigenous children in rural and remote settings: A global scoping review.

Indigenous communities internationally have demonstrated remarkable strength despite significant challenges. Health disparities among Indigenous peoples persist due to historical injustices and ongoing racial discrimination, not inherent vulnerabilities. Disparities are rooted in a legacy of colonisation, systemic exclusion, and socio-economic inequities impacting access to healthcare, education, and employment. Preliminary searches show limited literature on models of care for remote living Indigenous children. This review aimed to identify internationally, effective models of care for Indigenous children in rural and remote areas. A scoping review was conducted, analysing literature on models of care for remote Indigenous children. This study followed the JBI's Scoping Review Guidance and PRISMA Scoping Review guideline. Inclusion criteria were aged ≤18, rural or remote areas, majority Indigenous, reported health outcomes, described a model of care, in English, and published since 1990. Data were systematically extracted, quality appraised using the 'Aboriginal and Torres Strait Islander Quality Appraisal Tool' then analysed using descriptive-analytical methodology. This review included 16 papers: 8 case series, 3 qualitative studies, and 5 trials. Of these, 7 studies were in Australia, 7 in the USA and 2 in Canada. All studies primary aim was to improve quality of care. Models of care described in the included papers varied, being delivered in traditional healthcare settings, homes, and elsewhere in the community. This review provides insights into the design and implementation of models of care in remote communities with primarily Indigenous populations. The authors recommend 1) that future reviews privilege 'realist evaluation' when examining models of care, 2) designers consider whether a model of care will run for a fixed-period versus ongoing as they have different requirements for success and 3) a toolkit approach to model of care development like the Qungasvik toolkit which provides evidenced modules adaptable to local conditions, easing workload on local people developing programs.