Freeman Joseph, Stubbs Thomas, Chadwick Verity, Pickard Anita, Esgin Tuguy, Elliott Elizabeth J, Martiniuk Alexandra
Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
PLOS Glob Public Health. 2025 Jul 17;5(7):e0004934. doi: 10.1371/journal.pgph.0004934. eCollection 2025.
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.
国际上的原住民社区尽管面临重大挑战，但仍展现出了非凡的力量。由于历史上的不公正待遇和持续的种族歧视，而非自身固有的脆弱性，原住民之间的健康差距依然存在。这些差距源于殖民化的遗留问题、系统性排斥以及影响医疗保健、教育和就业机会的社会经济不平等。初步检索显示，关于偏远地区原住民儿童护理模式的文献有限。本综述旨在在国际范围内确定针对农村和偏远地区原住民儿童的有效护理模式。我们进行了一项范围综述，分析关于偏远地区原住民儿童护理模式的文献。本研究遵循了循证卫生保健国际协作组（JBI）的范围综述指南和系统综述与Meta分析扩展版范围综述（PRISMA-Sc）指南。纳入标准为年龄≤18岁、居住在农村或偏远地区、多数为原住民、报告了健康结果、描述了护理模式、以英文撰写且自1990年以来发表。数据被系统提取，使用“原住民和托雷斯海峡岛民质量评估工具”进行质量评估，然后采用描述性分析方法进行分析。本综述纳入了16篇论文：8篇病例系列研究、3篇定性研究和5项试验。其中，7项研究来自澳大利亚，7项来自美国，2项来自加拿大。所有研究的主要目标都是提高护理质量。纳入论文中描述的护理模式各不相同，在传统医疗环境、家庭和社区的其他地方提供。本综述为主要由原住民组成的偏远社区护理模式的设计和实施提供了见解。作者建议：1）未来的综述在考察护理模式时优先采用“现实主义评价”；2）设计者在考虑护理模式是定期运行还是持续运行时，要考虑到它们对成功有不同的要求；3）采用像Qungasvik工具包这样的护理模式开发工具包方法，该工具包提供了适用于当地情况的循证模块，减轻了当地项目开发人员的工作量。
