Stubbs Thomas, Bedford Mudge, Bear Emma, Carter Emily, Pickard Anita, Davies Jadnah, Thomas Sue, Martiniuk Alexandra L C, Elliott Elizabeth J, Rice Lauren J
The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, New South Wales, Australia
The University of Sydney, Faculty of Medicine and Health, Speciality of Child and Adolescent Health, Sydney, New South Wales, Australia.
BMJ Open. 2025 Sep 1;15(9):e093608. doi: 10.1136/bmjopen-2024-093608.
Aboriginal and Torres Strait Islander people living with disability have unequal access to health and disability support services. The impacts of colonialism and the deficit-based, Western medical model of disability have been identified as barriers to services in remote Aboriginal communities. This study explored different perceptions of disability and identified strategies to help bridge the gap between Aboriginal community members in the Fitzroy Valley and Western health and disability support services.
Aboriginal Participatory Action Research approach with in-depth interviews. Transcripts were analysed using reflexive thematic analysis. Preliminary results were presented to community representatives for contextualisation, validation and to co-design recommendations.
Fitzroy Valley in the Kimberley region, Western Australia.
Aboriginal community members with lived experience of disability (n=7) and health and disability support service providers (n=12).
Eight themes were identified: (1) Aboriginal kinship systems are a community strength and support for people living with disability; (2) Aboriginal people from the Fitzroy Valley perceive disability as a social construct; (3) Western medical model of disability differs from Aboriginal perceptions of disability; (4) Aboriginal people from the Fitzroy Valley perceive different types of disabilities in various ways; (5) good awareness of fetal alcohol spectrum disorder in the Fitzroy Valley, but more education is wanted; (6) focus on functional needs and supports for disability; (7) barriers to disability services and (8) decolonise disability services. Community co-designed recommendations focus on centring the Aboriginal worldviews of disability in the Fitzroy Valley.
Decolonising disability services is needed to improve access for Aboriginal and Torres Strait Islander communities. This should involve adapting the current Western medical model of services to enable strengths-based diagnostic and support services that align with Aboriginal and Torres Strait Islander kinship systems, cultures and ways of being. Community leadership must play a central role in this shift.
残疾的原住民和托雷斯海峡岛民在获得健康和残疾支持服务方面机会不平等。殖民主义的影响以及基于缺陷的西方残疾医学模式已被确定为偏远原住民社区获得服务的障碍。本研究探讨了对残疾的不同看法，并确定了有助于弥合菲茨罗伊山谷原住民社区成员与西方健康和残疾支持服务之间差距的策略。
采用深入访谈的原住民参与式行动研究方法。使用反思性主题分析对访谈记录进行分析。将初步结果提交给社区代表，以便进行背景化、验证并共同设计建议。
西澳大利亚金伯利地区的菲茨罗伊山谷。
有残疾生活经历的原住民社区成员（n = 7）以及健康和残疾支持服务提供者（n = 12）。
确定了八个主题：（1）原住民亲属制度是社区的优势，为残疾人士提供支持；（2）菲茨罗伊山谷的原住民将残疾视为一种社会建构；（3）西方残疾医学模式与原住民对残疾的看法不同；（4）菲茨罗伊山谷的原住民以各种方式看待不同类型的残疾；（5）菲茨罗伊山谷对胎儿酒精谱系障碍有较高认识，但仍需要更多教育；（6）关注残疾的功能需求和支持；（7）残疾服务的障碍；（8）使残疾服务去殖民化。社区共同设计的建议侧重于将菲茨罗伊山谷原住民对残疾的世界观置于中心位置。
需要使残疾服务去殖民化，以改善原住民和托雷斯海峡岛民社区获得服务的机会。这应包括调整当前西方的服务医学模式，以实现基于优势的诊断和支持服务，使其与原住民和托雷斯海峡岛民的亲属制度、文化和生存方式相一致。社区领导力必须在这一转变中发挥核心作用。
