What barriers might be present when providing services for Aboriginal and Torres Strait Islander people?

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This guide identifies barriers to health service use for Aboriginal and Torres Strait Islanders and provides recommendations for improved access to health services. It also includes health promotion activities to encourage health service participation.

"It is important to provide males with appropriate health services that meet their cultural and gender-specific needs to encourage them to access health services more regularly..."

These recommendations are particularly relevant to health services working with Aboriginal and Torres Strait Islander men, but may also be relevant to other health services seeking to improve accessibility and engagement with males.

Overview

Aboriginality and low socio-economic status place Aboriginal and Torres Strait Islander males as the most disadvantaged population group in Australia in terms of physical well-being. The underutilisation of health services by Aboriginal and Torres Strait Islander males is a contributing factor to the poor state of Aboriginal and Torres Strait Islander male health in Australia.

Key Systemic Barriers to Health Service Use:

• General issues - distance to health services, transport, cost, racism, problems with Medicare cards, long waiting times, having to go to hospitals in the city for specialist services and dying away from “country” and other issues (affecting all Aboriginal and Torres Strait Islander people);
• Cultural issues - lack of cultural understanding by health staff, lack of culturally specific Aboriginal and Torres Strait Islander medical services, language barriers, specific “skin” relationships to clinic staff and others; having to go to hospitals in the city for specialist services and dying away from “country” and other issues (affecting all Aboriginal and Torres Strait Islander people.
• Specific male issues - gender-specific access, separate location, male Aboriginal and Torres Strait Islander health workforce, male-specific “places”, clinic or service, specialist male services including counselling/mental health/sexual problems.

Key Recommendations for Improved Access to Health Services:

• A gender-specific and cultural approach that meets the needs of males.
• Having more male health staff (doctors and nurses), male health coordinators, and male counselling programs where possible to support males and to encourage access to health services.
• Extending clinic hours (outside of normal business hours) and displaying male health material.

Key Health Promotion Activities to Encourage Health Service Participation:

• Well Men’s Check Program – aims to facilitate AHWs to conduct health checks on all males over 15 years of age in their community
• 
  Pit Stop Program uses a car analogy and concept of regular maintenance to maintain health.
• Medicare Benefits Scheme(MBS)
  
    – Health Assessments for Aboriginal and Torres Strait Islander Australians.
• Chronic Disease Management(CDM)
  
    GP services enable GPs to plan and coordinate the health care of patients with chronic medical conditions, including multidisciplinary, team-based care from a GP and at least two other health or care providers.
• National Bowel Screening program
  
    Free bowel cancer screening test kits are provided to all Australians in the year they turn 50, 55, 60 or 65.
• Health promotion in different settings - Taking health promotion activities to where males are and feel more comfortable, rather than expecting them to come to the service, can help encourage males to think about their health. Health promotion activities (eg male health information sessions, display of male health information) can be provided in a range of settings, such as sporting clubs, pubs, local betting shops and other male venues.

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Volume 4, Issue 4, December 2017, Pages 207-210

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This article seeks to address some of the factors, particularly cultural barriers, contributing to inequity in healthcare service provisions for indigenous Australians. Furthermore, this article presents ways for healthcare professionals to take action on culture-related health equity issues. Finally, this article addresses what nurses can do to support more operational interventions and enhance the quality of services for indigenous Australians and Torres Strait Islanders.

Recently, scholarly literature in Australia has focused on the issue of ensuring equitable access to healthcare for aboriginal Australians and Torres Strait Islanders, who are regarded as economically, socially, politically and culturally disadvantaged (Larkins et al, 2016; Lowell, 2013).1, 2 However, in spite of significant efforts on the part of the Australian government, scholars, policy makers and communities to provide fair and equitable healthcare, this challenging and longstanding issue remains unresolved and needs to be addressed immediately (Australian Institute of Health and Welfare, 2015; Australian Bureau of Statistics (ABS), 2011).3, 4

Using the Population, Intervention and Outcome framework, several databases (PUBMED, MEDLINE, and SCOPUS) and government web-based literature resources were searched to identify original research articles published from 2000 to 2016.

Health inequity exists among aboriginal Australians and Torres Strait Islanders, and the cultural barriers are vital factors in addressing aboriginals' health inequity. Healthcare professionals could be part of an effective solution for diminishing racial/ethnic disparities in healthcare. Different types of nurses could play different roles in addressing aboriginal cultural barriers among aboriginal Australians and Torres Strait Islanders.

Nurses are uniquely positioned to initiate and sustain contact with aboriginal Australians and Torres Strait Islanders in healthcare workplaces, as they can intervene at the points of greatest need in the community to address socially significant healthcare and social issues.

The different roles of nurses in providing health and social care interventions to aboriginal Australians and Torres Strait Islanders could be utilized to increase equity in access to healthcare and help aboriginals attain better levels of health.

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From: The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: a multiple case study