| Abstract | Overview
The program of research presented in this thesis was designed to increase understanding of the central issues related to Indigenous peoples’ hospitalisation experiences. Emphasis was given to Indigenous peoples’ cardiovascular health care. This area was chosen because cardiovascular disease has been described as one of the major contributors to the health disparity between Indigenous and non-indigenous peoples in Australia. This was of interest to me because the main study setting is a cardiothoracic hospital. This hospital is the largest referral centre for cardiac conditions in Queensland, surrounding states, and neighbouring countries, including Papua New Guinea.
This program of research comprised four studies. The first study, a metasynthesis, was undertaken to gather a worldwide perspective of Indigenous peoples’ experiences of acute care. In the second study, a narrative inquiry was undertaken. It focused on Indigenous Australians’ experiences of acute cardiac care. The third study was a systematic review. It adopted a broader perspective to investigate the effectiveness of Australian Indigenous cardiovascular health programs. The final study, an autoethnography, utilised reflective inquiry to examine issues related to researching with Indigenous people. Background
There are many explanations given to explicate sources of health disparities for Indigenous people. Most of the factors have their roots in past colonialism and its policies. Past practices by former Australian governments devalued the Indigenous culture, tortured individuals both physically and psychologically, and effectively marginalised the Indigenous population. Indigenous people still experience elements of tacit and overt discriminatory practices within the healthcare system. A range of cultural and Indigenous-specific factors also impact Indigenous health in a negative way. As a result, Australian Indigenous people encounter noteworthy health inequalities when compared to non-Indigenous Australians. In recognition and response to this disparity in health status, the Australian government launched a “Close the Gap” campaign in 2008. The campaign attempts to narrow the health differences and life expectancy, while also considering other factors that impact Indigenous health such as education and employment opportunities.
Coming to hospital is a challenge for most Indigenous Australians. In Australia, Indigenous people are often geographically isolated in scattered settlements, and living in relatively small communities, leading to fragmented services and support for health and social programs. They are isolated both geographically and culturally when they come to hospital. In most cases, they have to relocate in order to access the services they need. This experience can be overwhelming due to the different culture of hospital practices and world views of healthcare professionals, who are mainly from westernised backgrounds. In most healthcare settings, Indigenous peoples’ culture and views of health have not been integrated into mainstream health. In a way, Indigenous people are forced to leave their way of life at home and adapt to western culture when hospitalised. This can cause discomfort for Indigenous people in many ways. As a result, some avoid accessing health services even when such services are needed and are available to them.
A few aspects of Indigenous culture may be presented in hospital settings but usually at tokenistic or symbolic levels. This includes items such as flags at the front of the hospital and Indigenous paintings on display. Health professionals’ attitudes, as well as the hospital policies that guide their practice, do not usually accommodate Indigenous values into practice. Bedside manners and ward practices have remained the same for many years – fashioned and practiced in the ways of the dominant culture.
In Australia, cardiovascular disease is known to constitute one of the major single causes of ill health and death for Indigenous peoples. As a result, it contributes significantly to life expectancy differentials between this population and other Australians. Indigenous Australians suffer major gaps in health status even when compared with other Indigenous peoples in other first-class nations. This includes Indigenous peoples from Canada, New Zealand and the United States of America. Health practitioners, therefore, need to be aware and proactively act on the underlying causes of poor health outcomes among Indigenous people. Methods
Four studies were conducted over the period of this program of research using qualitative and quantitative research methods. The first study was a metasynthesis of qualitative research studies. Its aim was to investigate current evidence of Indigenous peoples’ hospital experiences in order to summarise current knowledge. Systematic procedures were employed to retrieve studies from the period between 2000 to 2016. The review process was conducted following Joanna Briggs Institute (2014) guidelines for conducting systematic review and synthesis of qualitative data.
The second study utilised narrative inquiry, a qualitative methodology in which face to face interviews were used to enable participants to recount their experiences of hospitalisation. Narrative inquiry was selected specifically because it involves storytelling, which is culturally familiar to Indigenous people. The aim was to explore Indigenous peoples’ experiences of hospitalisation of acute cardiac care. To accomplish this, data were collected using a purposeful sample of Indigenous cardiac participants: all Indigenous patient participants had been hospitalised for acute cardiac care.
The third study was a systematic review. Its aim was to investigate the effectiveness of cardiovascular health care programs designed for Indigenous Australians. Analysis of the strategies that were used to achieve successful outcomes was conducted. Studies that used experimental designs and reported interventions or programs explicitly aimed at improving Indigenous cardiovascular health were considered for inclusion. The search period was between 2008 to 2017.
The fourth study was an autoethnography. This study involved use of personal diary-based data and reflective inquiry to present a researcher perspective of the experience of conducting research with Indigenous people. The aim was to share the experience to inform others of aspects for consideration when conducting research with Indigenous participants. The purpose was to offer a true picture of conducting research from my perspective. The study enabled examination of the interplay of my personal, social, professional life and how these impact on my clinical and research practice. Findings
The metasynthesis revealed that overall, Indigenous peoples, worldwide, have remained in a disadvantaged position when it comes to their health and wellbeing. Several factors were identified that contribute to widespread inequality in Indigenous healthcare. It was increasingly clear that current healthcare systems are not effectively working well in addressing Indigenous peoples’ health needs.
The findings of the narrative inquiry indicated that three themes characterised Indigenous peoples’ experiences of hospitalisation which were as follows: the impact of the past, reality of the present, and anticipating the future in Australia. Hospitalisation remains a challenge for Indigenous peoples. This is due to a sense of dislocation and lack of cultural and spiritual aspects to care, as well as the persisting poor relational interactions encountered.
Quantitative research studies that implemented interventions targeted for management of cardiac conditions among Indigenous population within Australia were included in the systematic review. The results revealed that there were limited published studies targeted specifically towards Indigenous Australians’ cardiac health improvement. However, positive outcomes were reported in terms of achieving clinical targets. Physical aspects such as blood pressure reduction, exercise attendance, and enhancing cardiac health knowledge in biomedical interventions for the Indigenous communities were the main focus.
The autoethnography revealed that with adequate preparation and involvement of Indigenous people the research process can be made easier. Again, because of past experiences which have led Indigenous people to be over researched with little feedback to them; researching this population group is challenging. Most researchers in the past have conducted research that has not effectively benefited the community. In some cases, research outcomes have misrepresented participants through use of methodologies that are not appropriate for Indigenous peoples. It is not unusual for Indigenous peoples to view the word “research” as a “dirty” word that brings uncomfortable feelings. In some instances, Indigenous participants have not seen its benefits of the research or understood the outcomes. Conclusions
In summary, the program of research appraised current evidence. Further, it presented new knowledge that can inform and support practitioners in their quest to progress Indigenous peoples’ healthiness and welfare. Highlighting issues from Indigenous peoples ’perspectives can facilitate development of a better understanding of issues that impact their experiences with healthcare institutions. Such revelations can help in the identification of limitations faced by health professionals or constraints they encounter in the delivery of healthcare among Indigenous people. This could assist in revealing issues that are barriers to being effective in designing and implementing effective strategies to improve Indigenous health and wellbeing. Further research is warranted to follow up on the issues identified in this research. |
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