Seeking health care was often based on acute need rather than proactive or preventive care; however, participants recognised that providing health education and health promotion should be a priority for the service.
- Improving youth engagement seems to be central to increasing acceptability and, hence, use. This requires that staff able to engage with young people are recruited, trained, and retained. More immediately, a range of simpler changes to service provision focus and environment for young people could potentially make important differences.
Warwick S, Atkinson D, Kitaura T, LeLievre M, Marley JV. Young Aboriginal People’s Perspective on Access to Health Care in Remote Australia: Hearing Their Voices. Prog Community Health Partnersh 2019; 13:171-181.
- Dr Susannah Warwick, RCSWA Derby
- A/Professor Julia Marley, RCSWA
- Tracey Kitaura, DAHS
- Matthew LeLievre, DAHS
- Professor David Atkinson, RCSWA
The NINI HELTHIWAN project: Improving Primary Care for Aboriginal mothers and babies in the Kimberley region of Western Australia
Providing quality health care for pregnant women and young children in remote areas is both vitally important and challenging. We are conducting three inter-related research projects that will contribute to the development of a regional enhanced model of primary health care for Aboriginal pregnant women and mothers of young children.
Nini regional midwife coordinators are helping to improve the support of primary care providers who are caring for Aboriginal mothers through a peer led process [telephone assistance, email, clinic visits]. Nini Helthiwan is using a randomised stepped wedge cluster design to provide this extra support by:
- Improving guidelines and training tools for regional priorities:
- Maternal nutrition, and substance abuse [alcohol and cigarette smoking]
- Social and emotional wellbeing [Kimberley Mum’s Mood Scale (KMMS)]
- Treatment and follow up practices for maternal and infant anaemia [iron infusion policy]
- Early infant care practices [breastfeeding, bonding, attachment]
- Assistance with problem solving and follow up [referrals, care-co-ordination, discharge planning]
- Assistance with implementing regional guidelines:
- Screening for perinatal anxiety and depression [Implementing the KMMS Study]
- Screening for gestational diabetes [ORCHID Study]
- On the job education and training, including assistance with use of electronic primary care systems.
To see if improvements in health care leads to improved health outcomes Nini regional child health workers (located in West and East Kimberley), are assessing neurodevelopment and anaemia levels in Kimberley Aboriginal babies and anaemia levels in their mothers when the baby is 6-10 months old.
Progress so far:
Australian pregnancy care guidelines note the importance of culturally safe care, but this is not always assured for Aboriginal women. Studies exploring Aboriginal women’s antenatal care experiences in various locations have identified local strengths and priority areas. Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015–2018 provided qualitative data during the Nini health assessment or standalone interview with an Aboriginal researcher. Most women expressed that overall they had a positive antenatal care experience. Key themes were:
- importance of positive relationships with antenatal care providers,
- the valuable role of family support during the antenatal period,
- challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services including high staff turnover.
- Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles.
The experiences shared by these Kimberley women add to evidence from other parts of Australia, showing a need to improve culturally safe antenatal care for all Aboriginal women. This includes having more local Aborig