Indigenous Health Research Monitoring, March 2021

In this issue:

Descriptive Section

  List of scientific publications and articles

Analytical Section

Social health inequalities

Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences

Jones, B., Heslop, D. & Harrison R. (2020). Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International Journal for Equity in Health, 19, 222.

Context

Aboriginals and Torres Strait Islanders in Australia face social health inequalities that can be exacerbated by the quality of health services they receive. Patients’ experience with the health system is a major factor contributing to the quality of health services and the perceived results.

Objectives

The objectives of this systematic literature review were to:

  • Understand the lived experiences of Aboriginals and Torres Strait Islanders within the Australian healthcare system;
  • Identify shortcomings of the methods used to collect data about patient experiences.

Methodology and data

Given the qualitative nature of the extracted data, a meta-narrative approach was used. The aim of this approach was to develop a storyline based on the results of the studies. Each study was associated with a research tradition and an academic discipline, determined by the research team.

A total of 54 articles were included from the fields of medicine, nursing, public health and Indigenous public health. The selected articles used different methods to collect data about patient experience: sharing circles, semi-structured interviews and surveys.

What was learned?

Three main themes emerged from the analysis:

  • The main differences in the concepts of wellbeing, health and service delivery between the Western model and the Aboriginals and Torres Strait Islanders holistic model pertain to social, mental, spiritual and community health needs.
  • Developing the trust of Aboriginals and Torres Strait Islanders in the healthcare system generally and in service providers specifically is of the utmost importance. In Australia, this sense of trust is impacted not only by personal experiences, but by the experiences of community members and hearsay.
  • Positive Aboriginals and Torres Strait Islanders experiences with the Australian health system are associated with various factors, including open, respectful and culturally sensitive communication. Medical jargon is broken down into concepts that patients can understand, while linguistic barriers are removed, and time restrictions reduced. Adapting the physical environment also fosters positive experiences.

In order to implement actions to improve the experience of Aboriginals and Torres Strait Islanders peoples with the Australian healthcare system, university health programs need to improve training on approaches rooted in cultural safety. Moreover, it would be appropriate to develop strategies to better take into account and measure the experience of Aboriginal peoples with the healthcare system.

Limitations

Criteria used in the literature review, including selecting only articles that had been peer-reviewed, may have influenced results. Researcher perspectives may also have had an impact on the concepts that emerged and the themes that were developed. Finally, the study’s conclusions cannot be applied to all communities, given their diversity.

Alzheimer’s disease and related dementia in Indigenous populations: a systematic review of risk factors

Walker, J. D., Spiro, G., Loewen, K., & Jacklin, K. (2020). Alzheimer’s disease and related dementia in Indigenous populations: a systematic review of risk factors. Journal of Alzheimer’s Disease, 78(4), 1439‑1451.

Context

In Canada, it is estimated that the number of people suffering from Alzheimer’s disease and related dementia will double in the next 25 years. The proportion of people affected is expected to rise more rapidly among Indigenous populations than among non-Indigenous populations, and the initial symptoms of the disease will appear at a younger age. The disease often results from a combination of genetic and environmental risk factors. However, fewer than 5% of Indigenous patients with Alzheimer’s disease receive a diagnosis of hereditary illness, suggesting the presence of a multitude of other risk factors.

Objectives

The purpose of this systematic literature review was to explore modifiable and non-modifiable risk factors for Alzheimer’s disease and related dementia among Indigenous populations. The authors adopted a holistic health perspective and used an approach based on life trajectory to understand risk and protective factors for the disease. This approach aimed to determine the effects of various life events on neurocognitive growth and decline.

Methodology and data

A systematic search of articles in the Medline, Embase and PsychINFO databases was used to build a corpus of peer-reviewed scientific articles published between 2007 and 2018. Of that corpus, 13 sources were selected. The authors applied a quality assessment process to the selected articles.

The analysis presented in the articles pertained to quantifiable risk factors, either modifiable or non-modifiable.

What was learned?

The authors identified a total of 14 different modifiable risk factors in the selected articles. The most statistically significant and most cited risk factors in the selected articles were: low level of education, comorbid cardiovascular disease, hypertension and head injury. The authors point out that certain modifiable risk factors may be related to conditions occurring earlier in life. For example, intrauterine factors such as maternal obesity and gestational diabetes predispose children to certain cardiovascular diseases.

Only two non-modifiable risk factors were identified in the review: age and male sex. The researchers emphasize that the large number of modifiable risk factors compared with non-modifiable risk factors shows the importance of life context in the disease’s development. A tendency to prioritize genetic explanations over social ones may distract attention from proximal, intermediate and distal health determinants that are modifiable.

Limitations

The authors report that due to the heterogeneity of measurement methods, a meta-analysis of risk factors could not be conducted. They point out that the inclusion criteria used to select studies for the review did not allow all Indigenous populations to be represented.

Finally, while Indigenous populations around the world may face similar challenges when it comes to health, the researchers remind us that considerable diversity exists with respect to Indigenous cultures and experiences with colonialism, raising concerns about the external validity of the models described in this review.

Early childhood and child development (0–5 years of age)

Improving antenatal engagement for Aboriginal women in Australia: a scoping review

Simpson, N., Wepa, D., & Bria, K. (2020). Improving antenatal engagement for Aboriginal women in Australia: A scoping review. Midwifery, 91, 102825.

Context

According to the scientific literature, Aboriginal women are less engaged in prenatal services than non‑Aboriginal women because of inequitable access to health services. In Australia, an Aboriginal woman is 10 times more likely not to use various prenatal services than is a non‑Aboriginal woman. In addition to inequalities in the health services offering, a multitude of other obstacles exist, including a lack of transportation and language barriers.

A patient’s prenatal engagement is essential to ensure the health and wellbeing of the mother and baby, as well as to provide adequate care.

Objectives

The objective of this scoping review was to map all known literature on the prenatal engagement of Aboriginal women in Australia in order to:

  • Identify facilitators of and barriers to the engagement of Aboriginal women in prenatal services;
  • Describe how culturally adapted services influence engagement in prenatal care.

Methodology and data

A research in five databases, plus Google Scholar, identified a body of peer-reviewed scientific articles published between 2009 and 2019. Nine articles were included in this review: three qualitative studies, three quantitative studies and three mixed-methods studies.

What was learned?

Several barriers to prenatal engagement must be overcome by Aboriginal women in Australia. Geographical distance from services, travel to a hospital or service centre outside the community, low socioeconomic status, pregnancy at a young age, smoking, limited social support, and fragile mental health were all barriers identified in the article.

Several facilitators of prenatal engagement were also identified. The possibility of giving birth in the community and the availability of transportation to appointments are two examples. Home visits, the presence of Aboriginal care providers, protection of privacy and confidentiality, reminders of appointments, involvement of the community in maternal programs, and the participation of the mother in decision making were also mentioned by the researchers.

Several studies mention cultural safety as a determinant in the engagement of Aboriginal women in prenatal services. Aboriginal culture—including traditions, beliefs and the way they view their health—is an integral part of Aboriginal identity and must be taken into consideration when designing services.

Limitations

The study underscores a dearth of literature about facilitators of and barriers to prenatal engagement among Aboriginal women in Australia. Despite a rigorous and transparent methodology, the review is relatively small, which may affect the results. Furthermore, the validity of the selected articles was verified by only one researcher.

Finally, several of the studies included in the review were subject to recall bias, as the data was collected more than nine months after the birth.

Methodology and knowledge

What do you mean by engagement? – evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations – scoping review

Wali, S., Superina S., Mashford-Pringle A., Ross H., & Cafazzo J. A. (2021). What do you mean by engagement? – evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations – scoping Review. International Journal for Equity in Health. 20,8.

Context

The prevalence of chronic diseases among Indigenous populations has increased considerably over the last decade. An understanding of the local context and problems faced in accessing health services is essential to improving the health and wellbeing of Indigenous populations. To achieve this, researchers are increasingly using community engagement methods, including participatory research, to build partnerships with Indigenous peoples for designing and implementing chronic disease-based interventions.

Objectives

The purpose of this study was to examine researchers’ level of community engagement in designing or implementing interventions targeting Indigenous populations dealing with chronic diseases.

Methodology and data

A scoping review was conducted using a methodological framework based on a five-phase iterative review process: 1) formulation of the research question; 2) search for relevant studies; 3) study selection; 4) data extraction; and 5) summary and reporting of results. A total of 23 studies were included.

What was learned?

Despite the known benefits of community engagement by researchers, this study shows that levels of engagement vary and that few studies adequately use participatory research methods. Selected studies range from involving community members at various stages in the research process to only at the report approval stage by an elder or local Indigenous ethics committee.

In the same way, community empowerment has been identified as a key factor in the uptake and longevity of an intervention, but few studies took this into account. Evaluating research objectives, approving or refusing methods, suggesting alternatives, and ensuring that the community can make informed decisions are at the heart of a population’s wellbeing and the establishment of trust in the relationship with researchers.

The absence of standards concerning minimum community engagement efforts required to appropriately conduct research with Indigenous peoples has led researchers to rely on their own understanding of what a sufficient level of community engagement means in the context of their research.

In order to improve participatory research with Indigenous populations, researchers should concentrate on developing ongoing, flexible partnerships with the community. This makes it possible to evaluate community research goals and draw on the strength of Indigenous knowledge. Moreover, in order to ensure that the reactions of the community are correctly understood and taken into account, researchers should meet with the community at various stages during the implementation of an intervention.

Limitations

The scoping review was limited by the number of studies that met the research criteria.

Some studies may not have been identified: those without a keyword pertaining to participatory research or community engagement, as well as those not making reference to participatory research efforts.

The information selected expresses the opinion of the authors quoted and not that of the INSPQ. The methodology for monitoring research into Indigenous health is available here.

The French version is entitled Veille scientifique en santé des Autochtones.
Translation by Services d’édition Guy Connolly.