Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus

Authors: Jessica Conway, Sharon Lawn, Susan Crail, Stephen McDonald

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their ‘Country’ (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on ‘Country’, reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service.

Methods

Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck.

Results

The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role.

Conclusions

The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients.
Appendix
Available only for authorised users
Literature
1.
2.
Grace BS, Clayton P, Cass A, et al. Socio-economic status and incidence of renal replacement therapy: a registry study of Australian patients. Nephrol Dial Transplant. 2012;27:4173–80.CrossRef
3.
4.
Cass A, Cunningham J, Snelling P, Wang Z, Hoy W. Exploring the pathways leading from disadvantage to end-stage renal disease for indigenous Australians. Soc Sci Med. 2004;58:767–85.CrossRef
5.
6.
Cass A, Devitt K, Preece C, Cunningham J, Anderson K, Snelling P, Eris J, Ayanian J. Barriers to access by indigenous Australians to kidney transplantation: the IMPAKT study. Nephrology. 2004;9(Suppl 4):144–6.CrossRef
7.
8.
9.
Preston-Thomas A, Cass A, O’Rourke P. Trends in the incidence of treated end-stage kidney disease among indigenous Australians and access to treatment. Aust N Z J Public Health. 2007;31(5):419–21.CrossRef
10.
11.
12.
Le B, Kickett M. Dislocation and dialysis in aboriginal patients with renal failure. Aborig Isl Health Worker J. 2009;33(4):10–3.
13.
Anderson P. Priorities in Aboriginal Health. In: Robinson G, editor. Aboriginal health, social and cultural transitions: proceedings of a conference at the Northern Territory University, Darwin, 29–31 September, 1995. Darwin: NTU Press; 1996.
14.
Devitt J, McMasters A. “They don’t last long”: aboriginal patient experience of end-stage renal disease in Central Australia. Nephrology. 1998;4: Suppl:111–7.CrossRef
15.
Denhaerynck K, Manhaeve D, Dobbels F, et al. Prevalence and consequences of nonadherence to hemodialysis regimens. Am J Crit Care. 2017;16:222–35.
16.
Preece C. Developing a model of care to improve the health and wellbeing for indigenous people to receiving renal dialysis treatment. In: Masters by Research Thesis. Brisbane, Queensland: Queensland University of Technology; 2010. http://​eprints.​qut.​edu.​au/​37644/ Accessed 31 Dec 2017.
17.
Murdoch-Flowers J, Tremblay M-C, Hovey R, Delormier T, Gray-Donald K, Delaronde E, Macaulay AC. Understanding how indigenous culturally-based interventions can improve participants’ health in Canada. Health Promot Int. 2017. https://​doi.​org/​10.​1093/​heapro/​dax059.
18.
Chatwood S, Paulette F, Baker GR, Eriksen AMA, Lenert Hansen K, Eriksen H, Hiratsuka V, Lavoie J, Lou W, Mauro I, Orbinski J, Pambrun N, Retallack H, Brown A. Indigenous values and health systems stewardship in circumpolar countries. Int J Environm Res Public Health. 2017. https://​doi.​org/​10.​3390/​ijerph14121462.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Bessarab D, Ng’andu B. Yarning about yarning as a legitimate method in indigenous research. Int J Crit Indigenous Stud. 2010;3(1).
29.
Berry RSY. Collecting data by in-depth interviewing. British Educational Research Association Annual Conference. University of Sussex at Brighton; 1999.
30.
31.
Strauss AL, Corbin J. Basics of qualitative research: Techniques and procedures for developing grounded theory. 2nd ed. Thousand Oaks, California: Sage Publications; 1998.
32.
Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. London: Sage Publications; 2013.
33.
34.
Aspin C, Brown N, Jowsey T, Yen L, Leeder S. Strategic approaches to enhanced health service delivery for aboriginal and Torres Strait islander people with chronic illness: a qualitative study. BMC Health Serv Res. 2012;12:143.CrossRef
35.
Anderson I, Crengle S, Leialoha Kamaka M, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 2006;367(9524):1775–85.CrossRef
36.
Harris R, Cormack D, Tobias M, et al. The pervasive effects of racism: experiences of racial discrimination in New Zealand over time and associations with multiple health domains. Soc Sci Med. 2012;74(3):408–15.CrossRef
37.
Gao S, Manns BJ, Culleton BF, Tonelli M, Quan H, Crowshoe L, Ghali WA, Svenson LW, Ahmed S, Hemmelgarn BR. Access to health care among status aboriginal people with chronic kidney disease. Can Med Assoc J. 2008;179(10):1007–12.CrossRef
38.
Maar M, Erskine B, McGregor L, Larose TL, Sutherland ME, Graham D, Shawande M, Gordon T. Innovations on a shoestring: a study of a collaborative community-based aboriginal mental health service model in rural Canada. Int J Ment Health Syst. 2009. https://​doi.​org/​10.​1186/​1752-4458-3-27.
39.
Reeves A, Stewart SL. Exploring the integration of indigenous healing and western psychotherapy for sexual trauma survivors who use mental health services at anishnawbe health Toronto. Can J Coun Psychother. 2014;48:57–78.
40.
Castor ML, Smyser MS, Taualii MM, Park AN, Lawson SA, Forquera RA. A nationwide population-based study identifying health disparities between American Indians/Alaska natives and the general populations living in select urban counties. Am J Public Health. 2006;96(8):1478–84.CrossRef
41.
42.
43.
Castleden H, Bennett E. Pictou landing native Women’s group, Lewis D, Martin D. “put it near the Indians”: indigenous perspectives on pulp mill contaminants in their traditional territories (Pictou landing first nation, Canada)Progress in Community Health Partnerships. Res Educ Action. 2017;11(1).
44.
Harasemiw O, Milks S, Oakley L, Lavallee B, Chartrand C, McLoed L, Di Nella M, Rigatto C, Tangri N, Ferguson T, Komenda P. Remote dwelling location is a risk factor for CKD among indigenous Canadians. Kidney Int Rep 2018;825–32.
45.
46.
Dawson A, Russel A, Caponi A. Asthma project at Pika Wiya health services: identifying barriers and developing resources. Aborig Isl Health Worker J. 2003;27(5):20–2.
47.
48.
49.
Streak Gomersall J, Gibson O, Dwyer J, O’Donnell K, Stephenson M, Carter D, Canuto K, Munn Z, Aromataris E, Brown A. What indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Aust NZ J Public Health. 2017. https://​doi.​org/​10.​1111/​1753-6405.​12687.
50.
Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between aboriginal patients and healthcare workers. Med J Aust. 2002;176:466–70.PubMed
51.
Devitt J, McMasters A. Living on medicine: A cultural study of end-stage renal disease among Aboriginal people. Alice Springs: IAD Press; 1998.
52.
Stewart MA. Effective physician patient communication and health outcomes: a review. Can Med Assoc J. 1995;152:1423–33.
53.
Copeman RC. Assessment of aboriginal health services. Community Health Stud. 1988;12(3):251–5.CrossRef
54.
Brant JM, Fallsdown D, Iverson ML. The evolution of a breast health program for plains Indian women. Oncol Nurs Forum. 1999;26(4):731–9.PubMed
55.
Kelly J, Luxford Y. Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young aboriginal women in Adelaide. Collegian. 2007;14(3):15–20.CrossRef
56.
Downing R, Kowal E, Paradies Y. Indigenous cultural training for health workers in Australia. Int J Qual Health Care. 2011;23(3):247–57.CrossRef
57.
58.
59.
Bartlett B, Boffa J. Aboriginal community controlled comprehensive primary health care: the central Australian aboriginal congress. Aust J Primary Health. 2001;7(3):74–82.CrossRef
60.
Freeman T, Edwards T, Baum F, Lawless A, Jolley G, Javanparast S, Francis T. Cultural respect strategies in Australian aboriginal primary health care services: beyond education and training of practitioners. Aust N Z J Public Health. 2014;38(4):355–61.CrossRef
61.
62.
63.
DiGiacomo M, Abbott P, Davison J, Moore L, Davidson P. Facilitating uptake of aboriginal adult health checks through community engagement and health promotion. Qual Prim Care. 2010;18(1):57–64.PubMed
Metadata
Title
Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
Authors
Jessica Conway
Sharon Lawn
Susan Crail
Stephen McDonald
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3849-4

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Comparing public and private providers: a scoping review of hospital services in Europe

Research article

Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model

Research article

The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses

Research article

Healthcare middle managers` experiences developing leadership capacity and capability in a public funded learning network

Research article

Refer-to-pharmacy: a qualitative study exploring the implementation of an electronic transfer of care initiative to improve medicines optimisation following hospital discharge

Research article

Qualitative analysis of national documents on health care services and pharmaceuticals` purchasing challenges: evidence from Iran