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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Yarning about health checks: barriers and enablers in an urban Aboriginal medical service

Warren Jennings A B C D , Geoffrey K. Spurling B C and Deborah A. Askew B C
+ Author Affiliations
- Author Affiliations

A The Aboriginal and Torres Strait Islander Community Health Service, 55 Annerley Road, Brisbane, Qld 4102, Australia.

B The University of Queensland, Discipline of General Practice, Level 8, Health Sciences Building, The Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia.

C Inala Indigenous Health Service, 64 Wirraway Parade, Inala, Qld 4077, Australia.

D Corresponding author. Email: w.jennings@uq.edu.au

Australian Journal of Primary Health 20(2) 151-157 https://doi.org/10.1071/PY12138
Submitted: 24 October 2012  Accepted: 16 February 2013   Published: 4 April 2013

Abstract

The annual health check for Aboriginal and Torres Strait Islander People has been welcomed as a means of conducting a comprehensive assessment to address preventive health care delivery, identify new diagnoses and initiate new treatments. Rates of health check uptake across Australia have been poor with less than 12% of the eligible population receiving one during 2009/10. This qualitative study sought to identify barriers and enablers to undertaking health checks in an urban Aboriginal Medical Service through semistructured interviews with 25 clinical staff (doctors, nurses and Aboriginal and Torres Strait Islander health workers). Clinical systems for conducting health checks were unclear to staff, with barriers relating to time pressures for both patients and clinic staff, and lack of clarity about staff responsibilities for initiating and conducting the health check. Additionally some staff perceived some content as sensitive, invasive, culturally inappropriate and of questionable value. Other barriers included concerns about community health literacy, disengagement with preventative health care, and suspicion about confidentiality and privacy. The development of clear service-wide systems that support the conduct of health checks are required to increase uptake, combined with supportive local clinical leadership and audit and feedback systems. Staff training, consideration of culture and roles, and critical review of health check content may improve staff confidence and community acceptance. Community-based health education and promotion is strongly supported by staff to increase client engagement, knowledge and acceptance of the health check.

Additional keywords: assessment, indigenous, preventative, preventive, qualitative.


References

Abbott P, Close G (2002) Vascular health risks in the Aboriginal community. A cultural approach. Australian Family Physician 31, 605–610.

Australian Bureau of Statistics (2006) 4705.0 – population distribution, Aboriginal and Torres Strait Islander Australians, 2006. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4705.0Main+Features12006?OpenDocument [Verified 29 August 2012]

Australian Government Department of Health and Ageing (2011) Medicare health assessment for Aboriginal and Torres Strait Islander Peoples. Adult health assessment (15–54yo) proformas (MBS Item 715). Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mha_resource_kit [Verified 9 January 2013]

Australian Government Department of Health and Ageing (2012) Medicare Benefits Schedule – (MBS) health assessments MBS items 701, 703, 705, 707, 715 and 10986 – fact sheet. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare_mbsitem_general_factsheet [Verified 9 January 2013]

Barnett L, Kendall E (2011) Culturally appropriate methods for enhancing the participation of Aboriginal Australians in health-promoting programs. Health Promotion Journal of Australia 22, 27–32.

Brady M, Sibthorpe B, Bailie R, Ball S, Sumnerdodd P (2002) The feasibility and acceptability of introducing brief intervention for alcohol misuse in an urban aboriginal medical service. Drug and Alcohol Review 21, 375–380.
The feasibility and acceptability of introducing brief intervention for alcohol misuse in an urban aboriginal medical service.Crossref | GoogleScholarGoogle Scholar | 12537708PubMed |

Brough M, Bond C, Hunt J (2004) Strong in the City: towards a strength-based approach in Indigenous health promotion. Health Promotion Journal of Australia 15, 215–220.

Clifford A, Shakeshaft A, Deans C (2012) How and when health-care practitioners in Aboriginal community controlled health services deliver alcohol screening and brief intervention, and why they don’t: a qualitative study. Drug and Alcohol Review 31, 13–19.
How and when health-care practitioners in Aboriginal community controlled health services deliver alcohol screening and brief intervention, and why they don’t: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 21426422PubMed |

Coleman JJ, Spurling GK, Askew DA, Hayman NE (2011) Indigenous child health checks: the view from the city. The Medical Journal of Australia 194, 535–536.

Couzos S, Delaney Thiele D (2009) Closing the gap depends on ACCHSs. The Medical Journal of Australia 190, 541

Digiacomo M, Abbott P, Davison J, Moore L, Davidson PM (2010) Facilitating uptake of Aboriginal adult health checks through community engagement and health promotion. Quality in Primary Care 18, 57–64.

Dryden R, Williams B, McCowan C, Themessl-Huber M (2012) What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health 12, 723
What do we know about who does and does not attend general health checks? Findings from a narrative scoping review.Crossref | GoogleScholarGoogle Scholar | 22938046PubMed |

Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O (2004) Diffusion of innovations in service organizations: systematic review and recommendations. The Milbank Quarterly 82, 581–629.
Diffusion of innovations in service organizations: systematic review and recommendations.Crossref | GoogleScholarGoogle Scholar | 15595944PubMed |

Hansen EC (2006) ‘Successful qualitative health research: a practical introduction.’ (Allen & Unwin: Sydney)

Harvey D, Tsey K, Cadet-James Y, Minniecon D, Ivers R, McCalman J, Lloyd J, Young D (2002) An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland. Australian and New Zealand Journal of Public Health 26, 426–431.
An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland.Crossref | GoogleScholarGoogle Scholar | 12413286PubMed |

Hayman N (2010) Strategies to improve indigenous access for urban and regional populations to health services. Heart Lung and Circulation 19, 367–371.
Strategies to improve indigenous access for urban and regional populations to health services.Crossref | GoogleScholarGoogle Scholar |

Kehoe H, Lovett RW (2008) Aboriginal and Torres Strait Islander health assessments – barriers to improving uptake. Australian Family Physician 37, 1033–1038.

Mayers NR, Couzos S (2004) Towards health equity through an adult health check for Aboriginal and Torres Strait Islander people: an important Australian initiative that sets an international precedent. The Medical Journal of Australia 181, 531–532.

McMasters A (1996) Research from an aboriginal health worker’s point of view. Australian and New Zealand Journal of Public Health 20, 319–320.
Research from an aboriginal health worker’s point of view.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zkvFGmsw%3D%3D&md5=cecf7ab84564613223d7087e73ea5d2aCAS | 8768425PubMed |

Miller G, McDermott R, McCulloch B, Leonard D, Arabena K, Muller R (2002) The well person’s health check: a population screening program in indigenous communities in north Queensland. Australian Health Review 25, 136–147.
The well person’s health check: a population screening program in indigenous communities in north Queensland.Crossref | GoogleScholarGoogle Scholar | 12536873PubMed |

Murray RB (2008) Organising prevention. In ‘Aboriginal primary health care: an evidence-based approach’. (Ed. A Mulvaney.) pp. 114–130. (Oxford University Press: Melbourne)

NACCHO/RACGP (2012) ‘National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.’ 2nd edn. (RACGP: Melbourne)

Panaretto K, Coutts J, Johnson L, Morgan A, Leon D, Hayman N (2010) Evaluating performance of and organisational capacity to deliver brief interventions in Aboriginal and Torres Strait Islander medical services. Australian and New Zealand Journal of Public Health 34, 38–44.

Patton MQ (2002) ‘Qualitative research and evaluation methods.’ (Sage Publications: Thousand Oaks, CA)

QSR International Pty Ltd (2010) NVivo qualitative data analysis software; version 9. Melbourne. Available at http://www.qsrinternational.com [Verified 7 March 2013]

Richards L (2009) ‘Handling qualitative data: a practical guide.’ (Sage Publications Inc: Thousand Oaks, CA)

Ridoutt L, Pilbeam V, Lee K (2010) Aboriginal health worker profession review. Northern Territory Department of Health and Families, Darwin. Available at http://www.healthinfonet.ecu.edu.au/health-systems/health-workers/publications/key-references [Verified 29 August 2012]

Russell L (2010) Indigenous health checks; a failed policy in need of scrutiny. Available at http://www.menzieshealthpolicy.edu.au/other_tops/pdfs_research/ATSIhealthchecks.pdf [Verified 29 August 2012]

Spurling GK, Hayman NE, Cooney AL (2009) Adult health checks for Indigenous Australians: the first year’s experience from the Inala Indigenous Health Service. The Medical Journal of Australia 190, 562–564.

Urbis Keys Young (2006) Aboriginal and Torres Strait Islander access to major health programs. Final report. (Urbis Keys Young: Sydney) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/3C4FDA1E7B3C6713CA25722C0016CB95/$File/accesshealthprograms.pdf [Verified 29 August 2012]