Oral Presentation Lowitja Institute International Indigenous Health and Wellbeing Conference 2016

The patient experience in eye care study: Exploring accessibility through community voices and sociocultural determinants (#68)

Aryati Yashadhana 1 2 3 , Ted Fields (Jnr) 3 4 , Wendy Fernando 3 4 , Godfrey Blitner 3 4 , Kelvin Brown 3 4 , Ruby Stanley 3 4 , Francis Hayes 3 4 , Bridgette Jerrard 3 4 , Brian Donnelly 3 4 , Anthea Burnett 1 2 3 , Anthony B Zwi 5 6
  1. Brien Holden Vision Institute, Sydney, NSW, Australia
  2. School of Optometry & Vision Science, UNSW, Sydney
  3. Vision Cooperative Research Centre, Sydney
  4. Ninti One Ltd, NT
  5. School of Social Sciences, UNSW, Sydney
  6. HEARD@UNSW, Sydney

Preventable diseases are the leading cause of illness and mortality for Indigenous Australians, especially those living in remote areas (Vos et al, 2009). The alarming prevalence of diabetes among Indigenous adults (39% >55 years) (ABS, 2013) has raised the risk of diabetic visual impairment. While the availability and continued funding of remote health services has granted better physical access to eye care, this does not always translate into equitable eye health outcomes.

In collaboration with four Aboriginal Community Controlled Health Services (ACCHS) the Patient Experience in Eye Care (PEEC) study, aimed to explore the interface between structural and sociocultural determinants and human agency, in order to understand how they have an impact on (1) accessibility of eye health and chronic disease services and (2) the potential for positive clinical eye health outcomes.

We used Participatory Action Research methods, with an aim to privilege the voices of Indigenous people through community collaboration. Semi-structured interviews (n=89) and focus groups (n=8) were conducted by Indigenous Community Based Researchers (CBRs) (TF, WF, GB, RS, FH, KB, BJ, BD) with Indigenous adults (>40 years) living with diabetes, in four remote communities (NSW and NT). Interviews (n=25) and focus groups (n=4) with primary health care clinicians in each community were also conducted. Data were audio recorded, transcribed, and analysed thematically using grounded theory, comparative analysis and Nvivo 10. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural and contextual appropriateness to interpreting responses, and knowledge exchange.

Presented are the core findings of the PEEC study, which examine the concept of accessibility through an in depth understanding of the social and cultural determinants of health across the four sampled communities. Three core determinants were identified–economic disadvantage, health literacy/education, and cultural marginalisation–which affected accessibility of services and the potential for patients to achieve positive clinical outcomes at every level of care. Our findings highlight the clinical realities of institutionalised and structural inequities, illustrated through the lived experiences of Indigenous patients and primary care clinicians. Included are community recommendations to address barriers to accessibility, and identified knowledge gaps around diabetic eye health.

  1. Vos, T., Barker, B., Begg, S., Stanley, L. & A.D. Lopez 2009, ‘Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: the Indigenous health gap’, International Journal of Epidemiology, vol. 38, no. 2, pp. 470–77.
  2. Australian Bureau of Statistics, 2013. National Aboriginal and Torres Strait Islander Health Survey 2012-2013 (4727.0.55.004).