ABSTRACT Introduction Oral diseases have a severe impact on rural and remote Indigenous communities of Australia with widespread, severe dental caries leading to a significant number of Indigenous children requiring multiple dental extractions under general anaesthesia each year; a scenario rarely seen elsewhere in Australia. This burden of oral disease occurs in these communities in the context of very limited availability of dental personnel and access to oral health care. The rural and remote Indigenous communities of Australia rely on Indigenous Health Workers as key primary health care personnel. Experience in Western Australia and the Northern Territory suggests that the oral health role of these personnel can be developed to improve community oral health and reduce the burden of oral disease in Indigenous communities. The development of the Indigenous Health Worker oral health role is supported by major stakeholders including: the peak Indigenous health organisation, the National Aboriginal Community Controlled Health Organisation; the peak dental health organisation, the Australian Dental Association; and by Australia’s National Oral Health Plan. Yet limited progress has been made in the development of this role. Why? This case study seeks to answer this question through the exploration of the complex, multiple factors influencing the development of the oral health role of Indigenous Health Workers in the Cape York region and so support the development of this role among Indigenous Health Workers. Methodology This research was conducted in accordance with the National Health and Medical Research Council’s Statement and Guidelines for ethical conduct of Indigenous health research. Ongoing consultation took place with key Indigenous health organisations of the region. including Apunipima Cape York Health Council, Gurriny Yealamucka Health Service and the Queensland Aboriginal and Torres Strait Islander Health Worker Training Aboriginal Corporation, to confirm that the research focus was a priority of the communities of the region and to gain input into the design and implementation of the project. With the support of these Indigenous health organisations the study focused on the three communities in which an initial introduction to oral health promotion was provided to Indigenous Health Workers by Queensland Health through its Crocodile Smiles Project. Qualitative methodologies were used with data collection in the region undertaken through semi-structured interviews with 58 health personnel in the remote Indigenous communities of Hopevale, Napranum and Yarrabah; and in the regional centres of Cairns, Cooktown and Weipa. These interviews explored the perceptions of Indigenous Health Workers, dental personnel and their co-workers regarding the priority, characteristics and support needs of the development of the Indigenous Health Worker oral health role in the region. Results Interviews with rural and remote health personnel highlighted the severe impact of oral disease in these communities and on their health services and the high priority given to the development of the Indigenous Health Worker oral health role. These health personnel are seen as key to Indigenous health promotion in the region. Contrasting perspectives were found among rural and remote health personnel regarding the characteristics of an appropriate Indigenous Health Worker oral health role with consistent support being given to the development of the oral health promotion role and varied perspectives found concerning the development of a clinical oral health role. Rural and remote health personnel also highlighted the significant barriers to the development of the Indigenous Health Worker oral health role existing at the clinic and regional levels. Conclusion This study identifies drivers of role development as including oral health needs and oral health skills shortages in rural and remote Indigenous communities of Cape York. Facilitators to role development were found to include: the legislative and policy environment; the support of Indigenous Health Workers and their co-workers; and the policies and plans of Queensland Health and the Indigenous Community Controlled Health Organisations of the region. Significant barriers include: the existing work burden of Health Workers; the lack of clarity of Health Worker role definition; and the difficulties inherent in the development of appropriate inter-professional and cross-cultural training and management support strategies which are able to be implemented in remote settings. The research highlights the complexity of factors to be considered in achieving the system¬wide changes needed to support the development of this role and makes recommendations in the areas of policy, training, management and research to best support the development of this role. In focusing on the development of the oral health role of Indigenous Health Workers the study has examined an area of significance to the Indigenous community using culturally sensitive research methods in remote settings and has addressed a significant though little explored area of dental research – the development of the oral health role of non-dental personnel.
| Identifer | oai:union.ndltd.org:ADTP/279248 |
| Creators | David Walker |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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