Translation of culturally and contextually informed diabetes training for Aboriginal primary health care providers on Aboriginal client outcomes: Protocol of a cluster randomized crossover trial of effectiveness.

BACKGROUND: Indigenous populations globally have significantly high rates of type 2 diabetes compared to their non-Indigenous counterparts. This study aims to implement and evaluate the effectiveness of a culturally and contextually informed Aboriginal Diabetes Workforce Training Program on Aboriginal primary health care workforce knowledge, attitude, confidence, skill and practice relating to diabetes care. METHODS: A Cluster Randomised Crossover Control Trial with two arms (Group A and Group B) will be conducted with Aboriginal primary health care services in South Australia. These services primarily provide primary health care to Aboriginal and Torres Strait Islander people. All healthcare service sites will be randomised into groups A and B to receive the training program. The training program consists of three components: 1) Peer support network, 2) E-Learning modules and 3) onsite support. Aboriginal Health Workers of participating sites will be invited to participate in the monthly online peer support network and all chronic disease staff are eligible to participate in the E-Learning modules and onsite support. The Peer Support Network runs for the entirety of the study, 17 months. Training components 2 and 3 occur simultaneously and are 2.5 months in length, with a six-month washout period between the two randomised groups undertaking the training. All primary outcomes of the study relate to diabetes management in a primary health care settings and measure participants' knowledge, attitude, confidence, practice and skills. These will be collected at seven time points across the entire study. Secondary outcomes measure satisfaction of the peer support network using a survey, interviews to understand enablers and barriers to participation, health service systems characteristics through focus groups, and medical record review to ascertain diabetes patients' care received and their clinical outcomes up to 12 months post training intervention. DISCUSSION: The findings will explore the effectiveness of the training program on Aboriginal primary health care provider knowledge, attitude, confidence, skill and practice relating to diabetes care. The final findings will be published in 2027. TRIAL REGISTRATION: The study was prospectively registered in The Australian New Zealand Clinical Trials Registry (ANZCTR), with registration number ACTRN12623000749606 at ANZCTR - Registration. Universal Trial Number (UTN) U1111-1283-5257.

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners.

Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

Rural and remote pharmacists' perspectives of grey nomads with diabetes travelling in Australia.

OBJECTIVE: The objective of the research was to explore rural and remote pharmacists' experiences of encountering grey nomads with diabetes. DESIGN: A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically. SETTING: The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research. PARTICIPANTS: Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed. RESULTS: The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists' preparedness to support grey nomads with diabetes. CONCLUSION: The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

Understanding the planning and preparation for diabetes self-management of grey nomads when travelling in rural and remote Australia: An exploratory survey.

OBJECTIVE: Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. METHODS: Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. RESULTS: A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. CONCLUSIONS: A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.

Grey nomads with diabetes self-management on the road - a scoping review.

INTRODUCTION: This scoping literature review explored the characteristics and behaviours of a subset of Australia's older population: 'grey nomads', many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads' self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia's rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. METHODS: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. RESULTS: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were under-prepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. CONCLUSION: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.

Grey nomads with diabetes: the experience of rural and remote diabetes educators in South Australia.

The phenomenon of grey nomads travelling in rural and remote regions of Australia is on the increase, and as this cohort is an older age group, they are often travelling with chronic conditions, such as diabetes. Seven rural and remote diabetes educators were interviewed about their experiences of grey nomad travellers with diabetes, to whom they provided services. The findings revealed problems associated with grey nomads with diabetes, including maintenance of equipment, medications, self-management, glycaemic control and unpredictable events. The problems highlighted by the participants were exacerbated when travelling long distances for extended periods, often with changes to their usual regime of self-management. The isolation and remoteness of some areas was a factor for the travellers who were often not prepared and often turned to pharmacists for help. The participants were able to enhance the care and self-management of the travellers with diabetes and identified several pathways travellers may undertake if they needed services related to their diabetes. The diabetes educators' capacity to provide services for travellers was stretched at times; however, this was viewed as positive in that it added diversity to their normal practice. Recommendations included a preparation checklist and information for travellers with diabetes and further education for pharmacists.