RESUMEN
CLINICAL RELEVANCE: Development of an Indigenous eye health framework could offer the opportunity for eye health professionals to enhance engagement with Indigenous populations. BACKGROUND: Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Maori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Maori experience and engagement with eye health services. This study seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles. METHODS: Qualitative methodology, guided by Indigenous Maori research principles, was used to evaluate interviews with five leading senior Maori academics surrounding the ongoing development and refinement of a Kaupapa Maori (Maori worldview centric) framework for eye care in Aotearoa New Zealand, created following Maori health consumer consultation. Interviews were semi-structured and analysed using reflexive thematic analysis. RESULTS: Seven key themes arose in relation to the development of a Kaupapa Maori framework for eye care in Aotearoa New Zealand: 1) vision is critical to Maori well-being, 2) cultural safety is important, 3) Maori health beliefs must be upheld, 4) achieving pae ora (healthy futures) is important, 5) key concepts and focus of the framework must be clear, 6) purakau (traditional Indigenous stories) are valuable resources in developing health frameworks and 7) embedding Matariki (fundamental Maori) principles is valuable. CONCLUSIONS: Using Kaupapa Maori principles allowed development and refinement of a framework that encourages clinicians to consider Indigenous health principles when engaging with Maori patients who seek eye care. Application of this framework may contribute to enhancing cultural safety and responsiveness of eye care for Maori.
RESUMEN
BACKGROUND: Indigenous peoples experience worse eye health compared to non-Indigenous peoples. Service providers and researchers must avoid perpetuating this inequity. To help achieve this, researchers can use the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples (CONSIDER) statement. This study aimed to identify the degree to which the CONSIDER statement has been used by eye health researchers when conducting and reporting research with an Indigenous component, and how they perceive its relevance in their future research. METHODS: We used purposive sampling to recruit eye health researchers from any country who have undertaken research with an Indigenous component. The online survey collected quantitative and qualitative data and was analysed using descriptive statistics and reflexive thematic analysis. Responses were gathered on a four-point Likert scale (1 to 4), with four being the most positive statement. RESULTS: Thirty-nine eye health researchers from nine countries completed the survey (Aotearoa New Zealand, Argentina, Australia, Brazil, Canada, Colombia, Guatemala, Panama, Peru); almost two-thirds (n = 24) undertake epidemiological research. On average, participants disclosed only 'sometimes' previously reporting CONSIDER items (2.26 ± 1.14), but they thought the items were relevant to eye health research and were motivated to use these guidelines in their future research. Some participants requested clarity about how CONSIDER aligned with existing guidelines, and when and how to apply the statement. Others shared rich experiences of the benefits to their research of Indigenous leadership and collaboration. CONCLUSIONS: The CONSIDER statement is perceived as a valuable tool by these eye health researchers, and there are opportunities to maximise uptake and use, including increasing awareness of the statement, clarity about when it applies, and availability of institutional-level support.
Asunto(s)
Pueblos Indígenas , Humanos , Encuestas y Cuestionarios , Investigadores , Oftalmología , Masculino , Femenino , Proyectos de Investigación , Investigación Biomédica/normas , Servicios de Salud del IndígenaRESUMEN
CLINICAL RELEVANCE: Vision Bus Aotearoa is a fully equipped mobile eye health clinic designed to provide a novel platform for undergraduate optometry clinical training, community eye health research and deliver services to underserved communities. BACKGROUND: Aotearoa New Zealand has inequitable access to eye health care. Vision Bus Aotearoa aims to work in partnership with communities to provide comprehensive mobile primary eye health care services while training optometry students, and integrating community eye health research. METHODS: A description is provided of the governance model which has been involved throughout the project. RESULTS: The process of vehicle manufacture, clinical set-up, funding models and service delivery are described. The aims of the project are detailed in terms of optometry teaching, clinical services in partnership with communities, and research integration and implementation. CONCLUSION: Vision Bus Aotearoa represents a valuable opportunity to deliver mobile eye health care to historically underserved communities, enhance undergraduate optometry teaching and to provide a unique platform for community eye health research.
Asunto(s)
Atención a la Salud , Optometría , Humanos , Optometría/educación , Educación en Salud , Salud Pública , Nueva ZelandaRESUMEN
CLINICAL RELEVANCE: Efforts to provide accessible eye care must consider the extent to which travel-distance may be a barrier for some communities. BACKGROUND: This study aimed to determine the distribution of - and geographic access to - eye health services in Aotearoa New Zealand. We further sought to identify communities who might benefit from provision of eye health services that were more geographically accessible. METHODS: We obtained addresses of optometry and ophthalmology clinics from regulatory bodies and augmented this with online searches. Address locators were created using a Land Information dataset and geocoded using ArcGIS 10.6. A national population was derived using Statistics New Zealand's Integrated Data Infrastructure. We generated population-weighted centroids of each of New Zealand's 50,938 meshblocks and calculated the travel distance along the road network between each clinic and population (meshblock centroid). The proportion of the population living >50 km from each clinic type was calculated; as was the median, inter-quartile range and maximum distance across area-level deprivation quintiles in each district. RESULTS: A national population of 4.88 million was identified, as were addresses for 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Nationally and within each district, travel distance to optometry was shorter than to either type of ophthalmology clinic. The region of Northland - with a high proportion of the population Maori and in the highest quintile of area-level deprivation - had the furthest average distance to travel to optometry and public ophthalmology, while the West Coast region on the South Island had the farthest to travel to private ophthalmology. Several communities were identified where longer distances intersected with higher area-level deprivation. CONCLUSION: Most New Zealanders live within 10 km of eye health services. However, to achieve equitable eye health, strategies are required that make affordable eye health services accessible to communities for whom large travel distances intersect with high deprivation.
Asunto(s)
Oftalmología , Optometría , Humanos , Accesibilidad a los Servicios de Salud , Nueva Zelanda , Servicios de SaludRESUMEN
Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Maori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.