Issues that impact on Aboriginal health workers' and registered nurses' provision of diabetes health care in rural and remote health settings.

UNLABELLED: Type 2 diabetes mellitus is an established health problem for Indigenous Australians. One strategy to address this issue is to educate health professionals in diabetes management and education. OBJECTIVE: The objective of this paper is to identify important issues that compromise the clinical practice of rural and remote Aboriginal health workers (AHWs) and registered nurses (RNs) who undertook an accredited Australian Diabetes Educators Association diabetes course and to suggest strategies to improve practice. DESIGN: The design used a qualitative approach and discussion schedule to elicit responses. SETTING: The setting involved two Aboriginal community controlled and seven mainstream health services in the Far Western region of New South Wales. PARTICIPANTS: The participants were experienced diabetes educators (RNs and AHWs), managers and students currently enrolled in the course (n = 17). RESULTS: The results indicated issues that compromise diabetes practice and identified strategies to improve practice. Issues were: the confusing funding practices by health providers, the duplication of health services, the lack of recognition of diabetes qualifications and the transient nature of Indigenous people. Strategies included the need for: continuous dedicated diabetes health funding, a role clarification for diabetes educators, strategic diabetes planning and the importance of diabetes educators working in partnership. CONCLUSION: The conclusion from this study indicates that if the delivery of diabetes health services to Indigenous Australians is to improve it is necessary to address these identified issues.

The experiences of remote and rural Aboriginal Health Workers and registered nurses who undertook a postgraduate diabetes course to improve the health of Indigenous Australians.

This paper reports on an evaluation of an educational initiative that seeks to improve the diabetes health outcomes of a vulnerable group, Indigenous Australians residing in remote and rural New South Wales. In this context seven Aboriginal Health Workers (AHWs) and ten registered nurses (RNs) undertook an accredited Australian Diabetes Educators Association (ADEA) course. The aims of this study were to identify the beliefs, attitudes and experiences of this group concerning specialist diabetes training, strategies already used by managers and those that could be used to help consolidate the diabetes expertise of AHWs and RNs. The findings indicate specialist diabetes training and constructive support is required if AHWs and RNs are to develop from a novice to an expert. We concluded that the ADEA diabetes course is highly relevant to the needs of Indigenous Australians and that constructive support from managers and the university is most important in the development of diabetes expertise.

The impact of a postgraduate diabetes course on the perceptions Aboriginal health workers and supervisors in South Australia.

Contemporary diabetes management is a specialised area of health care and qualified health professionals in this country seeking employment as diabetes educators are first advised to undertake a postgraduate accredited Australian Diabetes Educators Association (ADEA) course. In 1998, aware that type 2 diabetes was a major health problem in the Aboriginal population, Flinders University opened its ADEA accredited course to Aboriginal health workers. This initiative was supported by the South Australian Aboriginal Health Partnership, and the Aboriginal Health Council of South Australia and, as a result, three cohorts of Aboriginal health workers (n=31) were funded to undertake the diabetes course between 1998 and 2001. This was the first time in Australia that health workers in large numbers had undertaken an accredited ADEA course that had been developed for registered nurses and allied health professionals. In view of the different educational background of the two groups, it was thought that the course may not meet the learning needs of Aboriginal health workers. Thus, a qualitative study using critical ethnography was undertaken in fourteen sites in South Australia. The aim was to identify the perceptions of the course held by the health workers who had undertaken the course and the supervisors whose responsibility it was to oversee their clinical activities. It also included establishing whether the course was relevant to the health care needs of Aboriginal people with diabetes in South Australia. The participant group was comprised from the health workers (n=18) who had undertaken the diabetes course and their supervisors (n=21). Data collection and analysis took place between 2001 and 2002. The instrument used was a semi-structured questionnaire. The methods included interviewing and tape recording, observation and fieldwork. The transcripts were thematically analysed and managed by using NVivo software. Three main themes emerged: the positive and negative perceptions of the course held by the participants, the development of the health workers as health professionals and the relevance of the course to the health care needs of Aboriginal people with diabetes. We concluded that other Schools of Nursing & Midwifery in Australia who offer ADEA courses might also enable Aboriginal health workers to access their courses. This contribution would greatly help improve the diabetes health status of Aboriginal people.

Co-operative inquiry: the development of a visual impairment prevention program initiative for two Aboriginal communities in South Australia.

Impaired vision and blindness are two serious health problems in Australian Aboriginals. In an initiative known as the Visual Impairment Prevention Program (VIPP) commonwealth funding was made available to each state/territory to improve eye status of the Aboriginal population. The South Australian Department of Human Services selected two Aboriginal communities to take part in this initiative. This paper outlines how Flinders University participated in this process. The aim was to conduct an eye program for Aboriginal health workers and develop eye health promotional resources for educational use in the Aboriginal community. The principles of Co-Operative Inquiry were used to guide the process. An evaluation indicated that both products were culturally acceptable to the Aboriginal community.