The compromised health outcomes for Aboriginal and Torres Strait Islander peoples are well documented. The Quality Use of Pathology Program (QUPP) enabled three projects (Table 11) to explore ways to improve the health outcomes for Indigenous Australians through raising awareness of the need to become a stakeholder in their own health care. This was achieved through culturally appropriate and clinically effective strategies to engage Aboriginal Australians in understanding the benefits of actively participating in their own health care to achieve positive health outcomes. One area for future consideration noted from this integrated analysis included:
Further evaluation and extension of the ‘Flip Chart’ concept as noted in the report Optimising Health Benefits for Aboriginal People who take Warfarin
Project Name
Grant Recipient/s
1
Optimising Health Benefits for Aboriginal People who take Warfarin (2009)
Royal Australian College of General Practitioners (RACGP)
2
Quality Assurance for Aboriginal Medical Services (QAAMS) (Current)
Flinders University
3
Quality Assurance for Aboriginal Medical Services (QAAMS) Quality Assurance Program (Current)
Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (RCPA QAP)
Optimising Health Benefits for Aboriginal People who take Warfarin (2009)
Description
This project sought to examine the use of anticoagulants and International Normalised Ratio (INR) testing in Aboriginal and Torres Strait Islander people, and to develop educational resources for their use. Lack of a shared understanding between doctors and patients of the benefits and risks of Warfarin treatment (a brand of anticoagulant medication), particularly involving patients with limited literacy skills, has been demonstrated to be a contributing factor in poor INR control.
This project has progressed through two stages:
Consultation through yarning groups (focus groups) with Aboriginal and Torres Strait Islander patients taking anti-coagulant medication, and emerging from this consultation;
The development of a ‘Flip Chart’ which is an educational resource to be used as a discussion aid between a health worker and a patient to provide information about the need for INR tests when taking anticoagulant medication.
Grant Recipient
Royal Australian College of General Practitioners (RACGP)
to identify the needs of Aboriginal people with respect to a common and important pathology test, namely the INR blood test, performed for patients taking Warfarin
to design culturally sensitive information strategies that improve the knowledge of pathology testing in relation to INR amongst a group of Aboriginal communities
to make recommendations about future information strategies for pathology tests in Aboriginal communities.
These aims and objectives were achieved by this project.
Outcome
The most culturally appropriate and clinically useful information strategy to improve knowledge of INR testing was the development of pictorial hard copy materials rather than any electronic/video format. In this project a ‘Flip Chart’ was created which was a 31 page A4 size document structured to be placed on a desk or flat surface in an A-Frame form. This enabled the patient to see the images clearly displayed while the health professional discussed particular aspects of the image that related to INR testing.
Finding
The use of yarning groups/interviews with patients was the most effective method of identifying Aboriginal people’s needs in relation to INR testing.
Recommendations
This project’s design is a recommended model for cross-organisational work in Aboriginal Health. The model’s key features included:
engaging with Aboriginal people and communities in needs assessment and development of interventions/educational strategies
partnership arrangements between a lead organisation and Aboriginal Medical Services (AMSs), including clarity regarding ownership and dissemination of data collected by AMSs
consultation with clinical staff in AMSs throughout the implementation of the project
flexibility in times and outcomes in response to needs of AMSs and patients.
The project design should be extended to other pathology tests of critical importance to Aboriginal and Torres Strait Islander people in order to develop culturally appropriate tools to assist people to undertake tests.
The project design should be extended to other clinical and health issues in Aboriginal Health (not restricted to pathology testing) in order to develop culturally appropriate educational interventions.
A study should be undertaken to test the effectiveness of the ‘Flip Chart’ as an educational intervention to improve medication and INR test compliance by Aboriginal and Torres Strait Islander patients.
The content of the ‘Flip Chart’ be developed into formats that can be easily taken home by patients and their families to reinforce the messages from the ‘Flip Chart’ discussed in the consultation. A leaflet or comic book appears to be the most appropriate format.
Canvass opportunities to fund ‘reminders’ for Aboriginal and Torres Strait Islander patients to take Warfarin and have INR tests. The range of appropriate ‘reminders’ identified in the yarning group phase of the project include fridge magnets, text messages to mobile phones, calendars etc.
Key Project Learnings
There was strong support by the Aboriginal communities for the content of the ‘Flip Chart’ to be produced in the form of leaflets or booklets for the patients to take home.
Future projects utilising the same project design/model should consider including the following amendments:
gain ‘in-principle’ commitment to the project by specific AMSs during the development of the proposal rather than recruiting AMSs after funding has been received
employ a dedicated ‘project manager’ (ideally an Indigenous person) in the lead agency with minimal responsibilities outside the project
clarify the specific Human Research Ethics Committees that require approval of the project during the planning stages
