Health  Vol.8 No.6 , April 2016
“I Am Getting Healthier”. Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program
Abstract: Chronic disease is a main contributor to the disproportionately high burden of illness experienced by Aboriginal and Torres Strait Islander Australians. However, there are very few programs addressing chronic disease self-management and rehabilitation which are designed specifically for urban Aboriginal and Torres Strait Islander people. This paper aims to explore client and staff perceptions of the Work It out Program, a chronic disease rehabilitation and self-management program designed for urban Aboriginal and Torres Strait Islander people. The study used a mixed methods approach to explore the success, barriers and self-reported outcomes of the program. Quantitative data were collected through a structured survey, comprising social and demographic data. Qualitative data were collected through interviews using Most Significant Change theory. Twenty-eight participants were recruited, 6 staff and 22 clients (M = 7, F = 21) with an age range between 21 and 79 years of age (Mean = 59.00, SD = 17.63). Interviews were completed in 2013 across four Work It out locations in Southeast Queensland. Semi-structured interviews were conducted either individually or in groups of two or three, depending on the participants’ preference. Thematic analysis of the data revealed six main themes; physical changes, life improvements, social and emotional well-being, perceptions about the successful features of the program, perceived barriers to the program and changes for the future. This exploratory study found that clients and staff involved in the Work It out Program perceived it as an effective self-management and rehabilitation program for urban Aboriginal and Torres Strait Islander Australians. Further evaluation with a larger sample size is warranted in order to establish further outcomes of the program.
Cite this paper: Nelson, A. , Mills, K. , Dargan, S. and Roder, C. (2016) “I Am Getting Healthier”. Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program. Health, 8, 538-547. doi: 10.4236/health.2016.86057.

[1]   Australian Burea of Statistics (ABS) (2006) National Aboriginal and Torres Strait Islander Health Survey 2004-2005, cat. no. 4715.0. ABS, Canberra.

[2]   Australian Bureau of Statistics (ABS) (2013) Australian Aboriginal and Torres Strait Islander Health Survey, cat. no. 4727.0.55.001. ABS, Canberra.

[3]   Australian Institute of Health and Welfare (AIHW) (2012) Risk Factors Contributing to Chronic Disease, cat. no. PHE 157. AIHW, Canberra.

[4]   Australian Institute of Health and Welfare (AIHW) (2010) Contribution of Chronic Disease to the Gap in Adult Mortality between Aboriginal and Torres Strait Islander and Other Australians, cat. no. IHW 48. AIHW, Canberra.

[5]   Waugh, E. and Mackenzie, L. (2011) Ageing Well from an Urban Indigenous Australian Perspective. Australian Occupational Therapy Journal, 58, 25-33.

[6]   National Aboriginal Health Strategy Working Party (NAHSWP) (1989) A National Aboriginal Health Strategy—Report. Australian Government Publishing Service, Canberra.

[7]   Henderson, S. (2011) The Effectiveness of Culturally Appropriate Interventions to Manage or Prevent Chronic Disease in Culturally and Linguistically Diverse Communities: A Systematic Literature Review. Health and Social Care in the Community, 19, 225-249.

[8]   Liaw, S.T., Lau, P., Pyett, P., Furler, J., Burchell, M., Rowley, K. and Kelaher, M. (2011) Successful Chronic Disease Care for Aboriginal Australians Requires Cultural Competence. Australian and New Zealand Journal of Public Health, 35, 238-248.

[9]   Frolich, A., Host, D., Schnor, H., Norgaard, A., Ravn-Jensen, C., Borg, E. and Hendriksen, C. (2010) Integration of Healthcare Rehabilitation in Chronic Conditions. International Journal of Integrated Care, 10, e033.

[10]   Brach, C. and Fraser, I. (2000) Can Cultural Competency Reduce Racial and Ethnic Disparities? A Review and Conceptual Model. Medical Care Research and Review, 57, 181-217.

[11]   Kowanko, I., Helps, Y., Harvey, P., Battersby, M., McCurry, B., Carbine, R., Boyd, J. and Abdulla, O. (2012) Chronic Condition Management Strategies in Aborginal Communities: Final Report 2011. Flinders University and the Aboriginal Health Council of South Australia, Adelaide.

[12]   Flinders Human Behaviour and Health Research Unit F. U. (2010) The Flinders Program for Chronic Condition Management: Information Paper. Flinders University, Adelaide.

[13]   Ah Kit, J., Prideaux, C., Harvey, P., Collins, J., Battersby, M., Mills, D. and Dansie, S. (2003) Chronic Disease Self-Management in Aboriginal Communities: Towards a Sustainable Program of Care in Rural Communities. [Special Issue: The Management of Chronic Disease in Primary Care Settings]. Australian Journal of Primary Health, 9, 168-176.

[14]   Pearce, S., Thomas, A.-M. and Gorman, D. (2005) The Better Living Diabetes Project. Aboriginal and Islander Health Worker Journal, 29, 4-6.

[15]   Abbott, P., Davison, J. and Moore, L. (2007) Challenges and Benefits of Implementing a Chronic Disease Self-Management Program in an Aboriginal Community Controlled Health Setting. Australian Journal of Primary Health, 13, 35-39.

[16]   D’Abbs, P., Schmidt, B., Dougherty, K. and Senior, K. (2008) Implementing a Chronic Disease Strategy in Two Remote Indigenous Australian Settings: A Multi-Method Pilot Evaluation. Australian Journal of Rural Health, 16, 67-74.

[17]   Harvey, P.W., Petkov, J., Kowanko, I., Helps, Y. and Battersby, M. (2013) Chronic Condition Management and Self-Management in Aboriginal Communities in South Australia: Outcomes of a Longitudinal Study. Australian Health Review, 32, 330-338.

[18]   Chan, L.C., Ware, R., Kesting, J., Marczak, M., Good, D. and Shaw, J.T. (2007) Short Term Efficacy of a Lifestyle Intervention Programme on Cardiovascular Health Outcome in Overweight Indigenous Australians with and without Type 2 Diabetes Mellitus: The Healthy Lifestyle Programme (HELP). Diabetes Research and Clinical Practice, 75, 65-71.

[19]   Rowley, K.G., Daniel, M., Skinner, K., Skinner, M., White, G.A. and O’Dea, K. (2000) Effectiveness of a Community-Directed “Healthy Lifestyle” Program in a Remote Australian Aboriginal Community. Australian and New Zealand Journal of Public Health, 24, 136-144.

[20]   Canuto, K., McDermott, R., Cargo, M. and Esterman, A. (2011) Study Protocol: A Pragmatic Randomised Controlled Trial of a 12-Week Physical Activity and Nutritional Education Program for Overweight Aboriginal and Torres Strait Islander Women. BMC Public Health, 11, 655.

[21]   Clark, R., Coffee, N., Turner, D. , Eckert, K., van Gaans, D., Wilkinson, D., Stewart, S. and Tonkin, A. (2014) Access to Cardiac Rehabilitation Does Not Equate to Attendance. European Journal of Cardiovascular Nursing, 13, 235-242.

[22]   Dimer, L., Dowling, T., Jones, J., Cheetham, C., Thomas, T., Smith, J., McManus, A. and Maiorana, A. (2013) Build It and They Will Come: Outcomes from a Successful Cardiac Rehabilitation Program at an Aboriginal Medical Service. Australian Health Review, 37, 79-82.

[23]   Clifford, A., Pulver, L.J., Richmond, R., Shakeshaft, A. and Ivers, R. (2011) Smoking, Nutrition, Alcohol and Physical Activity Interventions Targeting Indigenous Australians: Rigorous Evaluations and New Directions Needed. Australian and New Zealand Journal of Public Health, 35, 38-46.

[24]   Nelson, A. and Allison, H. (2007) Relationships: The Key to Effective Occupational Therapy Practice with Urban Australian Indigenous Children. Occupational Therapy International, 14, 57-70.

[25]   Guba, E. and Lincoln, Y. (1994) Competing Paradigms in Qualitative Research. In: Denzin, N. and Lincoln, Y., Eds., Handbook of Qualitative Research, Sage, Thousand Oaks, 105-117.

[26]   Tariq, S. and Woodman, J. (2013) Using Mixed Methods in Health Research. Journal of the Royal Society of Medicine Short Reports, 4, 2042533313479197.

[27]   Davies, R. and Dart, J. (2005) The “Most Significant Change” (MSC) Technique. A Guide to Its Use.

[28]   NHMRC (2010) The NHMRC Road Map II: A Strategic Framework for Improving the Health of Aboriginal and Torres Strait Islander People through Research. NHMRC, Canberra.

[29]   D’Onise, K., McDermott, R.A. and Campbell, S.K. (2013) Benefits of Modest Weight or Waist Circumference Loss in a Remote North Queensland Indigenous Population. Australian and New Zealand Journal of Public Health, 37, 345-349.

[30]   Carson, B., Dunbar, T., Chenhall, R.D. and Bailie, R. (Eds.) (2007) Social Determinants of Indigenous Health. Allen and Unwin, Crows Nest.

[31]   Brough, M., Bond, C., Hunt, J., Jenkins, D., Shannon, C. and Schubert, L. (2006) Social Capital Meets Identity: Aboriginality in an Urban Setting. Journal of Sociology, 42, 396-411.

[32]   Muenchberger, H. and Kendall, E. (2010) Predictors of Preventable Hospitalization in Chronic Disease: Priorities for Change. Journal of Public Health Policy, 31, 150-163.