Dismantling sociocultural barriers to eye care with tele-ophthalmology: lessons from an Alberta Cree community (original) (raw)
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International Journal of Circumpolar Health, 2004
Introduction. In British Columbia, Aboriginal diabetes prevalence, hospitalization and mortality rates are all more than twice as high as in the rest of the population. We describe and evaluate a program to improve access to diabetes care for Aboriginal people in northern communities. Study design. Cost-effectiveness evaluation. Methods. A diabetes nurse educator and an ophthalmic technician travel to Aboriginal reserves, offering people with diabetes services recommended in current clinical practice guidelines: retinopathy screening by digital retinal fundus photography, glaucoma screening by tonometry, point-of-care urine and blood testing to detect microalbuminuria and dyslipidemia and to measure glycated hemoglobin, foot examinations and foot care advice, blood pressure and height and weight measurement and diabetes care advice. Via electronic communication, an ophthalmologist and an endocrinologist in Vancouver review the findings and supervise the mobile clinic staff. Results. During the first year, 25 clinics were held at 22 sites, examining 339 clients with diabetes. Exit surveys showed high levels of client satisfaction. Mean cost per client (Cdn$1,231) was less than for the alternative, transporting clients to care in the nearest cities (Cdn$1,437). Conclusions. The mobile clinic is cost-effective and improves access to the recommended standard of diabetes care.
International journal of circumpolar health, 2018
Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertensio...
Lancet Western Pacific , 2021
What is already known? ► Vision and impairment and blindness among Indigenous Australians is largely preventable and treatable, yet uptake of primary and tertiary eye care remains fragmented. What are the new findings? ► Our study presents a novel analysis of Indigenous patient perspectives specifically related to diabetic eye health. ► Culture, communication and trust are key determinants of access to and uptake of eye care, and prevention of diabetic eye diseases. What do the new findings imply? ► Our findings highlight the need for increased health promotion activity to be undertaken in Indigenous language speaking communities: through access to Indigenous interpreter services, and translation of key health promotion messages targeting diabetic retinopathy. ► Shared health knowledge can help bridge the communication gap, support Indigenous patients to make informed health decisions and enable culturally safe access to eye care services.
Seeing Clearly: A Community-Based Inquiry Into Vision Care Access For a Rural Northern First Nation
Canadian Journal of Optometry, 2015
There are a variety of barriers to eye-care service access in rural Northern First Nations communities. Semi-structured, opened-ended key informant interviews were conducted on the topic of eye care, with eight First Nations individuals employed by the health office in a small Northern British Columbian First Nations community. Data analysis comprised identifying themes by analyzing similarities and dissimilarities in participants’ narratives, including comparing and contrasting viewpoints of participants and placing themes within broader sociocultural and historic contexts. Themes identified in the data included the current state of community eye care, facilitators and barriers to accessing eye care, and community needs and preferences. The theme of “facilitators and barriers” was further analyzed, resulting in subthemes of awareness, attitudes, social, economic, and service related. Better understanding of the barriers and their interactions would provide a foundation upon which i...
Social Science and Medicine, 2021
The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal') Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.
The prevalence of diabetes mellitus among Aboriginal populations in Canada represents a health crisis. Researchers and Aboriginal patients have identified barriers to prompt diagnosis and treatment of diabetes in Aboriginal communities. These barriers include poverty, co-morbidities, cultural indifference, and lack of healthcare resources. This study discusses the barriers to care of Aboriginal people with diabetes from the perspective of healthcare providers on Vancouver Island. Nonstandardized surveys containing multiple-choice and open-ended questions were distributed to 33 healthcare providers on Vancouver Island who reported working with Aboriginal people with diabetes; 18 completed surveys were returned. Descriptive statistics were prepared for the multiple-choice section of the questionnaire. Open-ended questions were coded and organized into substantive categories to identify trends. Barriers identified by participants include access to transportation, educational material, traditional care and medicine, and diagnostic services. Suggestions for possible solutions to barriers were grouped into three categories: education, overcoming systemic barriers, and cultural relevance. While some specific barriers were emphasized by participants, the general trends were similar to those perceived by Aboriginal patients and researchers as reported in the literature. The postulated solutions emphasize regional disparity in healthcare resources and the need to respect Aboriginal worldviews in western medical practice.
BMC Health Services Research, 2018
Background: There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. Methods: The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports. Results: A total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes.
Exploring Canadian Physicians' Experiences with Diabetes Care for Indigenous Patients
Canadian journal of diabetes, 2017
The perspectives of physicians caring for Indigenous patients with diabetes offer important insights into the provision of health-care services. The purpose of this study was to describe Canadian physicians' perspectives on diabetes care of Indigenous patients, a preliminary step in developing a continuing medical education intervention described elsewhere. Through in-depth semistructured interviews, Canadian family physicians and specialists with sizeable proportions of Indigenous clientele shared their experiences of working with Indigenous patients who have type 2 diabetes. Recruitment involved a purposive and convenience sampling strategy, identifying participants through existing research and the professional relationships of team members in the provinces of British Columbia, Alberta and Ontario. Participants addressed their understanding of factors contributing to the disease, approaches to care and recommendations for medical education. The research team framed a thematic...