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Respiratory follow-up to improve outcomes for Aboriginal children: twelve key steps
Pamela Laird1,2, Roz Walker3, Fenella J Gill4
1Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue Nedlands WA 6009, Australia.
Insights
Effective medical follow-up for Aboriginal children hospitalized with acute respiratory infections is crucial. Identifying barriers and facilitators, like improved communication and culturally responsive care, is key to preventing bronchiectasis.
Area of Science:
- Paediatric Health
- Indigenous Health
- Health Services Research
Background:
- Acute respiratory tract infections (ALRIs) pose a significant health burden on Aboriginal children, often leading to bronchiectasis post-hospitalization.
- Clinical guidelines recommend one-month medical follow-up post-discharge to manage persistent symptoms and prevent bronchiectasis, yet this is not routinely implemented.
- This study addresses the gap in routine medical follow-up for Aboriginal children after ALRI hospitalization.
Purpose of the Study:
- To identify barriers and facilitators to medical follow-up for Aboriginal children hospitalized with ALRIs.
- To map the necessary steps for implementing effective medical follow-up.
- To inform strategies for improving post-hospitalization care for this vulnerable population.
Main Methods:
- A qualitative study employing knowledge translation and participatory action research principles.
- Data collection through semi-structured interviews and focus groups with parents and hospital staff.
- Analysis involved reflexive thematic grouping and process mapping to identify key steps and themes.
Main Results:
- Eighteen parents and 144 healthcare staff participated, revealing parental barriers such as lack of information and facilitators like clear instructions.
- Staff barriers included unawareness of follow-up needs, limited culturally responsive care skills, and system issues; facilitators involved training and improved discharge processes.
- Twelve essential steps were identified for ensuring effective medical follow-up, highlighting the complexity of the process.
Conclusions:
- Barriers and enablers for effective medical follow-up were identified, categorized into four main themes.
- Successful follow-up requires collaboration among parents, hospital staff, hospital systems, and primary healthcare services.
- A comprehensive knowledge translation approach is recommended to enhance the medical follow-up process for Aboriginal children post-ALRI hospitalization.
Background:
Among Aboriginal children, the burden of acute respiratory tract infections (ALRIs) with consequent bronchiectasis post-hospitalisation is high. Clinical practice guidelines recommend medical follow-up one-month following discharge, which provides an opportunity to screen and manage persistent symptoms and may prevent bronchiectasis. Medical follow-up is not routinely undertaken in most centres. We aimed to identify barriers and facilitators and map steps required for medical follow-up of Aboriginal children hospitalised with ALRIs.
Methods:
Our qualitative study used a knowledge translation and participatory action research approach, with semi-structured interviews and focus groups, followed by reflexive thematic grouping and process mapping.
Findings:
Eighteen parents of Aboriginal children hospitalised with ALRI and 144 Australian paediatric hospital staff participated. Barriers for parents were lack of information about their child's condition and need for medical follow-up. Facilitators for parents included doctors providing disease specific health information and follow-up instructions. Staff barriers included being unaware of the need for follow-up, skills in culturally responsive care and electronic discharge system limitations. Facilitators included training for clinicians in arranging follow-up and culturally secure engagement, with culturally responsive tools and improved discharge processes. Twelve-steps were identified to ensure medical follow-up.
Interpretation:
We identified barriers and enablers for arranging effective medical follow-up for Aboriginal children hospitalised with ALRIs, summarised into four-themes, and mapped the steps required. Arranging effective follow-up is a complex process involving parents, hospital staff, hospital systems and primary healthcare services. A comprehensive knowledge translation approach may improve the follow-up process.
Funding:
State and national grants and fellowships.
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