Health Challenges Facing Australian Aboriginal Children - Term Paper Example

Health Challenges Facing Australian Aboriginal Children A Research Proposal Saosan Almogisib Course Instructor: Stephen Polgar Course Code and Name: PHE 2 AHR - Applied Health Research (2010) Assignment due: Week 13 Health Challenges Facing Australian Aboriginal Children (Research Proposal) Improved quality and availability of health care programs and outcomes are being delivered by Australian governments; however, Aboriginal and Torres Strait Islander communities have not shared equally in the increasing benefits of the new health care service delivery initiatives. Not only does quality health care remain unavailable to most of these communities, but their way of life has also remained largely marginalised. It is therefore evident that the government must provide these Aboriginal communities with greater access to health care services. Preliminary analysis of the current body of knowledge indicates the need for more concerted efforts in accelerating the quality and outcome of health care services to Aboriginal people. Improving health-care providers’ knowledge and skills is a focus of current research to disseminate interventions in Indigenous health-care settings; however, there is a clear need for research on secondary prevention, and to establish reliable measures of Indigenous-specific health-care delivery (Clifford et al., 2009). The process of helping the communities overcome the obstacles that impede their optimal health, includes the effect of non-intervention on children. Not only are sub-optimal living and health conditions widespread, but most of the afflictions facing the Australian Aboriginal children are easily identifiable, preventable and treatable. Perhaps, as this paper posits, the best way of helping Indigenous children is to consider actions that similar countries have undertaken to bridge the health ‘gap’ for their Indigenous people. To improve health workers’ knowledge and skills, and to address issues on secondary prevention, increasing the financial support and improving the standard of living for Indigenous communities are perhaps the most efficacious. Statement of the Problem The quality and outcomes of health care service delivery in Australia is not reflected in remote Aboriginal communities. McDonald et al. (2009) found that living conditions characterised by failure of health hardware, overcrowding, and poor hygiene practices were common to many such communities, and that these constituted barriers to hygiene improvement and to reducing the high burden of infection among children. The purpose of this study is to review the data and provide an assessment of the major health problems that are currently facing Indigenous children. Background Indigenous Australians experience disabilities and illness arising from smoking, poor nutrition, alcohol misuse and physical inactivity. Bailie et al. (2010) recently studied associations between common childhood illness, housing and social conditions in remote communities. They found that respiratory infection was related with breastfeeding in infancy, and the condition of the house; skin infection was associated with poor temperature control, or pests and vermin in the house; diarrhoea/vomiting related to hygienic state of food preparation and storage areas; whilst ear infection was dependent on child care. Dental care research for Indigenous children indicated that developmental enamel defects resulted from low fluoride exposure, poor oral hygiene, and a diet high in refined sugar. These dental problems are easily identifiable, treatable and even preventable (Amin & Harrison, 2009; Seow et al., 1996). Middle ear infections too, which are among the most common reasons for hospital admission for Indigenous children, represent another conspicuous ailment that may be prevented (Jacoby et al., 2008; Morris et al., 2005). This research will seek to identify how environmental and social barriers bar the aboriginal communities from achieving safe levels of hygiene for Indigenous children, such as McDonald et al.’s (2009) identification of non-functioning housing infrastructure, crowding, poor standards of domestic and personal hygiene conditions as triggers of poor health. From such an approach, this study seeks to establish the high burden of infection and disease experienced by Indigenous children in remote communities. Skin infections in Indigenous children in Central and Northern Australia include scabies and streptococcal pyoderma (skin sores) (Currie & Carapetis, 2000). The authors state that sustainable and long-term improvements these and other skin conditions require fundamental changes that address living conditions, which can largely be attributed to high poverty levels among the Aboriginal communities. This research will also identify how poverty has had a profound impact on the health and welfare of Indigenous children and which health maladies accrue directly from such poverty repercussions (Tsey et al., 2010). An example of such impact is that Indigenous women are more likely to give birth to underweight babies than non-indigenous women and that, since most Aboriginal babies are breastfed with little access to nutritious food during weaning years, the majority of the children are undernourished. Consequently, malnutrition reduces immunity, so children are more likely to catch infections (Gracey & King, 2009). Objectives The objectives of this study are to identify: common illnesses among Indigenous Torres Strait Islander children aged from one to five years, as profiled by the Commonwealth Department of Health and Ageing, State departments of health, social workers and health care establishments socio-economic factors that predispose, cause and contribute to the frequency and seriousness of the common illnesses among Torres Strait Islander children aged from one to five years. Research Questions The research questions are thus: 1. What are the most common illnesses among Indigenous Torres Strait Islander children aged from one to five years as profiled by the department of health, social workers and health care establishments over the last five years? 2. What are the socio-economic factors that predispose, cause and contribute to the frequency and seriousness of common illnesses among Indigenous children aged from one to five years? Methodology The aim of this research is to identify the most common illnesses suffered by Indigenous children and to establish the most probable causative and predisposing socio-economic factors among one to five year-olds for these illnesses. The hypothesis is that the most common illnesses among this cohort are those resulting from poor nutrition and hygiene. Further, this research hypothesises that these common illnesses among young children can be traced back to poverty among Australian aboriginal communities, their poor sanitation and housing, scarce health care facilities and services, as well as ignorance or dismissal of hygienic factors. From the literature review, it is of interest that researchers have problems analysing part of the quantitative data, particularly for small Aboriginal communities. In dealing with such small samples, qualitative research methodology provides a better analytical option to identify the extent of the health problems encountered by Aboriginal and Torres Strait Islander communities, as qualitative studies can include the socio-economic factors that are influential in the health status of a community. Qualitative statistical methods equip researchers with considerable knowledge of the region and population to be studied contributing to the validity of their results since they allow the researchers to collect unique, unrestricted, comprehensive findings and not to simply to list data in terms of numbers and percentages as the quantitative studies do (Creswell et al., 2007). This research will therefore adopt a mixed-methods approach that combines primary and secondary data collection methods, qualitative and quantitative data collection and analysis. Initially, the research will use a literature survey to document research methods used to collect data in the field. These studies constitute the available body of knowledge, from which the research will use to profile the health issues of Indigenous Torres Strait Islander children (cf. Freemantle et al. 2006). The study thus employs a document analysis method of data collection, analysis and presentation, relying on the literature survey and secondary resources of creditable government and public documents. The purpose of the selected method is to identify those factors within the literature, reports and statistics which will determine the parameters for the field of enquiry and develop a viable argumentative conclusion (Smith et al. 2009). The methodology thus employs a contextual approach of two research methods, exploratory (to review the contemporary literature and extant information on the health status of Indigenous children) and explanatory (seeking to explain and critique of the body of knowledge acquired during the exploration). There is thus two phases of research with the intent of analysis and findings contributing to conclusions and recommendations for future research, and to actions by decision makers. To deepen and extend potential findings, the study will also conduct primary data collection, using questionnaires and face to face interviews with members of the Torres Strait Islander community to establish which health problems most affect their children. The face to face interviews will involve health care providers in the remote communities (community nurses and other practitioners) as well as the community members (Smith et al., 2009). Data Collection The population identified for this study are parents and carers of all Indigenous children aged from one to five years in Torres Strait Islander communities identified by the Australian Government1. The study will thus collect its data regarding a representative sample of that population who have been diagnosed and admitted into hospital or clinic for any illnesses in the last 2 years as documented by the relevant authority or service in the area. Health care establishments in the Torres Strait will be identified as the source of the study sample with the choice of establishments based on the number of children aged between 1 and 5 years they have hospitalised in the last two years. The two hospitals with the highest number of children aged between one and five years constitute the sample. In the sample, ten parents with children hospitalised in either of the two hospitals will be located, verified and interviewed and then asked to contribute through a questionnaire. The parents will be recruited for the interviews and questionnaires using a purposive sampling method, where the first parent (or the second if the first is unavailable) for each a child admitted in the months of June through to October in each year for the last five years will be sampled, five parents from each of the two hospitals. Further, ten community health nurses will be identified, interviewed or asked to fill in a questionnaire through email. The nurses will be sampled non-purposively (randomly) based on a random selection of five names from duty rosters from each of the two hospitals (Creswell et al. 2007). A selection of possible questions is included in Table 1 below. Table 1 Examples of questions to be used in semi-structured interviews or questionnaires Questions for Community Health Nurses Questions for Parents of Hospitalised Indigenous Children Interviews What are the most common diseases and ailments do you diagnose and treat for Indigenous children? Please mention at least five in the order you think they occur. What are the most common diseases and ailments that your child has been diagnosed and treated for in the last two years? Please mention all the ailments you can remember. What are the major socio-economic factors that predispose the health conditions you diagnose in the Indigenous children? Do these include poverty or hygiene? How often does your child get sick? Questionnaires How long have you worked with Indigenous children? How many times have you come to the hospital or any other health care facility in the last three months? In your experience, which are the five most probable contributory, predisposing or causative factors afflicting the Indigenous children and which have a direct impact on their health status? Why do you think your child has health problems as you have mentioned above? Do you feel that the problems result in any way from your income level, hygiene, availability of health care facilities and services or lack of knowledge on your part? Data Analysis With a small sample, the questionnaire and interview data will be collected at the time of interview or next day, so that a complete return of data is expected. The document analysis and that of face to face interviews will be tabulated and again analysed using both a stratified and aggregated system. On the other hand, the results of the questionnaires will be quantitatively analysed as totals, percentages, stratified relationships, and aggregated data. The data will be assessed to find themes emerging for illnesses and causes, and these will be correlated the first analysis and finally with the literature. A research report will be prepared and as well the findings will be prepared as an illustrated presentation (pictures, tables and graphs) to advise a committee or other group. As mentioned earlier, this research will seek the context of the socio-economic factors among the Indigenous children that contribute to, cause or predispose their common illnesses. Ethical Issues In this study, several ethical issues are expected to arise. The identity of the respondents, especially the parents with hospitalised children will be protected and kept confidential so that the study will not add stress to their lives (Australian Institute of Aboriginal and Torres Strait Islander Studies, 2000). All data sources will be treated confidentially, and the information they provide will only be used for the purposes of research and not in any other way. Again, the findings of the research will be authentic, with the statics employed to depict the realistic situation and not a fabrication of the researcher. Indeed, the researcher will maintain an objective position in the collection, analysis and treatment of the data so that it reflects the realistic situations and not the preconceived bias of the researcher or other participants. Conclusion This study aims to add to the body of knowledge regarding Indigenous children’s health issues. It takes a specific focus on Torres Strait children, who have a particular form of isolation as communities on sometimes very small islands, and can easily be cut off from aid. There is some interaction between Torres Strait Islanders and Papuans and New Guineans, so that there may be transmitted infections from other groups which are not usually found in Australia. Lastly, very small or itinerant groups can be isolated from the regular visits of health professionals or care representatives. For these reasons, and in the pursuit of knowledge, this research will seek to establish the most common illnesses among Indigenous children aged from one to five years, and the socio-economic factors that contribute to the occurrence of common illnesses among Indigenous Torres Strait Islander children aged from one to five years. References Australian Institute of Aboriginal and Torres Strait Islander Studies (2000). Guidelines for Ethical Research in Indigenous Studies, Author, Canberra, ACT. Amin, M.S. & Harrison, R.L. (2009). Understanding parents' oral health behaviors for their young children. Qualitative Health Research, 19(1):116-27. Bailie, R., Stevens, M., McDonald, E., Brewster, D., & Guthridge, S. (2010). Exploring cross-sectional associations between common childhood illness, housing and social conditions in remote Australian Aboriginal communities, BioMed Central Public Health, 10 Article 147. Accessed 22 October from http://www.biomedcentral.com/1471-2458/10/147 Brewster, D.R. (2006). Critical appraisal of the management of severe malnutrition: 4. Implications for Aboriginal child health in northern Australia. Journal of Paediatrics and Child Health, 42(10), 594-595. Clifford, A., Jackson Pulver, L., Richmond, R., Shakeshaft, A., & Ivers, R. (2009). Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps, Health Promotion International, 24(4): 404-415 Creswell, J.W., Hanson, W.E., Clark, V.L., & Morales, A., (2007). Qualitative research designs: selection and implementation, Counseling Psychologist, vol. 35, no. 2, pp. 236-264. Currie, B.J., & Carapetis, J.R. (2000). Skin infections and infestations in Aboriginal communities in northern Australia. Australasian Journal of Dermatology, 41(3), 139-143. Freemantle, C.J., Read, A.W., de Klerk, N.H., McAullay, D., Anderson, I.P. & Stanley, F.J. (2006). Patterns, trends, and increasing disparities in mortality for Aboriginal and non-Aboriginal infants born in Western Australia, 1980-2001: population database study. Lancet 27, 367(9524), 1758-66. Gracey, M., & King, M. (2009). Indigenous health part 1: determinants and disease patterns. The Lancet, 374 (9683): 65-75. Jacoby, P., Coates, H., Arumugaswamy, A., Elsbury, D., Stokes, A., Monck, R., Fiucane, J., Weeks, S., & Lehmann, D. (2008). The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder region of Western Australia. Medical Journal of Australia, 188(10), 599-603. McDonald, E., Bailie, R., Grace, J.M., & Brewster D. (2009). A case study of physical and social barriers to hygiene and child growth in remote Australian Aboriginal communities. BioMed Central Public Health, 9 Article 346. Accessed 22 October from http://www.biomedcentral.com/1471-2458/9/346. 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