Pneumococcus in Aboriginal and Torres Strait Islander Peoples: the Role of Aboriginal

Pneumococcus in Aboriginal and Torres Strait Islander peoples: the role of Aboriginal Health Workers and implications for nursing practice

Hiba Deek,1,2 Penelope Abbott,3,4 Louise Moore,3 Joyce Davison,3 Sonya Cameron,3 Michelle DiGiacomo,2 Sarah J McGrath,2 Tessa Dharmendra,2 Patricia M. Davidson2,5

1. American University of Beirut, Lebanon

2. University of Technology Sydney, Australia

3. Aboriginal Medical Service Western Sydney, Mt Druitt, Australia

4. University of Western Sydney, Sydney, Australia

5. Johns Hopkins University, Baltimore, Maryland, USA

HibaDeek -

Penelope Abbott -

Louise Moore –

Joyce Davison –

Sonya

Michelle DiGiacomo –

Sarah J McGrath -

Tessa Dharmendra –

Patricia M. Davidson -

Pneumococcus in Aboriginal and Torres Strait Islander peoples: implications for Aboriginal Health Workers and nurses

Abstract

Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women.

Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up.

Method: An integrative literature review, using both published and grey literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus.

Results: The literature was summarized under the following themes: pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals.

Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.

KeywordsAboriginal and Torres Strait Islander peoples, Indigenous Australians, Aboriginal health, pneumococcus, vulnerable population, social determinants of health

Background

Aboriginal and Torres Strait Islander peoples (hereafter, Aboriginal)are the traditional owners of Australia. Theysuffer a disproportionate burden of health and social disparities(Gray & Bailie, 2006). For example, the burden of cardiovascular disease among this population is striking and the rates of rheumatic heart disease are a cause of national shame (Carapetis, Currie, & Mathews, 2000).Aboriginal Australians suffer higher rates of many health conditions. Diabetes is ten times more prevalent in Aboriginal peoples and the onset is much earlier than in the non-Aboriginal population(NSW Health, 2005). Furthermore, some pulmonary diseases, such as pneumonia,are ranked as the first and second most common causes of hospitalization inAboriginalmen and women, respectively(Torzillo, 1997). Pneumonia is significantly more prevalent among Aboriginal Australians than non-Aboriginal Australians(Menzies, Turnour, Chiu, & McIntyre, 2008).

Aboriginal peoples are four times more likely to die than their non-Aboriginal counterparts and are less likely to reach the age of 40. Furthermore, seventy percent of Aboriginal Australians die before the age of 65 years(Forsyth, 2007),resulting in a life expectancy gap of approximately 10-17 years between Aboriginal and non-Aboriginal Australians(Haluska et al., 2008).The highest reason for the health differentialAboriginal and non-Aboriginal Australians is attributable to social determinants of health(Brown, 2009). The World Health Organization (WHO) defines social determinants of health as all factors that frame the way people live, starting from birth and moving along all the social, financial, physical and functional aspects of life. These factors are influenced by the availability or lack of money, authority, and resources(World Health Organization, 2011).

The incidence of pneumonia among Aboriginal Australians is thought to be three times higher than that in non-Aboriginal Australians(Australian Indigenous HealthInfoNet 2007-2011). Reasons behind this are many and varied andinclude lack of access to care(Department of Health and Ageing, 2013). A number of initiatives including immunization are focused on decreasing morbidity and mortality and are an important focus of preventive health care.

Method

This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. The method of an integrative review was usedas it allows collation and synthesis of information from a range of philosophical principles to address a matter of interest (Whittenmore and Knafl, 2005).Design of the search strategy for this review was supervisedby a health librarian. Key words used for this search were Aboriginal and Torres Strait Islanders, Indigenous Australian, Aboriginal health, vulnerable population, pneumococcus,and social determinates of health. Databases searched included CINAHL, MedLine, and PsychInfo for peer-reviewed literature and the World Health Organization website for grey literature. Reference lists of relevant articles were also searched for additional material. Articles were included if they were published between 2000 and 2013, but older articles were included from the reference lists if highly relevant. Articles included also had to address the health, health care delivery, and access issues, particularly regarding immunization and pneumonia in Aboriginal Australians. Articles were excluded if they did not pertain to the Australian Aboriginal population. The first author conducted the search, applied inclusion and exclusion criteria, extracted data from papers.

Results

Thirty-three articles were retrieved from CINAHL (11), MedLine (9), and PsychInfo (7) and the World Health Organization (6). Contentanalyses of results identified three concentrations in the literature. This information is summarized under the following headings: pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; screening interventions, information tracking system; culturally competent interventions; and the role of Aboriginal health professionals.

Pneumococcal disease

Pneumococcal disease is caused by Streptococcus pneumonia(Bogaert, De Groot, & Hermans, 2004). Invasive pneumococcal disease includes bacteraemia and meningitis. This bacterium can also lead to life threatening infections involving the lungs or the layers of the brain(Bogaert et al., 2004). Susceptible people are those who are immuno-compromised, young children, the elderly and those with chronic illnesses. Invasive pneumococcal disease is significantly more prevalent among Aboriginal Australians than non-Aboriginal Australians (Australian Indigenous HealthInfoNet, 2012). Pneumococcal disease can present as a co-morbid disease with chronic cardiovascular, liver, lung and infectious diseases,(Hoover, Sambamoorthi, & Crystal, 2004)as well as diabetes mellitus (Willis, Ndiaye, Hopkins, & Shefer, 2005).

Prevention strategies

There are over 90 strains of the bacteria Streptococcus pneumoniawhich are not all covered by vaccines(Department of Health and Ageing, 2013). Today, there aretwo available vaccinesthat assist in the prevention of 23 of the most common existing strains. These vaccines are recommended for children above two years of age, non-Aboriginal Australians aged 65yearsand older, and Aboriginal Australians age 50 years and over. Other people indicated for these vaccines are those with chronic conditions such as heart and lung diseases, diabetes, alcoholism, immunodeficiency and cirrhosis, among others (Abbott, 2013).In addition to immunization, general prevention strategies such as hand washing and prevention of droplet infection should be considered.

Access to care

A major barrier to immunisation is the accessibility of health care services.Johanson and Hill (2011)have documented limited access to primary health care. Lack of identifiable data of Indigenous status further limits monitoringof access(DiGiacomo et al, 2010). Limited health literacy limitsaccess to information for many populations and this may be exacerbated amongst Aboriginal people. Health literacy is the ability to read, understand and use healthcare information to make decisions and follow instructions for treatment(Nielsen-Bohlman, Panzer, & Kindig, 2004). This is an important step by which patients get to understand their health condition, and make plans for theirfuture.

Durey, Thompson, and Wood (2012)reported that health professionals can promote engagement with communities through engaging in culturally sensitive and appropriate communication and the knowledge of patients’ backgrounds and beliefs. Effective communication is critical in establishing rapport and providing trusting environment between caregivers and care seekers. Appreciating nuances of non-verbal communication will assist health professionals to spend more time and provide more useful information to their Aboriginal patients and thus provide better care.

Improving access to vaccinations

A number of strategies can be used to ensure access to preventative measures. Regular screening during opportunistic encounters, such as presentation to the Emergency Department is an important strategy to promote access to preventive strategies(DiGiacomo, Abbott, Davison, Moore, & Davidson, 2010). Another approach is through the use of regular screening approaches through community-based interventions.

DiGiacomo et al. (2010b)conducted a two day screening clinic to provide adult health checks and screening for diseases and disease risk factors at a metropolitan Aboriginal health service. Transportation, consultations, risk factor screening, education, and referrals were provided. This model succeeded in overcoming many obstacles to delivery and access to care. Community ownership was crucial to the success of this program. This one-off event becamean annual occurrence, now entirely community-driven and operated.

Screening interventions

Screening campaigns should be frequently done through mass media and in clinics. People at risk should be identified and contacted to be vaccinated against the strains of this bacterium of which they are susceptible. Engaging health care workers in screening programs especially in the beginning of autumn, as this is the best timing for influenza vaccination(Department of Health and Ageing, 2013).

Information tracking systems

Reminder and recall systems are strategies for tracking the schedules of follow-up and vaccines. These systems have shown good outcomes in children and adult vaccinations. Reminder systems prompt future follow-ups and recall systems track upcoming approaching appointments and vaccination timeframes(Tudge, 2005). These systemsassist in improving access to immunizations for individuals at risk.

Culturally competent interventionsand the role of Aboriginal health professionals

Culturally competent care includestailoringinterventions to specific settings and includes considering the cultural differences among the targeted group(French, 2003).Over the past three decades, more than 120 community controlledhealth facilities have been established for the Australian Aboriginal population to address issues related to access to health care services. These community-based facilities have been useful in overcoming the barriers in the provision of care, they are important as they recognize the cultural and social barriers to healthand are perceived as being culturally safe (Couzos, Lea, Murray, & Culbong, 2005).Reilly et al. (2008)documented that Aboriginal Australians found the community services to be a primary source of support, as they are culturally tailored and appropriate. Interventions must consider the history of the Aboriginal Australian people, their traditional beliefs related to their self, family and the communityin order to be culturally appropriate (Tsey et al., 2010).

Aboriginal Health Workers (AHWs) have an important role to play in the care of Aboriginal Australians, particularly in chronic disease management and care, and are key to addressing the life expectancy gap between Aboriginal and non-Aboriginal people(Si, Bailie, Togni, d Abbs, & Robinson, 2006). AHWsare important conduits to their communities(Abbott, Gordon, & Davison, 2008) and should be involved in the delivery of pneumococcus education and care. Aboriginal young people should be encouraged to maintain a healthy diet, exercise regularly and participate in early screening. Education strategies should also be implemented on chronic disease risk factors. Two Aboriginal registered nurses,Stuart and Nielsen (2010)concluded in their study that Aboriginal nurses are the best equipped to care for Aboriginal Australians as they have the necessary cultural knowledge and understanding. Cardiovascular Aboriginal health workers with training in cardiovascular health play a critical role in ensuringthese collaborations are culturally appropriate and tailored and targeted to local communities(Davidson et al., 2008; Davison, DiGiacomo, & Davidson, 2006).

Aboriginal nurses and health workers are also in a prime position to provide cultural knowledge and education to non-Aboriginal health workers and act as cultural brokers(DiGiacomo et al., 2010; Si et al., 2006). Collaborations between mainstream services in primary, secondary and tertiary care are also critical. Strategies that address the recruitment and retention of Aboriginal Australian health professionals are required.

Aboriginal Australians experience a high burden of pneumococcal disease causingpneumonia, otitis media, and lung and blood infections(Abbott, 2013). Pneumococcal disease can be prevented through vaccination; however due to access issues many Aboriginal Australians do not receive this vaccination. Moreover, the general reference to barriers to health care based on socioeconomic, historical, cultural & logistic factors and trust in healthcare services cause further hindrance to getting the vaccines (Abbott, Menzies, Davison, Moore, & Wang, 2013).Community controlled organizations have proven effective in reaching Aboriginal Australians that have had little or no engagement with mainstream healthcare settings(DiGiacomo et al., 2010).

Conclusions

Most pneumococcal infections are vaccine preventable and although vaccination is recommended, access to primarycare is limited by a range of factors, including lack of culturally appropriate services. Aboriginal Health Workers and nurses have an important role to play in improving the health outcomes of Aboriginal Australians through promoting pneumococcal vaccination and reducing the burden of pneumococcal disease. Ensuring policy and funding models address these issues of concern is an important consideration for improving health outcomes for Aboriginal Australians.

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