Indigenous selfmanagement project

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Indigenous self-management project

• Leda Barnett
• Centre for Practice Innovation
• Griffith University

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Presentation Overview

• Self-management and the Stanford course in
  Indigenous communities
• This research
• Core principles and localised themes to guide
  future Self-management interventions
• Future directions

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Self-management and the Stanford course in
Indigenous communities

• Self-management?
• Features of the Stanford course (The Chronic
  Disease Self-Management Workshop)
• Arthritis Queensland - Sharing Healthcare
• Evaluations in Queensland
• Minimal Indigenous participation
• Feedback from Indigenous people

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This research Murri CDM

• Research questions
• What are the principles that should guide health
  promotion and health education in Murri
  communities?
• What issues need to be considered to ensure
  acceptability of chronic disease self-management
  interventions within Murri communities?
• Three regions
• Urban
• Regional
• Rural
• Interviews and focus groups with community
  members, health professionals and course
  participants
• Thematic analysis
• 5 Core principles
• 4 Localised themes

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Core principles to guide future Chronic Disease
Management (CDM) interventions

• Historical Reluctance to engage with the Medical
  System
• Collective Management rather than Self-management
• Holistic Health Managing more than the Medical
• Cultural Incompetence in Non-Indigenous Services
• Colonial Communication Preventing Self-Management

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Historical reluctance to engage with the Medical
System

• Medical service delivery context
• Unfamiliarity with services and resources
• Language differences and understandings

other people knew they family were under a
lot of pressure but they hadnt made the link
that there was anything that these
organisations name people could do to help.
But there hadnt been that connection
recognition in the Murri community in terms of
being able to get help to change that or to
improve that situation at all. Non-Indigenous
Government Health Worker, Female, Southern Downs
region
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Collective Management rather than Self-Management

• Family and community participation
• Cultural and professional expectations

when we left Doctor said I want all you
kids to come in with me into the room so you can
learn how to do physio because you will need to
do this for your father three times a day for
postural drainage thats I dunno, 40 years ago
still has this lung Indigenous Community Elder,
Female, Southern Downs region
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Holistic Health Managing more than the Medical

• Holistic Health model intellectual, spiritual,
  emotional, physical and cultural
• Social and Emotional well-being
• Example Interaction between social and physical
  health

Youre not just dealing with the patient, youre
dealing with the family and the community they
all have to be healthy Indigenous Health
Worker, Male, North Queensland region
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Cultural Incompetence in Non-Indigenous Services

• Definition of Cultural Incompetence
• Cultural Incompetence in the medical establishment

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we only go to doctors when were really sick
Well have the symptoms for years and just put up
with it and learn to adapt around it. Indigenous
Carer, Female, Southern Downs region
The term medical establishment is coined to
represent those institutions existing within the
medical realm that provide health and medical
services (e.g. hospitals, medical centres and the
Health Department).
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Colonial Communication Preventing Self-Management

• Communication style
• Cultural communication context
• Range of literacy and language needs

Say somebody got them a Murri community member
to pick it the telephone up and say I need to
see a doctor and at the end of the line youve
got some arrogant white lady whose got no
patience who say Speak up, I cant understand
you and they put the phone down and they wont
ring up again. Indigenous Carer, Female,
Southern Downs region
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Localised themes to guide future CDM interventions

• Local Systems and kinship structures
• Cultural Traditions and Knowledge in the area
• Indigenous Methods the Murri Grapevine and the
  Power of Peers
• Supporting local Murri Leadership and Community
  Participation
• Interaction of core principles localised themes

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The Murri Grapevine is an established informal
network of contacts within the Murri community
through which information is dispersed.
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Future directions

• Template to guide health interventions
• Investigation of specific adaptations for regions
  (starting with North Brisbane)
• Family-based intervention