Avoiding the 'costly' crisis: Informing renal services design and delivery for Aboriginal people in rural/regional New South Wales, Australia

Abstract

Australian Aboriginal people experience at least eight times the incidence of chronic kidney disease progressing to end-stage kidney disease than non-Aboriginal Australians. No previous studies in rural Australia have explored the experience of Aboriginal patients with haemodialysis or renal services delivery. Methods An Indigenist research paradigm and community based participatory research methods informed interviews conducted with 18 Aboriginal haemodialysis recipients and 29 health professionals providing treatment or care. Results ‘Family’ was the motivator for persevering with haemodialysis. Comparison of both data sets revealed significant congruence between Aboriginal and provider perspectives. A combined thematic analysis produced a supervening theme of Avoiding the ‘costly’ crisis. Four sub themes were: better screening for early detection; flexible family-focussed care; system redesign to demonstrate cultural understanding; managing patient fear of mainstream services.

Institutional racism emerged as a barrier to effective care for Aboriginal renal patients. Health system redesign to meet participant’s perceptions of culturally acceptable care was the greatest challenge but with potential to improve quality of care and outcomes.

Conclusion Health services need to address less than optimal services for rural Aboriginal haemodialysis patients. Addressing residual institutionalised racism and the ongoing impact of past overt racism on Aboriginal people within health services will provide more culturally competent and effective treatment and care.