Co-creating a Health Navigator model of care to address social determinants of ear health among Aboriginal and Torres Strait Islander children: addressing upstream drivers rather than downstream symptoms

Abstract

Social determinants contribute to ear health inequities for Aboriginal and Torres Strait Islander children, including colonisation, crowded housing, poor living conditions, out-of-home care, tobacco smoke exposure, and barriers to culturally safe care. Despite this, no evaluated programmes directly target these determinants. Research has largely been non-participatory, prompting calls for co-created, community-led approaches. This thesis investigates determinants of ear health among Aboriginal and Torres Strait Islander children aged 0.5-18 years in NSW, embedding findings into the co-creation of the ACCESS Child Health Navigator model of care. Methods: A literature review of social determinants and Aboriginal research methodologies; Community Yarning circles exploring barriers and enablers to ear health; Quantitative analyses of otitis media and hearing loss prevalence and associated factors; A systematic review of Health Navigators for Indigenous child and adolescent populations; Co-creation of the ACCESS model, integrating findings into a community-led protocol. Results: The literature review revealed gaps in evaluations targeting social determinants. Yarning circles highlighted the cultural safety of Aboriginal Community Controlled Health Services versus barriers in mainstream services. Quantitative data showed high otitis media (~50% in children under three) and hearing loss (~25% overall), linked to childcare, foster care, infection history, and overcrowding. The Health Navigator review highlighted their potential to address social determinants but noted limited data on child-focused programmes and evaluations. Conclusion: This thesis underscores the essential role of ear health for development and lifelong outcomes. It highlights systemic barriers, including racism, and advocates for co-created, community-led solutions. The ACCESS model exemplifies culturally safe, community-led research to improve outcomes for Aboriginal and Torres Strait Islander children.