HealthBullletin 2(4)

This section of the Bulletin identifies recent theses, treatises, dissertations and other academic reports. If you are aware of material that would be appropriate for inclusion in this section please contact us.

Jones S (2001) The identification and management of foot problems by Aboriginal health workers. Unpublished Doctor of Philosophy thesis, University of South Australia, Adelaide.

The achievement and maintenance of optimal foot health is an important determinant of levels of mobility and quality of life. Factors that may influence foot health status, such as the presence of foot lesions, inability to provide adequate self-care and the presence of systemic conditions such as diabetes may pose significant long-term threats to foot function. Early identification of potential problems and implementation of appropriate management strategies can ensure that foot health is optimised. To do this, primary health care workers must be provided with appropriate education and skills.

Within the Australian Aboriginal and Torres Strait Islander community, the staff most appropriately positioned to provide primary level foot care are Aboriginal Health Workers. Yet despite projections of increases in morbidity due to rising levels of Type 2 diabetes, there has previously been no foot care education strategy developed for Aboriginal Health Workers addressing the long term prevention of foot complications within the Aboriginal and Torres Strait Islander community of South Australia.

This study was undertaken to address the need for early identification of foot problems.

The study was designed and conducted in three separate phases:

Phase one established the need for a foot education program. Information was gathered about issues of concern relating to foot health. Focus groups were conducted with members of the Aboriginal community and health staff in order to identify community concerns and priorities. In addition to community consultation, a questionnaire survey was conducted of Aboriginal Health Workers to identify their perceptions of needs for foot care services among their clients and to ascertain the extent of their foot care knowledge.

The main findings of this phase were:

Information gathered within phase one was used to inform the design and delivery of both phase two and phase three.

Phase two comprised a cross-sectional study of 1,092 Aboriginal and Torres Strait Islander people aged six to 75 years living in urban communities in South Australia. A data collection program examined the feet of volunteer subjects, identified foot disorders and examined footwear styles and size.

These findings informed the range of foot conditions that required inclusion within the foot education program and identified areas requiring Aboriginal Health Worker input.

Phase three of this study involved the development, presentation and evaluation of a foot education program for Aboriginal Health Workers, addressing the foot care issues identified within phases one and two. This was undertaken
using the following strategies:

Delivery of the education program was conducted as a two-phase activity, as a pilot program and main program, with evaluation of each conducted upon completion of the program and again three months later. Evaluation of the pilot at the completion of the program was positive, with participants reporting that they would use the information in their workplace. However, at the three-month review, self-reported utilisation of the foot care knowledge and skills was low, with only three of the ten participants (30 percent) reporting the use of any form of foot checks. The main problem identified was a lack of confidence to transfer the foot examination skills to the workplace setting, due to a combination of insufficient clinical reasoning experience and lack of resources to undertake clinical testing and examination.

As a consequence, the duration of the main program was increased (from three and a half hours to six hours) in order to include more clinical reasoning exercises and a three-hour practical clinical placement component was added, in order to provide hands-on experience in a community practice. These changes proved successful in increasing participant confidence to apply foot-screening skills in their own workplace. At the three-month evaluation of the main foot education program, 11 of the 13 program participants (85 percent) reported they were conducting foot screening of clients.

Development of the foot education program will assist Aboriginal Health Workers to provide appropriate and timely foot screening services within the community, thus reducing the risk of preventible foot morbidities developing into mobility-threatening or life-threatening complications.

Maher P (1998) The provision of rehabilitation services to Aboriginal people. A qualitative case study. Unpublished Master of Applied Science in Physiotherapy thesis, School of Physiotherapy, University of South Australia, Adelaide.

The central question considered by this research was what are the perceptions of Aboriginal patients and rehabilitation staff as to the factors which affect the rehabilitation of Aboriginal inpatients. The aims were to consider the factors which impact on the rehabilitation process from the viewpoints of Aboriginal patients and staff; to analyse the factors identified; and to identify possible recommendations to the rehabilitation process which may increase the effectiveness of the delivery and outcome of rehabilitation services to Aboriginal people.

The research involved interviews with five Aboriginal subjects who were inpatients of the rehabilitation ward at the Royal Darwin Hospital. Focus groups were held with rehabilitation staff after the discharge of subjects from the rehabilitation unit. Field notes taken by the researcher in the participant observer role and relevant medical notes provided further sources of data.

Triangulation of data occurred via different methods of data collection and from different sources. Transcripts of the interviews and partial transcripts of the focus groups underwent thematic content analysis to identify factors perceived to be influencing the rehabilitation process. Field notes and relevant medical notes provided further depth to the data collected.

Numerous factors were identified as impacting on the ability of the rehabilitation unit to provide services to Aboriginal people. These included: the limited understanding by subjects of the concept of rehabilitation; the differing operational and cultural frameworks of staff and subjects; the quality of relationships and communication between subjects and staff; the family of subjects; the lack of knowledge by staff regarding cultural aspects of disability; a number of specific Aboriginal cultural issues; and uncertainty regarding discharge destination and date.

These factors are discussed and changes hypothesised which, if implemented, may result in improvements in the delivery of rehabilitation services to Aboriginal patients at the Royal Darwin Hospital.

Australian Indigenous

HealthInfoNet

Theses



Australian Indigenous HealthBulletin Vol.2 No.4 October 2002 - December 2002: ISSN 1445-7253 An electronic journal from the Australian Indigenous HealthInfoNet Theses This section of the Bulletin identifies recent theses, treatises, dissertations and other academic reports. If you are aware of material that would be appropriate for inclusion in this section please contact us. The identification and management of foot problems by Aboriginal health workers added 1 October 2002 The provision of rehabilitation services to Aboriginal people. A qualitative case study added 20 November 2002 Jones S (2001) The identification and management of foot problems by Aboriginal health workers. Unpublished Doctor of Philosophy thesis, University of South Australia, Adelaide. The achievement and maintenance of optimal foot health is an important determinant of levels of mobility and quality of life. Factors that may influence foot health status, such as the presence of foot lesions, inability to provide adequate self-care and the presence of systemic conditions such as diabetes may pose significant long-term threats to foot function. Early identification of potential problems and implementation of appropriate management strategies can ensure that foot health is optimised. To do this, primary health care workers must be provided with appropriate education and skills. Within the Australian Aboriginal and Torres Strait Islander community, the staff most appropriately positioned to provide primary level foot care are Aboriginal Health Workers. Yet despite projections of increases in morbidity due to rising levels of Type 2 diabetes, there has previously been no foot care education strategy developed for Aboriginal Health Workers addressing the long term prevention of foot complications within the Aboriginal and Torres Strait Islander community of South Australia. This study was undertaken to address the need for early identification of foot problems. The study was designed and conducted in three separate phases: *Phase one* established the need for a foot education program. Information was gathered about issues of concern relating to foot health. Focus groups were conducted with members of the Aboriginal community and health staff in order to identify community concerns and priorities. In addition to community consultation, a questionnaire survey was conducted of Aboriginal Health Workers to identify their perceptions of needs for foot care services among their clients and to ascertain the extent of their foot care knowledge. The main findings of this phase were: An unmet need for information about foot problems existed among both members of the Aboriginal and Torres Strait Islander community and among the surveyed Aboriginal Health Workers, particularly in regard to the identification and management of commonly encountered foot lesions, diabetes management and footwear use. There was a high level of concern among members of the community about the lower limb complications of diabetes (particularly lower limb amputations) but an absence of knowledge about the mechanisms involved or the existence of preventive measures. Aboriginal Health Workers were not undertaking any form of foot assessment or education with their clients, due to a lack of knowledge about foot care. Aboriginal Health Workers expressed a strong interest in developing their knowledge about foot care through attendance at a workshop-style education program. Information gathered within phase one was used to inform the design and delivery of both phase two and phase three. *Phase two* comprised a cross-sectional study of 1,092 Aboriginal and Torres Strait Islander people aged six to 75 years living in urban communities in South Australia. A data collection program examined the feet of volunteer subjects, identified foot disorders and examined footwear styles and size. The main findings of this phase were: High levels of preventable or treatable skin lesions (corns and callus) and nail lesions (long nails and ingrown toenails) were recorded within the study population. High levels of diabetes were found within the sample. Seventeen percent of the sample aged over 30 years reported a diagnosis of Type 2 diabetes. Associated with this were high levels of peripheral vascular and neurological loss, particularly in subjects with a duration of diabetes greater than five years. Subjects with diabetes were found to have higher levels of skin and nail lesions than the wider sample, indicating a high risk for future development of ulcerative lesions in the absence of appropriate care. Approximately 71 percent of all subjects in the study were found to be wearing footwear which was measurably too small for their foot size. This was found to be strongly associated with the presence of self-reported foot pain and the presence of skin lesions such as corns and callus. These findings informed the range of foot conditions that required inclusion within the foot education program and identified areas requiring Aboriginal Health Worker input. *Phase three* of this study involved the development, presentation and evaluation of a foot education program for Aboriginal Health Workers, addressing the foot care issues identified within phases one and two. This was undertaken using the following strategies: Introduction of theoretical information about the aetiology and management of the commonly encountered foot problems using a combination of visual presentation and case study illustrations drawn from clinical experience in community practice. Development of screening and diagnostic skills through the use of practical sessions. Development of clinical reasoning skills integrating both the theoretical and practical components of the program through the use of case studies and clinical placements. Provision of appropriate supporting reference material, including examination checklists. Delivery of the education program was conducted as a two-phase activity, as a pilot program and main program, with evaluation of each conducted upon completion of the program and again three months later. Evaluation of the pilot at the completion of the program was positive, with participants reporting that they would use the information in their workplace. However, at the three-month review, self-reported utilisation of the foot care knowledge and skills was low, with only three of the ten participants (30 percent) reporting the use of any form of foot checks. The main problem identified was a lack of confidence to transfer the foot examination skills to the workplace setting, due to a combination of insufficient clinical reasoning experience and lack of resources to undertake clinical testing and examination. As a consequence, the duration of the main program was increased (from three and a half hours to six hours) in order to include more clinical reasoning exercises and a three-hour practical clinical placement component was added, in order to provide hands-on experience in a community practice. These changes proved successful in increasing participant confidence to apply foot-screening skills in their own workplace. At the three-month evaluation of the main foot education program, 11 of the 13 program participants (85 percent) reported they were conducting foot screening of clients. Development of the foot education program will assist Aboriginal Health Workers to provide appropriate and timely foot screening services within the community, thus reducing the risk of preventible foot morbidities developing into mobility-threatening or life-threatening complications. Abstract reproduced with permission of the author Maher P (1998) The provision of rehabilitation services to Aboriginal people. A qualitative case study. Unpublished Master of Applied Science in Physiotherapy thesis, School of Physiotherapy, University of South Australia, Adelaide. The central question considered by this research was what are the perceptions of Aboriginal patients and rehabilitation staff as to the factors which affect the rehabilitation of Aboriginal inpatients. The aims were to consider the factors which impact on the rehabilitation process from the viewpoints of Aboriginal patients and staff; to analyse the factors identified; and to identify possible recommendations to the rehabilitation process which may increase the effectiveness of the delivery and outcome of rehabilitation services to Aboriginal people. The research involved interviews with five Aboriginal subjects who were inpatients of the rehabilitation ward at the Royal Darwin Hospital. Focus groups were held with rehabilitation staff after the discharge of subjects from the rehabilitation unit. Field notes taken by the researcher in the participant observer role and relevant medical notes provided further sources of data. Triangulation of data occurred via different methods of data collection and from different sources. Transcripts of the interviews and partial transcripts of the focus groups underwent thematic content analysis to identify factors perceived to be influencing the rehabilitation process. Field notes and relevant medical notes provided further depth to the data collected. Numerous factors were identified as impacting on the ability of the rehabilitation unit to provide services to Aboriginal people. These included: the limited understanding by subjects of the concept of rehabilitation; the differing operational and cultural frameworks of staff and subjects; the quality of relationships and communication between subjects and staff; the family of subjects; the lack of knowledge by staff regarding cultural aspects of disability; a number of specific Aboriginal cultural issues; and uncertainty regarding discharge destination and date. These factors are discussed and changes hypothesised which, if implemented, may result in improvements in the delivery of rehabilitation services to Aboriginal patients at the Royal Darwin Hospital. Abstract reproduced with permission of the author