Enquiries:+61 2 8502 4571
 

Element 3: Wellbeing is supported by holistic care throughout the lifespan

An integrated cycle of care recognises that people’s healthcare needs extend beyond the physical body. For Aboriginal and Torres Strait Islander peoples, healthcare needs may be closely bound to their spiritual, family, cultural, community and Country connections. An integrated cycle of care also acknowledges that people’s needs differ according to where they are within their life-course. Ensuring that appropriate resources are available is also essential to meeting the often complex needs of Aboriginal and Torres Strait Islander clients.

PRINCIPLES

Principle 3a: Applying holistic approaches to address priorities determined with clients

Applying an holistic approach [18, 20, 28, 34, 35] includes addressing the physical, spiritual, social, emotional, psychological and cultural aspects of people’s health [6]. Primary healthcare providers must be aware of and, where possible, support people to address and work toward overcoming socio-economic disparities [27, 28, 36, 37]. This may include providing opportunities for healing from trauma and stress, as well as addressing the social and cultural determinants of health as part of chronic disease care [13, 38].

Principle 3b: Life-course approach from pre-conception to post-mortality

A life-course approach considers healthcare needs and priorities according to life stages [13]. In Aboriginal and Torres Strait Islander communities, a life-course approach extends from pre-conception to post-mortality [16, 27, 32]. The development of risk factors for chronic diseases is influenced by parents’ health prior to conception as well as during pregnancy [6]. Likewise, the ongoing responsibilities for people who have passed, together with higher rates of morbidity and mortality, can result in an increased burden of unresolved grief, loss and trauma [14, 24].

Principle 3c: Ensuring appropriate resources are available to meet local priorities and needs

Resources include guidelines, assessment tools and measures, and information that support the provision of healthcare to meet the specific needs of communities. Ideally, resources that are specific to local communities should be used or developed. However, where these are not available, it may be necessary to utilise or adapt generic resources to suit local contexts.

Principle 3d: Responding to family, community, cultural and spiritual responsibilities and obligations

Primary healthcare providers need to understand and be willing to respond appropriately to people’s range of cultural responsibilities, including family and kinship obligations [13, 20, 39, 40]. Wellbeing for Aboriginal and Torres Strait Islander peoples is closely connected to Country and cultural practices, as well as to the maintenance and application of traditional knowledge [6]. It is therefore important not only to respond appropriately to the diversity of healthcare needs, but also to respect cultural and social conditions at a local level [5, 13, 27, 41, 42].

APPLICATIONS

Applications associated with Principle 3a: Applying holistic approaches to address priorities determined with clients

Applying holistic approaches that address needs and priorities as determined with clients may be achieved by:

  • Identifying and responding to needs and priorities determined with clients [14-16, 38, 45, 52]
  • Encouraging and supporting people to be involved in the management of their healthcare [13, 37, 61]
  • Being prepared and having the capacity to engage in family-centred care, if desired [17, 42, 44, 45, 62]
  • Developing a range of approaches which can accommodate people with varying complex needs [15, 26, 53, 54]
  • Providing information to staff about external healthcare and non-healthcare services that are available to address people’s needs [25, 49]
  • Collaborating with non-healthcare services, including housing and other social services [14, 18, 26, 32, 35, 36, 44, 56]
  • Advocating on behalf of clients to access non-healthcare services [14, 20, 28, 44]
  • Establishing communication protocols and care pathways which ensure continuity of care when referring people to external services [16, 49]
  • Identifying and endeavouring to link clients with Aboriginal and Torres Strait Islander staff when referring them to external services [13]
  • Facilitating case conferences, potentially involving healthcare and non-healthcare service providers, clients and their families, and community Elders where appropriate [14, 20, 44]
Applications associated with Principle 3b: Life-course approach from pre-conception to post-mortality

A life-course approach may be applied by:

  • Implementing disease prevention and health promotion activities, including maternal and child health, and youth programs [5, 16, 37, 44]
  • Delivering age-appropriate health promotion activities in school settings in order to inform young people about the risks associated with developing chronic diseases [13, 42]
  • Identifying risks of chronic disease and providing early interventions to address these risks [13]
  • Enhancing health literacy throughout the lifespan [55]
  • Organising respite excursions on Country as a strategy for dealing with stress [13]
  • Facilitating support groups for various chronic diseases [13, 51]
  • Providing acute care services in addition to chronic disease management [44]
  • Supporting wellbeing within aged care services [13, 29]
  • Facilitating appropriate palliative care, and end of life support [13, 16, 27, 44, 55]
  • Providing services that support healing from grief and loss [13]

Applications associated with Principle 3c: Ensuring appropriate resources are available to meet local priorities and needs

Appropriate resources that meet local priorities and needs may be provided by:

  • Compiling Directories of all local Aboriginal and Torres Strait Islander services including descriptions of the roles and responsibilities of various services [13, 55]
  • Determining local priorities by utilising statistical data to identify trends and using qualitative evaluations to capture the stories that explain local trends [13]
  • Identifying and evaluating the appropriateness of and, where necessary, adapting existing resources to ensure they are appropriate for use in local Aboriginal and Torres Strait Islander communities [13, 14, 16, 41, 42, 44]
  • Ensuring information is user-friendly, for example, by using lay language [20, 50] or using visual aids to convey messages [16, 36, 56]
  • Identifying and utilising a variety of methods for disseminating information that take account of the contexts and needs of clients and communities [13, 22, 27, 33, 56]
  • Including local community members on resources such as flyers or posters [13]
  • Providing information to communities about how to identify and interpret symptoms of chronic disease, such as early signs of a heart attack [13]
  • Identifying and making use of healthcare standards, guidelines and programs that are appropriate for Aboriginal and Torres Strait Islander peoples [14, 16, 31, 63]
Applications associated with Principle 3d: Responding to family, community, cultural and spiritual responsibilities and obligations

Ensuring that primary healthcare services are aware of and respond appropriately to people’s family, community, cultural and spiritual responsibilities and obligations may be achieved by:

  • Actively seeking Aboriginal and Torres Strait Islander staff members’ advice in order to give context to the circumstances of clients’ families or their communities [17]
  • Building relationships with community members who could further contribute to understanding of the cultural responsibilities, obligations and practices of individuals [16, 32]
  • Developing procedures which ensure staff are aware of and respond appropriately to cultural sensitivities around gender and avoidance relationships [13]