Introduction
Materials and methods
Self-location
Systematic database literature search of academic and grey literature
Inclusion/Exclusion process of publications identified from the literature search
Synthesis and analysis of included publications through quality assessment, critical appraisal, and GSGL factor alignment
Aboriginal and Torres Strait Islander Quality Assessment Tool (ATSIQAT) analysis
Joanna Briggs Institute items | Aboriginal and Torres Strait Islander Quality Appraisal Tool items |
---|---|
Is there congruity between the stated philosophical perspective and the research methodology? | Did the research respond to a need or priority determined by the community? |
Is there congruity between the research methodology and the research question or objectives? | Was community consultation and engagement appropriately inclusive? |
Is there congruity between the research methodology and the methods used to collect data? | Did the research have Aboriginal and Torres Strait Islander research leadership? |
Is there congruity between the research methodology and the representation and analysis of data? | Did the research have Aboriginal and Torres Strait Islander governance? |
Is there congruity between the research methodology and the interpretation of results? | Were local community protocols respected and followed? |
Is there a statement locating the researcher culturally or theoretically? | Did the researchers negotiate agreements in regards to rights of access to Aboriginal and Torres Strait Islander peoples’ existing intellectual and cultural property? |
Is the influence of the researcher on the research, and vice- versa, addressed? | Did the researchers negotiate agreements to protect Aboriginal and Torres Strait Islander peoples' ownership of intellectual and cultural property created through the research? |
Are participants, and their voices, adequately represented? | Did Aboriginal and Torres Strait Islander peoples and communities have control over the collection and management of research materials? |
Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? | Was the research guided by an Indigenous research paradigm? |
Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? | Does the research take a strengths-based approach, acknowledging and moving beyond practices that have harmed Aboriginal and Torres Strait peoples in the past? |
Did the researchers plan to and translate the findings into sustainable changes in policy and/or practice? | |
Did the research benefit the participants and Aboriginal and Torres Strait Islander communities? | |
Did the research demonstrate capacity strengthening for Aboriginal and Torres Strait Islander individuals? | |
Did everyone involved in the research have opportunities to learn from each other? |
Joanna Briggs Institute (JBI) Critical Appraisal analysis
Alignment of reviewed publications with GSGL principles
Method for enablers and barrier thematic analysis
Results
Models of care
Included study | Study design and method | Sample | Context – Urban, Remote or Both | Home-based/ Respite/ Residential aged care | Degree of alignment with GSGL | Findings related to service delivery, implementing (MOC) principles into practice | JBI | QAT |
---|---|---|---|---|---|---|---|---|
1. Cairns et al. 2022 (QLD) [29] | Single program evaluation; Mixed-methods Action research framework | Unclear | Remote | All | High | Cultural responsiveness is the principle informing service design in remote settings. Co-design enables adaptation to provide meaningful services, improving outcomes. Reciprocal relationships are essential to achieving objectives, and developing strength-based approaches that define good living | H | H |
2. Carroll et al. 2010 (WA) [49] | Whole service MoC implementation: Evaluation of a locally designed community service MOC | 22 First Nations clients (15 aged care; 7 disability)- aged 15 to 83 | Remote | Home-based | High | Recommendations for co-design of integrated aged, disability and mental health service provision, include integrated service coordination facilitated by one culturally safe/community-controlled hub organization working together on common agenda and goals, community-based and culturally secure services, one service access point for Elders, First Nations workforce, and education/ training | H | H |
3. Dawson et al. 2021 (SA) [56] | Whole service MoC implementation; case studies Qualitative Interviews | 46 members of ACCHO staff & board—20 First Nations Australians, 26 non-First Nations | 2 metropolitan Aboriginal Community-controlled Services | All | High | Summarizes principles, enablers, challenges and outcomes of Aboriginal community-controlled aged care service delivery. Details nine implementation actions and service planning activities Sustainability was an issue | H | H |
4. Du Toit et al. 2014 (South Africa) [62] | Whole service MoC design; Qualitative Focus groups | 15 aged-care workers/ collaborators 8 First Nations, 7 non-First Nations | Urban | Residential | High | Practical suggestions include: meaningful engagement and respect; encompassing autonomy, choice, involvement in co-occupations, and physical accessibility, combined with quality of care | H | M |
5. Gidgup et al. 2022 (WA) [55] | Single program evaluation; Qualitative Yarning circles | 19 First Nations Elders (program participants) aged over 45 | Both – 2 organizations with one from each setting | Unclear | Medium | Learnings related to implementation—describes positive experiences allowing participants to meaningfully connect/ engage in a culturally appropriate program. A sense of belonging was key to attendance and continued participation, with benefits described as holistic in nature, in addition to those derived from the physical activities part of the program | H | H |
6. Harding et al. 2022 (NZ) [58] | Whole service MoC design; Interpretive research design guided by Kaupapa Maori theory | 17 Health & Social service professionals—12 Maori, 5 non-Maori | Unclear | Unclear | Medium | Key facilitators centered on external support, where participants reported program structure and experiences provide evidence supporting relevance and value of the intervention to their communities. Other key facilitators included process, and adaptability. The process facilitated community engagement during implementation & dissemination- increasing effectiveness & sustainability. Program adaptability enhances cultural/ community fit | H | M |
7. Hikaka et al. 2021 a (NZ) [60] | Single program design; Secondary analysis | Data from previous research | Urban | Home-based | Medium | Kaupapa theory underpins five Tiriti O Waitangi principles which structure this pharmacist-facilitated medicines review intervention for community-dwelling Māori Elders, with the objective of achieving equitable changes | M | M |
8. Hikaka et al. 2021 b (NZ) [61] | Single program evaluation; Qualitative Interviews | 17 First Nations Elders (program participants) aged 58–92 | Urban | Home-based | Medium | Recommendations include: medicines knowledge from a trusted professional; increased advocacy; ‘by Māori, for Māori’; increased confidence and control; financial and resource implications | H | H |
9. Lavrencic et al. 2021 (NSW) [50] | Single program evaluation; Mixed-methods Yarning circles | 7 First Nations Elders (program participants) aged between 62—81 | Remote | Home-based | Medium | Co-design process with First Nations communities and stakeholders which privileges First Nations leadership, and is culturally grounded at all stages of design and implementation ensured a high acceptability among participants and facilitators. This enables improved results relating to program objectives | H | M |
10. MacKell et al. 2022 (WA, NT, QLD) [51] | Single program design; mixed-methods, online survey, semi-structured interviews & focus groups | 99 First Nations and non-First Nations participants—50 artists, 25 art center staff members, 24 aged-care staff | Both | Both | High | Engagement underpinned by connection, Elder role, and culture. MOC is directed by Elders, providing holistic care through meaningful relationships. Reciprocity involves artists working for the center, & community in turn caring for artists | H | M |
11. Macniven et al. 2021 (NSW, WA, SA) [63] | Single program evaluation; Qualitative Yarning circles | 24 First Nations Elders (program participants)– aged over 45 | Both | Both | High | Learnings related to implementation - 6 Key themes around Knowing, Being, & Doing – resulting in a co-design program & resource relevant for Aboriginal people. Knowing involved elders connecting socially to share knowledge – elders value adequate program resourcing, facilities and sustainability. Group dynamics were preferenced, which elders viewed as providing vital social support in order to age well, as well as strengthening culture. Doing involved elders sharing their experiences on operating a culturally-safe, relevant program | M | M |
12. Murphy et al. 2010 (WA) [36] | Whole service MoC implementation; Mixed-methods Service data; interviews, journals | 22 First Nations clients (15 aged care; 7 disability)) – aged 15 to 83 | Remote | Home-based | High | Demonstrated a successful service MOC by incorporating 3 services – disability, older, mental illness—developed in collaboration with community members & key stakeholders addressing unmet needs | M | M |
13. Oetzel et al. 2020 (NZ) [59] | Whole service MoC design; Peer education intervention guided by Kaupapa Maori theory | 121 Māori Elders | Unclear | Unclear | High | Culturally appropriate peer education intervention can address social connectedness through cultural concepts—tribal identity, tautoko, whakawhangaungatanga | H | H |
14. Pelcastre—Villafuerte et al. 2017 (Mexico)- [57] | Whole service MoC design; Qualitative Semi-structured interviews & focus group | 44 First Nations Elders (aged over 60)– 10 allopathic providers, 10 traditional providers | Remote | Home-based | High | Practical MOC design suggestions made in strategic areas: (1) Sociocultural epidemiology; (2) Local healthcare resources; (3) Community participation; (4) Strategies for communication on health issues; (5) Inter-institutional communication/interaction; (6) Sustainability communication/interaction; and Sustainability | H | M |
15. Smith et al. 2010 (NT) [53] | Whole service MoC implementation; Qualitative Participant observation | 25–35 First Nations clients aged over 50 mostly frail aged | Remote | All | High | Describes the operating principles ‘cultural comfort’ & ‘community control’ that support Elders to live with family on country. Emphasize community MOC rather than institutional MOC | H | H |
16. Wettasinghe et al. 2020 (NSW) [54] | Whole service MoC design; Qualitative Semi-structured interviews & focus group | 34 First Nations clients aged 50 years and older | Both | Home-based | High | Practical MOC design suggestions include a culturally-appropriate aged care program which identifies health concerns around themes including physical health, social and emotional well-being, and poor service access. Looks to empower Elders through technology education | M | L |
Whole service models of care
Principles | Enablers |
- Respect traditional Aboriginal customs, values & beliefs - Support Aboriginal identity - Connect with elders & community - Culturally safe care - Focus on holistic wellbeing - Respect self-determination - Tailored services - Willingness to go the extra mile - Maintain credibility | - Strong governance - Effective leadership - Organisational culture centred on respect for clients’ Aboriginal identity - Local, caring, qualified & culturally safe aged care workforce - Effective workforce recruitment & training processes - Effective communication - Clear referral pathways - Effective organisational structures & operating systems - Effective financial management systems - Continuous quality improvement processes - Relationships with external organisations |
Challenges | Outcomes |
- Funding challenges - Workforce shortages - Change management processes - The need to rapidly develop knowledge of the aged care system - Aged care reforms - Lack of coordination between government departments - Aged care eligibility requirements - Navigating the online aged care portal - Unclear correspondence from social services & government departments | - Promotion of Aboriginal identity & cultural connections - Increased numbers of elders receiving aged care - Reduced pressure & responsibilities on family carers - Improvements in physical health outcomes - Increased access to affordable, culturally safe & quality aged care - Reduced complexities associated with navigating multiple services - Economies of scale - Increased numbers of local, qualified, culturally safe aged care workers |
Single program or service element
Results of the ATSIQAT analysis and JBI analysis
Alignment of reviewed publications with GSGL
Thematic analysis – enablers and challenges to implementing models of care
Culture informing First Nations health care—First Nations approach to health
Connecting with First Nations leadership (Elders) and community to co-design services
Supports and services must be based in co-design principles and planned for
Organizational level enablers
Enablers related to responding to client/family needs
‘It’d be you’d have to have your group saying what they want to know about. Could be health could be all of that, but led from the group … we’ve all got different skills. So it’s nice to be able to have somewhere where we can pass those skills on’ [52] (p. 3).
Development of workforce
Staff from community or First Nations staff
Supporting staff external to community
“Don’t make decisions for them, ask them. And I know that it’s – it’s talked about a lot, and it doesn’t happen often enough. I think that’s something people could learn from us” [56] (non-Indigenous ACCO staff member Dawson et al. 2021) (pg. 4).
Funding and resourcing
Discussion
Colonisation
System change/Change management
Workforce and staff training
Looking beyond health services
“In this way the local organization and local workers are enabled to work with families and to care for old people in a flexible and culturally appropriate way. It also means assisting families to maintain traditional ways of caring for older family members while providing new support services to complement and sustain traditional patterns of care” [53] (pg. 12).