Impact

A team of leading Aboriginal and Torres Strait Islander and non-Indigenous health researchers from the study team across multiple institutions are looking at the evidence to improve outcomes and services for Aboriginal and Torres Strait Islander children and families who have been impacted by a severe burn injury.

Baseline participant interviews started in January 2015 and finished in January 2018.

We spoke to over 200 families.
The final two year follow up finished in 2020.
Every attempt has been made since 2015 to contact each participant at 3, 6, 12 and 24 month intervals.

Key learnings from our sub-studies so far:

The cultural competency of telehealth remains unclear.
Existing models of care for burns injury do not meet all aspects of quality or cultural safety.
There is a disconnect between Western and Indigenous knowledges; this is manifest in both Australia’s mainstream healthcare system and in the documents that inform burns care.
Burns care is informed by multiple factors, including evidence, resources and resourcing, decision-making processes and values and beliefs. Imbalances of power and the perpetuation of colonisation, through hierarchal teams and the dominant use of the biomedical model, were evident throughout.
Equity in healthcare is limited with restricted capacity for the delivery of care based on needs other than those aligned with the biomedical model.
Multiple issues exist related to equity and equality in the delivery of burns care for Aboriginal and Torres Strait Islander children.
Families’ experiences in burn aftercare within health services in Australia comprised of significant barriers in accessing healthcare following their child’s burn.
Racism, distance to aftercare services, cost of transport and parking in hospital grounds for outpatient clinics and disconnection from family were some barriers that families voiced as central issues. However, there were also some clear facilitators such as the support of First Nations Health Workers and Liaison Officers.
It is fundamental for First Nations families to have input into care received and clear and concise communication on the care that is needed for ongoing burn aftercare to be effective.
Most barriers can be alleviated by First Nations Health Workers’ support and involvement in the child’s burn aftercare.
Inequities in injury burden are greatest in children from low socio-economic status backgrounds and those who experience longer hospital length of stay (LOS).
Aboriginal and Torres Strait Islander children have a hospital LOS 4 days longer than other Australian children for acute burns. Remoteness, flame burns, percentage total body surface area are contributing factors. These health inequities, low socio-economic status and Streptococcus sp. infection are greater in Aboriginal and Torres Strait Islander children than other Australian children.
The manifestation of inequities creates additional burden through Out-of-Pocket Healthcare Expenditure (OOPHE) on Aboriginal and Torres Strait Islander families. Travel, accommodation and medication are all OOPHE costs impacting families for their child’s burns treatment.
Reduced functional and HRQoL levels pre-injury or baseline, longer hospitalisation, and lower socioeconomic status were linked to poorer long-term outcomes.

Publications:

Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review. Read more...
Fraser, S, Mackean, T, Grant, J, Hunter, K, Towers, K and Ivers | Rural and Remote Health 2017
Burns injury models of care: a review of quality and cultural safety for care of Indigenous children. Read more...
Fraser, S, Grant, J Mackean, T, Hunter, K, Holland, AJA, Clapham, K, Teague, WJ and Ivers | Burns
What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children. Read more...
Fraser, S, Grant, J, Mackean, T, Hunter, K, Keeler, N, Clapham, K, Teague, WJ, Potokar, T and Ivers | Burns
Walking together to create harmony in research: A Murri woman’s approach to Indigenous research methodology. Qualitative Research in Organizations and Management. Read more...
Coombes J, Ryder C. | Qualitative Research in Organizations and Management
Factors that impact access to ongoing health care for First Nation children with a chronic condition. Read more...
Coombes J, Hunter K, Mackean T, Holland AJ, Sullivan E, Ivers R | BMC Health Services Research
A Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study. Read more...

Ivers, RQ., Hunter, K., Clapham, K., Coombes, J., Fraser, S., Lo, S., Gabbe, B., Hendrie, D., Read, D., Kimble, R., Quinn, L., Towers, K., Potokar, T., Mackean, T., Grant, J., Lyons, RA., Jones, L., Eades, Daniels, J, Holland J | BMJ Open
Equity in functional and health related quality of life outcomes following injury in children - a systematic review. Read more...
Ryder, C., Mackean, T., Hunter, K., Williams, H., Clapham, K., Holland, A. J. A., & Ivers, R. | Critical Public Health
Indigenous research methodology – weaving a research interface. Read more...
Ryder, C., Mackean, T., Coombs, J., Williams, H., Hunter, K., Holland, A. J. A., & Ivers, | International Journal of Social Research Methodology
Efficacy and cultural appropriateness of psychosocial interventions for Aboriginal and Torres Strait Islander paediatric burn patients and caregivers: a systematic review. Read more...
Williams H., Hunter K., Clapham K., Kimble R., Griffin B | BMC Public Health
The Journey of Aftercare for Australia’s First Nations Families Whose Child Had Sustained a Burn Injury. Read more...
Coombes J, Hunter K, Mackean T, Sullivan E, Ivers R. | BMC Health Services Research
Burn Injuries in Hospitalised Australian Children - An Epidemiological Profile. Read more...
Ryder, C. Mackean, M. Hunter, K. Rogers, K. Holland, J. Ivers, R
Factors Contributing to Longer Length of Stay in Aboriginal and Torres Strait Islander Children Hospitalised for Burn Injury. Read more...
Ryder, C. Mackean, M. Hunter, Towers, K. K. Rogers, K. Holland, J. Ivers, R
Yarning up about out-of-pocket healthcare expenditure in burns with Aboriginal families. Australian and New Zealand Journal of Public Health. 2021. Read more...
Ryder, C, Mackean, T. Hunter, K. Coombes, J. Holland, A. Ivers, R.
“They Are Worth Their Weight in Gold”: Families and Clinicians’ Perspectives on the Role of First Nations Health Workers in Paediatric Burn Care in Australia. Read more...
Julieann Coombes, Sarah Fraser, Kate Hunter, Rebecca Ivers, Andrew Holland, Julian Grant, and Tamara Mackean.Int J Environ Res Public Health. 2021 Mar; 18(5): 2297.
Considering difference: clinician reports insights into providing equal and equitable burns care for Aboriginal and Torres Strait Islander children and families. Read more...

Sarah Fraser, Julian Grant, Tamara Mackean, Kate Hunter, Dale Edgar, Kurt Towers, Warwick Teague and Rebecca Ivers.

Presentations

Australia’s First Nation Children’s need for Culturally Appropriate Burn After Care. Download here...

Burden of Burns in Australian Children. Download here...

The Coolamon study. Download here...

Burn injury models of care: a review of quality and cultural safety for care of Indigenous children. Download here...

What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children and families. Download here...

Considering difference:
clinician reports of providing
equal and equitable burns care for Aboriginal and Torres Strait Islander children and families. Download here...