Inclusiveness in Rural Australian Healthcare

Establishing a culturally inclusive healthcare environment to ensure Australians residing in rural areas receive equitable access to care and experience better health outcomes.

Australians residing in metropolitan areas have a choice of more than one health service which aligns with their values, beliefs or specialist needs.

Almost a third of the population, however, live outside major cities and they often experience poorer access to, and have limited choices for, healthcare services.

Dr Olivia Mitchell and the Culturally Inclusive Rural Health Care team at the Department of Rural Health, based in Shepparton, Melbourne Medical School, have been researching how services can become more responsive and inclusive for the communities they serve.

“Rural health services need to be able to cater for a culturally diverse population,” Dr Mitchell said.

“These include Aboriginal and Torres Strait Islander peoples, members of the LGBTIQA+ community, people from culturally and linguistically diverse groups, socioeconomically disadvantaged groups, people with differing abilities, low English literacy, older people, young people, people experiencing family violence – any person who may need care but may experience barriers accessing it in a mainstream healthcare environment,” she said.

“It’s important for people to feel safe, comfortable, and able to access health services when they need to because even though they live in some very beautiful rural places, statistically they have shorter life expectancy and a greater burden of disease.”

Dr Mitchell and her colleagues are currently working on an Australian Research Council (ARC) Discovery project which examines increasing inclusion in four rural health services.

The health services include a small rural hospital, a community health service, a youth mental health service and a maternal child health service.

“Each health service has a different group they want to be more inclusive for and we are documenting the journey of each organisation as they undertake this process,” Dr Mitchell said.

The aim is to generate a body of knowledge about how health services can become more inclusive and the likely challenges and enablers that may be encountered on this journey.

Her research includes elements of organisational change, culture change, practice change and patient-centred care.

“It’s about getting healthcare organisations to think about the assumptions they make about the community and individuals,” Dr Mitchell said.

To challenge organisations to ask themselves:

• What do we take as a given when someone walks into our health service?
• What do we assume that may create a barrier for that person to access the care they need?

“For instance, patients may be asked to fill in a form and this process makes a lot of assumptions,” Dr Mitchell said.

“It assumes you can read the form; you understand all of the words and language in the form, and have the confidence and capacity to be able to fill in the form accurately,” she said.

“We have found they [the health services] are all coming up against similar problems; how to be more inclusive and how to engage with populations who are not using the health service or not seeking healthcare before they become very ill.”

In engaging health services in social research, particularly around inclusion, Dr Mitchell has found there is a significant period of time associated with developing working relationships and forming partnerships with each organisation.

She has estimated it can take 12-18 months to engage meaningfully with a health service; understand how they work, how it is funded, establish trust and demonstrate the research collaboration is valuable for both parties.

As the partnerships evolves, the research team assists in the development of strategies to empower the health service to drive their own inclusiveness initiatives, as shown through a long-term collaboration with one rural health service.

“The organisation initially wanted to improve access to and utilisation of the health service for the local Aboriginal and Torres Strait Islander population and leadership at the service were unsure how to do this,” Dr Mitchell said.

“Working together with management staff, we established a working group, re-developed their Aboriginal Health Action Plan and a developed a program to engage health service staff in cultural awareness training,” she said.

These steps, in conjunction with the appointment of an Aboriginal Health Liaison Officer, have seen the utilisation of the health service for the local Aboriginal community increase significantly over the past two years.

“When you look at the utilisation numbers there has been a massive increase in the number of Aboriginal children accessing the healthcare service,” Dr Mitchell said.

“Providing this feedback to senior management and the board of directors at the health service has been very valuable to show the importance of these initiatives even though they take a long time,” she said.

“Based on the initial success of improving access to and utilisation of the service for the local Aboriginal population, the organisation is now exploring how similar strategies can be implemented to improve responsiveness and inclusion for other vulnerable groups within the community.”

“Once thinking is challenged around assumptions commonly made about people wanting to access the service, the inclusiveness culture starts to expand.”

The next phase for this project involves interviewing community members to understand from their perspectives, what makes a health service inclusive or not inclusive.

This information will provide feedback to services and assist them to develop a framework to further improve their inclusivity.

Dr Mitchell and her colleagues plan to develop an inclusiveness toolkit which can be contextualised based on the needs of each rural health service.

“We would like to highlight strategies on how to overcome barriers to inclusion and how to enable health services to recognise improvements,” Dr Mitchell said.

“If we can develop a framework and toolkit that can be contextualised for different types of health services, then we will hopefully assist organisations to maximise opportunities to strengthen the inclusivity of their service,” she said.