Introduction:A recent implementation project (11 stroke/rehabilitation wards, 9 NSW hospitals) improved inpatient guideline-recommended continence care. However, this practice-change package lacked tailoring for Aboriginal people. We aimed to co-create culturally responsive solutions to deliver guideline-recommended continence care that are appropriate and beneficial for Aboriginal people.
Methods:Our research was conducted on country at Armidale, Uralla, and Narrabri. The team included Aboriginal Elders (n=2), Aboriginal clinicians and managers (n=9), and non-Aboriginal clinicians [stroke (n=2), rehabilitation (n=1), nurse researcher (n=1)]. Participants groups included Aboriginal Elders and community (three groups, n=24), Aboriginal staff (three groups, n=12), and interested staff (four groups, n=21).
We applied community consultation through yarning to a three-phase co-creation framework:
1.Gather participant perceptions and insights regarding continence issues and care.
2.Identify key themes and potential solutions.
3.Undertake an iterative process to develop and finalise solutions.
Field notes were taken at each yarn, discussed, and actioned.
Results:All participant groups perceived the key barrier was lack of knowledge. Elders and community identified that solutions should: address men’s and women’s business, remove embarrassment, encourage speaking up, highlight that many adults experience symptoms impacting on quality of life, outline common symptoms/ causes and where to get help. Aboriginal staff wanted more knowledge about continence and referral pathways. Non-Aboriginal staff wanted knowledge to deliver culturally safe continence care. Solutions included: location-specific artworks incorporated into promotional resources, posters, waiting room videos, yarning cards, clinician training (stroke case study) and resources, and improving access to continence nurses.
Conclusion:To co-create appropriate solutions, we prioritised building strong respectful relationships with Elders, community, and staff, incorporating their knowledge, and promoting self-determination.
Relevance to clinical practice/patient experience:Authentic, community-led co-creation is a powerful model for health service improvement. The solutions are owned and embraced by community members. We will share the resources/ findings widely and incorporate them into the practice-change package.
Authors: in conjunction with the “Tablelands Community Support Elders Group, Armidale and Uralla” and “Narrabri Aboriginal Women interested in Women's Business”.