An investigation of the barriers to infectious disease interventions in Indigenous Australian communities
This research uses qualitative methods to investigate barriers to infectious diseases in Indigenous Australian communities using two infectious diseases as examplars; strongyloidiasis (ICD B78.9) and swine influenza, H1N1 (ICD J10.1) that caused a pandemic in 2009. An infection with Strongyloides stercoralis, a parasitic intestinal worm causing a disease-strongyloidiasis, is not a notifiable disease in Australia. Alternatively, the influenza A strain known as H1N9p2009 is a notifiable disease
... thin the Australian health care system. The purpose of using these diseases as exemplars is to provide a better understanding of barriers to effective interventions for infectious diseases in selected Indigenous Australian communities in two studies -Strongyloides and Influenza H1N1. This thesis focuses on addressing three research questions. These are: 1. What are, and have been, the barriers that have prevented effective of control and treatment of Strongyloides and H1N1 swine influenza in Indigenous Australian communities? 2. How are these barriers understood and articulated by Aboriginal communities/people, health staff and researchers? and 3. How does the outcome of this research inform Indigenous communities, researchers and public health policy makers about the barriers of controlling infectious diseases in Indigenous communities? Two studies based on the exemplars were undertaken for this research is and presented in publications as book chapters and peer reviewed journals to form the structure of the thesis. There are 3 book chapters and 11 peer reviewed journal articles; 11 publications are core to this thesis and 3 articles are extensions to the influenza part of this study. The purpose of including the extension research is to highlight the biological and immunological barriers within Indigenous peoples for influenza prevention and treatment. The Strongyloides study and related articles used qualitative methods to investigate the views and perspectives of Indigenous community members, health professionals and researchers to the barriers of controlling and treating Strongyloides in Indigenous Australian communities. Interviews were undertaken using purposive sampling, qualitative data was recorded and verified with participants and thematically analysed. The findings were categorised into major and sub themes. vii The influenza H1N1 study applied a PAR framework to better understand community members' perceptions and risks of pandemic influenza. The outcome of using a qualitative PAR framework was an effective way to gain depth of knowledge and understandings from participants. Aboriginal and Torres Strait Islander community controlled organisations and health services were involved in the implementation, interpretation and monitoring of the project. As a result, novel features of PAR with Aboriginal and Torres Strait Islander communities and organisations emerged. These novel features included the importance of working in a multi-disciplinary team with Aboriginal and Torres Strait Islander researchers; the complexities and importance of obtaining multi-site human research ethics approval processes; the importance and value of building the research capacity of both experienced and novice researchers in PAR; the need to use localised sampling protocols; and the process of undertaking a collective research process and enacting action research and feedback. The most effective responses of this project are in pre-existing relationships that had been established over a long period between Aboriginal medical services and investigators while research relationships established specifically for the purposes of the project, were less successful.