Aboriginal health workers and health information in rural Northern Territory, short report : a study carried out on behalf of the N.T. Department of Health and Community Services

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ABORIGINAL HEALTH WORKERS and

HEALTH INFORMATION

in

RURAL NORTHERN TERRITORY

SHORT REPORT

A study carried out on behalf of the NT Department of Heal th and Community Services by Tracey Djoymi, Clifford Plummer, Jessica May and Tony Barnes.

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'l'lr.!'! NT DEPARTMENT OF HEAL TH

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AND COMMUNITY SERVICES

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"We the Aboriginal Health Workers strongly feel that we want to and should manage the health of our own people"

"How can we do this properly (all the way) when we do not have the proper training and do not understand properly what health information and statistics is all about?"

Common feeling felt by most of the Aboriginal Health Workers in the project

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Section

Study Team Photo Project

Map - Health Centres Visitted Results:

Health Centres Visitted AHW s Interviewed

Grades of Interviewed AHWs

AHW Involvement with Clinic Activities

We feel that it was very important to do a Short Report of the Full Report of the "Aborginal Health Workers and Health Information in Rural Northern Territory" and to make this report as easy as possible for Aboriginal people to understand - this is that Short Report. We apologise that we were not able to put all the results/tables in this report, however, if you need to see them, please see the Full Report.

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ABORIGINAL HEALTH WORKER AND HEALTH INFORMATION PROJECT In September 1992, the Community Health Program Directorate of the NT Department of Health and Community Services ran a Workshop on Rural Health Information .. It was a 2 day workshop held at Health House in Darwin and people who went to the workshop were from the NT Department of Health and Community Services, Community Controlled Services and other interested peoples.

Many issues were talked about in relation to health information in rural health. However, one of the main issues that the workshop group realised was that the health information systems in the rural health centres were weak and not very good.

Other important issues recognised were:

a) the present health information systems did not meet the needs of all people working in the health area.

b) the involvement of Aboriginal Health Workers (AHWs) in the collection and use of health statistics and most people at this workshop did not know for sure or had a clear picture of AHW s involvement in this area.

This group felt it was very important that all Health Organisations knew what the true picture was in relation to AHW's and statistics.

Therefore, one of the outcomes was the project: Aboriginal Health Worker and Health Information (Statistics)

Study Objectives (Reasons for doing the project)

The main aim of the project was to find out the AHWs perceptions (that is what they thought about certain issues) in relation to health statistics. It must be remembered that this was the first time that anything like this project had happened.

Other areas were also covered, such as:

to find out how AHWs, if any, were involved in the collection and use of statistics;

did they know what statistics they were collecting and why they were collecting them;

were they able to "read", "interpret" these health statistics;

who did they think owned the community's statistics and why they thought this;

what were their views on the confidentiality of health statistics;

who did they feel owned the health statistics;

if an outsider wanted to look at patients health records, who did they feel could give permission for this.

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They were asked what was the "best way" to feedback any health information to Aboriginal people. To do this question, they were shown the following 8 charts which told the same story but in 8 different ways:

1. pie chart 2. table

3. bar chart.one

4. pictorial chart one - stick pictures of children 5. pictorial chart two - stick pictures of children

6. bar chart two

7. line graph - like (like the "road to health chart") 8. written

After doing this we asked them if they could tell us what the story that the charts were telling them.

The AHWs were asked so many questions (about 80) to do in 45 minutes on their own, without anybody else being there when they were being interviewed. The reason that this was done was so that the AHW s felt free, comfortable and relaxed to talk about these issues with the interviewer.

Methodology (how the project was done) 1. Individual interviews

The total numer of AHW s interviewed was 81. In this method a questionnaire was used in a face to face interview. Two AHWs did not want to be interviewed. Usually Clifford and Tony interviewed the men and Tracey and Jessica interviewed the women. But a few times Tracey and Jessica interviewed the men when Clifford and Tony were not there.Clifford and Tony also intereviewed women when Tracey and Jessica were not there. However, before this could be done we had to check with the local people as to whether it was alright to do this and there were no problems.

Thirty communities were covered, 28 in the NT and 2 in South Australia. The ages of the AHWs intereviewed were between 20-50 years. Of these 75% were registered and 25% were trainees.

2. Group discussions

These were usually with AHW s from the same health centres. At a few places where the communities were close to each other they came together and formed one group. Questions we asked them in this method was a bit similar to the face to face interview, but sometimes, depending on the group and how they were going we would change it a bit. A lot of times during these group discussions, people got very excited and "worked up" about certain issues.

This was especially so in the issue of "Aboriginal health in Aboriginal hands", that is, self determination and management of their own people's health.

3. Unstructured telephone interviews

These were unstructured telephone interviews with key people involved with the AHW movement, both in the NT Department of Health and Community Services and Community Health Services. 12 people were interviewed. They were asked 3 main questions and these interviews took no more than 10 minutes. This interviewing was done by the one team member.

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Consultation and Negotiation Process

Before the project could even start certain (processes) basic things had to take place.

Extensive consultations took place. Firstly in Darwin, then in all districts and the various health centres, community councils, health councils and community controlled health services. Even though this project was not really or could be classified as a research project, the team members felt that it was important that it still be submitted for comment to the:

a) Top End Aboriginal Sub-Ethics Research Committee, where it was considered and approved and

b) in Alice Springs the chairperson of the Alice Springs Ethics Committee stated that formal approval was not needed.

We had Entry Permits to visit Aboriginal Lands and Adjoining Seas.

Also other issues were taken into account, such as making sure it was not ceremony time.

Usually the day before the team left on field trips, a member would ring the community to make sure that it was still alright to visit.

Project Team

This study was done between March and June 1993 by 4 people directly working on the project and doing the field trips. They were:

Clifford Plummer, a senior AHW originally from Tennant Creek and now working at Menzies School of Health Research~

Tracey Djoymi, a senior AHW from Galiwinku;

Jessica May, a Research Officer (registered nurse, midwife and maternal/child health nurse) with the NT Health Department and

Tony Barnes, an Associate Professor in Biostatistics and on sabbatical leave from The University of Queensland.

We want to thank all those people who helped us

in

this project - we haven't got room here to name them all, but they are all in the Full Report.

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HEAL TH FACZLITIES IN THE NORTHE.qN TERRITORY

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HEAL TH CENTRES VISITED

Community Controlled- 6

Grant-in-aid- 5 NT Health- 19

NUMBER OF AHW's INTERVIEWED

Grcint-in-aid- 24

NT Health-40

Controlled- 17

relates to table I in main report

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GRADES OF INTERVIEWED AHWs

TRAINEES 23

GRADE 4/5 = 2

GRADE 2 = 23

GRADE 3 = 18

AHWs of all grades were interviewed

Table 4 in main report

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AHW INVOLVEMENT WITH CLINIC ACTIVITIES

Outpatient tasks Home Visits Childrens Health Outstn/camp visit Work with diabetics Work w hypertensives Antenatal women Give immunisations Train other AHW s Talk to community

0 20 40 60 80

Number of AHWs

Things most AHWs do at work

relates to table 5 in main report

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AHW INVOLVEMENT WITH COLLECTING INFORMATION

Diabetics

Hypertensives

Antenatal Care

Rheumatic H F

Under fives

STDs

Immunisation

Death

Emergency Evacuation

0 20 40 60 80 100

Percent of AHWs

Things most AHWs collect information about

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Institution of Clinic

Health Council

Community Council

Don't know

All community people

AHWs only

Nurses/doctors only

All Clinic staff

AHWs and Nurses

MAIN RESPONSIBILITY FOR CONFIDENTIALITY

0 10 20 30 40 50 60 70 80 90 1 00

Percent of AHWs Who AHWs think are responsible for confidentiality

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MAIN RESPONSIBILITY FOR OWNERSHIP

Institution of Clinic

Health Council

Community Council

Don't know

All community people

AHWs only

Nurses/doctors only

All Clinic staff

AHWs and Nurses

0 10 20 30 40 50 60 70

Percent of AHWs Who AHWs think own the health information

80 90 100

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WHO SHOULD PERMISSION

FOR ACCESS BE OBTAINED FROM?

"THe Council"

AHWs

Nurses

Doctors

District Manager

Central Office DHCS

Patients etc

0 20 40 60 80 I 00

percent of AHWs

Nearly all AHWs think they should be involved in giving permission

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WHICH CHARTS DO AHW s THINK ARE GOOD?

Pie Diagram

Table

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Bar chart II

Pictorial chart I

Pictorial chart II

Written Account

Line Graph

0 20 40 60 80 100

percent of AHWs

A lot of AHWs picked pictorial charts but not many picked writing or line graphs

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CAN YOU TELL ME THE "GROWTH OF CHILDREN STORY"

Half Right 28

Right 26

Not righUNo answer 25

Some AHWs understood the story well, others a bit and others not at all

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RECOMMENDATIONS

1. Employers, in consultation with the AHW s should develop clear guidelines on all areas of health information systems in their health centres.

2. A working group, which includes a large number of AHWs, should develop a health information system that deals with ways of feeding back health information to their communities.

3. Training at Batchelor College on all areas of health information and statistics in the Certificate and Associate Diploma courses should be reviewed.

4. Training at Batchelor College on all areas of numeracy and literacy for the Certificate course shoud be reviewed.

5. An in-service training and support for working AHW s on health information and statistics must be developed as soon as possible and should be implemented by the AHW Trainers with support from others in that area.

6. A lot of training is needed for the AHW Trainers if they are to properly train and support AHW s in the area of health information and statistics.