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. 2018 Dec 29;18(1):1010.
doi: 10.1186/s12913-018-3849-4.

Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus

Jessica Conway  1 , Sharon Lawn  2 , Susan Crail  3 , Stephen McDonald  4
Affiliations

Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus

Jessica Conway et al. BMC Health Serv Res. .

Abstract

Background: Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their 'Country' (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on 'Country', reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service.

Methods: Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck.

Results: The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role.

Conclusions: The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients.

Keywords: Chronic kidney disease; Haemodialysis; Indigenous health; Mobile Dialysis; Remote dialysis access.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted by the Aboriginal Health and Research Ethics Committee (AHREC), with reference number 04–16-669. Written consent was obtained from staff and patients for participation before data collection.

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Towns serviced by the dialysis bus and relative distance to Adelaide (Capital of SA). Source: SA Health, Data and Reporting Services Branch, Finance and Corporate Services. Country Health SA Local Health Network Satellite Haemodialysis Units. Adelaide: Author; 2015
Fig. 2
Fig. 2
Themes arising from the data
See this image and copyright information in PMC

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