Access to primary health care services for Indigenous peoples: A framework synthesis.

Carol Davy,Alexa Mcarthur,Alex Brown,Stephen Harfield,Zachary Munn

doi:10.1186/s12939-016-0450-5

Abstract

BackgroundIndigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services.MethodsTo be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague’s accessibility framework.ResultsIssues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs.ConclusionsIndigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague’s accessibility framework should be broadened to include factors related to the health care system such as funding.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0450-5) contains supplementary material, which is available to authorized users.

Highlights

Indigenous peoples often find it difficult to access appropriate mainstream primary health care services
Of the 62 papers included in the original scoping review, 50 met the inclusion criteria for this framework synthesis [see Additional file 1: Table S1]
Twenty four of these papers reported on Indigenous Health Care Services based in Australia, 15 within the United States, four in Canada and New Zealand, two in South America and one in Papua New Guinea

Summary

Introduction

Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. Quantitative measures of socioeconomic status with indicators of disadvantage have been included [14, 15] These quantitative perspectives ignore many of the access issues relevant to Indigenous peoples such as the ability of the service to accommodate the social and cultural needs of Indigenous peoples, the provision of health care by Indigenous staff in an Indigenous friendly space and considering the important role that communities and families often play within the care process [16]

Methods

Results

Conclusion