Improving care pathways for otitis media in First Nations children

Background: Otitis media (OM) disproportionately impacts First Nations children, affecting speech and language development, social and cognitive development and, in turn, education and life outcomes. Ear and hearing care (EHC) programs are critical to early detection and management of OM. Program sustainability depends on health policy, which secures funding and resources. This thesis aimed to; (i) chart approaches, sustainability factors, and areas of focus across the EHC pathway for First Nations EHC programs in Australia, New Zealand, Canada, and the United States, and (ii) explore utilisation of two tools to appraise Australian EHC policies for Aboriginal children.  

Method: A scoping review was conducted to identify program core elements in high-income colonial-settler countries. A policy appraisal pilot study was conducted utilising the Aboriginal and Torres Strait Islander Quality Appraisal Tool and Morestin’s Policy Appraisal Tool to evaluate feasibility of utilising these tools to assess Australian EHC policies.  

Results: The review identified 28 eligible studies. Programs approaches included; (i) connecting patients to specialist services, (ii) ensuring cultural safety of services, and (iii) increasing entry into EHC pathways. The policy pilot indicated that the Aboriginal and Torres Strait Islander Quality Appraisal Tool has dimensions of cultural safety that overlap between research and policy. Morestin’s Policy Appraisal Tool indicated the feasibility of utilising this tool for analysis of Australian EHC policies.  

Discussion: Programs connected patients to care through outreach, mobile health clinics, and telehealth services. Cultural safety was achieved by employing Indigenous Health Workers (IHWs) or providing cultural awareness training for non-IHWs. Access to EHC pathways was increased with screening or awareness programs. The preliminary findings of the policy appraisal pilot study indicated feasibility of utilising the Aboriginal and Torres Strait Islander Quality Appraisal Tool and Morestin’s Policy Appraisal Tool for appraising two separate culturally-specific EHC policies in Australia.