Translation of a culturally responsive stroke rehabilitation service for Aboriginal and Torres Strait Islander peoples into a real-world setting in northern Australia: a hybrid effectiveness implementation study.

Aboriginal and Torres Strait Islander Australians experience stroke at a younger age, more than twice as frequently and are three times more likely to be disabled after stroke as non-Aboriginal Australians. Paradoxically, uptake of stroke rehabilitation services is substantially lower¹. Provision of culturally responsive rehabilitation services for Aboriginal and Torres Strait Islander Australians has been identified as an urgent need in The Clinical Guidelines for Stroke Management (2017)². This study is the first step in translation, to a real world setting, of an evidence-based culturally responsive rehabilitation intervention for Aboriginal and Torres Strait Islander people with an acquired communication disorder (ACD) after stroke.

Wuchopperen Health Service (WHS) in Cairns will host this collaborative Type I effectiveness-implementation hybrid study³, conducted by a multi-disciplinary team from across northern Australia. The communication intervention to be implemented has been informed by the Missing Voices Project (NHMRC #1046228)⁴ and developed and successfully piloted in the Wangi (Talking) Project (Stroke Foundation#1621)⁵. Eight Aboriginal and Torres Strait Islander stroke survivors will participate in 24 sessions across an 12-week period, delivered by a speech pathologist in partnership with an Aboriginal and Torres Strait Islander Allied Health Assistant(AHA). Individually tailored activities will be undertaken within a ‘yarning’ framework⁶, with family involvement, and culturally relevant resources. Change in everyday communication and barriers and enablers to implementation will be assessed.

Aboriginal and Torres Strait Islander Australians continue to be marginalised from services that are crucial to long term adjustment and quality of life after stroke². This study will provide direction for health services and rehabilitation therapists. It will directly contribute to the evidence-base for development of Clinical Guidelines for Stroke Management to promote engagement and improve quality of care. Crucially, this study will prepare for full-scale implementation of the culturally responsive service model that in turn, will contribute to closing the gap on health disadvantage for Aboriginal and Torres Strait Islander Australians.

References:

1. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples Vol Cat. no. IHW 147. . Canberra: AIHW2015.
2. National Stroke Foundation. Clinical Guidelines for Stroke Management 2017. Melbourne, Australia2017.
3. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217-226.
4. Armstrong E, D. H, Katzenellenbogen JM, et al. Study Protocol: Missing Voices – Communication difficulties after stroke and traumatic brain injury in Aboriginal Australians. . Brain Impairment. 2015.
5. Ciccone N, Armstrong E, Hersh D, Adams M, McAllister M. The Wangi (talking) project: a feasibility study of a culturally sensitive rehabilitation model for Aboriginal people with acquired communication disorders after stroke. International Journal of Stroke. 2017;12:26.
6. Lin I, Green C, Bessarab D. ‘Yarn with me’: applying clinical yarning to improve clinician-patient communication in Aboriginal health care. Aust J Prim Health. 2016;22(5):377-382.