Telehealth has been a game changer for many First Nations people worldwidealso in Australia.
It has given First Nations people access to health care close to home – whether that means screening for health problems, diagnosing disease or monitoring existing conditions. It has done this while minimizing exposure to COVID.
But one recent review of telehealth for First Nations people – in Australia, Canada, New Zealand and the United States – shows that we can do better.
Unreliable internet access, services designed without meaningful First Nations input, and concerns about establishing rapport with health professionals were among the concerns.
This is where we can take our game to the next level to ensure reliable, equitable and culturally safe telehealth care for First Nations people in Australia, whether they live remote or in our cities.
Read more: Video and phone consultations are just the tip of the iceberg of what telehealth has to offer
What exactly is telehealth?
Telehealth uses information and communication technology to deliver health care at a distance. In Australia, this is mainly done through telephone and video consultations.
Telehealth can be provided by any health care provider, including physicians, nurses, and allied or supportive care providers. Telehealth is not a complete replacement for personal care. But it can be used instead of some personal arrangements.
Aboriginal community-controlled health organizations have traditionally provided primary (initial) health care and some specialist care to First Nations people in Australia. Telehealth enables them to have a wider range of specialist services. This gives First Nations people access to care close to home, with optional support from an indigenous health worker.
Read more: First Nations people in the NT receive only 16% of an average Australian’s Medicare funding
Where things are going well
Have telehealth services for First Nations people improved social and emotional well-being, clinical outcomes, access to health services and increased screening rates.
During COVID, telehealth increased the number of First Nations people having access to health care while reducing the chance of transmission of the virus. For customers, telehealth reduces time spent on usual activities, travel, and associated out-of-pocket expenses.
Telehealth can contribute to this culturally safe healthcare. In practice, this means care that does not challenge the identity or experience of First Nations people. It is when both the caregiver and the person receiving care communicate with respect, share knowledge, and improve overall health.
It allows an individual to remain in the country while accessing some healthcare services. Telehealth can also reduce the trauma associated with travel, reduce family disruptions, and reduce the stress associated with using health care.
Telehealth also enables family and other supports, such as an Indigenous health worker, to attend specialized consultations and for the person to receive care in a supportive environment.
But First Nations communities need more of a say
But delivering telehealth services in a culturally safe manner that improves health requires that essential services be co-designed with First Nations people. First Nations communities must also own the services.
Co-designing is a highly collaborative approach where researchers, industry stakeholders and Aboriginal communities work together to achieve a goal, and where there is sustained and equitable community engagement.
True co-design puts Aboriginal voices and lived experiences first, aiming to strengthen communities through shared decision-making toward community-defined goals. When done right, co-design leads to services and results authentically aligned with the needs and preferences of the community.
Co-designing culturally safe telehealth solutions would mean Aboriginal people working closely with industry and researchers to determine what currently works, what doesn’t work well and where there are gaps. This is so that solutions – simple or highly innovative – can be developed for the community.
Read more: Aboriginal – Māori: how Indigenous health suffers on both sides of the ditch
… and more reliable internet
Access to reliable internet is a barrier to providing video consultations, especially for remote communities. Investments in infrastructure by the government, NGOs and the private sector can solve such connectivity problems.
However, solutions are often expensive. Thus, centralizing telehealth services at Aboriginal Community Controlled Health Organizations can yield economies of scale.
Investing in training Indigenous health professionals in telehealth can also increase the use and reach of telehealth appointments.
First Nations people want that connection
One barrier to telehealth for First Nations people is the concern about establishing a trusting relationship with their health care provider through telehealth.
There is some evidence that rapport can be improved by the provider visiting communities and personally conducting the initial consultations.
Providers should familiarize themselves with local services available in the communities they care for, as this will improve their ability to integrate care with local services.
Cultural awareness training for all providers is also desirable.
Read more: Birthing on Country services center First Nations cultures and empower women through pregnancy and childbirth
It’s not just about rural communities
Gone are the days when telehealth was used exclusively for rural and remote people. Thus, providers must provide telehealth care to First Nations people, regardless of where they live.
The benefits of telehealth — such as cultural security, reduced travel, the ability to involve family — are just as relevant to First Nations people living in metropolitan areas as they are to those living in rural and remote locations.
Read more: Urban Aboriginal people face unique challenges in the fight against coronavirus