Addressing unresolved tensions to build effective partnerships: lessons from an Aboriginal cancer support network

International Journal for Equity in Health

Sandra C. Thompson¹  Shaouli Shahid¹  Dawn Bessarab²  Beatriz Cuesta-Briand¹ 

[1] Western Australian Centre for Rural Health, University of Western Australia, UWA, M706, 35 Stirling Highway, Crawley 6009, WA, Australia;Centre for Aboriginal Medical and Dental Health, UWA, Perth, Australia

关键词: Worldviews;    Support groups;    Perspectives;    Partnership;    Indigenous;    Collaboration;    cancer services;    Aboriginal Australians;   

Others  :  1231273
DOI  :  10.1186/s12939-015-0259-7

 received in 2015-03-12, accepted in 2015-10-27,  发布年份 2015

【 摘 要 】

Background

Cancer is the second leading cause of death among Aboriginal and Torres Strait Islander people and their survival once diagnosed with cancer is lower compared to that of other Australians. This highlights the need to improve cancer-related health services for Indigenous Australians although how to achieve this remains unclear. Cancer support groups provide emotional and practical support, foster a sense of community and belonging and can improve health outcomes. However, despite evidence on their positive effects on people affected by cancer, there is scarce information on the function and effectiveness of Indigenous-specific cancer peer-support programs in Australia.

Using qualitative data from an evaluation study, this paper explores different understandings of how a cancer support group should operate and the impact of unresolved tensions following the establishment of an Indigenous women cancer peer-support network in a regional town in Western Australia.

Methods

Data were collected through semi-structured interviews with 24 participants purposively selected among Indigenous and mainstream healthcare service providers, and group members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. NVivo was used to manage the data and assist in the data analysis. Rigour was enhanced through team member checking, coding validation and peer debriefing.

Results

Flexibility and a resistance to formal structuring were at the core of how the group operated. It was acknowledged that the network partly owned its success to its fluid approach; however, most mainstream healthcare service providers believed that a more structured approach was needed for the group to be sustainable. This was seen as acting in opposition to the flexible, organic approach considered necessary to adequately respond to Indigenous women’s needs. At the core of these tensions were opposing perspectives on the constructs of ‘structure’ and ‘flexibility’ between Indigenous and non-Indigenous participants.

Conclusions

Despite the group’s achievements, unresolved tensions between opposing perspectives on how a support group should operate negatively impacted on the working relationship between the group and mainstream service providers, and posed a threat to the Network’s sustainability. Our results support the need to acknowledge and address different perspectives and world views in order to build strong, effective partnerships between service providers and Indigenous communities.

【 授权许可】

   
2015 Cuesta-Briand et al.

【 参考文献 】

• [1]Cancer in Aboriginal and Torres strait islander peoples in Australia: an overview. Cat. no. CAN 75. Australian Institute of Health and Welfare, Canberra; 2013.
• [2]Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncol. 2008; 9:585-595.
• [3]Miller JVK, Wilson C, Cunningham J, Condon J, Roder D. Aboriginal and Torres strait islander cancer control research project. Canberra, Commonwealth of Australia; 2010.
• [4]Shahid S, Finn L, Bessarab D, Thompson SC. Understandings, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services. BMC Health Serv Res. 2009; 9:132. BioMed Central Full Text
• [5]Shahid S, Finn LD, Thompson SC. Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust. 2009; 190:574-579.
• [6]Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Serv Res. 2013; 13:460. BioMed Central Full Text
• [7]Ussher J, Kirsten L, Butown P, Sandoval M. What do cancer support groups provide which other supportive relationships do not? The experience of peer support groups for people with cancer. Soc Sci Med. 2006; 62:2565-2576.
• [8]Hoey LM, Ieropoli SC, White VM, Jefford M. Systematic review of peer-support programs for people with cancer. Patient Educ Counsell. 2008; 70:315-337.
• [9]Macvean ML, White VM, Sanson-Fisher R. One-to-one volunteer support programs for people with cancer: a review of the literature. Patient Educ Counsell. 2008; 70:10-24.
• [10]Poudrier J, Thomas Mac-Lean R. ‘We’ve fallen into the cracks’: Aboriginal women’s experiences with breast cancer though photovoice. Nurs Inq. 2009; 16:306-317.
• [11]Shahid S, Beckmann KR, Thompson SC. Supporting cancer control for Indigenous Australians: Initiatives and challenges for cancer councils. Aust Health Rev. 2008; 32:56-65.
• [12]Paasse G, Adams K. Working together as a catalyst for change: The development of a peer mentoring model for the prevention of chronic disease in Australian Indigenous communities. Aust J Primary Care. 2011; 17:214-219.
• [13]Taylor KP, Thompson SC. Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services. Aust Health Rev. 2011; 35:297-308.
• [14]Cuesta-Briand B, Bessarab D, Shahid S, Thompson SC. ‘Connecting tracks’: Exploring the roles of an Aboriginal women cancer support network. Health Soc Care Community. 2015. doi:10.1111/hsc.12261. [Epub ahead of print]
• [15]Finn LD, Pepper A, Gregory P, Thompson SC. Improving Indigenous access to cancer screening and treatment services: Descriptive findings and a preliminary report on the Midwest Indigenous Women’s Cancer Support Group. Aust Med J. 2008; 2:1-21.
• [16]Oliver P, Jupp V. Purposive sampling. In The SAGE dictionary of social research methods. Jupp V ed. London: Sage; 2006:244–245.
• [17]Green J, Willis K, Hughes E, Small R, Welch N, Gibbs L, Daly J. Generating best evidence from qualitative research: The role of data analysis. Aust N Z J Public Health. 2007; 31:545-550.
• [18]NVivo. http://www. qsrinternational.com/products_nvivo.aspx webcite
• [19]Bazeley P, Jackson K. Tools and strategies for visualizing data. In: Qualitative data analysis with NVivo. 2nd ed. Bazeley P, Jackson K, editors. SAGE Publications Ltd, London; 2013: p.217-241.
• [20]Siccama CJ, Penna S. Enhancing validity of a qualitative dissertation research study by using NVivo. Qual Res J. 2008; 8:91-103.
• [21]Morse JM, Barrett M, Mayan M, Olson K, Spiers J. Verification strategies for establising reliability and validity in qualitative research. Int J Qual Meth. 2002; 1:13-22.
• [22]Le H, Penniment M, Carruthers S, Roos D, Sullivan T, Baxi S. Radiation treatment compliance in the Indigenous population: the pilot Northern Territory experience and future directions. J Med Imaging Radiat Oncol. 2013;57(2):218-21. doi:10.1111/1754-9485.12010. Epub 2013 Mar 26
• [23]Braun KL, Kagawa-Singer M, Holden AE, Burhansstipanov L, Tran JH, Seals BF, Corbie-Smith G, Tsark JU, Harjo L, Foo MA, Ramirez AG. Cancer patient navigator tasks across the cancer care continuum. J Health Care Poor Underserved. 2012; 23:398-413.
• [24]Burhansstipanov L, Krebs LU, Dignan MB, Jones K, Harjo LD, Watanabe-Galloway S, Petereit DG, Pingatore NL, Isham D. Findings from the native navigators and the Cancer Continuum (NNACC) study. J Cancer Educ. 2014; 29:420-427.
• [25]Mattesich PW, Murray-Close M, Monsey M. Collaboration: what makes it work. 2nd ed. Fieldstone Alliance, Nashville, TN; 2001.
• [26]James J, Cameron S, Usherwood T. The practice of confidentiality in an Aboriginal medical service. Aust Fam Physician. 2009; 38:837-842.
• [27]Haynes E, Taylor KP, Durey A, Bessarab D, Thompson SC. Examining the potential contribution of social theory to developing and supporting Australian Indigenous-mainstream health service partnerships. Int J Equity Health. 2014; 13:75. BioMed Central Full Text
• [28]Burhansstipanov L, Wound DB, Capelouto N, Goldfarb F, Harjo L, Hatathlie L, Vigil G, White M. Culturally relevant “Navigator” patient support. The Native sisters. Cancer Pract. 1998; 6:191-194.