Abstract:
The burden of stroke for Aboriginal and Torres Strait Islander peoples in Australia is significant. The National Stroke Foundation has identified that Aboriginal and Torres Strait Islander people are more likely to have a stroke at a younger age than the non-Indigenous population and are twice as likely for stroke to result in death, and that those Aboriginal and Torres Strait Islander people living in rural and remote areas are less likely to have access to an acute stroke unit. The only acute stroke unit in Far North Queensland treats six times more Aboriginal and Torres Strait Islander patients than the Queensland average, a large proportion of whom reside in the rural and remote communities of the Cape and Torres Strait. This article describes part of the qualitative phase of a project titled ‘Culturally appropriate stroke services for Aboriginal and Torres Strait Islander people’, received Closing the Gap funding to identify the needs of Aboriginal and Torres Strait Islander stroke survivors in Far North Queensland and  establish a model of care that is responsive to these needs.

Objectives: The overall aim of this project is to establish a culturally appropriate model of service delivery that met the needs of Aboriginal and Torres Strait Islander stroke survivors. The project consisted of two phases within the Far North Queensland site.

Study type:  Data were collected from 24 stroke survivors, 10 carers and 70 stakeholders through surveys. The surveys incorporated open-ended questions and were administered through face to face interviews with participants from across 18 diverse Aboriginal and Torres Strait Islander communities within Far North Queensland. Guided by the principles of thematic analysis the data were coded, categories created and themes and subthemes identified.

Results:  This study emphasises the need for an inclusive coordinated and culturally responsive approach to Aboriginal and Torres Strait Islander stroke care that values the role of the client, their family and community. The Aboriginal and Torres Strait. Data were grouped into six broad themes and related subthemes. The themes are presented as a representation of the patient journey from the perspectives of stroke survivors, carers and stakeholders.

Conclusion:  An integrated patient centred model of care that spans the care continuum and places value on an extended role for the Aboriginal and Torres Strait Islander health worker workforce is indicated, as is an increased utilisation of allied health and specialist follow-up close to home.

Key Findings:

• A shortage of Aboriginal and Torres Strait Islander health workers in the primary health care workforce was identified, reflecting findings from Gibson et al . Identified benefits of these health workers in the workforce are improved engagement of patients, a friendly and relaxed patient environment, provision of cultural safety, integration of cultural protocols and, when trained, an improved ability to provide regular health checks and education about health risks and self-management.
• Participants highlighted the lack of access to a stroke unit. There is overwhelming evidence that stroke unit care significantly reduces death and disability after stroke compared with conventional care in general wards for all people with stroke.
• The importance of staying on Country, of Law and language for the health and wellbeing of Aboriginal and Torres Strait Islander community members and the provision of community based culturally safe services to facilitate access to care has been thoroughly documented . For the health of Aboriginal and Torres Strait Islanders to improve, they must have access to appropriate, affordable, acceptable and comprehensive primary health care.