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Decision-Making Matrix to Co-design Evidence-based Care Solutions with First Nations Peoples

posted on 2023-11-06, 13:28 authored by Maria Alejandra Pinero de PlazaMaria Alejandra Pinero de Plaza

Decision-Making Matrix to Co-design Evidence-based Care Solutions with First Nations Peoples

The Evidence-Based Decision-Making Matrix and Metadata offered here are part of the work developed by Pinero de Plaza et al. (accepted by the International Journal of Integrated Care - IJIC - 2023-10-31 08:05 AM GMT). This matrix is extracted from the study titled "Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease," which responds to this question:

What are the health system enablers and barriers to continuity of care for First Nations Peoples living with chronic conditions?

Achieving continuity of care is vital for addressing the existing gaps in healthcare delivery and other disparities faced by First Nations Peoples worldwide. These disparities are evident in First Nations populations in Australia, Canada, and Aotearoa (New Zealand), who share a history of colonisation and face common drivers of health inequities, including a high prevalence of chronic diseases, despite having universal healthcare systems. Whilst each of these countries has culturally specific differences, their First Nations Peoples' understanding of health and wellbeing are holistic, interconnected, strength-based, and extend beyond the Western biomedical understandings of disease and illness (by which their healthcare systems are designed).

The study leveraged real-world implementation strategies outlined in WHO's Framework on Integrated People-Centred Health Services (IPCHS) to comprehend and address the presented challenges and synthesise empirical knowledge on the barriers and enablers of continuity of care from a health system perspective. It was initiated by the South Australian (SA) Aboriginal Chronic Disease Consortium, demonstrating its commitment to prioritising evidence-based approaches that promote comprehensive chronic disease prevention, management, and care. The Consortium is an Aboriginal-led partnership of health stakeholders that drives the delivery of collaborative, appropriate, well-coordinated and evidence-based strategies to reduce the burden of heart disease, cancer, and diabetes.

Methods: The matrix is a direct outcome of the qualitative review and was meticulously co-designed with key stakeholders (co-authors of the manuscript). The review encompassed a thorough examination of studies published in English from January 2010 to July 2022. It emphasised chronic conditions such as cancer, cardiovascular disease, chronic kidney disease, and diabetes, significantly impacting First Nations Peoples across the regions mentioned. From an initial pool of 1654 articles, 153 studies were deemed pertinent and thus included in the review. Various appraisal tools were thoughtfully employed to assess the quality of these selected studies rigorously.

The Decision-Making Matrix: This matrix is a valuable tool, providing profound insights for prioritising and co-designing healthcare solutions with First Nations Peoples to improve their health outcomes concerning chronic diseases. It offers a meticulous identification and ranking of key enablers for care continuity within the healthcare system. These enablers are thoughtfully ranked in order of importance, ranging from 1 to 18, based on the frequency of themes identified during the qualitative review process. This structured approach presents a practical resource well-positioned to address the critical points where continuity of care and care coordination barriers have surfaced for First Nations Peoples. These findings are also documented and illustrated in the study (accepted for publication by IJIC). The abstract of this publication is provided below:

"Introduction: Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand).

Methods: A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services.

Results: Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum.

Discussion: The support and co-creation of care solutions must be a dialogical participatory process adapted to each community.

Conclusions: Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan."

It should be noted that this matrix and the review are complemented by supporting appendixes uploaded to this open-access site, which serve as supplementary information (Metadata) that bolsters the review's findings. These appendixes are important for assisting individuals in understanding and using the information and insights this work provides. For a comprehensive analysis and understanding of the practical applications of the matrix, please refer to the IJIC publication or contact Dr Maria Alejandra Pinero de Plaza, PhD.

Key References

  1. WHO. Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centred health services. 2018.
  2. Pinero de Plaza MA, Brown S, Wu C-J, et al. System enablers and barriers to continuity of care for First Nations people living with chronic conditions: A rapid qualitative review protocol. https://figshare.com/articles/online_resource/System_enablers_and_barriers_to_continuity_of_care_for_First_Nations_people_living_with_chronic_conditions_A_rapid_qualitative_review_protocol/20310117 (2022).


The authors would like to acknowledge the traditional custodians of the lands where this work has been conducted, the Kaurna People. We acknowledge the Kaurna Peoples as the traditional custodians of the Adelaide and Adelaide Plains region; we pay respect to their ancestors, Elders and the next generation of the Kaurna. We acknowledge their continuing physical, spiritual, and emotional connection to their lands and seas. The authors would like to highlight the contributions of the South Australian Aboriginal Chronic Disease Consortium in the problem identification of this research. The authors want to acknowledge the importance of the experience and expertise that Odette Pearson brings to the study as a Kuku Yalanji/Torres Strait Islander woman, co-Theme Leader of the Wardliparingga Aboriginal Health Equity Theme at South Australian Health and Medical Research Institute, an affiliate Associate Professor at the Adelaide Medical School, University of Adelaide. The authors also acknowledge the 25 years of experience in service and systems design in Aboriginal health and community services and the family connections that Kim Morey brings as an Anmatyerre/Eastern Arrernte descent. She leads Health Systems Research and is the co-theme Leader of Wardliparingga Aboriginal Health Equity Theme at the South Australian Health and Medical Research Institute. She has extensive knowledge of public sector systems, policy development, strategic advice, and monitoring.


The South Australian Department for Health and Wellbeing funded this project. The content is solely the authors' responsibility and does not necessarily represent the views of the Government of South Australia.


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