| Abstract | The health and well-being of people around the world depend critically on the performance of the health systems that serve them,” Dr Gro Harlem Brundtland, Director-General, World Health Organization (Brundtland, 2000). This speech reflects the important role played by Aboriginal and Torres Strait Islander health workers in our health system. They are universally regarded as the main providers of primary health services to our Aboriginal and Torres Strait
Islander communities, especially in remote and rural areas. The important work they do might be better supported through ongoing availability of health informatics programs in their practice locations, particularly those that encompass a culturally-appropriate multimedia model.
This study suggests the use of Information Technology, in the form of interactive multimedia self-paced learning methodology to develop system for a health informatics program delivery via a common multimedia storage drives CDROM/USB drive that can be used by Aboriginal
and Torres Strait Islander health workers in their own work place. This assumption was assessed and explored through the design, development, and formative evaluation of an
interactive multimedia health informatics CD-ROM program, entitled “Interactive Multimedia Health Program: Tuberculosis”.
The theoretical framework for this study based on the empowerment and community participation theory as outlined in the Declaration of Alma-Ata, World Health Organization
(WHO). This thesis reports on a qualitative study which has explored gaps in the current Aboriginal and
Torres Strait health workers’ continuing education and professional development programs, and examined the need for new approach that differs from the traditional school-based ‘face to face’ approach; and rather advocates the need to deliver sustainable, efficient and cultural
appropriate continuing education program for health workers.
The application of choice of a qualitative approach as a methodology for the study enables this assumption to be checked by testing this model against the ideas, experiences and recommendations of participants in the study; who have worked for many years in the field of
the education and training of health workers of Aboriginal and Torres Strait Islander heritage.
The views of participants have been collected through a series of interviews and a review of the
limited literature available in this field covering the following topic: 1) Aboriginal and Torres Strait Islander Australians history and health state with emphasis on
the burden of communicable diseases, focusing particularly on Tuberculosis (TB); 2) Aboriginal and Torres Strait Islander health workers’ history, role, challenges, education and training; 3) The potential for Information Technology to support health workers through the provision of self-paced health training programs as a tool for the delivery of multimedia information, and the future opportunity for the use of interactive multimedia technology in health care education; 4) Methodologies for multimedia model development and educational and systematic approach for multimedia model development; 5) Learning theories, principles and approaches; 6) Key factors that would impact model development, and 7) Australian Aboriginal learning approaches, values, and pedagogy.
This thesis adopts a research methodology is in the form of:
1) Qualitative semi-structured interviews with 10 various stakeholders from different backgrounds all are working in the field of Aboriginal and Torres Strait Islander health worker education. The research was supported by archival research, and then expanded to a study of the needs that exist for Aboriginal and Torres Strait Islander health workers in continuing their education and professional development. The author then searched for and analysed the
techniques that might best address this need. Interviews were also conducted to identify the keys factors need to be considered in the development of an interactive multimedia informatics program to meet these needs.
2) Using a detailed approach to describe and review the process of preliminary model development entitled 'Interactive Multimedia Health Program: Tuberculosis'. The work begins with a review of relevant literature from the field of collaborative learning and multimedia, Tuberculosis, and Australian Aboriginal culture.
3) Employed the Likert Scale and open-ended questionnaire for the formative evaluation of the preliminary model through expert and peer review with 15 stakeholders in the fields of Aboriginal and Torres Strait Islander health workers’ education, Information Technology.
The main themes that emerged from analysis of the data include those relevant to: - Cultural appropriateness; Efficiency; Sustainability; The need for a unified government body; - The need for greater coordination and consistency across The entire system of government
agencies responsible for Aboriginal and Torres Strait Islander health workers and the management of their continuing education; - The need to manage the gap between what health workers learned and what they did in their
working lives; - The need for better Information Technology tools; the ad hoc nature of workplace training to
date; The need for relevant information; and The need for a business perspective.
The study highlights the effect of economic and cultural issues, and lack of coordination upon the development of a continuing education program for Aboriginal and Torres Strait Islander health workers. The finding of the study describes how issues such as cultural factors, learning
aspects, computer literacy, availability of technological tools, and pre-existing knowledge of interactive multimedia principles are key factors in developing a CD-ROM model. Further, the findings point out the elements and cultural principles that are important to keep in mind when
producing the model, such as cultural localisation, cultural context, cultural knowledge base, and oral cultural traditions for Aboriginal and Torres Strait Islander peoples. This premise has been tested and applied through the production of a detailed preliminary design for a culturally-appropriate multimedia model on CD-ROM, using Tuberculosis as a focus topic for the model, a copy of which find attached to this thesis.
In summary, the key findings are: 1. The identification of significant gaps in the current continuing professional development program for Aboriginal and Torres Strait Islander health workers. Three main issues in the current program were revealed: Lack of sustainability, co-ordination and consistency in Aboriginal and Torres Strait Islander health workers’ continuing education and training; lack of efficiency of the current program and the presence of learning gaps between what health workers study and the tasks they perform. This inefficiency is an important factor in the struggle of health workers to fulfill their roles. There is also a lack of suitability and presence of
a cultural gap in the current continuing education program; which is due to the lack of deep understanding of socio-cultural contexts in which health problems are constructed. This cultural gap is evident in the current program design which is concerned mainly with adding Aboriginal art and pictures without a deep look into cultural localisation, cultural contextualisation, cultural knowledge base, and their oral cultural background in the current program. The results presented here are indicative of the need for a different approach in order to deliver a sustainable, efficient and culturally-acceptable continuing development program. Using Information Technology is a promising new approach for closing this gap and in improving
Aboriginal and Torres Strait Islander health workers’ continuing professional development opportunities.
2. Identification of the methodology for the development of an interactive multimedia self-paced informatics health program, which is based on multi-disciplinary development
methodologies, including educational and systematic approaches. 3. This study recommends the adoption of socio-cultural and constructivist learning theories, with adult learning, population health, narrative, and medical education approaches incorporated into the development of the program. 4. It is further recommended that a systematic approach to creating a culturally-appropriate program for Aboriginal health workers needs to be full mindful of and respectful of cultural dimensions during the design process; and similarly there is a real need to provide a
culturally-sensitive learning environment. 5. The most important key factors for the development of an interactive multimedia/culturally appropriate health informatics model could be categorised under four main headings: cultural
factors, Information Technology availability and literacy, learning aspects, and interactive multimedia factors. Cultural factors included cultural inclusivity, oral cultural, pre-existing knowledge, and Aboriginal learning styles. Interactive multimedia factors included the
requirements for the process, fitting and design of the program. 6. Formative evaluation of the model confirmed the study hypothesis that interactive multimedia CD-ROM/USB drive health informatics could be used as an alternative material for updating Aboriginal and Torres Strait Islander health workers’ knowledge.
The study outlines several applications of these findings, focusing on how an informatics interactive multimedia program could be made culturally relevant to Aboriginal and Torres Strait Islander health workers. Also the thesis provides recommendations for policy development and further research:
• The need to provide more culturally and contextually appropriate continuing education
programs for Aboriginal and Torres Strait Islander health workers.
• The need to empower Aboriginal and Torres Strait Islander health workers through their
involvement in developing the strategy and program for their continuing education is
crucial for any improvement in their education and to closing their triple divided gaps
(Health, Education, and Digital).
• The development of a best practice model in Aboriginal and Torres Strait Islander
education resources requires input from members of the target audience through their
continuing evaluation; this helps ensure that the resource is culturally safe, applicable and
appropriate to the target group.
• There is need for further research and study. Detailed recommendations are provided in
Chapter 11. |
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