title: Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study.
abstract: BACKGROUND
  Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6-12 months post-event, in central Australia.
  
  
  METHODS
  This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients' "typical" journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels.
  
  
  RESULTS
  Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey.
  
  
  CONCLUSIONS
  Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented to improve communication on all levels and reduce systemic barriers operating within the health system.
authors.affiliation: Social Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide, Australia.
authors.forename: Stella
authors.initials: S
authors.lastname: Artuso
authors.forename: Margaret
authors.initials: M
authors.lastname: Cargo
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.forename: Mark
authors.initials: M
authors.lastname: Daniel
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000208:ethnology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D036301:Qualitative Research