title: Service providers' perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: a qualitative study.
abstract: OBJECTIVE
  Providing services to rural dwelling minority cultural groups with serious chronic disease is challenging due to access to care and cultural differences. This study aimed to describe service providers' perspectives on health services delivery for Aboriginal people receiving haemodialysis for end-stage kidney disease in rural Australia.
  
  
  METHODS
  Semistructured interviews, thematic analysis
  
  
  METHODS
  A health district in rural New South Wales, Australia
  
  
  METHODS
  Using purposive sampling, 29 renal and allied service providers were recruited, including nephrologists, renal nurses, community nurses, Aboriginal health workers, social workers and managers. Six were Aboriginal and 23 non-Aboriginal.
  
  
  RESULTS
  Improving cultural understanding within the healthcare system was central to five themes identified: rigidity of service design (outreach, inevitable home treatment failures, pressure of system overload, limited efficacy of cultural awareness training and conflicting priorities in acute care); responding to social complexities (respecting but challenged by family obligations, assumptions about socioeconomic status and individualised care); promoting empowerment, trust and rapport (bridging gaps in cultural understanding, acknowledging the relationship between land, people and environment, and being time poor); distress at late diagnosis (lost opportunities and prioritise prevention); and contending with discrimination and racism (inherent judgement of lifestyle choices, inadequate cultural awareness, pervasive multilevel institutionalised racism and managing patient distrust).
  
  
  CONCLUSIONS
  Service providers believe current services are not designed to address cultural needs and Aboriginality, and that caring for Aboriginal patients receiving haemodialysis should be family focused and culturally safer. An Aboriginal-specific predialysis pathway, building staff cultural awareness and enhancing cultural safety within hospitals are the measures recommended. Increasing patient support for home haemodialysis may improve health and the quality of care outcomes.
authors.affiliation: University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Rix
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.forename: Shawn
authors.initials: S
authors.lastname: Wilson
authors.forename: Janelle
authors.initials: J
authors.lastname: Stirling
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
keywords: NEPHROLOGY; QUALITATIVE RESEARCH