Poor awareness, high staff turnover and the belief that chronic wet cough is normal are delaying care for Aboriginal children, Australian researchers say.
The widespread perception that chronic wet cough is “normal” in Aboriginal children is contributing to delayed diagnosis and treatment of potentially serious respiratory disease, according to new Australian research.
The qualitative study, published in the Medical Journal of Australia, found inadequate health promotion and high turnover of healthcare staff were also major barriers to timely care, while Aboriginal-led, culturally secure health education emerged as a key solution.
“Key barriers identified included inadequate health promotion, the common perception that CWC is normal and high turnover among health staff, leading to mistrust of newly onboarded health staff,” the researchers wrote.
“The overarching facilitator identified was knowledge dissemination through health promotion, delivered in person by Aboriginal health staff using culturally secure resources, supplemented by posters placed in the community and the use of radio and social media.
“Individual communities expressed varied preferences regarding specific health promotion methods and designs. Communities valued staff who had spent considerable time within the community, allowing for the development of trust and rapport.”
Chronic wet cough (CWC), defined as a daily wet cough lasting more than four weeks, can be a sign of protracted bacterial bronchitis (PBB), a known precursor to bronchiectasis.
PBB affects an estimated 10% of preschool children in the West Kimberley, and researchers said timely recognition of CWC provided an opportunity to diagnose and treat the condition before irreversible lung damage developed.
The researchers conducted semi-structured interviews and focus groups with 167 parents and carers of Aboriginal children in eight communities across Western Australia, the Northern Territory and Queensland between May 2021 and July 2023.
The communities ranged from a major metropolitan centre to small remote communities.
Limited knowledge of CWC was reported across all communities, with most carers saying they had never received information about the condition.
Carers in every community also described chronic wet cough in children as normal, sometimes reflecting reluctant acceptance of symptoms because they were so common.
“She’s [daughter] like just learnt to just deal with it and continue on. Like, that’s just her normal,” one mother told researchers.
Some carers felt their concerns had been dismissed by clinicians, while others reported feeling uncomfortable or judged when questioned about how long their child had been coughing. Some also believed clinicians themselves had limited awareness of CWC.
Clinic factors compounded the problem. Long waiting times were reported in most communities and, with the exception of the Queensland site, high staff turnover was identified as a barrier to building trust and rapport.
“The doctors that have been here a long time are good too. But if there are different doctors, it gets a bit confusing because they tell you different things. But if the doctor knows our history, then it is easier,” one mother told the researchers.
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The researchers said the strongest message from carers was the need for better health promotion, with local Aboriginal health staff taking central roles.
Preferences differed between communities. Smaller communities favoured approaches including door-to-door education, community gatherings and opportunistic yarning, while larger communities wanted organised events.
Radio and word-of-mouth were more important in some remote settings, while social media was widely used in communities with better mobile coverage.
Carers also called for culturally secure, visually engaging resources, including posters, flipcharts and video messages, with the sound of a wet cough incorporated to help families recognise the symptom. Some remote communities wanted resources translated into local languages.
The researchers said the consistency of the findings across geographically and culturally diverse communities suggested broader systemic problems in the way common childhood conditions were addressed.
High workforce turnover was of particular concern. The researchers cited previous estimates of average annual turnover of 151% in regional and remote Aboriginal Community Controlled Health Service clinics in Western Australia and the Northern Territory, noting that carers in the current study repeatedly linked continuity of staff with trust and willingness to seek care.
They called for community-led, locally tailored health promotion alongside efforts to improve workforce retention.
“Given the high rates of CWC and high burden of chronic lung disease among First Nations people, urgent action is required to develop and implement these community-identified strategies,” the researchers concluded.
“A co-design approach involving First Nations communities is crucial for developing locally tailored solutions and ensuring the cultural relevance and effectiveness of health initiatives.
“Further, efforts to reduce staff turnover in primary care clinics cannot be underestimated.”
