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Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia
  1. Aryati Yashadhana1,2,3,
  2. Ted Fields2,
  3. Godfrey Blitner2,
  4. Ruby Stanley2,
  5. Anthony B Zwi4
  1. 1School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Vision Cooperative Research Centre, Sydney, New South Wales, Australia
  3. 3Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia
  4. 4Faculty of Arts and Social Sciences, School of Social Sciences, The University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Aryati Yashadhana; a.yashadhana{at}


Introduction Our study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.

Methods In collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11.

Results More than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care.

Discussion We outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.

  • eye diseases
  • diabetes
  • health systems
  • public health
  • qualitative study

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  • Handling editor Seye Abimbola

  • Correction notice This article has been corrected since it was published. The article type has been updated.

  • Funding This study was funded by the Australian Government Department of Industry's Cooperative Research Centre initiative under the Vision CRC.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Due to Human Research Ethics Committee and intellectual property requirements data is not available.

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