Acute Rheumatic Fever (ARF) among Indigenous Australians: Contributing Factors and Prevention Interventions

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Health and Communication: Acute Rheumatic Fever (ARF)
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Health and Communication: Acute Rheumatic Fever (ARF)
Introduction
Acute Rheumatic Fever (ARF) is a disease originating from an abnormal response to
Group A beta-haemolytic streptococcus infection. It is one of the most frequently acquired
diseases among children (Rémond, Hodder, Nelson, Martin, Nelson, and Atkinson, 2013). Over
the years, ARF has become a rare diagnosis among non-Indigenous Australians. On the other
hand, the disease has become one of the highest reported conditions among the Indigenous
people in Australia. Prevalence of GAS throat is common among Aboriginals; however, clinical
evidence is still unclear regarding GAS pharyngitis (NACCHO and RACGP 2018). In fact, the
prevalence of ARF among Aboriginal people is the highest in the world. Moreover, children
from Aboriginal communities and other Indigenous population such as Torres Strait Islander
people have been identified as at high risk of ARF (Shahid, Teng, Bessarab, Aoun, Baxi, and
Thompson, 2016). It is estimated that the reported cases represent about 300 people per 100,000
individuals especially for children between the age of 5 and 14 (NACCHO and RACGP 2018).
This value is more than 100 times the prevalence among non-Indigenous Australians. Based on
this high rate of representation, it is important to understand the underpinning causes and
prevention interventions that could be used to achieve the desired healthcare and experience
standards among the Indigenous people of Australia. This paper evaluates the factors that
contribute to the high level of ARF among Indigenous people in Australia using the Theory of
Planned Behavior and how to achieve sustainable prevention milestones using the Socio-
Ecological Model.

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Overview of the Theory of Planned Behavior
Different theories have been used to describe how individual behavior could impact one’s
health. The Theory of Planned Behavior (TPB) is a reasoned action theory that was established
back in the 1980s to explain the reasons why someone could engage in a particular behavior at a
specific place or time. The theory is founded on behavioral intent, which has been used to
explain different health behaviors including health service utilization, drug abuse, breastfeeding,
smoking, and violence. A critical review of the theory presents five key elements of behavior and
how they impact the health of an individual. When the scope of the theory is extended beyond a
single person and viewed from the lens of a community, it becomes possible to explain why a
particular condition could be prevalent among a specific population in the society. The first
dimension of the theory is the attitude of an individual of the community regarding favorable or
unfavorable interest where the outcomes of undertaking an activity inform decisions made. The
second factor is behavioral intention, which revolves around the motivations that influence a
person to adhere to a specific action or behavior. The third element is the subjective norms that
imply thee degree to which other people in the same setting approve or disapprove that specific
behavior. A related factor to subjective norms is social norms, which entirely is restricted to the
customary codes and values that define the community’s existence. The fifth dimension is
perceived power and behavior control, where the main focus internal and external factors that
may encourage or impede the prevalence of specific behaviors. Based on these five factors it is
possible to highlight the reasons behind the prevalence of ARF among Indigenous population in
Australia.

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Contributing Factors to ARF among Aboriginal People
Socioeconomic factors such as political history and background determine how they
relate to their environment, which also impacts health. A justification for this analogy is founded
on the Theory of Planned Behavior. The beliefs, behavior, experience, and knowledge of patients
within their social networks defines how they relate with available health services (McCabe,
Mellor, Ricciardelli, Mussap, and Hallford, 2016). Australian Indigenous people have
experienced ongoing racism combined with adverse colonization history that has contributed to
the negative life experiences. Australian Aboriginals have developed rooted trust issues and
experienced poor health-related communication, which impact how the population perceives
available primary and secondary healthcare services in the country. The attitude of some service
providers about Aboriginals affects the extent to which patients feel safe while seeking for
medical healthcare (Shahid et al., 2016). In this case, there is a high rate of morbidity with
limited success intervention because of the impact of colonization and racism that Australian
Aboriginals face. Increased prevalence of ARF in this population partly originates from
willingness to access, attend, or adhere to available diagnostic guidelines.
Moreover, lower socioeconomic conditions have contributed to the prevalence of ARF
among Aboriginals. Indigenous Australians have failed to access healthcare interventions for
ARF because of the stressors in life. Overall life situation among Aboriginals affects their ability
to afford healthcare services or seek early interventions to prevent adverse outcomes. Access to
employment opportunities and a source of stable income has resulted in critical socioeconomic
conditions among Aboriginals (McCabe et al., 2016). These economic and social disadvantages
have a positive relationship with the prevalence of ARF in this population. Income disparity
comes with other factors such as poor housing and nutrition. With all these elements into the