Health and Communication: ARF Case Study among Indigenous Australians

This case study analyzes Acute Rheumatic Fever (ARF), a significant health issue among Indigenous Australians, exploring its causes and potential prevention strategies. It examines the prevalence of ARF, the role of the Theory of Planned Behavior, and socioeconomic factors, including historical and ongoing racism, limited access to healthcare, and cultural expectations. The study highlights the importance of understanding these factors to develop effective prevention interventions, using the Socio-Ecological Model to address individual, community, and structural determinants. Recommendations include policy changes to improve access to healthcare, health awareness programs, early screening, and immunization, as well as addressing behavioral aspects and promoting healthy lifestyles. The analysis underscores the need for culturally sensitive healthcare practices and collaborative relationships between healthcare providers and Indigenous communities to reduce the prevalence of ARF and improve health outcomes.

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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

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picture, some Aboriginal families are unable to provide adequate or standard care for their
children and older people. In fact, the ARF rate is high among children and older people because
of the lifestyle practices that encourage the spread of the condition (Zhao, Wright, Begg, and
Guthridge, 2013). Poor housing leads to crowding and lack of a stable source of income comes
with inability to afford quality healthcare services. While the government has tried to reduce the
poverty gap between Indigenous and non-Indigenous Australians, socioeconomic disadvantage
still exists among Aboriginals and is part of the reasons for the current ARF overrepresentation.
A dominant pattern exists among Aboriginals regarding access to healthcare service,
which is part of the reason why some key health conditions are dominant in this population.
Families living in remote or rural areas have complained about the difficulties they face while
seeking medical service (Shahid et al., 2016). ARF requires immediate intervention to prevent
exacerbation of patient’s condition. When there is limited access to medical services, there is a
higher chance of death or acute diagnosis. There is limited infrastructural support in rural areas
tailored to meet the diverse health needs of Indigenous people (Zhao et al., 2013). In a society
where there is limited access to medical service as well as poor socioeconomic interactions, there
is a high level of exacerbated health experiences. The same case is true when it comes to the
scenario characterizing Aboriginals and ARF diagnosis. Availability of specialist doctors in the
rural or remote areas makes it a great challenge for Aboriginals to access quality care for ARF
patients. Such a scenario implies that those who get infection end up being symptomatic before
accessing medical services. In chronic cases, the patient’s condition gets worse because of
waiting time to acquire mean to refer the case to advanced facilities or care centers, which come
with ambulatory costs.

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Apart from the socioeconomic and accessibility factors, a lack of culturally safe
atmosphere that favors Aboriginals has encouraged the prevalence of ARF in the community.
The perception among Indigenous people regarding the lack of culturally safe interaction with
non-Indigenous people affects the level of willingness to seek medical care and participate in
preventive interventions. This problem comes with the poor rate of retention and recruitment of
health professionals deployed in rural areas in Australia. In most cases, those practitioners who
lack cultural awareness and with limited experience in culturally safe healthcare practices
impede successful disease prevention and treatment among Aboriginals. The high rate of
turnover of specialist doctors and clinicians in rural or remote areas affect the level of trust and
collaborative relationships between Aboriginal patients and practitioners. A higher percentage of
deployed nurses and doctors have little or no knowledge regarding the culture and history of
Indigenous Australians, which means that they cannot adequately relate to the disease and
diagnostic patterns exhibited among Aboriginals (Shahid et al., 2016). Lack of cultural
sensitivity in healthcare service in remote areas creates a communication gap that influences the
ARF indicators among Aboriginals. Scholars have shown that the problem of cultural safety
practices among practitioner as well as the high rate of turnover cuts across all level of healthcare
professionals working in remote areas occupied by Indigenous Australians (Shahid et al., 2016).
Furthermore, cultural expectations among Aboriginals also contribute to the prevalence
of ARF in the community. It is the culture of Indigenous Australians to look for one another and
sometimes this cultural divine practice impedes the process of deciding to seek medical attention.
Most cases are reported at the critical stage, which affects the nature of treatment outcomes. In
some cases, communicable diseases tend to be overrepresented in the community because of this
practice. For example, women tend to ignore symptom-related signals because of the cultural

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expectations and demands about family. At the same time, men are associated with numerous
preoccupations, which lead to minimal time for self and health prioritization (Shahid et al.,
2016). The use of traditional medicine is a common practice among those who lack knowledge
about the reliability of tested and approved medication. ARF patients require appropriate
diagnosis and subsequent treatment, which means that the use of bush medicine and trial and
error approach could lead to mortality cases (Carapetis, Beaton, Cunningham, Guilherme,
Karthikeyan, and Mayosi, 2016). It is possible that there are numerous Aboriginals who are not
included in clinical data regarding diverse diagnostics because they relied on bush medicine.
Stigma and shame that comes with sickness especially among adults is another challenge that
exacerbates the disparity in healthcare service accessibility and disease prevention awareness.
Prevention Interventions for ARF Based on the Socio-Ecological Model
Based on the individual, community, and structural factors that contribute to the
prevalence of ARF among Aboriginal people, preventive mechanisms should target these key
areas. The government of Australia should consider the role of policy strategy in enhancing the
level of access to healthcare services among this population (NACCHO and RACGP 2018). A
significant number of individuals are unable to access quality care because of fear of racisms and
public profiling; however, through proper policy framework and public awareness, this problem
could be solved (He, Condon, and Ralph, 2016; Coffey, Ralph, and Krause, 2018). Moreover,
education programs and socioeconomic interventions meant to improve the welfare of
Indigenous people in Australia could narrow the poverty gap, which is a move towards
eliminating healthcare inequalities (NACCHO and RACGP 2018). At the same time, the
government should initiate health awareness programs to educate Aboriginal people on how to
prevent ARF and how to it is important to seek early treatment interventions.

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Immunization and early screening is another approach that could be used to reduce the
prevalence of diagnosis of ARF among Aboriginals. Immunization should target people with the
previous history of the condition (Beaton and Carapetis, 2015). The intervention should be
administered based on a routine to target children and adults and should be combined with
influenza vaccination each year (NACCHO and RACGP 2018). Regular screening of pregnant
women should be carried out as part of the compulsory clinical assessment, which should
involve a detail evaluation of family medical history relating to cardiovascular conditions. At the
same time, people with a history of ARF or cardiac murmurs should be screened and assisted
based on the available clinical management guidelines.
Furthermore, as noted in the previous section, behavioral aspects among Aboriginal
people have contributed to the current overrepresentation in ARF diagnosis, which implies that
preventive interventions should also consider this dimension. Individuals who have been
previously diagnosed with ARF or RHD should be encouraged to consider the advantages of
seeking early medical assistance especially in cases such as sore throat and skin infections. There
is also the need to encourage people to live a positive and healthy lifestyle. In this case, it is
important to encourage practices such as smoking cessation, taking balanced diet, regular
exercising, maintaining proper dental health, and regular clinical reviews to check of one’s
health status (NACCHO and RACGP 2018). Women should be given contraceptive advice and
childbearing awareness to limit cases of unintended pregnancies to balance between the number
of children and the ability of the family to afford their needs.
Environmental considerations are equally important and should be targeted to people
living in setups where there is a regular GAS infection which is a precursor to ARF prevalence.
Through the help of public health, the overcrowding degree should be assessed appropriately and

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the social housing support should be included onboard in case the situation is extreme (Bowen,
Harris, and Holt, 2016). Where cases of scabies or impetigo are reported, skin health
interventions should be adopted. On the other hand, pharmacological preventive interventions
are part of ARF programs that should be carried out for Aboriginal people, which should include
chemoprophylaxis (NACCHO and RACGP 2018).
Conclusion
In conclusion, the Theory of Planned Behavior ascertains how some practices in a
community could lead to factors that encourage specific health characteristics and outcomes.
Based on the history, culture, socioeconomic dimension, and perception of other people,
Aboriginals are among the highly represented communities in ARF diagnosis. In line with these
structural, community, and individual causative element, the preventive mechanisms should be
equally framed according to the postulates of the socioecological model. Indigenous Australians
are overrepresented in ARF diagnosis because of the lack of access to quality care. The
government has not entirely invested in rural or remote area healthcare development. At the
same time, lack of cultural safety and awareness has affected the trust between Aboriginal
patients and healthcare practitioners because of the rooted racism and historical injustice. At the
same time, the culture of Aboriginal people equally contributes to the high rate of ARF in the
community. The use of bush medicine and extreme preoccupation at the expense of one’s health
affects diagnosis and treatment efficiency. In this case, preventive mechanisms should enhance
awareness through community education programs, collaboration, and engagement of
stakeholders to support the creation of a safe environment.

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References
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