We have designed this clinic to help overcome barriers faced by Aboriginal and Torres Strait Islander people to access culturally safe and effective diabetes care in Mount Druitt, and reverse high rates of non-attendance at general diabetes clinics.
We set up the clinic in response to the significant barriers faced by Aboriginal and Torres Strait Islander people in accessing culturally safe and effective diabetes care. Mount Druitt is home to the highest Aboriginal population in the Blacktown local government area and was showing a high non-attendance rate at the established diabetes clinic. A review revealed that a lack of culturally specific care and the clinic’s location were key reasons for this. Aboriginal and Torres Strait Islander patients were not receiving the culturally competent care needed to address their medical and social needs, which was affecting their health outcomes.
The clinic works to:
- develop the workforce with cultural training and community engagement, which fosters a stronger and more inclusive healthcare system.
- address barriers such as transport, housing and financial instability to support Aboriginal people’s active participation in health decisions. This helps to reduce health disparities and contributes to better health outcomes overall.
This clinic advances the Closing the Gap Priority Reform Area – Transforming Government Organisations, specifically focused on improving access to healthcare and delivering culturally safe, responsive services. The clinic aligns with the strategic direction of culturally appropriate care outlined in the NSW Aboriginal Health Plan 2024-2034 through the integration of Aboriginal chronic care nurses and culturally competent staff. The clinic also ensures a holistic and community-driven model of care to address the social determinants of health, a key focus of the NSW Health Aboriginal Health Strategy.
Tackling non-attendance at diabetes clinics
Aboriginal people were involved early in the project through the Aboriginal steering committee, which included representatives from local Aboriginal health services such as the Greater Western Aboriginal Health Service, community leaders and stakeholders. Committee discussions highlighted the need for a clinic that integrated cultural safety into clinical care and addressed barriers such as transport and social determinants of health. Aboriginal input was critical in shaping the clinic’s model, ensuring it was built around the community's unique needs and values.
This collaboration and engagement ensures that the project not only addresses immediate healthcare access issues but also fosters long-term trust and engagement between Aboriginal patients and the healthcare system, creating a more inclusive and responsive environment for diabetes care.
Designing a diabetes clinic for Aboriginal people
We decided to set up the clinic in Mount Druitt because of its high Aboriginal population. We strategically located the clinic near a shopping centre with easy access to public transport and parking to increase accessibility. Recognising that transport was a major barrier for patients, we partnered with the Integrated Team Care program to provide transport services. Providing this service was essential in the initial stages of the project to ensure that logistical challenges did not stop people from accessing care.
At the core of the clinic’s model is the integration of culturally safe care. We worked closely with the Aboriginal steering committee to ensure the clinic was culturally responsive. An Aboriginal chronic care nurse was embedded in the clinic to provide cultural support, act as a liaison between patients and clinicians, help patients understand the clinical process, and address broader social issues such as housing or financial difficulties. This was crucial in shaping the care model and ensured that services were aligned with Aboriginal cultural practices and values.
Aboriginal people played a vital role in identifying the need for culturally specific diabetes care. Their insights informed the clinic’s design, staffing decisions, and creation of culturally safe spaces and processes that respected Aboriginal patients’ preferences. Moving forward, we plan to expand the model by engaging more GP practices and further integrate Aboriginal leadership within the clinic, ensuring that the project continues to be community-driven and culturally relevant.
Important lessons about transport, cultural safety and community engagement
Since the establishing the clinic, we’ve learned three key lessons that will guide future improvements to the service:
- Culturally safe spaces are essential: Culturally safe spaces are important for building trust and encouraging Aboriginal patients to engage with healthcare services. The presence of the Aboriginal chronic care nurse during consultations has been invaluable to ensure patients feel respected and understood. Their involvement addresses medical issues and social determinants of health like housing and finances, and reinforces the importance of culturally responsive care that considers the whole person.
- Engage and involve the community early and throughout the project: Early and ongoing engagement with the Aboriginal community through the Aboriginal steering committee was crucial in shaping our approach. The community provided invaluable insights into their unique needs and preferences, ensuring the clinic’s design and service delivery is aligned with Aboriginal values and priorities. The diabetes prevention officer from Western Sydney Diabetes was the key liaison between stakeholders, played a vital role as secretary of the steering committee and ensured seamless communication and coordination. This engagement has reinforced the importance of Aboriginal people leading and informing the project from the outset and means the clinic is community-driven and responsive. Aboriginal people will continue to play a pivotal role in the project’s evaluation process, ensuring that any adjustments or improvements are community-driven and aligned with their needs.
- Addressing transport issues is key to improving access:
Consistent and reliable transport was and remains a significant barrier for patients. Travel support from the Integrated Team Care program has been essential to improving access, along with flexibility of appointment times and ongoing outreach services like the bimonthly case conferences at the Greater Western Aboriginal Health Service. However, we must expand these options to reduce gaps in our service delivery and improve access for patients.
