Townsville Rural Stroke Outreach Service
Development of Educational
Material for Aboriginal and
Torres Strait Islander Patients
Living with Stroke
Ian Meade
Aboriginal Stroke Project
(National Stroke Foundation 2003)
What is stroke? Mainly Aboriginal people don’t know
what stroke is, so it is a lot of learning about the
problem. When it first happens they panic, most think
it is a heart attack. How do we handle stroke?
(Community leader – Geraldton)
Aboriginal Stroke Project
(National Stroke Foundation 2003)
‘Stroke Survivors consistently stated, that the
provision of information, support and education is
critical in ensuring a positive stroke experience’
Aim
• To review available stroke information
• Determine how health information is best understood
by Aboriginal and Torres Strait Islanders
• To develop user friendly, culturally appropriate, stroke
information
• Facilitate secondary prevention and behavioural
change
Process
• Design by Aboriginal and Torres Strait Islanders
graphic artist
• Cyclical review by indigenous liaison officers,
health workers and local Aboriginal and Torres
Strait Islanders patients/families
• Expert review of content
• Development of education resource by
multidisciplinary team
• Pilot and Evaluation
Education Booklet Design
Booklet Design
Elders meaning of turtle:
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They live for a long time
Have much Wisdom
Are slow and steady (slow gains)
Move at there own pace
Associated with water - motion
Spiritual meanings - turtle's shell for protection, withdraw if they
want to and come out when they are ready and is associated with
the moon cycles (sea people)
They have a lot of patience
Turtles and Stroke
• That people will withdraw and become
depressed but do eventually come back out
again to face the world in their own time, and
patience is needed to get through the healing
process. (Indigenous Child Health Coordinator)
Turtles and Stroke
• Water / sea, to be seen as cleansing, to be
cleansed from the inside out. As having a stroke
is not the time of the end but a new beginning
and the water in and around the turtle can be
seen to help refresh and rejuvenate the spirit not
only to the body but also to the soul
(Graphic Designer)
What was wanted in a resource?
Tools to engage the reader
• Use pictures with black faces
• Comics, cartoons and stories
• Clear and simple English
• Avoiding medical jargon
• Font not presented as a
government document
• Durable
Strategy - Layers of information
• Content presented through
different visual mediums
• Limited literacy skills
– key points
• Positive message
-there is life after stroke
Positive Message
Gotta have a strong mind, a will to do things, not
lay back and let others take charge of your life.
That’s what I’d like to say... you know. Be
determined to get out of that rut and be strong in
what you do!
Male stroke survivor from Palm Island
Content
• Seeing the patient as a whole person
• Focus on the Health team providing information
rather then discipline specific information
• Highlight the importance of patients family/friends
• Culturally appropriate language
Initial draft
A.
B.
A.
B.
A.
B.
A.
B.
What’s wrong love?
Well… it’s been a long time since we’ve been alone together in the same
bed and I’m a bit anxious that you will have another stroke if we have sex
tonight
Yeah, I’m a bit scared too, but I have been reading a sheet about resuming
sex after stroke that says that there is no link between having sex and
having another stroke.
That sounds promising
Talking about what we are thinking and feeling can also help.
Like everything else since your stroke, this could take some
time as we work through our thoughts and feelings.
I’m feeling pretty good. How about we start with a hug and kiss
and see what happens after that.
I think giving me a back massage would be better.
First Draft
1pm – Indigenous Liaison Offices started
laughing
First Draft
2.30pm – Indigenous Liaison Officers still
laughing – commenced re-write
End Result
A – What you reckon, you
coming to bed?
B- No, I’m scared you might
have another stroke
A- Yeah but they said its OK
to have a bit of fun
B- Well, come here then eh?
Feedback from stroke booklet
• “I have a grade 4 education, able to understand
all words written (except how do you say
hypertension?)” ( Doomadgee lady )
• “Will go and see my doctor regarding my high
blood pressure” (Mt Isa man )
• “Will talk to the dietician regarding losing weight”
(diabetic)
Feedback from stroke booklet
• “I want to take the booklet home, as I think my
brother in law, has had a stroke” ( relative )
• “Now I understand what stroke is - blockage or
bursting of blood vessels in the brain”
( new Palm Island male health worker)
Family Feedback
Congratulations on a very good resource for
stroke victims and their family. I found the book
very helpful in explaining to my nephews and
niece what “stroke” meant, how this will impact
on their dad’s and their lives and how the family
could help in Dad leading “ An Ordinary Life”
beyond his stroke.
The Journey Continues
• 50 copies printed – distributed to NSW, NT,
Victoria and Qld
• Evaluation – positive ++
• 400 more copies printed with funding from the
Qld Rural Stroke Outreach Service
• National Stroke Foundation supportive
Recovery After Stroke
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Mt Isa Hospital
Mareeba Hospital
Cairns Hospital
P.A. Hospital
Ipswich Hospital
Royal Darwin Hospital , N.T.
Swan District Hospital, WA
Campbelltown Hospital, NSW
Queens Elizabeth Hospital, Vic
Mary Rural Referral Hospital, NSW
Wodonga Campus, Vic
Cardinia Casey Community Rehab. Service, NSW
The Journey Continues
• Patients and families with limited English
• Multiple morbidity patients – eg. Chronic kidney
disease
• Children
• Resource for multidisciplinary health workers in
remote and rural communities
• Acquired Brain Injury Association Outreach
Service Qld and STEPS
Where to from here!
If you work with indigenous patients the Townsville
Rural Stroke Outreach Service can provide your unit
with a copy of the booklet ‘Journey After Stroke’
Also available ‘Journey After Spinal Injury’ booklet
Please contact Ian_Meade@health.qld.gov.au
References
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The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, 2005 available
at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4704.0/ (accessed 12/4/08)
Richards, B and Hill, V (1985) Success or failure in rehabilitation of Aborigines in Queensland.
Conference paper: Far East and South Pacific International Spinal Conference (FESPIC) Mt
Gravatt Brisbane
Aldridge, M. (2004). Writing and designing readable patient education materials. Nephrology
Nursing Journal, 31(4), 373-377.
Bond, C (2005). A culture of ill health: public health of Aboriginality? eMJA Australia. 183 (1), 3941.
Calgaret, T. (2007). Enhancing the planning and delivery of services to Aboriginal people in
Western Australia. [Electronic version]. Perth: Department for Child Protection.
Catholic Education Office. (2008). Important facts to remember when teaching Aboriginal studies.
Retrieved 19 March 2008 from Aboriginal Studies Across the Curriculum site:
http://www.teachers.ash.org.au/wattle/abstuds1/impfacts.html
Protocols for consultation and negotiation with Aboriginal people Department of Aboriginal and
Torres Strait Islander Policy and Development
National Stroke Unit Program Aboriginal Stroke Project National Stroke Foundation 2003
“A Cancer Journey” (Brochure, booklet) Queensland Health Queensland Government
References
“Give it up and live it Up 2008 make a choice Create a Change” (Calendar) joint project
by Queensland Health and the Cancer Council Queensland
Zhao, Y and Dempsey (2006) Causes of inequalities in life expectancy between
Indigenous and non-indigenous people in the Northern Territory, 1981-2000: a
decomposition analysis MJA: 184 (10):490-494
City of Sydney. (2005). Aboriginal and Torres Strait Islander protocols. Sydney: City of
Sydney Trudgen, R.I. Why Warrior Lie down and Die. 5th printing (with corrections)
Adelaide 2003 Open Book Print
Durie, M. (2004). An Indigenous model of health promotion. Health Promotion Journal of
Australia. 15(3), 181-185.
Hoffmann, T & Worrall, L. (2004). Designing effective written health education materials:
Considerations for health professionals. Disability and Rehabilitation, 26 (19), 1166
– 1173.
http://www.wired.org.au/crh/ partnerships.htm last accessed 29/2/08 \partnerships when
working with people in remote communities. Robyn Glynn Centre for Remote Health
Tsey, K. (1997). Aboriginal self-determination education and health: towards a radical
change in attitudes to education. Australian and New Zealand Journal of Public
Health - 21(1), 77-83.