Optimising access to the New South Wales Mid North Coast Brain Injury Service for local aboriginal people (Dunghutti Muri project): a participatory action research study

PURPOSE: To improve access for people of Aboriginal background with traumatic brain injury (TBI) to the New South Wales Mid North Coast Brain Injury Rehabilitation Service (MNCBIRS). METHODS: The participatory action research (PAR) project was led by the Dunghutti Muri steering committee, comprising key Aboriginal Health Workers from the region alongside MNCBIRS staff. A service file audit described current and recent Aboriginal clients, with a subset of clients/family members participating in semi-structured interviews around access facilitators/barriers to MNCBIRS. Audit and interview data then drove a series of initiatives to enhance service access. A time series analysis tested whether the project increased Aboriginal clients as an overall proportion of the service caseload. RESULTS: The audit identified 27 Aboriginal clients (Male = 19/Female = 8; TBI = 21/ABI = 6), with 11 clients/family members interviewed. Thematic/inductive analysis elicited themes within the six categories of the Theory of Access framework (Accessibility, Availability, Affordability, Accommodation, Acceptability, Awareness). Ten new service initiatives were implemented to improve access. Timeseries models found a significant increasing proportion of the caseload were Aboriginal since Dunghutti Muri Project inception, compared to pre-program (P-value = 0.038). DISCUSSION: Initial evidence was found for improved Aboriginal access to mainstream specialised brain injury rehabilitation services using PAR.