First Nations Australians face multiple barriers to accessing rheumatology services including delayed referrals and inadequate cultural support that appear to be “perpetuated” by the current model of care, a study suggests.

Researchers from UNSW Sydney and Prince of Wales Hospital said despite there being a widely acknowledged need to improve health outcomes, minimal research had assessed existing models of care from a First Nations perspective.

The qualitative study involved semi‐structured interviews with 16 patients who self‐identified as First Nations (75% female) attending a Sydney hospital-based rheumatology clinic in 2021 with a musculoskeletal or autoimmune condition.

Participant ages ranged from 23-77 but over half (56%) were aged 40 and older.

Most were referred for inflammatory disease, and osteoarthritis was the most common noninflammatory disease, noted the researchers.

Barriers to rheumatology care included the logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments or health worker behaviours, and inadequate cultural support.

Nearly all participants mentioned the wait times to accessing rheumatology clinics as a barrier, with some expressing feeling like giving up because of large appointment delays.

Transport to appointments also provided challenges due to cost and inconvenience, with one participant mentioning the discomfort of catching the bus while in pain.

Some patients reported experiencing a lack of cultural safety, usually in the waiting room rather than during health consultations. These experiences included feeling looked down upon or unwelcome.

Some suggested that cultural recognition, such as through First Nations artwork in the waiting room, would lead to more positive experiences.

Younger patients mentioned the stereotype of rheumatology being a service for older people as a barrier to seeking care, with visits linked to feelings of shame.

Miscommunication due to the use of medical jargon or complex information and feelings of not being heard by health professionals were also widely reported.

Most participants were not aware of the role of a rheumatologist before attending the clinic, had sense of uncertainty about their management options and the necessity of follow‐up, and had limited medical knowledge about their condition.

Some also mentioned the lack of culturally adapted information available.

“Pamphlets specifically would be very helpful… rheumatology, my God it’s a difficult one to get your head around,” noted one participant.

Aboriginal Health Workers were identified as having a positive role in the care of participants, assisting with the navigation of health services, acting as a patient advocate and facilitating cross‐cultural communication.

Other enabling factors included family member involvement and telehealth.

“It is clear there are ongoing barriers to service access especially related to referral pathways, cultural responsivity of the clinic setting and cross‐cultural communication challenges,” the researchers, which included rheumatologists and Aboriginal Health Workers, wrote in Health Expectations [link here].

“Engaging clinicians in delivering culturally safe practices revising the clinic environment so that it is culturally safe, incorporating culturally tailored education resources and involvement of Aboriginal Health Workers and families in care are likely to improve the experience and in turn outcomes of First Nations Australian patients in rheumatology.”

They concluded that future research should focus on models of care co-designed with First Nations Australians to ensure services were culturally appropriate.