Article type
Abstract
Background
The ongoing impacts of colonisation in Australia and New Zealand have resulted in First Nations Peoples experiencing substantial marginalisation, leading to an excess burden of chronic kidney disease experienced by Aboriginal and Torres Strait Islander Peoples, and Māori. Clinical practice guidelines have traditionally been developed with a Western biomedical view and have not incorporated the Indigenous holistic view of health.
Objective
To describe the development of guidelines on managing chronic kidney disease among Aboriginal and Torres Strait Islander Peoples and guidelines on the management of chronic kidney disease for Māori in Aotearoa New Zealand.
Methods
We undertook targeted community consultation to ensure that the priorities of the First Nations communities were identified and incorporated into the guidelines scope. We searched literature databases in May 2022 and summarised findings using narrative synthesis. The studies were appraised using appropriate study design tools, as well as the involvement of First Nations Peoples involvement. A multidisciplinary expert Working Group interpreted the findings and drafted recommendations that received feedback from community reference groups and leading Indigenous health organisations and experts.
Results
The development of these guidelines involved 16 community consultations. The inclusion of First Nations Peoples in the 422 included studies were poorly reported and undertaken in most studies. The knowledge gained from the community consultations was uniquely incorporated into the Australian guidelines through the Four C’s (community voice, clinical evidence, cost, equity and resources, cultural safety considerations) to support guideline recommendations. In the Māori guidelines, an evidence alignment scheme was developed that considered of the reporting of First Nations Peoples involvement in included studies, the involvement of Māori stakeholders, and the consistency of findings across studies using unique Māori language and knowledge. The guidelines have uniquely developed 36 recommendations focused on institutional racism, earlier diagnosis and referral to kidney health services, and increased rural and remote dialysis.
Conclusions
These are the first guidelines to address chronic kidney disease management among First Nations Peoples. The guidelines have led to a working group within the Australia and New Zealand Society of Nephrology focused on Indigenous Health Advancement, such as institutional racism and improved service delivery.
The ongoing impacts of colonisation in Australia and New Zealand have resulted in First Nations Peoples experiencing substantial marginalisation, leading to an excess burden of chronic kidney disease experienced by Aboriginal and Torres Strait Islander Peoples, and Māori. Clinical practice guidelines have traditionally been developed with a Western biomedical view and have not incorporated the Indigenous holistic view of health.
Objective
To describe the development of guidelines on managing chronic kidney disease among Aboriginal and Torres Strait Islander Peoples and guidelines on the management of chronic kidney disease for Māori in Aotearoa New Zealand.
Methods
We undertook targeted community consultation to ensure that the priorities of the First Nations communities were identified and incorporated into the guidelines scope. We searched literature databases in May 2022 and summarised findings using narrative synthesis. The studies were appraised using appropriate study design tools, as well as the involvement of First Nations Peoples involvement. A multidisciplinary expert Working Group interpreted the findings and drafted recommendations that received feedback from community reference groups and leading Indigenous health organisations and experts.
Results
The development of these guidelines involved 16 community consultations. The inclusion of First Nations Peoples in the 422 included studies were poorly reported and undertaken in most studies. The knowledge gained from the community consultations was uniquely incorporated into the Australian guidelines through the Four C’s (community voice, clinical evidence, cost, equity and resources, cultural safety considerations) to support guideline recommendations. In the Māori guidelines, an evidence alignment scheme was developed that considered of the reporting of First Nations Peoples involvement in included studies, the involvement of Māori stakeholders, and the consistency of findings across studies using unique Māori language and knowledge. The guidelines have uniquely developed 36 recommendations focused on institutional racism, earlier diagnosis and referral to kidney health services, and increased rural and remote dialysis.
Conclusions
These are the first guidelines to address chronic kidney disease management among First Nations Peoples. The guidelines have led to a working group within the Australia and New Zealand Society of Nephrology focused on Indigenous Health Advancement, such as institutional racism and improved service delivery.