Improving care pathways for Otitis Media in Aboriginal children (0-12): A case study approach

The vast majority of hearing loss in Aboriginal children is arguably a direct result of persistent and pervasive otitis media (OM). Its high prevalence is linked with poorer educational outcomes, social and behavioural problems, and contributes to over-representation within the health and criminal justice systems. Compared with the non-Indigenous population in Australia, OM occurs earlier, more frequently, and is more severe and has been referred to by the World Health Organisation as a “massive public health problem”. High prevalence rates are associated with the social determinants of Aboriginal health and important to address within a longer-term context of “Closing the Gap” for Aboriginal people. Effective pathways for early detection and management of OM can significantly reduce the severity and longer-term impacts of OM and the resultant hearing loss. While multiple programs continue to be financially supported by governments, these have had limited impact on the prevalence and impacts of OM for Aboriginal children. Fragmentation of existing programs and poor data capture make it difficult to assess, and early evidence of ill-matched pathways and models of care to community needs and values are likely to underpin the failure of programs to address this major health challenge.
To address this, in partnership with 3 Aboriginal Community Controlled Health Services spanning urban, rural and remote geographical areas, we will use the WHO framework for health systems performance assessment to map the current healthcare system for OM in Aboriginal children (0-12 years) and identify the gaps in this, then co-design, implement, and evaluate a connected method of addressing OM and hearing loss in children aged 0-12 (encompassing the early years through to primary school ages). We will identify the enablers and barriers to successful hearing healthcare delivery and deliver a toolkit [including guidelines and training programs] to apply these findings to other communities to localise successful approaches to hearing healthcare across Australia.
Persistent and pervasive middle ear disease in Aboriginal children has life-long effects on health, education, employment and social and emotional well-being. While considerable funding, goodwill and the fundamental building blocks have been in place for many years, the success of programs has been limited. The study aims to explore the reasons for this, and co-design, implement and evaluate an alternative approach to addressing this major public health problem.