Original Research

Indigenous Australian perspectives on incorporating the social determinants of health into the clinical management of type 2 diabetes


name here
Amanda Frier1
MPH/MBA, PhD Candidate *

name here
Sue Devine2
DrPH, Head, Public Health and Tropical Medicine

name here
Kristin E McBain-Rigg3
PhD, Lecturer

name here
Fiona Barnett4
PhD, Head, Sport and Exercise Science

name here
Zara A Cassady5
Aboriginal and Torres Strait Islander Primary Health Care Certificate 4, Alcohol and Other Drugs Certificate 4, Community Services Certificate 4

name here
Trisha Dunning6
PhD, Professor

name here
Robyn L Reese7
Aboriginal and Torres Strait Islander Primary Health Care Certificate 3


1, 2, 3 College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Townsville, Qld 4814, Australia

4 College of Healthcare Sciences, Australian Institute of Tropical Health & Medicine, James Cook University, Douglas, Townsville, Qld 4814, Australia

5, 7 Northern Australia Primary Health, Douglas, Townsville, Qld 4814, Australia

6 School of Nursing & Midwifery, Deakin University, Geelong, Vic. 3220, Australia

ACCEPTED: 6 April 2021

early abstract:

Background: Type 2 diabetes mellitus (T2DM) and social disadvantage are related. In Australia, this association is most pronounced amongst Indigenous people. Indigenous Australians are among the most socially disadvantaged in the country, with the worst social determinants of health (SDoH). SDoH are typically addressed at a population level, and not on an individual or clinical level. However; the SDoH related needs of individuals also require attention. The adverse link between T2DM and SDoH suggests that simultaneous consideration at an individual, clinical level may be beneficial for T2DM care and self-management. Identifying and addressing SDoH related barriers to T2DM self-management may augment current care for Indigenous Australians.
Aims: This study aimed to combine the perspectives of Indigenous Australians with T2DM, and Indigenous health workers to explore the SDoH related barriers and facilitators to self-managing T2DM, and how SDoH could be incorporated into usual clinical care for Indigenous Australians with T2DM.
Methods: Under the guidance of a cultural advisor and an Indigenous health worker, seven Indigenous people with T2DM and seven Indigenous health workers from rural and remote north Queensland, Australia, participated in a series of semi-structured, in-depth face-to-face interviews and yarning circles. A clinical yarning approach to data collection was used, and both an inductive and deductive data analysis was applied. Data were analysed, and themes were identified using QSR NVivo 12.
Results: Study participants described a holistic view of health that innately includes SDoH. Specific to T2DM care, participants identified that culturally responsive service delivery;  suitable transport provision; an infinite flexible approach to accommodate for individuals’ unique social circumstances; appropriate client education and appropriate cultural education for health professionals; support mechanisms and community support services were all essential components. These were not seen as separate entities, but were interrelated, and all were required to incorporate SDoH into care for Indigenous Australians with T2DM.
Conclusions: SDoH are implicit to the Indigenous Australian holistic view of health. Consequently, an approach to T2DM care that complements this view by simultaneously considering SDoH, and usual T2DM clinical management could lead to enhanced T2DM care and self-management for Indigenous Australians.