Table 8.

Facilitators for hospital staff to facilitate medical follow-up for Aboriginal children hospitalised with ALRI

Theme	Subtheme	Domain	Exemplars or consensus of focus group
1.Knowledge	1•1Medical knowledge of clinicians	Training for clinicians on Aboriginal lung health	Focus group consensus: 1. Provide training to clinicians – at hospital and in primary care in person, online modules, and podcasts. 2. Easy access to best practice guidelines
	1•2 Cultural knowledge of staff	Training for staff on culturally responsive care	Provide training for clerks:1. How to ask Aboriginal status. 2. How to ask about local doctor. Doctor in Aboriginal health: “The question needs to be rephrased: ‘where is your local clinic?’”
	1•3Parent health literacy	Clinicians to teach parents about lung health and need for follow-up	Focus group consensus:1. Doctors teach parents on wards. 2. Nurses provide follow-up support education. 3. Clinicians ensure families given pamphlet with instructions
2. Skills	2•1Communication with parents	Provide staff with rationale to provide to parents	Aboriginal health practitioner: “We need to make sure we have a reason why we need to do these things and explain that to our families...”
		Telephone contact from unblocked number	Nurse in Aboriginal health: “We have had the (telephone) number of our unit unblocked so our families know it is us. We have an easier time getting hold of families since we made this change.”
	2•2Cultural skills	Provide staff with training in culturally responsive care and engagement	Clerk 4: “It would be really helpful if we had mandatory training, so we know how to talk with families with actual examples...” Doctor 6: “It was not until now talking to you in person that I really understood the reason why we are following-up these kids and importance of engaging effectively with families. Most docs just won't get this from one lecture…Also, if you could offer … cultural training for all the doctors. We need practical ideas on how to engage. You will get more engagement and motivation by docs that way.” A lead clerk: “The clerks found the training in culturally secure engagement very helpful, and I would like all clerks to do it as I think it will help get the right information for the families.” Clinical nurse specialist: “…what we really need is practical training in how to work with families...”
		Provide role modelling	Doctor 2: “I think observing someone who is confident engaging with Aboriginal families would be very helpful. I can understand this may be logistically difficult, but it would be very helpful.” Doctor 3: “A buddy opportunity where I can observe a fellow clinician engaging with an Aboriginal family on the ward would be very helpful.”
3.Hospital processes and environment	3•1Cultural safety of environment	Aboriginal flags	Clerk 2: “I think the Aboriginal flags on the desk would be helpful...”
		Increase Aboriginal workforce and capacity of non-Aboriginal workforce	Doctor in Aboriginal health: “We have 2 ALOs for the whole hospital and their workload is too high. We need to improve the cultural capacity of our non-Aboriginal workforce and we need more ALOs employed.”
	3•2Provide culturally secure health literacy tools	Develop flip charts and pamphlets	Nurse in Aboriginal health: “Some families can't read, so we do not just want to give them a flyer. We need tools that will explain things to families, so they understand...”
		Ensure tools are readily available	Focus group feedback:1. Tools to easily accessible in clinical workrooms of each ward. 2. Tools need to be accessible electronically on hospital intranet
	3•3Admissions process	Timing of ascertaining patient information from parents	A lead Clerk: “The ward is calmer. We can have a nice conversation at admissions. It is a nicer situation for families as the ward gives everyone breathing time.”
	3•4Discharge process	Electronic discharge system	Focus group consensus:1. Add Aboriginal status to electronic discharge system. 2. Ensure local clinic is populated. 3. Template to be embedded into electronic system with clear instructions for local primary care clinician to know how to follow-up
	3•5Follow-up process	Primary care follow-up in 1-month	Focus group consensus: Follow-up should happen in primary care not at hospital
		SMS reminder	Focus group consensus:Send automated SMS reminder to patients to book an appointment with primary care doctor
		Clear hospital policy	Develop hospital policy for provision of culturally secure health information and follow-up for Aboriginal children hospitalised with ALRI, with clear directives on roles and responsibilities and processes.
4. Professional role and identity	4•1 Staff prejudice of parents	Provide staff with training in culturally responsive care	Provide staff with training in culturally responsive care

Abbreviations:

ALO: Aboriginal Liaison Officer

SMS: Short Message Service