→ Pika Wiya Aboriginal Health Service, Port Augusta, SA
→ Spencer Gulf Rural Health School, University of SA

A pilot chronic disease self-management course, Living Improvements for Everyone (LIFE) has lead to the increased clinic attendance for chronic conditions at the Pika Wiya Aboriginal Health Service in Port Augusta, South Australia.

Participating in the LIFE program involves developing a care-plan for long-term conditions such as diabetes and heart disease. It also involves taking part in group workshops and camps as part of learning to live with a chronic illness and sharing techniques for dealing with its social and emotional effects.

LIFE was developed with the assistance of Port Augusta Elders from an extensively evaluated chronic disease self-management tool and training package from Stanford University, USA. LIFE also incorporates the 'Flinders Model' of Chronic Condition Self-Management support, developed at Flinders University, SA.

'Self-management' is a patient's ability to understand their condition and to manage and organise their access to key elements of their care. Kate Warren from the University of South Australia & Spencer Gulf Rural Health School says that while this may be a goal to work towards, many people are not ready for it.

"There are huge issues surrounding grief and loss in this community to the extent that we have decided to include a grief cycle similar to how the symptom cycle is portrayed. Participants come to recognise the sequence of painful and difficult issues in their lives and how they interconnect; and they have the opportunity to talk about them in a non-confrontational way.

"We see ourselves training 'life leaders', enabling people with positive life skills that are relevant to everyone, community people and health workers," says Kate.

The program consists of a six week course (2½ hours per week) where people with different chronic conditions get together and share their experiences in peer-led sessions involving problem solving techniques, appropriate exercise techniques and use of medicines, as well as effective communication and nutrition.

"It is important to start with people where they are at," says Fiona Coulthard, Master Trainer of the LIFE program. "This way, we sit down with people and really listen to what they are telling us. We work out what is the most pressing, the most difficult problem in their life right now and deal with it, and find out what the background issues are."

Both Kate and Fiona have completed Stanford University's master training program in chronic disease self-management, with Kate also completing the train-the-trainer package.

At the commencement of the Port August pilot (funded by SA's Sharing Health Care project) Kate and Fiona sat down with local Elders, and went through the Stanford model and changed it to make it more culturally appropriate. Since the pilot finished, a growing number of community members and health professionals have undertaken the LIFE course.

During the program, says Fiona, participants develop their own action plans, which are carefully stepped to make sure they are achievable.

"We want to fit with people's lifestyle. Small changes that can be made very gradually; and build people's confidence so they can say 'Hey, I can do this!'."

"With peers leading the program, participants turn what they know into real action, doing more physical activity, using techniques to relieve stress, or making healthy changes to their diet. Group members support each other. So, it's a two-way process," says Kate.

Training manuals and supporting literature designed for any Indigenous health service are now available, although some changes would still be necessary to suit local circumstances.

As one participant put it, "I wish I knew then what I know now. Perhaps I could have prevented myself getting these things."

LIFE training is planned for Port Lincoln and number of other centres. Unfortunately, the Sharing Health Care project funding has run out and where the program's next funds will come from is unclear. Fiona and Kate continue to develop LIFE nevertheless and plan to deliver some sessions in their own time after hours.

"I see participants down the street everyday who ask, 'When are we going to have our session again? When are we going to have another get together?'," says Fiona.

Find out more

Spencer Gulf Rural Health School, University of SA
Phone: 08 8647 8129
Email: Kate.Warren [at] unisa.edu.au