Medical yarn ups: towards closing the gap

Medical Yarn Ups (MYU) are a model of health care that involves a process of individual medical consultations, carried out sequentially with a number of patients. They are led by both a skilled facilitator and medical (or primary care) provider, with other patients with similar concerns sharing the journey.

Research demonstrates that adopting the MYU model has the potential to change the healthcare experience for Aboriginal and Torres Strait Islander people by creating an environment that is Aboriginal-led, accessible, culturally safe and clinically responsive. Led by a trained and trusted facilitator and healthcare provider such as a general practitioner (GP), the MYU model can be used to deploy effective one-off group consultations or a program of knowledge, skill and behavioural change to prevent and manage lifestyle-related illness.

Programs developed using the MYU model are being used, for example, in preventing, managing and putting into remission type 2 diabetes (T2DM) and other chronic conditions. The model is successful because it privileges Aboriginal and Torres Strait Islander people’s knowledge and science and embraces the principle of self-determination, with a significant focus on social determinants and lifestyle interventions.

Indeed, according to MYU participants, they are ‘The way Aboriginal people had always done business before colonisation’.

Australia adheres to a Western healthcare model and, as a result, embraces mostly Western healing methods. First Nations recognise this but have adopted a decolonised, principled approach to their health model of care. This decolonised model of care utilises a transdisciplinary approach where First Nations researchers, clinicians, health workers and community members with varied areas of expertise come together with non-First Nations researchers, clinicians and health workers to co-design and co-construct healthcare models. It can, however, also embrace modern technologies, methods and processes if they benefit patient outcomes.

This was the fundamental philosophy and model of care that a team from Waminda (South Coast Women’s Health and Wellbeing Aboriginal Corporation, New South Wales) embraced as it rose to the challenge identified by their community, who were experiencing increasingly high rates of T2DM and an urgent need to prevent, manage and reverse this chronic illness.

Waminda clients had previously participated in the MYU model of care and it is now utilised in a number of healthcare programs within the service. Waminda combined old and new ways to make something innovative. In partnership with leading MYU proponents, the Australasian Society of Lifestyle Medicine (ASLM), they co-designed a place-based, three-pronged protocol involving:

• the wearing of continuous glucose monitors (CGM) for up to 12 weeks
• Nyully Cooking, a seven-session program using pre-colonised principles to find, prepare and eat modern-day equivalent foods
• a seven-week program of MYU where knowledge, skill and motivation in self-management of T2DM is provided by a MYU-trained facilitator, followed by individual consultations with the Waminda GP in the presence and with the support of other participants.

In a trial where 25 of 40 women completed the protocol (in four groups), seven of the 25 (28 per cent) achieved remission and maintained this for 12 months. Overall, 18 of the 25 (75 per cent) reduced their HbA1c levels and maintained some reduction for 12 months. There were also significant reductions in weight, and improved systolic blood pressure, liver enzymes and time-in-range blood glucose levels. In addition, patients were more actively engaged and distress caused by T2DM symptoms decreased significantly. Participants regarded the protocol as safe and accessible, and it was potentially financially self-sustaining.

Inspired by Waminda’s application of the MYU model, a number of Northern Territory (NT) Aboriginal Community Controlled Health Organisations (ACCHOs) asked the NT Primary Health Network to invite Waminda and ASLM to share their knowledge, experience and support. The ACCHOs wanted to test the feasibility of MYU in their services, to help manage the rapid rise of chronic illness, particularly T2DM, in their communities.

Research findings involving MYU (often referred to as shared medical appointments or group consultations) indicate that they have the potential to revolutionise illness prevention and chronic disease management in both Indigenous and non-Indigenous primary care settings. For this reason alone, the model deserves a greater level of support and application.