Yarning Up on Burns Out-of-Pocket Healthcare Expenditure with Aboriginal Families

Dr Courtney Ryder1, Associate Professor Tamara  Mackean1, Dr Julianne Coombes2, Dr Kate Hunter2, Professor Andrew J A Holland3, Professor Rebecca Ivers4

1Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia, 2Aboriginal and Torres Strait Islander Health Research Program,  The George Institute for Global Health, Sydney, Australia, 3The Children’s Hospital at Westmead Clinical School, Faculty of Medicine & Health, The University of Sydney, Westmead, Australia, 4School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia


Burn injuries are expensive to treat, especially for families through out-of-pocket healthcare expenditure (OOPHE). OOPHE are additional health related costs not covered by universal taxpayer funded health insurance, and include medication, transport, wage, or educational loss. This study sought to understand the impact of burns specific OOPHE on Aboriginal families.
Families participating in a larger Australia-wide study (Coolamon) on burn injuries in Aboriginal and Torres Strait Islander children were approached to participate. Inclusion required children who had sustained a severe burn injury, defined as ≥1 night hospital stay with follow-up care and TBSA%≥10. Yarning sessions with participants over their child’s burn treatment and follow up care explored OOPHE. Yarning is an Indigenous research method, encompassing a conversational technique to gather information from participants. Thematic analyses were used with transcripts and data organised using qualitative analysis software (NVivo, Version 12).
Four yarning sessions were conducted across South Australia, New South Wales and Queensland. A range of OOPHE were identified included: costs (transport, pain medication, bandages), loss (employment capacity, social and community) and support (family, service support). The need to cover OOPHE significantly impacted on participants, from restricting social interactions to paying household bills. Family connections and networks were protective in mitigating financial burden.
OOPHE for burn care financially impacts Aboriginal families. Economic hardship was reported in families residing rurally or with reduced employment capacity. Further examination to understand these impacts will continue through the Safer Pathways program.


Dr Courtney Ryder is Teaching Program Director Public Health, Senior Lecturer in Aboriginal and Torres Strait Islander Public Health at Flinders University. She is also an early career researcher and Nunga woman from Southern South Australia.

As an ECR Dr Ryder is establishing a research track record on understanding the nuanced ways in which health inequity manifestations impact on Aboriginal and Torres Strait Islander families. This includes work on Indigenous Data Sovereignty with a particular focus on injury epidemiology. Dr Ryder is also a world leader in Aboriginal health education, having spent over a decade revolutionising Aboriginal health education at Flinders University. Currently she oversees all public health courses at Flinders University and has designed and coordinated large and complex topics, pertaining to Aboriginal health and social health sciences in the Doctor of Medicine, Nursing, Midwifery, Health Science and Public Health programs. Work which has transformed student learning, and been recognised nationally and internationally.

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