BACKGROUND:
In Australia Aboriginal communities experience significant health inequities, including hospitalisation rates 2.3 times higher and longer lengths of stay compared to non-Indigenous Australians [1]. These disparities are compounded by out-of-pocket healthcare expenditure (OOPHE), such as travel, accommodation, which are costs not covered by universal taxpayer-funded insurance [2].

METHODS:
Using knowledge interface methodology, this Aboriginal-led project wove together research approaches of yarning, deep listening, thematic coding and psychometric assessment to design and develop a OOPHE Patient Reported Measure (PRM)[1,2]. The process began by exploring the lived experiences of OOPHE among rurally based Aboriginal families to identify key themes [1]. These findings informed the development of PRM items in collaboration with content experts. The measure was then pilot tested, followed by psychometric evaluation using exploratory factor analysis (EFA) and test–retest reliability assessment.

RESULTS:
Seven themes emerged from OOPHE yarns: travel, barriers to healthcare, personal and social loss, restricted autonomy, financial strain, support initiatives, and protective factors. Participants reported strategies such as sleeping rough, selling assets, and missing appointments to mitigate OOPHE [2]. Cultural practices and family connections acted as protective factors [2]. These insights informed development of a 15-item PRM, with EFA revealing a two-factor structure (internal consistency: 0.91 and 0.85). Test–retest reliability was strong (κ = 0.61–0.87; ICC = 0.75–0.92). Two items were removed, resulting in a final 13-item PRM.

CONCLUSIONS:
Aboriginal families face significant OOPHE burdens when accessing healthcare, necessitating systemic reform. The validated PRM provides a robust mechanism for quantifying this burden, and will be translated into a larger OOPHE research program designing and developing a OOPHE WebApp to mitigate OOPHE burden in Aboriginal households.