Attitudes toward indigenous Australians: The issue of “special treatment”

Discharge interventions for First Nations people with a chronic condition or injury: a systematic review

BACKGROUND

Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people.

METHODS

A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement.

RESULTS

Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments.

CONCLUSION

Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes.

REGISTRATION

This study was prospectively registered in PROSPERO (ID CRD42021254718).

Why aren’t we there yet? A typology for evaluating resistant and counter-hegemonic practices

Neo-liberalism continues to expand its grip on education, despite fierce opposition. As an economic and political hegemony, neo-liberalism silences alternative viewpoints and neutralises resistance. Using an example of integrating Australian Indigenous pedagogy in early childhood initial teacher education, this article puts forward a typology for examining and evaluating various forms of resistant and counter-hegemonic endeavours. Taking a Gramscian perspective of hegemonic struggles as multifaceted and dynamic, the proposed model comprises three levels: practical, critical and political. Neo-liberalism has intricate linkages to the colonial past. The current domination of Northern theory expounds knowledge primarily from the industrial West in the Global North. In contrast, Indigenous knowledge from the marginalised Global South is envisioned as a counter-hegemonic force. Within this context, the authors illustrate how the proposed model could be used to evaluate resistant practices in the case of practising Australian Indigenous pedagogies of dadirri and yarning circles in early childhood initial teacher education.

Much being Written about Us, not much being Written with Us: Examining how alcohol and other drug use by indigenous Australians is portrayed in Australian Government policies and strategies: A discourse analysis

BACKGROUND

Using critical discourse analysis, this study examined the portrayal of Aboriginal and Torres Strait Islander people in Australian Government policies regarding alcohol and other drug (AOD) use.

METHODS

We used critical discourse analysis, informed by an Indigenous Research Paradigm, to analyse texts and contexts of six key Australian Government AOD drug policies; two Aboriginal AOD data documents, two reporting documents and two AOD strategy documents.

RESULTS

The social practice analysis found issues of power imbalance relating to the socio-political situation the documents were created in. Textual analysis identified: culture being performative or functional in documents; cultural unsafety in construction of targets and outcomes, and; the decentring of Aboriginal peoples in the framing of the documents. The discourse analysis identified that the documents often wrote about Aboriginal peoples rather than writing documents with or by Aboriginal peoples. This typically: absented complexities of consultation occurring within a complex power imbalanced cultural interface; did not support an Aboriginal paradigm; centred Gubba people in power and; promoted a paternalistic view of 'helping' Aboriginal people.

CONCLUSIONS

There is an urgent need to move from policy relating to Aboriginal affairs that relies on a deficit discourse, to more effective AOD policy that improves power balance in policy development, is written with or by Aboriginal people, is inclusive of Aboriginal epistemologies and ontologies, and represents a paradigm-shift to a strength-based approach.

Hazardous and harmful alcohol use in the Northern Territory, Australia: the impact of alcohol policy on critical care admissions using an extended sampling period

AIMS

To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia DESIGN, SETTING AND PARTICIPANTS: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single-centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use.

MEASUREMENTS

Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full-time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post-intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site.

FINDINGS

Overall, there was a 4.5% [95% confidence interval (CI) = 0.8-8.2%] absolute risk reduction between the time-periods (95% CI = 23.4 versus 18.9% for baseline and post-intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = -0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively).

CONCLUSIONS

Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use.

Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectional population-based study

Background

Racism is a key determinant of the health of Indigenous Australians that may explain the unremitting gap in health and socioeconomic outcomes between Indigenous and non-Indigenous Australians. We quantified the population-based prevalence of experiences of racism of Indigenous adults in the Australian state of Victoria and investigated whether this was independent of social determinants and lifestyle risk factors.

Methods

We combined data from the 2011, 2012 and 2014 Victorian Population Health Surveys to obtain a sample size of 33,833 Victorian adults, including 387 Indigenous adults. The survey is a cross-sectional, population-based, computer-assisted telephone interview survey conducted annually. Using logistic regression, experiences of racism was the dependent variable and Indigenous status the primary independent variable of interest. Secondary independent variables included age, sex, rurality, socioeconomic status, social capital, and lifestyle risk factors.

Results

Indigenous Victorian adults were four times more likely than their non-Indigenous counterparts to have experienced racism in the preceding 12 months; odds ratio (OR) = 4.3 (95% confidence interval (CI): 3.2–5.8). Controlling for social determinants and lifestyle risk factors attenuated, but did not eliminate, the association between experiences of racism and Indigenous status; OR = 3.1 (95% CI: 2.2–4.3). The social determinants of age and social trust made the largest contribution to the attenuation of the association. Education also had a large impact on the association, but in the opposite direction, suggesting that a low level of education may be protective against experiences of racism. When the non-Indigenous comparison group consisted of adults of mainly Anglo-Celtic origin, Indigenous adults were seven times more likely (OR = 7.2; 5.3–9.7) to have experienced racism.

Conclusions

Racism directed against Indigenous Victorians is significant and cannot be ascribed to any specific attributes such as socioeconomic status or lifestyle risk factors. We argue that a human rights-based approach to policy-making for the elimination of systemic and interpersonal racism offers an opportunity and viable alternative to current policy-making, that continues to be dominated by a paternalistic approach that reinforces racism and the resulting inequities.

Please note

Throughout this document, the term Indigenous is taken to include people of Aboriginal and Torres Strait Islander descent. While not our preferred term, Indigenous is used in preference to Aboriginal and Koori as not all Indigenous people living in Victoria are Aboriginal or Koori. We recognise that, with the exception of the term ‘Koori’, these terms are Eurocentric having been imposed upon a people of many nations with distinct languages and cultures. The use of such terms is akin to referring to the peoples of the continent of Europe as ‘Europeans’.

Nursing students' perspectives of the health and healthcare issues of Australian Indigenous people

BACKGROUND

Indigenous people are the most disadvantaged population within Australia with living conditions comparable to developing countries. The Bachelor of Nursing programme at the University of Western Sydney has embedded Indigenous health into the undergraduate teaching programme, with an expectation that students develop an awareness of Indigenous health and healthcare issues.

AIM

To gain insight into students' perceptions of Indigenous people and whether the course learning and teaching strategies implemented improved students' learning outcomes and attitude towards Indigenous people and Indigenous health in Australia.

DESIGN

A mixed methods prospective survey design was chosen.

METHODS

Students enrolled in the Indigenous health subject in 2013 were invited to complete pre- and post-subject surveys that contained closed- and open-ended questions. Students' socio-demographic data was collected at baseline, but the 'Attitude Toward Indigenous Australians' (ATIA) scale, and the 3-item Knowledge, Interest and Confidence to nursing Australian Indigenous peoples scale were administered at both pre- and post-subject surveys.

RESULTS

502 students completed the baseline survey and 249 students completed the follow-up survey. There was a statistically significant attitudinal change towards Indigenous Australians, measured by the ATIA scale, and participants' knowledge, intent to work with Indigenous Australians and confidence in caring for them increased significantly at follow-up. Based on the participants' responses to open-ended questions, four key themes emerged: a) understanding Indigenous history, culture and healthcare; b) development of cultural competence; c) enhanced respect for Indigenous Australians' culture and traditional practices; and d) enhanced awareness of the inherent disadvantages for Indigenous Australians in education and healthcare. There were no statistically significant socio-demographic group differences among those who commented on key themes.

CONCLUSION

Addressing health inequalities for Indigenous Australians is paramount. Nurses need cultural awareness and sensitivity to deliver culturally appropriate healthcare in Australia.

Perspective taking and opinions about forms of reparation for victims of historical harm

The authors investigated the effects of perspective taking on opinions about reparations for victims of historical harm. In two studies, they showed that when non-Indigenous Australians took an Indigenous Australian perspective, this increased perceived entitlement to, and decreased anger toward, monetary compensation. Moreover, perceived entitlement mediated the relationship between anger about monetary compensation and perspective taking. Study 2 demonstrated the mutual influence of emotions and perceived entitlement. In particular, self-image shame rather than group-based guilt or anger predicted support for reparation when an Indigenous Australian perspective was adopted. The results suggest that taking the perspective of people who have experienced harm from one's own group can bolster a commitment to positive social change in relation to a pressing social issue.

Effects of Non-Indigenous Australian Human Resource Managers' Gender and Attitudes and Applicants' Ethnicity and Gender on Resumé Evaluations

In this web-based survey, 60 non-Indigenous Australian human resource (HR) professionals reviewed four fictitious job resumés for an Indigenous male, Indigenous female, non-Indigenous male and non-Indigenous female. Participants rated the resumés against five key selection criteria and then ranked them in terms of suitability for a HR position, team fit (TF) with participants' current HR team, and suitability for a customer service (CS) position. Finally, participants completed a modified Attitude toward Indigenous Australians scale. Although participants' gender and attitudes and applicants' gender and ethnicity did not have an effect on resumé ratings, rank differences for the HR position and TF for the whole sample were significantly different, with the non-Indigenous male applicant being preferred to the Indigenous male and female applicants. Participants holding a negative attitude toward Indigenous people consistently ranked the non-Indigenous male applicant more favourably than the Indigenous male and female applicants and the non-Indigenous female applicant more favourably than the Indigenous male applicant. Female participants ranked the non-Indigenous male applicant more favourably than the Indigenous male and female applicants for the HR position and TF. Implications for Indigenous Australian employment disadvantage are examined with reference to social identity and contemporary racism theories.

Bystander Antiprejudice: Cross-Cultural Education, Links With Positivity Towards Cultural ‘Outgroups’ and Preparedness to Speak Out

This article describes a 12-week intervention targeting positivity towards asylum seekers, Indigenous Australians and Muslim Australians. The study also assessed change in the intention to engage in bystander activism in four different scenarios: two Indigenous (old-fashioned and modern prejudice), one Muslim and one asylum seeker. There was a significant increase in positivity towards asylum seekers, Indigenous Australians and Muslim Australians. There was also a significant increase in ‘speaking out intention’, a form of bystander anti-prejudice, in three of the scenarios, but not in response to the Indigenous old-fashioned prejudice scenario. The study indicates that structured education on cross-cultural issues can improve attitudes to perceived ‘outgroups’ and, for the most part, increase participants' intention to speak out against prejudice.

Oh deer, what can the matter be? Landholder attitudes to deer management in Queensland

Deer are not native to Australia but have been present in the country for more than 150 years. For most of that time they have not been regarded as either an agricultural or environmental pest, but in the last few years there have been calls for their numbers to be reduced. Four species of deer can be found in well established populations in Queensland, mostly occurring on private land. Hence the effectiveness of any management of deer as pests will be heavily influenced by the actions of the land owners. This paper reports on a survey of the attitudes of landholders towards deer on their properties. A total of 2621 surveys was mailed to landowners and managers in regions known to support wild deer in Queensland. Of the 28.3% of surveys returned, over 75% of respondents conducted some form of primary production on their land and 65% of these had deer on their properties at least some of the time. Responses to questions were mostly uniform throughout the state, with over 50% of respondents wanting the deer population to stay at current levels or increase. Only 5% of respondents supported poisoning as a management strategy, with 17% supporting trapping. Recreational hunting and game-meat harvesting were favoured management options, with 42% and 51% support respectively. Only 25% of respondents thought wild deer caused environmental damage and 30% thought wild deer caused agricultural damage, with most associating wild deer as a less significant pest than those species already declared under state legislation. Of those surveyed, 56% agreed with the statement ‘It is important to maintain wild deer populations for future generations to enjoy’. The spread of deer in Australia is of increasing concern to ecologists, and there have been calls for action to reduce their numbers on private and public land. The results of this survey imply that a significant proportion of Queensland landholders would resist legislation aimed at managing deer as a pest in areas with long-established wild deer populations.