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Butler T, Gall A, Garvey G, Ngampromwongse K, Hector D, Turnbull S, Lucas K, Nehill C, Boltong A, Keefe D, Anderson K. A Comprehensive Review of Optimal Approaches to Co-Design in Health with First Nations Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316166. [PMID: 36498237 PMCID: PMC9735487 DOI: 10.3390/ijerph192316166] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Australia's social, structural, and political context, together with the continuing impact of colonisation, perpetuates health care and outcome disparities for First Nations Australians. A new approach led by First Nations Australians is required to address these disparities. Co-design is emerging as a valued method for First Nations Australian communities to drive change in health policy and practice to better meet their needs and priorities. However, it is critical that co-design processes and outcomes are culturally safe and effective. Aims: This project aimed to identify the current evidence around optimal approaches to co-design in health with First Nations Australians. METHODS First Nations Australian co-led team conducted a comprehensive review to identify peer-reviewed and grey literature reporting the application of co-design in health-related areas by and with First Nations Australians. A First Nations Co-Design Working Group (FNCDWG) was established to guide this work and team.A Collaborative Yarning Methodology (CYM) was used to conduct a thematic analysis of the included literature. RESULTS After full-text screening, 99 studies were included. Thematic analysis elicited the following six key themes, which included 28 practical sub-themes, relevant to co-design in health with First Nations Australians: First Nations Australians leadership; Culturally grounded approach; Respect; Benefit to First Nations communities; Inclusive partnerships; and Evidence-based decision making. CONCLUSION The findings of this review provide a valuable snapshot of the existing evidence to be used as a starting point to guide appropriate and effective applications of co-design in health with First Nations Australians.
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Affiliation(s)
- Tamara Butler
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Alana Gall
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore 2480, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | | | | | | | | | | | - Anna Boltong
- Cancer Australia, Sydney 2010, Australia
- Kirby Institute, UNSW Medicine, The University of New South Wales, Kensington 2052, Australia
| | | | - Kate Anderson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
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Allan J, Kleinschafer J, Saksena T, Rahman A, Lawrence J, Lock M. A comparison of rural Australian First Nations and Non-First Nations survey responses to COVID-19 risks and impacts: implications for health communications. BMC Public Health 2022; 22:1276. [PMID: 35773669 PMCID: PMC9245509 DOI: 10.1186/s12889-022-13643-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction This study investigated differences between rural Australian First Nations and non-First Nations survey respondents’ perceptions of COVID-19-related risks and analysed other variables that could predict an exacerbation of anxiety related to COVID-19 harms. Methods A cross-sectional online and paper survey of rural residents from the western regions of NSW, Australia, was conducted. Descriptive and multivariate statistical analyses were used to assess links between First Nations status and demographic measures including postcode, age, gender, education, rural or town/village location, proximity to medical services and living situation. The analysis included five items related to perceptions about COVID-19: perceived likelihood of contracting COVID-19 in the next 12 months, perceived harmfulness of the virus, how often people felt afraid, perception about respondents’ ability to do something about the virus and perceived economic impacts of the pandemic. Results There were significant differences between First Nations (n=60) and non-First Nations (n= 639) respondents across all sociodemographic categories. The results reflect a significantly higher level of anxiety among the First Nations Australians in the sample: they felt afraid more often, felt it was highly likely they would catch the virus and if they did catch the virus perceived that it would be very harmful. Living with children under eighteen years of age and in small rural towns were key factors linked to feeling afraid of COVID-19 and First Nations status. Conclusion Health risk communication in pandemic response should include an equitable focus on rural areas, recognising that First Nations Australians are a significant proportion of the rural population with different risk factors and concerns than those of non-First Nations Australians. This principle of First Nations-led design is critical to all health policy and planning. The Australian Government should include rural areas in planning pandemic responses, recognising that First Nations populations are a significant proportion of the rural population creating syndemic conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13643-6.
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Affiliation(s)
- Julaine Allan
- University of Wollongong, School of Health and Society, Wollongong, NSW, Australia.
| | | | - Teesta Saksena
- Western NSW Local Health District, Bathurst, NSW, Australia
| | | | | | - Mark Lock
- University of Technology, Sydney, NSW, Australia
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Flemington T, Fraser J, Gibbs C, Shipp J, Bryant J, Ryan A, Wijetilaka D, Marks S, Scarcella M, Tzioumi D, Ramanathan S, Clague L, Hartz D, Lonne B, Lock (Ngiyampaa) M. The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5381. [PMID: 35564775 PMCID: PMC9102959 DOI: 10.3390/ijerph19095381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced "Dahl-beer-weer gum-um-be-goo" in the Gumbaynggirr language means 'safe children') model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety in health care settings, and privileges the cultural voices of many diverse Aboriginal peoples. When adapted appropriately for local clinical and cultural contexts, it will contribute to a patient journey experience of respect, dignity and empowerment.
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Affiliation(s)
- Tara Flemington
- Nursing, Midwifery and Service Reform, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jennifer Fraser
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
- Nursing, Midwifery and Education, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
| | - Clinton Gibbs
- Health Reform, Opportunities and Transition, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joanne Shipp
- Integrated Child, Youth and Family Wellbeing, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joe Bryant
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Amanda Ryan
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Devika Wijetilaka
- Paediatrics, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Susan Marks
- Child Protection Unit, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Mick Scarcella
- Aboriginal Health, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Dimitra Tzioumi
- Child Protection Unit, The Sydney Children’s Hospitals Network, Randwick, NSW 2031, Australia;
- Child Protection and Wellbeing, Ministry of Health, St Leonards, NSW 2065, Australia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia;
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Liesa Clague
- School of Nursing, Midwifery, Health Science and Physiotherapy, The University of Notre Dame, Darlinghurst, NSW 2010, Australia;
| | - Donna Hartz
- School of Nursing and Midwifery, College of Medicine Health & Wellbeing, University of Newcastle, Gosford, NSW 2250, Australia;
| | - Bob Lonne
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Mark Lock (Ngiyampaa)
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
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The Barriers and Facilitators of Sport and Physical Activity Participation for Aboriginal Children in Rural New South Wales, Australia: A Photovoice Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041986. [PMID: 35206182 PMCID: PMC8871796 DOI: 10.3390/ijerph19041986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Participating in physical activity is beneficial for health. Whilst Aboriginal children possess high levels of physical activity, this declines rapidly by early adolescence. Low physical activity participation is a behavioral risk factor for chronic disease, which is present at much higher rates in Australian Aboriginal communities compared to non-Aboriginal communities. Through photos and ‘yarning’, the Australian Aboriginal cultural form of conversation, this photovoice study explored the barriers and facilitators of sport and physical activity participation perceived by Aboriginal children (n = 17) in New South Wales rural communities in Australia for the first time and extended the limited research undertaken nationally. Seven key themes emerged from thematic analysis. Four themes described physical activity barriers, which largely exist at the community and interpersonal level of children’s social and cultural context: the physical environment, high costs related to sport and transport, and reliance on parents, along with individual risk factors such as unhealthy eating. Three themes identified physical activity facilitators that exist at the personal, interpersonal, and institutional level: enjoyment from being active, supportive social and family connections, and schools. Findings highlight the need for ongoing maintenance of community facilities to enable physical activity opportunities and ensure safety. Children held strong aspirations for improved and accessible facilities. The strength of friendships and the family unit should be utilized in co-designed and Aboriginal community-led campaigns.
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Bailey J, Blignault I, Renata P, Naden P, Nathan S, Newman J. Barriers and enablers to Aboriginal and Torres Strait Islander careers in health: A qualitative, multisector study in western New South Wales. Aust J Rural Health 2021; 29:896-908. [PMID: 34494693 DOI: 10.1111/ajr.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non-Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. DESIGN Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. SETTING Western New South Wales. PARTICIPANTS Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non-Aboriginal; n = 28). MAIN OUTCOME MEASURES Identified barriers and enablers and regional strategies for improving career pathways. RESULTS Aboriginal people interested in pursuing a career in health face barriers in: pre-employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. CONCLUSION To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self-determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members.
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Affiliation(s)
- Jannine Bailey
- Bathurst Rural Clinical School, Western Sydney University, Bathurst, NSW, Australia
| | - Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Pamela Renata
- Bila Muuji Aboriginal Corporation Health Service, Dubbo, NSW, Australia
| | - Phil Naden
- Bila Muuji Aboriginal Corporation Health Service, Dubbo, NSW, Australia
- Coonamble Aboriginal Health Service, Coonamble, NSW, Australia
| | - Sally Nathan
- School of Public Health & Community Medicine, UNSW Sydney, Randwick, NSW, Australia
| | - Jamie Newman
- Bila Muuji Aboriginal Corporation Health Service, Dubbo, NSW, Australia
- Orange Aboriginal Medical Service, Orange, NSW, Australia
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De Cotta T, Knox J, Farmer J, White C, Davis H. Community co-produced mental health initiatives in rural Australia: A scoping review. Aust J Rural Health 2021; 29:865-878. [PMID: 34784085 DOI: 10.1111/ajr.12793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Inaccessibility of mental health services in rural Australia is widely reported. Community co-produced mental health and well-being initiatives could fill gaps and complement other services. OBJECTIVE This scoping review summarises findings from peer-reviewed articles to identify the key features of co-produced Australian rural mental health initiatives that engage communities in their design, delivery or evaluation processes. DESIGN Between 2009 and 2019 inclusive, 14 articles met inclusion criteria and were reviewed using Arksey and O'Malley's review methodology. FINDINGS Communities co-produced initiatives through informing, collaborating and instigating them. Some initiatives operated in specific places, for example an art gallery, while others operated across regions. Only two initiatives involved community members in multiple activities targeting prevention, early intervention, education and service accessibility; other initiatives were more focused, for example designing a new service. Over half of initiatives found were targeted at Aboriginal and Torres Strait Islander Peoples. Most articles discussed evaluation approaches, though methods were diverse. DISCUSSION Published peer-reviewed evidence about Australian rural community co-produced mental health initiatives appears scant. Evidence found suggests they generate a range of supports that could complement or mitigate for lack of, public health services. The overall lack of evidence, diversity of initiatives and inconsistent evaluation makes it difficult to assess effectiveness and which activities might be scaled-up for wider benefit. CONCLUSION Rural communities have limited resources, and evidence of what constitutes best practice in co-producing mental health services would help to avoid 'reinventing the wheel.' Greater efforts in evaluating and publishing about initiatives would be helpful.
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Affiliation(s)
- Tracy De Cotta
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
| | - Jasmine Knox
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
| | - Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
| | | | - Hilary Davis
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
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Anderst A, Conroy K, Fairbrother G, Hallam L, McPhail A, Taylor V. Engaging consumers in health research: a narrative review. AUST HEALTH REV 2021; 44:806-813. [PMID: 32780985 DOI: 10.1071/ah19202] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/24/2020] [Indexed: 01/30/2023]
Abstract
Objective Consumer and community engagement (CCE) in research is increasingly valued in a contemporary healthcare environment that seeks to genuinely partner with consumers and the wider community. Although there is widespread agreement at research governance levels as to the benefits of CCE in research, there is little available research-based guidance as to how best to proceed with CCE organisationally and how to manage and overcome barriers. The aim of this narrative review was to draw together the available research, review findings and relevant governance-related material and to discuss these in light of a case series among research-engaged consumers in order to chart a practical way forward. Methods A narrative literature review about CCE in research was conducted. Following this, a case series among seven consumers who had been engaged as partners in health research was conducted. Finally, the lived experience of these consumers was explored against the findings of the narrative review. Results In all, 121 papers were identified and reviewed, 37 of which were used to inform the content of this paper. The most important benefits of CCE to both consumers and healthcare researchers were related to improvements in trust between consumer and researchers, and the increased relevance and ethics of research agendas ultimately pursued. Barriers to CCE were found to be pragmatic, attitudinal and organisational. Enabling factors that capitalise on the benefits and help address the barriers to meaningful CCE are outlined and discussed in light of a case series conducted among research-engaged consumers in Australia and internationally. Conclusion Best practice standards, organisational commitments and resources are needed to improve the status quo in Australia and to provide health research end-users with research outcomes that better align with their priorities and needs. What is known about the topic? Consumer and community engagement (CCE) in research is increasing in prevalence and is likely to be beneficial to both consumers and healthcare providers and researchers. What does this paper add? Following review of the available research findings and governance statements about CCE, enabling strategies are presented in light of a case series among Sydney-based research-engaged consumers. What are the implications for practitioners? Barriers to consumer and community engagement can be overcome if well understood and tackled organisationally. The potential benefits of shifting to a fully consumer- or community-engaged healthcare research environment are multifactorial and represent a paradigm shift in favour of evidence-based patient and family-centred care.
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Affiliation(s)
- Ania Anderst
- The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW 2042, Australia. ; and Corresponding author.
| | - Karena Conroy
- The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW 2042, Australia. ; and Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia. ; ; ;
| | - Greg Fairbrother
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia. ; ; ; ; and University of Sydney, Faculty of Medicine and Health, Level 11, King George V Building, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Laila Hallam
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia. ; ; ; ; and The University of Sydney, Centre for Disability Research and Policy (CDRP), 92-94 Parramatta Road, Camperdown, NSW 2050, Australia
| | - Alan McPhail
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia. ; ; ;
| | - Vicki Taylor
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia. ; ; ; ; and University of Sydney, Faculty of Medicine and Health, Level 11, King George V Building, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
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Gilroy J, Bulkeley K, Talbot F, Gwynn J, Gwynne K, Henningham M, Alcorso C, Rambaldini B, Lincoln M. Retention of the Aboriginal Health, Ageing, and Disability Workforce: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25261. [PMID: 34047698 PMCID: PMC8196347 DOI: 10.2196/25261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite a plethora of research into Aboriginal employment and recruitment, the extent and nature of the retention of frontline Aboriginal people in health, ageing, and disability workforces are currently unknown. In this application, frontline service delivery is defined as Aboriginal people who are paid employees in the health, ageing, and disability service sectors in roles that involve direct client, participant, or patient contact. There is a need to identify the factors that inhibit (push) and promote (pull) staff retention or departure of this workforce from the sectors. This study will provide additional insight about this topic. Objective The objective of this project is to uncover the factors that influence the retention of frontline Aboriginal workers in the health, ageing, and disability workforces in New South Wales (NSW) who do not have university qualifications. The aim of the proposed project aims to discover the push and pull factors for the retention of the frontline Aboriginal workforce in the health, ageing, and disability sectors in NSW in relation to their role, employment, and community and design evidence-based strategies for retaining the Aboriginal frontline workforce in the health, ageing, and disability sectors in NSW. Methods The proposed research will use a mixed methods approach, collecting both quantitative and qualitative data via surveys and interviews to capture and represent the voices and perspectives of Aboriginal people in a way that the participants chose. Results Indigenous research methodologies are a growing field in Aboriginal health research in Australia. A key strength of this study is that it is led by Aboriginal scholars and Aboriginal controlled organizations that apply an Indigenous methodological framework throughout the research process. Conclusions This study uses a mixed methods design. The survey and interview questions and model were developed in partnership with Aboriginal health, ageing, and disability service workers rather than relying only on research publications on the workforce, government policies, and human resources strategies. This design places a strong emphasis on generalizable findings together with an inductive approach that explores employers and workers’ lived experience of the Aboriginal health workforce in NSW. Excluding workers who have graduated from university places a strong focus on the workforce who have obtained either school or Technical and Further Education or registered training organizations qualifications. Data collection was conducted during the COVID-19 pandemic, and results will include the unique experiences of Aboriginal workers and employers delivering services in an extremely challenging organizational, community, and personal context. International Registered Report Identifier (IRRID) PRR1-10.2196/25261
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Affiliation(s)
- John Gilroy
- The University of Sydney, Sydney, NSW, Australia
| | - Kim Bulkeley
- The University of Sydney, Sydney, NSW, Australia
| | - Folau Talbot
- The University of Sydney, Sydney, NSW, Australia
| | | | - Kylie Gwynne
- The University of Sydney, Sydney, NSW, Australia
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Percival N, Boucher P, Conte K, Robertson K, Cook J. Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia. BMC Med Inform Decis Mak 2020; 20:286. [PMID: 33143691 PMCID: PMC7607732 DOI: 10.1186/s12911-020-01300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory's publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. METHODS A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. RESULTS 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, 'needs assessment' findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. CONCLUSION This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.
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Affiliation(s)
- Nikki Percival
- Faculty of Health, Australian Centre for Public and Population Health Research, University of Technology Sydney, UTS Building 10, Level 8, 235-253 Jones Street, Ultimo, Sydney, NSW, 2007, Australia.
| | - Priscilla Boucher
- Department of Health, Strategic, Policy and Planning, Northern Territory Government, Darwin, NT, Australia
| | - Kathleen Conte
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy and University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Kate Robertson
- Department of Health, Strategic, Policy and Planning, Northern Territory Government, Darwin, NT, Australia
| | - Julie Cook
- Department of Health, Top End Health Services, Primary Health Care Outreach Team, Northern Territory Government, Katherine, NT, Australia
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Bovill M, Chamberlain C, Bar-Zeev Y, Gruppetta M, Gould GS. Ngu-ng-gi-la-nha (to exchange) knowledge. How is Aboriginal and Torres Strait Islander people's empowerment being upheld and reported in smoking cessation interventions during pregnancy: a systematic review. Aust J Prim Health 2020; 25:395-401. [PMID: 31586502 DOI: 10.1071/py18186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/01/2019] [Indexed: 11/23/2022]
Abstract
Smoking during pregnancy is a national priority to improve Aboriginal health. Empowerment approaches underpin the priorities set by the government to improve Aboriginal health and wellbeing; however, empowerment is seldom evaluated within interventions for Aboriginal people. Literature was searched to April 2018 and data was extracted using an assessment tool with domains of individual and community empowerment in smoking cessation during pregnancy studies with Aboriginal women. Three interventions were found in published and grey literature. Elements of individual empowerment were embedded in all interventions. Interventions considered barriers for Aboriginal women to quit smoking and areas for capacity building. Interventions used health education resources. There was limited reporting of community empowerment domains. Aboriginal ethics and capacity building was the only criterium addressed by all studies. Interventions are incorporating individual empowerment, but seldom report community empowerment. The development of reporting guidelines or extensions of current guidelines would be beneficial to set a consistently high standard reporting across Aboriginal health interventions, similar to the work conducted to develop the extension of Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) for health equity in systematic review reporting. Reporting empowerment domains would reflect the government priority of empowerment to improve Aboriginal health, as well as enhancing knowledge translation into practice.
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Affiliation(s)
- Michelle Bovill
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and Corresponding author.
| | - Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Level 3, George Singer Building, Bundoora, Vic. 3086, Australia; and Murdoch Children's Research Institute, Flemington Road, Parkville, Vic. 3052, Australia; and School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Yael Bar-Zeev
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Maree Gruppetta
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Gillian S Gould
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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Snijder M, Wagemakers A, Calabria B, Byrne B, O'Neill J, Bamblett R, Munro A, Shakeshaft A. 'We walked side by side through the whole thing': A mixed-methods study of key elements of community-based participatory research partnerships between rural Aboriginal communities and researchers. Aust J Rural Health 2020; 28:338-350. [PMID: 32755008 PMCID: PMC7508167 DOI: 10.1111/ajr.12655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To advance the rural practice in working with Aboriginal communities by (a) identifying the extent of community partners' participation in and (b) operationalising the key elements of three community-based participatory research partnerships between university-based researchers and Australian rural Aboriginal communities. DESIGN A mixed-methods study. Quantitative survey and qualitative one-on-one interviews with local project implementation committee members and group interviews with other community partners and project documentation. SETTING Three rural Aboriginal communities in New South Wales. PARTICIPANTS Thirty-seven community partners in three community-based participatory research partnerships of which 22 were members of local project implementation committees and 15 were other community partners who implemented activities. INTERVENTION Community-based participatory research partnerships to develop, implement and evaluate community-based responses to alcohol-related harms. MAIN OUTCOMES MEASURES Community partners' extent of and experiences with participation in the community-based participatory research partnership and their involvement in the development and implementation processes. RESULTS Community partners' participation varied between communities and between project phases within communities. Contributing to the community-based participatory research partnerships were four key elements of the participatory process: unique expertise of researchers and community-based partners, openness to learn from each other, trust and community leadership. CONCLUSION To advance the research practice in rural Aboriginal communities, equitable partnerships between Aboriginal community and research partners are encouraged to embrace the unique expertise of the partners, encourage co-learning and implement community leadership to build trust.
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Affiliation(s)
| | | | - Bianca Calabria
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
- National Centre for Epidemiology and Public HealthAustralian National UniversityCanberraACTAustralia
| | - Bonita Byrne
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Jamie O'Neill
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
- Murrin Bridge Local Aboriginal Lands CouncilLake CargelligoNSWAustralia
| | - Ronald Bamblett
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Alice Munro
- Western New South Wales Local Health DistrictOrangeNSWAustralia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
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Gwynn J, Skinner J, Dimitropoulos Y, Masoe A, Rambaldini B, Christie V, Sohn W, Gwynne K. Community based programs to improve the oral health of Australian Indigenous adolescents: a systematic review and recommendations to guide future strategies. BMC Health Serv Res 2020; 20:384. [PMID: 32375764 PMCID: PMC7204065 DOI: 10.1186/s12913-020-05247-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact. METHODS Data sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied. RESULTS Nine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth. CONCLUSIONS Few good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.
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Affiliation(s)
- Josephine Gwynn
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Angela Masoe
- NSW Ministry of Health Centre for Oral Health Strategy, 30 Christie Street, Wollstonecraft, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Vita Christie
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Woosung Sohn
- The University of Sydney School of Dentistry, 1 Mons Road, Westmead, Australia
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
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Young J, Watson K, Craigie L, Neville J, Hunt J. Best practice principles for research with Aboriginal and Torres Strait Islander communities in action: Case study of a safe infant sleep strategy. Women Birth 2019; 32:460-465. [DOI: 10.1016/j.wombi.2019.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022]
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Haynes E, Marawili M, Marika BM, Mitchell AG, Phillips J, Bessarab D, Walker R, Cook J, Ralph AP. Community-based participatory action research on rheumatic heart disease in an Australian Aboriginal homeland: Evaluation of the 'On track watch' project. EVALUATION AND PROGRAM PLANNING 2019; 74:38-53. [PMID: 30849711 DOI: 10.1016/j.evalprogplan.2019.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
Strategies to date have been ineffective in reducing high rates of rheumatic heart disease (RHD) in Australian Aboriginal people; a disease caused by streptococcal infections. A remote Aboriginal community initiated a collaboration to work towards elimination of RHD. Based in 'both-way learning' (reciprocal knowledge co-creation), the aim of this study was to co-design, implement and evaluate community-based participatory action research (CBPAR) to achieve this vision. Activities related to understanding and addressing RHD social determinants were delivered through an accredited course adapted to meet learner and project needs. Theory-driven evaluation linking CBPAR to empowerment was applied. Data collection comprised focus groups, interviews, observation, and co-development and use of measurement tools such as surveys. Data analysis utilised process indicators from national guidelines for Aboriginal health research, and outcome indicators derived from the Wallerstein framework. Findings include the importance of valuing traditional knowledges and ways of learning such as locally-meaningful metaphors to explore unfamiliar concepts; empowerment through critical thinking and community ownership of knowledge about RHD and research; providing practical guidance in implementing empowering and decolonising principles / theories. Lessons learned are applicable to next stages of the RHD elimination strategy which must include scale-up of community leadership in research agenda-setting and implementation.
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Affiliation(s)
- Emma Haynes
- University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia; Charles Darwin University (CDU), Darwin, Northern Territory, Australia.
| | - Minitja Marawili
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Charles Darwin University (CDU), Darwin, Northern Territory, Australia
| | | | - Alice G Mitchell
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Charles Darwin University (CDU), Darwin, Northern Territory, Australia
| | - Jodi Phillips
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Charles Darwin University (CDU), Darwin, Northern Territory, Australia
| | - Dawn Bessarab
- University of Western Australia, Perth, Western Australia, Australia
| | - Roz Walker
- University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jeff Cook
- Laynhapuy Homelands Health Service, Yirrkala, Northern Territory, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Charles Darwin University (CDU), Darwin, Northern Territory, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Gwynn J, Sim K, Searle T, Senior A, Lee A, Brimblecombe J. Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review. BMJ Open 2019; 9:e025291. [PMID: 30948579 PMCID: PMC6500365 DOI: 10.1136/bmjopen-2018-025291] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people. STUDY DESIGN Systematic review of peer-reviewed literature. DATA SOURCES MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet. STUDY SELECTION Peer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots. RESULTS Thirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes. CONCLUSIONS Store-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation. PROSPERO REGISTRATION NUMBER CRD42015029551.
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Affiliation(s)
- Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kyra Sim
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tania Searle
- Department of Sociology, Flinders University, Adelaide, South Australia, Australia
| | - Alistair Senior
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
- School of Life and Environmental Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Lee
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
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Macniven R, Elwell M, Ride K, Bauman A, Richards J. A snapshot of physical activity programs targeting Aboriginal and Torres Strait Islander people in Australia. Health Promot J Austr 2019; 28:185-206. [PMID: 28110644 DOI: 10.1071/he16036] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Participation in physical activity programs can be an effective strategy to reduce chronic disease risk factors and improve broader social outcomes. Health and social outcomes are worse among Aboriginal and Torres Strait Islanders than non-Indigenous Australians, who represent an important group for culturally specific programs. The extent of current practice in physical activity programs is largely unknown. This study identifies such programs targeting this population group and describes their characteristics. Methods Bibliographic and Internet searches and snowball sampling identified eligible programs operating between 2012 and 2015 in Australia (phase 1). Program coordinators were contacted to verify sourced information (phase 2). Descriptive characteristics were documented for each program. Results A total of 110 programs were identified across urban, rural and remote locations within all states and territories. Only 11 programs were located through bibliographic sources; the remainder through Internet searches. The programs aimed to influence physical activity for health or broader social outcomes. Sixty five took place in community settings and most involved multiple sectors such as sport, health and education. Almost all were free for participants and involved Indigenous stakeholders. The majority received Government funding and had commenced within the last decade. More than 20 programs reached over 1000 people each; 14 reached 0-100 participants. Most included process or impact evaluation indicators, typically reflecting their aims. Conclusion This snapshot provides a comprehensive description of current physical activity program provision for Aboriginal and Torres Strait Islander people across Australia. The majority of programs were only identified through the grey literature. Many programs collect evaluation data, yet this is underrepresented in academic literature. So what? Capturing current practice can inform future efforts to increase the impact of physical activity programs to improve health and social indicators. Targeted, culturally relevant programs are essential to reduce levels of disadvantage experienced by Aboriginal and Torres Strait Islanders.
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Affiliation(s)
- Rona Macniven
- Prevention Research Collaboration, School of Public Health, Sydney Medical School (6N52), Level 6 The Hub, Charles Perkins Centre (D17), University of Sydney, NSW 2006, Australia
| | - Michelle Elwell
- Australian Indigenous HealthNet, Edith Cowan University, 2 Bradford Street, Mount Lawley, WA 6050, Australia
| | - Kathy Ride
- Australian Indigenous HealthNet, Edith Cowan University, 2 Bradford Street, Mount Lawley, WA 6050, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, School of Public Health, Sydney Medical School (6N52), Level 6 The Hub, Charles Perkins Centre (D17), University of Sydney, NSW 2006, Australia
| | - Justin Richards
- Prevention Research Collaboration, School of Public Health, Sydney Medical School (6N52), Level 6 The Hub, Charles Perkins Centre (D17), University of Sydney, NSW 2006, Australia
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Reilly L, Rees S. Fatherhood in Australian Aboriginal and Torres Strait Islander communities: An Examination of Barriers and Opportunities to Strengthen the Male Parenting Role. Am J Mens Health 2018; 12:420-430. [PMID: 29025357 PMCID: PMC5818118 DOI: 10.1177/1557988317735928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/11/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Traditional Australian Aboriginal and Torres Strait Islander societies value men's role as parents; however, the importance of promoting fatherhood as a key social determinant of men's well-being has not been fully appreciated in Western medicine. To strengthen the Aboriginal and Torres Strait Islander male parenting role, it is vital to examine current barriers and opportunities. The first author (a male Aboriginal health project officer) conducted yarning sessions in three remote Australian communities, two being Aboriginal, the other having a high Aboriginal population. An expert sample of 25 Aboriginal and 6 non-Aboriginal stakeholders, including maternal and child health workers and men's group facilitators, considered barriers and opportunities to improve men's parenting knowledge and role, with an aim to inform services and practices intended to support men's parenting. A specific aim was to shape an existing men's group program known as Strong Fathers, Strong Families. A thematic analysis of data from the project identified barriers and opportunities to support men's role as parents. Challenges included the transition from traditional to contemporary parenting practices and low level of cultural and male gender sensitivity in maternal and child health services. Services need to better understand and focus on men's psychological empowerment and to address shame and lack of confidence around parenting. Poor literacy and numeracy are viewed as contributing to disempowerment. Communities need to champion Aboriginal and Torres Strait Islander male father role models. Biases and barriers should be addressed to improve service delivery and better enable men to become empowered and confident fathers.
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Affiliation(s)
- Lyndon Reilly
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Royal Flying Doctor Service (Queensland), Cairns, Australia
| | - Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry University of New South Wales,. Academic Mental Health Unit, Liverpool Hospital, New South Wales, Australia
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Quinn E, O’Hara BJ, Ahmed N, Winch S, McGill B, Banovic D, Maxwell M, Rissel C. Enhancing the get healthy information and coaching service for Aboriginal adults: evaluation of the process and impact of the program. Int J Equity Health 2017; 16:168. [PMID: 28877697 PMCID: PMC5586001 DOI: 10.1186/s12939-017-0641-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable chronic diseases in Australia contribute to approximately 85% of the total burden of disease; this proportion is greater for Aboriginal communities. The Get Healthy Service (GHS) is effective at reducing lifestyle-based chronic disease risk factors among adults and was enhanced to facilitate accessibility and ensure Aboriginal cultural appropriateness. The purpose of this study is to detail how formative research with Aboriginal communities was applied to guide the development and refinement of the GHS and referral pathways; and to assess the reach and impact of the GHS (and the Aboriginal specific program) on the lifestyle risk factors of Aboriginal participants. METHODS Formative research included interviews with Aboriginal participants, leaders and community members, healthcare professionals and service providers to examine acceptability of the GHS; and contributed to the redesign of the GHS Aboriginal program. A quantitative analysis employing a pre-post evaluation design examined anthropometric measures, physical activity and fruit and vegetable consumption of Aboriginal participants using descriptive and chi square analyses, t-tests and Wilcoxon signed-rank tests. RESULTS Whilst feedback from the formative research was positive, Aboriginal people identified areas for service enhancement, including improving program content, delivery and service promotion as well as ensuring culturally appropriate referral pathways. Once these changes were implemented, the proportion of Aboriginal participants increased significantly (3.2 to 6.4%). There were significant improvements across a number of risk factors assessed after six months (average weight loss: 3.3 kg and waist circumference reduction: 6.2 cm) for Aboriginal participants completing the program. CONCLUSIONS Working in partnership with Aboriginal people, Elders, communities and peak bodies to enhance the GHS for Aboriginal people resulted in an enhanced culturally acceptable and tailored program which significantly reduced chronic disease risk factors for Aboriginal participants. Mainstream telephone based services can be modified and enhanced to meet the needs of Aboriginal communities through a process of consultation, community engagement, partnership and governance.
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Affiliation(s)
- E. Quinn
- Public Health Unit, Sydney Local Health District, Level 9, King George Building, RPAH, Missenden Road, Camperdown, 2050 Australia
| | - B. J. O’Hara
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Level 6, The Hub, Charles Perkins Centre D17, 2006 Camperdown, Australia
| | - N. Ahmed
- NSW Office of Preventive Health, NSW Ministry of Health, Liverpool Hospital, Level 1, Don Everett Building, West End, Elizabeth Street, Liverpool, NSW 2170 Australia
| | - S. Winch
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW 2540 Australia
| | - B. McGill
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Level 6, The Hub, Charles Perkins Centre D17, 2006 Camperdown, Australia
| | - D. Banovic
- Planning Unit, Sydney Local Health District, KGV Missenden Road, Camperdown, NSW 2050 Australia
| | - M. Maxwell
- Centre for Population Health, NSW Ministry of Health, 73 Miller Street, North Sydney, 2060 Australia
| | - C. Rissel
- NSW Office of Preventive Health, NSW Ministry of Health and Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, Australia
- NSW Office of Preventive Health, Liverpool Hospital, Level 1, Don Everett Building, West End, Elizabeth Street, Liverpool, NSW 2170 Australia
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Bovill M, Bar-Zeev Y, Gruppetta M, O'Mara P, Cowling B, Gould GS. Collective and negotiated design for a clinical trial addressing smoking cessation supports for Aboriginal and Torres Strait Islander mothers in NSW, SA and Qld – developing a pilot study. Aust J Prim Health 2017; 23:497-503. [DOI: 10.1071/py16140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/16/2017] [Indexed: 11/23/2022]
Abstract
Tobacco smoking leads to one in five deaths of Aboriginal Australians and accounts for 17% of the reversible health gap. One in two Aboriginal women are reported to smoke during pregnancy, with no effective strategies currently available for health practitioners to utilise for supporting Aboriginal women. Aboriginal community participation in primary health research is crucial to implementing ethical research, with a clear benefit to the people and communities involved. However, currently there is little evidence on how Aboriginal programs and interventions are being developed in partnership with Aboriginal people and communities. ‘Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy’ aims to address the prevalence of smoking during pregnancy by enhancing health providers’ training in offering evidence-based smoking cessation care to Aboriginal mothers during pregnancy. This paper outlines the participatory research approach adopted for the developmental phase of the ‘ICAN QUIT in Pregnancy’ project developed in partnership with two Aboriginal Community-Controlled Health Services in NSW, and negotiation processes undertaken to implement a pilot intervention across NSW, SA and Qld.
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Singer J, Bennett-Levy J, Rotumah D. "You didn't just consult community, you involved us": transformation of a 'top-down' Aboriginal mental health project into a 'bottom-up' community-driven process. Australas Psychiatry 2015; 23:614-9. [PMID: 26530350 DOI: 10.1177/1039856215614985] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recently, there has been a consistent call for Indigenous health research to be community-driven. However, for a variety of reasons, many projects, such as the one featured here, start as 'top-down'. Using ten accepted principles for Aboriginal health research, the present article illustrates how a top-down project can be transformed into a 'bottom-up' community-driven project. METHOD A table of examples is provided to show how the ten principles were translated into practice to create a bottom-up process. RESULTS We suggest that key elements for creating a bottom-up process are iterative conversations and community involvement that goes beyond notional engagement. A feature of community involvement is generating and sustaining ongoing conversations with multiple levels of community (organisations, health professionals, Elders, community members, project-specific groups) in a variety of different forums across the entire duration of a project. Local research teams, a commitment to building capacity in the local Indigenous workforce, and adequate timelines and funding are other factors that we hypothesise may contribute to successful outcomes. CONCLUSION The article contributes to a much-needed evidence base demonstrating how appropriate structures and strategies may create bottom-up processes leading to successful outcomes.
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Affiliation(s)
- Judy Singer
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - James Bennett-Levy
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Darlene Rotumah
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
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O'Donahoo FJ, Ross KE. Principles Relevant to Health Research among Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5304-9. [PMID: 25996884 PMCID: PMC4454968 DOI: 10.3390/ijerph120505304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 11/21/2022]
Abstract
Research within Indigenous communities has been criticised for lacking community engagement, for being exploitative, and for poorly explaining the processes of research. To address these concerns, and to ensure ‘best practice’, Jamieson, et al. (2012) recently published a summary of principles outlined by the NHMRC (2003) in “one short, accessible document”. Here we expand on Jamieson et al.’s paper, which while commendable, lacks emphasis on the contribution that communities themselves can make to the research process and how culturally appropriate engagement, can allow this contribution to be assured, specifically with respect to engagement with remote communities. Engagement started before the research proposal is put forward, and continued after the research is completed, has integrity. We emphasise the value of narratives, of understanding cultural and customary behaviours and leadership, the importance of cultural legitimacy, and of the need for time, not just to allow for delays, but to ensure genuine participatory engagement from all members of the community. We also challenge researchers to consider the outcomes of their research, on the basis that increasing clinical evidence does not always result in better outcomes for the community involved.
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Affiliation(s)
- Francis J O'Donahoo
- Environmental Health, School of the Environment, Flinders University, Adelaide, SA 5001, Australia.
| | - Kirstin E Ross
- Environmental Health, School of the Environment, Flinders University, Adelaide, SA 5001, Australia.
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