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Rashid M, Arseneau N, Kemble T, Lightning MP, Forbes KL. Exploring medical students' experiences with indigenous patient care: a phenomenological study. MEDICAL EDUCATION ONLINE 2024; 29:2350251. [PMID: 38720424 PMCID: PMC11086002 DOI: 10.1080/10872981.2024.2350251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. METHOD Phenomenology was used, guided by Goffman's theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants' experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. RESULTS Four main themes emerged from students' descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students' clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. CONCLUSIONS In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.
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Affiliation(s)
| | - Nicole Arseneau
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | | | - Mosom Patrick Lightning
- Elder in Residence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Karen L. Forbes
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Gibson M, Leske S, Ward R, Weir B, Russell K, Kolves K. Aboriginal and Torres Strait Islander youth suicide mortality and previous mental health, suicidality and service use in Queensland, Australia, from 2001 to 2021. J Affect Disord 2024; 354:55-61. [PMID: 38484672 DOI: 10.1016/j.jad.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The current study aimed to compare current suicide rates, trends, previous treatment, suicidality and mental health diagnoses for First Nations and non-Indigenous young people who died by suicide. METHODS Age-specific suicide rates (ASSRs) were calculated per 100,000 persons/year using suicides aged 10-19 years in the Queensland Suicide Register. Rate Ratios (RRs) and 95 % CIs compared ASSRs for First Nations and non-Indigenous youth dying by suicide in Queensland, Australia, from 2001 to 2018. Risk ratios (RiskR) with 95 % CIs compared characteristics between First Nations and non-Indigenous youth suicides. Joinpoint regression was used to identify any changes in trends and annual percentage change (APC) in suicides with 95 % CIs. RESULTS The First Nations youth ASSR was 24.71 deaths per 100,000 persons/year, 4.5 times the non-Indigenous ASSR (95 % CI = 3.74-5.38, p < 0.001). Both non-Indigenous and First Nations suicide trends were stable with no joinpoints (APC: 0.3 %, 95 % CI: -1.6-2.2, p = 0.78; APC: 0.9 %, 95 % CI: -0.2-2.1, p = 0.11). Less than a quarter (23.9 %) of First Nations young people had ever received mental health treatment, significantly fewer than non-Indigenous youth (RiskR = 0.80, 95 % CI = 0.71-0.90, p < 0.001). Similarly, in the three months preceding their death, only 14.5 % of First Nations young people had received mental health treatment (RiskR = 0.89, 95 % CI = 0.83-97, p = 0.015). LIMITATIONS Reported mental illness, suicidality and help-seeking could be underreported due to concealment from family or police. CONCLUSIONS The current study finds no change in the gap between the First Nations and Non-Indigenous youth suicide rates nor evidence of decrease in the First Nations youth suicide rate. There is a need for alternative approaches to Indigenous youth suicide prevention, such as assertive outreach models outside of traditional triage and mental health systems to proactively build trusting relationships with young people in communities to identify young people needing support.
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Affiliation(s)
- M Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.
| | - S Leske
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia; UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, Queensland, Australia
| | - R Ward
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia; Institute for Resilient Regions, Knowledge Broker First Nations Engagement Southern Queensland & Northern NSW Drought Resilience Adoption & Innovation Hub, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - B Weir
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - K Russell
- Beyond the Pale Aboriginal and Torres Strait youth mental health support services, Australia
| | - K Kolves
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Young C, Burgess L, Falster K, Zoega H, Banks E, Clapham K, Woolfenden S, Cutmore M, Williamson A. Mental health-related service and medicine use among a cohort of urban Aboriginal children and young people: Data linkage study. Aust N Z J Psychiatry 2024:48674241248357. [PMID: 38711323 DOI: 10.1177/00048674241248357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE The objective was to describe mental health service and psychotropic medicine use among a cohort of Aboriginal young people and quantify their relation to sociodemographic, family and health factors. METHODS In a prospective cohort study with data linkage, 892 Aboriginal children aged 0-17 years living in urban and regional areas of New South Wales, Australia, were included. We assessed mental health-related service use, paediatric service use and psychotropic medicine dispensing claims covered by the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from July 2012 to June 2017. RESULTS Most children (71%) did not have a record of mental health service or psychotropic medication use. 18.7% had ⩾1 mental health-related service claim; 26.7% had ⩾1 paediatric service claim; and 20.3% had ⩾1 psychotropic medicine dispensing claim. General practitioner services were the most accessed mental health-related service (17.4%) and 12.7% had been dispensed attention-deficit hyperactivity disorder medicines. Child characteristics associated with treatment included emotional and behavioural problems (prevalence ratio: 1.97, 95% confidence interval = [1.46, 2.64] for mental health services; prevalence ratio: 2.87, 95% confidence interval = [2.07, 3.96] for medicines) and risky behaviour (prevalence ratio: 1.56, 95% confidence interval = [1.12, 2.16] for mental health services; prevalence ratio: 2.28, 95% confidence interval = [1.54, 3.37] for medicines). Parent-related factors included chronic illness (prevalence ratio: 1.42, 95% confidence interval = [1.03, 1.95] for mental health services; prevalence ratio: 2.00, 95% confidence interval = [1.49, 2.69] for medicines) and functional limitations (prevalence ratio: 1.61, 95% confidence interval = [1.16, 2.24] for mental health services; prevalence ratio: 1.86, 95% confidence interval = [1.34, 2.59] for medicines). CONCLUSIONS Most Aboriginal children and young people did not have claims for mental health services or medicines. Aboriginal children with emotional and behavioural problems, or parents with health problems were more likely to have mental health service or medicine claims.
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Affiliation(s)
| | | | - Kathleen Falster
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Helga Zoega
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Emily Banks
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Sue Woolfenden
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Chamberlain C, Anderson I, Fredericks B, Calma T, Eades S. Indigenous peoples' health after Australia's No vote. BMJ 2024; 384:q24. [PMID: 38212046 DOI: 10.1136/bmj.q24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Catherine Chamberlain
- Onemda: Aboriginal and Torres Strait Islander Health and Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Tom Calma
- University of Canberra, Canberra, Australia
| | - Sandra Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Hughes JT, Owen KJ, Kelly J, Cundale K, Majoni SW, D'Antoine M, McDonald SP. Cultural bias in kidney care and transplantation: review and recommendations to improve kidney care for Aboriginal and Torres Strait Islander people. Med J Aust 2023; 219 Suppl 8:S11-S14. [PMID: 37839026 DOI: 10.5694/mja2.52110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Jaquelyne T Hughes
- Rural and Remote Health, Flinders University, Darwin, NT
- Royal Darwin Hospital, Darwin, NT
| | - Kelli J Owen
- National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, SA
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA
| | - Janet Kelly
- Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Katie Cundale
- National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, SA
- Adelaide Medical School, University of Adelaide, Adelaide, SA
| | | | - Matilda D'Antoine
- National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, SA
| | - Stephen P McDonald
- Adelaide Medical School, University of Adelaide, Adelaide, SA
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA
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Lewis ME, Wildcat S, Anderson A. Visioning an Effective Health Encounter: Indigenous Healthcare Experiences and Recommendations for Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6917. [PMID: 37887655 PMCID: PMC10606678 DOI: 10.3390/ijerph20206917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/05/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Indigenous patients experience challenges while accessing and utilizing healthcare services that relate to worsened health experiences. Bias towards Indigenous patients is prevalent in healthcare settings and leads to poor health outcomes. The purpose of this study was to learn about the healthcare experiences, both positive and negative, of Indigenous patients and solicit subsequent recommendations to improve care delivered to this population. METHODS This study sampled Indigenous patients (n = 20) from an Indigenous-serving health clinic to discuss participants' health experiences and elicit recommendations for improved care. Four focus groups were conducted, and template analysis was employed to analyze the data. RESULTS A total of 15 themes were developed under the category of an effective health encounter. Highlighted themes include healthcare that is free of stigma, quality care, respecting trauma experiences, expanded integrated care and the patient-provider relationship. Based on participant recommendations, a checklist was created for healthcare professionals to improve care delivery to Indigenous patients. Results indicated that bias in healthcare settings may masquerade as poor clinical care but is really founded in biased beliefs and healthcare delivery. Alternatively, when patients received good quality care, their healthcare outcomes improved. Further, effective healthcare incorporates culture, family, tribe, and community and addresses these aspects of health in both clinical and systemic settings. CONCLUSIONS With some of the largest proportions of health disparities and bias experiences in the US, it is critical that healthcare delivered to Indigenous patients incorporate culturally safe care to regain dignity and improve health outcomes for this population.
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Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO 65201, USA
| | - Sky Wildcat
- Department of Higher Education, College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72701, USA
| | - Amber Anderson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Cama E, Beadman M, Beadman K, Hopwood M, Treloar C. Health workers' perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia. Harm Reduct J 2023; 20:116. [PMID: 37633903 PMCID: PMC10463284 DOI: 10.1186/s12954-023-00844-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma. METHODS Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia. RESULTS Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services. CONCLUSIONS Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Mitch Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Durey A, Naylor N, Slack-Smith L. Inequalities between Aboriginal and non-Aboriginal Australians seen through the lens of oral health: time to change focus. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220294. [PMID: 37381845 DOI: 10.1098/rstb.2022.0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/21/2023] [Indexed: 06/30/2023] Open
Abstract
Inequitable social environments can illustrate changes needed in the social structure to generate more equitable social relations and behaviour. In Australia, British colonization left an intergenerational legacy of racism against Aboriginal people, who are disadvantaged across various social indicators including oral health. Aboriginal Australian children have poorer health outcomes with twice the rate of dental caries as non-Aboriginal children. Our research suggests structural factors outside individual control, including access to and cost of dental services and discrimination from service providers, prevent many Aboriginal families from making optimum oral health decisions, including returning to services. Nader's concept of 'studying up' redirects the lens onto powerful institutions and governing bodies to account for their role in undermining good health outcomes, indicating changes needed in the social structure to improve equality. Policymakers and health providers can critically reflect on structural advantages accorded to whiteness in a colonized country, where power and privilege that often go unnoticed and unexamined by those who benefit incur disadvantages to Aboriginal Australians, as reflected in inequitable oral health outcomes. This approach disrupts the discourse placing Aboriginal people at the centre of the problem. Instead, refocusing the lens onto structural factors will show how those factors can compromise rather than improve health outcomes. This article is part of the theme issue 'Evolutionary ecology of inequality'.
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Affiliation(s)
- Angela Durey
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Nola Naylor
- Aboriginal Health Strategy, Clinical Service Planning & Population Health, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
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Wicks M, Hampshire C, Campbell J, Maple-Brown L, Kirkham R. Racial microaggressions and interculturality in remote Central Australian Aboriginal healthcare. Int J Equity Health 2023; 22:103. [PMID: 37231471 DOI: 10.1186/s12939-023-01897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND An epidemic of type 2 diabetes in remote Aboriginal people in Central Australia, contributes to high rates of morbidity and mortality. Remote non-Aboriginal Health Care Workers (HCW) and the Aboriginal people they serve inhabit a complex cultural interface. This study aimed to recognise racial microaggressions in the everyday discourse of HCWs. It proposes a model of interculturality for remote HCWs that avoids racialisation and essentialising of Aboriginal people's identities and cultures. METHODS Semi-structured in-depth interviews were undertaken with HCWs from two Primary Health Care services in very remote Central Australia. Fourteen interviews were analysed from seven Remote Area Nurse, five Remote Medical Practitioners and two Aboriginal Health Practitioners. Discourse analysis was employed to explore racial microaggressions and power relations. NVivo software assisted in the thematic organisation of microaggressions according to a predefined taxonomy. RESULTS Seven microaggression themes were identified - racial categorization and sameness, assumptions about intelligence and competence, false colour blindness, criminality and dangerousness, reverse racism and hostility, treatment as second-class citizens and pathologizing culture. A model of interculturality for remote HCWs was based on concepts of the third space, deCentred hybrid identities and small culture formation on-the-go combined with a duty-conscious ethic, cultural safety and humility. CONCLUSIONS Racial microaggressions are common in the discourse of remote HCWs. The model of interculturality proposed could improve intercultural communication and relationships between HCWs and Aboriginal people. This improved engagement is required to address the current diabetes epidemic in Central Australia.
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Affiliation(s)
- Mary Wicks
- Menzies School of Health Research, Charles Darwin University, PO Box 1294, Alice Springs, NT, 0871, Australia.
- Pintupi Homelands Health Service, PMB 145 Kintore via Alice Springs, Alice Springs, NT, 0872, Australia.
| | - Christine Hampshire
- Central Australian Health Service, PO Box 721, Alice Springs, NT, 0871, Australia
| | - Jeannie Campbell
- Central Australian Health Service, PO Box 721, Alice Springs, NT, 0871, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
- Department of Endocrinology, Royal Darwin and Palmerston Hospitals, PO Box 41326, Casuarina, Darwin, NT, 0811, Australia
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
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Olko J, Galbarczyk A, Maryniak J, Krzych-Miłkowska K, Tepec HI, de la Cruz E, Dexter-Sobkowiak E, Jasienska G. The spiral of disadvantage: Ethnolinguistic discrimination, acculturative stress and health in Nahua indigenous communities in Mexico. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023. [PMID: 37060286 DOI: 10.1002/ajpa.24745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that ethnic and ethnolinguistic discrimination, and Post-Traumatic Stress Disorder (PTSD) related to being Indigenous as well as different aspects of acculturative stress, are associated with poorer health and higher levels of depression among the Nahua Indigenous communities. MATERIALS AND METHODS Our quantitative survey was carried out in four different regions inhabited by the Nahua people in Mexico. Self-rated health and depression, the symptoms of PTSD, two facets of acculturative stress and ethnolinguistic discrimination were assessed by questionnaires. The data were analyzed using binary logistic regression models. RESULTS The symptoms of PTSD and acculturative stress experienced in the workplace were significantly associated with a higher risk of poor self-rated health, adjusted for various socio-demographic characteristics. Acculturative stress, discouragement of language use, language avoidance and ethnolinguistic discrimination were related to a higher risk of depression and PTSD. DISCUSSION Our research implies that ethnic and linguistic discrimination, acculturative stress and the memory of harm linked to being Indigenous reflected in the symptoms of PTSD, are important predictors of poorer health and depression among Nahua groups in Mexico. These adverse effects could be significantly counteracted by effective dealing with stigmatization and discrimination against Indigenous people in Mexico and by replacing strong assimilation pressures with integrational approaches that respect ethnolinguistic diversity and reduce socioeconomic marginalization.
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Affiliation(s)
- Justyna Olko
- Center for Research and Practice in Cultural Continuity, Faculty of "Artes Liberales", University of Warsaw, Warsaw, Poland
| | - Andrzej Galbarczyk
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Joanna Maryniak
- Center for Research and Practice in Cultural Continuity, Faculty of "Artes Liberales", University of Warsaw, Warsaw, Poland
| | - Karolina Krzych-Miłkowska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Eduardo de la Cruz
- Center for Research and Practice in Cultural Continuity, Faculty of "Artes Liberales", University of Warsaw, Warsaw, Poland
- Instituto de Docencia e Investigación Etnológica de Zacatecas, Zacatecas, Mexico
| | - Elwira Dexter-Sobkowiak
- Center for Research and Practice in Cultural Continuity, Faculty of "Artes Liberales", University of Warsaw, Warsaw, Poland
| | - Grazyna Jasienska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Carrigan A, Austin EE, Clay-Williams R, Hibbert PD, Maka K, Holden N, Grigg S, Loy G, Braithwaite J. Birang Daruganora: a protocol for a qualitative study to elicit Aboriginal and Torres Strait Islander community views about cultural needs and experiences for a new Australian health facility. BMJ Open 2023; 13:e069951. [PMID: 37024254 PMCID: PMC10083773 DOI: 10.1136/bmjopen-2022-069951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION To address challenges regarding the delivery of healthcare, governments and health services are focusing on the implementation of models that are flexible, person-centred, cost-effective and integrate hospital services more closely with primary healthcare and social services. Such models increasingly embed consumer codesign, multidisciplinary teams and leverage digital technologies, such as telehealth, attempting to deliver care more seamlessly and to continually improve services. This paper provides a study protocol to describe a method to explore Aboriginal and/or Torres Strait Islander consumer and healthcare provider needs and expectations for the design and development of a new healthcare facility in Australia. METHODS AND ANALYSIS A qualitative study of consumer members' and health providers' needs and expectations. Data collection includes a short consumer-specific and provider-specific, demographic questionnaire and culturally appropriate facilitator-coordinated consultation workshops. Data will be analysed thematically (qualitatively). ETHICS AND DISSEMINATION The results will be actively disseminated through peer-reviewed journals, conference presentations, reports to stakeholders and community meetings. This study was reviewed and approved by a health service-based Ethics Committee in New South Wales, Australia and the Aboriginal Health and Medical Research Committee.
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Affiliation(s)
- Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Narelle Holden
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Shai Grigg
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Curtis M, Dietze P, Wilkinson AL, Agius PA, Stewart AC, Cossar RD, Butler T, Walker S, Kirwan A, Winter RJ, Stoové M. Discontinuation of opioid agonist treatment following release from prison in a cohort of men who injected drugs prior to imprisonment in Victoria, Australia: A discrete-time survival analysis. Drug Alcohol Depend 2023; 242:109730. [PMID: 36516552 DOI: 10.1016/j.drugalcdep.2022.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Retention in opioid agonist treatment (OAT) following release from prison is associated with improved outcomes, however factors associated with post-release OAT discontinuation in Australia are poorly understood. We examined post-release OAT discontinuation in a cohort of men who engaged in approximately monthly injecting drug use (IDU) prior to imprisonment in Victoria, Australia. METHODS Longitudinal data were used to calculate incidence of first-event post-release OAT discontinuation among men released from prison receiving OAT, and single-event discrete-time survival methods were used to estimate associations with post-release OAT discontinuation. RESULTS Among 110 participants, 55 OAT discontinuations were observed in the two years post-release, an overall crude incidence rate (IR) of 46 per 100 person-years (PY) (95 % confidence interval [95 %CI]: 36-60 per 100PY). Incidence was greatest between release from prison and first follow-up (IR: 84 per 100PY, 95 %CI: 62-116 per 100PY). Initiating OAT during index imprisonment (versus transitioning from community OAT; adjusted hazard rate [AHR]: 2.17, 95 %CI: 1.14-4.13) and identifying as Aboriginal and/or Torres Strait Islander (AHR: 4.95, 95 %CI: 2.00-12.25) were associated with an increased hazard of OAT discontinuation. CONCLUSION In a cohort of men with recent histories of IDU released from prison receiving OAT, half reported OAT discontinuation within two years of release from prison, with incidence of discontinuation greatest soon after prison-release. Targeted support for men who initiate OAT during episodes of imprisonment and Aboriginal and/or Torres Strait Islander peoples is necessary to reduce incidence of OAT discontinuation among people at greatest risk of discontinuation.
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Affiliation(s)
- Michael Curtis
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia.
| | - Paul Dietze
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Anna L Wilkinson
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul A Agius
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ashleigh C Stewart
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Forensic Medicine, Monash University, VIC, Australia; Victorian Institute of Forensic Medicine, Melbourne, VIC, Australia
| | - Reece D Cossar
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- Justice Health Research Program, School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Shelley Walker
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Amy Kirwan
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Rebecca J Winter
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
| | - Mark Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Chakraborty A, Walke E, Bainbridge R, Bailie R, Matthews V, Larkins S, Burgess P, Askew D, Langham E, Smorgon S, Swaminathan G, Cameron D, Piccoli T, Passey M. VOICE-Validating Outcomes by Including Consumer Experience: A Study Protocol to Develop a Patient Reported Experience Measure for Aboriginal and Torres Strait Islander Peoples Accessing Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:357. [PMID: 36612678 PMCID: PMC9819546 DOI: 10.3390/ijerph20010357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Aboriginal and Torres Strait Islander peoples' (hereafter respectfully referred to as Indigenous Australians) experiences of health care are shaped by historical, social and cultural factors, with cultural security critical to effective care provision and engagement between services and community. Positive patient experiences are associated with better health outcomes. Consequently, it is an accreditation requirement that primary health care (PHC) services must formally gather and respond to patient feedback. However, currently available patient feedback tools were not developed with Indigenous Australians, and do not reflect their values and world views. Existing tools do not capture important experiences of care of Indigenous Australians in PHC settings, nor return information that assists services to improve care. Consistent with the principles of Indigenous Data Sovereignty, we will co-design and validate an Indigenous-specific Patient Reported Experience Measure (PREM) that produces data by and for community, suitable for use in quality improvement in comprehensive PHC services. This paper presents the protocol of the study, outlining the rationale, methodologies and associated activities that are being applied in developing the PREM. Briefly, guided by an Aboriginal and Torres Strait Islander Advisory Group, our team of Indigenous and non-Indigenous researchers, service providers and policy makers will use a combination of Indigenous methodologies, participatory, and traditional western techniques for scale development. We will engage PHC service staff and communities in eight selected sites across remote, regional, and metropolitan communities in Australia for iterative cycles of data collection and feedback throughout the research process. Yarning Circles with community members will identify core concepts to develop an "Experience of Care Framework", which will be used to develop items for the PREM. Staff members will be interviewed regarding desirable characteristics and feasibility considerations for the PREM. The PREM will undergo cognitive and psychometric testing.
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Affiliation(s)
- Amal Chakraborty
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Emma Walke
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Paul Burgess
- NT Health, Northern Territory Government, Casuarina, NT 0811, Australia
| | - Deborah Askew
- School of Medicine, Faculty of Medicine, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Erika Langham
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Samantha Smorgon
- The Royal Australian College of General Practitioners (RACGP), East Melbourne, VIC 3002, Australia
| | - Girish Swaminathan
- Australian Commission on Safety and Quality in Health Care (ACSQHC), Sydney, NSW 2000, Australia
| | - Danielle Cameron
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Tracey Piccoli
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Megan Passey
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
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14
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Fraser S, Mackean T, Grant J, Hunter K, Ryder C, Kelly J, Holland AJA, Griffin B, Clapham K, Teague WJ, Darton A, Ivers RQ. Patient journey mapping to investigate quality and cultural safety in burn care for Aboriginal and Torres Strait Islander children and families - development, application and implications. BMC Health Serv Res 2022; 22:1428. [PMID: 36443783 PMCID: PMC9703784 DOI: 10.1186/s12913-022-08754-0] [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: 07/23/2021] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Quality and safety in Australian healthcare is inequitably distributed, highlighted by gaps in the provision of quality care for Aboriginal and Torres Strait Islander children. Burns have potential for long-term adverse outcomes, and quality care, including culturally safe care, is critical to recovery. This study aimed to develop and apply an Aboriginal Patient Journey Mapping (APJM) tool to investigate the quality of healthcare systems for burn care with Aboriginal and Torres Strait Islander children. STUDY DESIGN Interface research methodology, using biomedical and cultural evidence, informed the modification of an existing APJM tool. The tool was then applied to the journey of one family accessing a paediatric tertiary burn care site. Data were collected through yarning with the family, case note review and clinician interviews. Data were analysed using Emden's core story and thematic analysis methods. Reflexivity informed consideration of the implications of the APJM tool, including its effectiveness and efficiency in eliciting information about quality and cultural safety. RESULTS Through application of a modified APJM tool, gaps in quality care for Aboriginal and Torres Strait Islander children and families were identified at the individual, service and system levels. Engagement in innovative methodology incorporating more than biomedical standards of care, uncovered critical information about the experiences of culturally safe care in complex patient journeys. CONCLUSION Based on our application of the tool, APJM can identify and evaluate specific aspects of culturally safe care as experienced by Aboriginal and Torres Strait Islander peoples and be used for quality improvement.
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Affiliation(s)
- Sarah Fraser
- grid.1005.40000 0004 4902 0432School of Population Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Tamara Mackean
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Julian Grant
- grid.1037.50000 0004 0368 0777Charles Sturt University, Bathurst, Australia
| | - Kate Hunter
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, UNSW, Sydney, Australia
| | - Courtney Ryder
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Janet Kelly
- grid.1010.00000 0004 1936 7304University of Adelaide, Adelaide, Australia
| | - Andrew J. A. Holland
- grid.1013.30000 0004 1936 834XThe University of Sydney, The Children’s Hospital at Westmead Clinical School, Sydney, Australia
| | - Bronwyn Griffin
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kathleen Clapham
- grid.1007.60000 0004 0486 528XUniversity of Wollongong, Wollongong, Australia
| | - Warwick J. Teague
- grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Anne Darton
- Agency for Clinical Innovation, St Leonards, Willoughby, Australia
| | - Rebecca Q. Ivers
- grid.1005.40000 0004 4902 0432School of Population Health, Faculty of Medicine, UNSW, Sydney, Australia
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15
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Wright A, Davis VN, Brinckley MM, Lovett R, Thandrayen J, Yap M, Sanders W, Banks E. Relationship of Aboriginal family wellbeing to social and cultural determinants, Central Australia: 'Waltja tjutangku nyakunytjaku'. Fam Med Community Health 2022; 10:fmch-2022-001741. [PMID: 36357009 PMCID: PMC9660685 DOI: 10.1136/fmch-2022-001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to apply a strength-based approach to examine the relation of cultural and social determinants to high family functioning for Aboriginal people in Central Australia. DESIGN Cross-sectional study involving a quantitative analysis of survey data. Prevalence rate ratios (PRs) and 95% CIs were calculated from binomial regressions, adjusted for gender and age. Qualitative data from workshops with Aboriginal leaders in Central Australia supported the interpretation of the research findings. PARTICIPANTS The study involved 639 Aboriginal people in Central Australia who participated in the Mayi Kuwayu Study. RESULT Overall, 57.9% (370/639) of participants reported high/very high family functioning, 16.9% (108/639) reported moderate and 13.3% (85/639) reported low. The adjusted prevalence of family functioning was similar across gender, age groups and household sizes. Family functioning was associated with lower family financial status (aPR=0.74, 95% CI=0.60 to 0.91) and receiving welfare (0.88, 0.77 to 1.00). Family functioning was greater with high community cohesion (2.72, 1.68 to 4.39), high individual agency in community (2.15, 1.63 to 2.85); having an Aboriginal language as a first language (1.20, 1.04 to 1.37); speaking your Aboriginal language a lot (1.37, 1.12 to 1.68); high exposure to cultural practice and knowledge (1.45, 1.28 to 1.65); and multigenerational or extended family households (1.19, 1.02 to 1.38). CONCLUSION High family functioning is a strength in Central Australia and is intrinsically connected with culture. Healthcare providers and programmes that build on the foundations of culture and family are an important approach to improving wellbeing.
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Affiliation(s)
- Alyson Wright
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Makayla-May Brinckley
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mandy Yap
- Centre for Aboriginal Economic and Policy Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - William Sanders
- Centre for Aboriginal Economic and Policy Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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16
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Francis-Cracknell A, Truong M, Adams K. 'Maybe what I do know is wrong…': Reframing educator roles and professional development for teaching Indigenous health. Nurs Inq 2022; 30:e12531. [PMID: 36222233 DOI: 10.1111/nin.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022]
Abstract
Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples' health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.
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Affiliation(s)
- Alison Francis-Cracknell
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mandy Truong
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Karen Adams
- Gukwonderuk Indigenous Engagement Unit, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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17
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Cullen P, Mackean T, Walker N, Coombes J, Bennett-Brook K, Clapham K, Ivers R, Hackett M, Worner F, Longbottom M. Integrating Trauma and Violence Informed Care in Primary Health Care Settings for First Nations Women Experiencing Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:1204-1219. [PMID: 33573523 DOI: 10.1177/1524838020985571] [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] [Indexed: 06/12/2023]
Abstract
It is imperative that access to primary health care services is equitable as health care practitioners are often the first responders to women who experience violence. This is of particular importance for First Nations women who disproportionately experience interpersonal and structural violence when compared to non-First Nations women, as well as the ongoing impact of colonization, racism, and intergenerational trauma. To understand how primary health care services can provide equitable and effective care for First Nations women, we explored how trauma and violence informed care is integrated in primary health care settings through the lens of an equity-oriented framework. A systematic search of electronic databases included Medline (via Ovid), Scopus, Informit, and PubMed and grey literature. Six studies were included in the review and we undertook a narrative synthesis using the equity-oriented framework to draw together the intersection of trauma and violence informed care with culturally safe and contextually tailored care. This review demonstrates how equity-oriented primary health care settings respond to the complex and multiple forms of violence and intergenerational trauma experienced by First Nations women and thus mitigate shame and stigma to encourage disclosure and help seeking. Key attributes include responding to women's individual contexts by centering family, engaging elders, encouraging community ownership, which is driven by a culturally competent workforce that builds trust, reduces retraumatization, and respects confidentiality. This review highlights the importance of strengthening and supporting the workforce, as well as embedding cultural safety within intersectoral partnerships and ensuring adequate resourcing and sustainability of initiatives.
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Affiliation(s)
- Patricia Cullen
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, 8691University of Wollongong, Wollongong, Australia
| | - Tamara Mackean
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Natasha Walker
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
| | | | | | - Kathleen Clapham
- Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, 8691University of Wollongong, Wollongong, Australia
| | - Rebecca Ivers
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Maree Hackett
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Faye Worner
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, Australia
| | - Marlene Longbottom
- Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, 8691University of Wollongong, Wollongong, Australia
- Visiting International Scholar, School of Social Work, University of Hawai'i Manoa, HI, USA
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Crooks K, Taylor K, Law C, Campbell S, Miller A. Engage, understand, listen and act: evaluation of Community Panels to privilege First Nations voices in pandemic planning and response in Australia. BMJ Glob Health 2022; 7:bmjgh-2022-009114. [PMID: 35940629 PMCID: PMC9364039 DOI: 10.1136/bmjgh-2022-009114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction First Nations Peoples of Australia have not been included in the development nor prioritised in pre-2009 pandemic plans despite being a priority population in Australian health policy. Marginalised groups experience amplified barriers and systemic disadvantage in emergencies, however, their voices have not been heard in past pandemic responses. Through effective engagement with disadvantaged and oppressed groups, health authorities can gain a deeper understanding of how to design and implement pandemic control strategies. There have been limited studies with First Nations Peoples that has focused on pandemic planning and response strategies. Deliberative inclusive approaches such as citizens juries have been a way to uncover public perceptions. Methods Qualitative thematic research methods were used to conduct the study. We convened five First Nations Community Panels in three locations in Australia between 2019 and 2020. We used an Indigenist research approach, community-based Participatory Action Research framework and ‘yarning’ to understand whether Community Panels were an acceptable and appropriate way of engaging First Nations Peoples. Forty First Nations participants were purposively recruited through local and cultural networks. Panels heard evidence supporting various pandemic response strategies, and cross-questioned public health experts. Results All 40 participants from the 5 panels verbally indicated strong support of the Community Panels approach as an effective way of engaging First Nations Peoples in making decisions about pandemic planning and response strategies. The main theme of ‘respect’ centred on the overarching principle that First Nations Peoples are important in the context of continuation of culture and ongoing political resistance. Conclusion First Nations Community Panels are a way of enabling active participation of First Nations peoples, increasing knowledge and understanding, and a way for government and policymakers to respectfully listen to First Nations opinions and values.
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Affiliation(s)
- Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia .,Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Kylie Taylor
- Population Health, Hunter New England Local Health District, Tamworth, New South Wales, Australia
| | - Charlee Law
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Sandra Campbell
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Adrian Miller
- Office of Indigenous Engagement, Central Queensland University, Townsville, Queensland, Australia
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Webster E, Hall Yuwaallaraay/Gamilaroi A, Hill Wiradjuri Y, See Wiradjuri C, Simons E, Havrlant R, Osten R. Building cultural responsiveness in a mainstream health organisation with '8 Aboriginal Ways of Learning': a participatory action research study. Aust N Z J Public Health 2022; 46:517-523. [PMID: 35557019 DOI: 10.1111/1753-6405.13245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Despite much effort and goodwill, the gap in health status between Aboriginal and non-Aboriginal Australians persists. Bringing Aboriginal cultural protocols and teaching strategies into healthcare could improve the fit between healthcare services provided and Aboriginal peoples. This approach to making healthcare more accessible has not been tested in mainstream health settings. This study aimed to introduce '8 Aboriginal Ways of Learning' to a mainstream health organisation and observe how learning about Aboriginal perspectives and processes shaped work-related project or program design. METHODS Program and network coordinators (n=18) employed in a state-wide health organisation joined in-person workshops and virtual sessions. Participatory Action Research methods guided the process and framework analysis transformed data. RESULTS Introducing '8 Ways' generated conversations which went beyond deficits in Aboriginal health. Learning about cultural processes provided scaffolding to show how services and models of care can change. CONCLUSIONS This strategy demonstrated potential to improve approachability, acceptability and appropriateness of mainstream healthcare for Aboriginal peoples. IMPLICATIONS FOR PUBLIC HEALTH Introduction of Aboriginal pedagogies were welcomed by mainstream healthcare workers as they provided scaffolding and support to plan and work in new ways. Future studies could examine outcomes on program design and access to services for Aboriginal peoples.
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Affiliation(s)
- Emma Webster
- School of Rural Health, University of Sydney, Dubbo, New South Wales
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20
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Glennie M, Dowden M, Grose M, Scolyer M, Superina A, Gardner K. Engaging Remote Aboriginal Communities in COVID-19 Public Health Messaging via Crowdsourcing. Front Public Health 2022; 10:866134. [PMID: 35646785 PMCID: PMC9135969 DOI: 10.3389/fpubh.2022.866134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Health comunication is a critical component of pandemic mitigation, but mainstream prevention messaging often lacks social, cultural and linguistic relevance to vulnerable populations. This community case study presents a novel, highly participatory pandemic prevention communication campaign that engaged individuals in remote Aboriginal communities of the Northern Territory of Australia directly in prevention messaging via crowdsourcing, and distributed videos to remote area post-codes via targeted Facebook advertising. Facebook metrics, administrative campaign data and national statistics are used to assess campaign reach and engagement. The case study discusses lessons learned from the campaign, including how seeking unscripted COVID-19 prevention video messaging can support community ownership of pandemic messaging, rapid content generation, and a high level of Facebook user engagement. It also discusses the effectiveness of targeting remote area post-codes via Facebook advertising both to reach the target audience, and to support quality improvement assessments to inform health communication decision-making in a low resource setting.
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Affiliation(s)
- Miriam Glennie
- Public Sector Research Group, University of New South Wales, Canberra, ACT, Australia
- *Correspondence: Miriam Glennie
| | | | | | | | | | - Karen Gardner
- Public Sector Research Group, University of New South Wales, Canberra, ACT, Australia
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21
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Mohamed Shaburdin Z, Bourke L, Mitchell O, Newman T. 'It's a cultural thing': excuses used by health professionals on providing inclusive care. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:1-15. [PMID: 34018893 DOI: 10.1080/14461242.2020.1846581] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.
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Affiliation(s)
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
| | - Olivia Mitchell
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
| | - Trudie Newman
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
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22
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Ahmadifard A, Forouhi S, Waterhouse P, Muirhead V. A student-led qualitative study to explore dental undergraduates' understanding, experiences, and responses to racism in a dental school. J Public Health Dent 2022; 82 Suppl 1:36-45. [PMID: 35726468 PMCID: PMC9328358 DOI: 10.1111/jphd.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Objectives This qualitative study explored dental student participants' understanding of racism, their experiences, and responses to racism in dental school, and the impacts of their experiences. Methods An interpretative phenomenological analysis design recruited students from the undergraduate dental degree and the BSc in Oral Health Science course at a UK dental school in December 2020. Two students and a qualitative researcher facilitated the online focus groups. A topic guide including scenario questions guided the discussions that lasted an average of 2 h. The recorded interviews were transcribed and analyzed using thematic analysis. Results Twenty‐five participants took part in five focus groups. Several themes emerged related to participants' experiences and reactions. They described a spectrum of racist encounters ranging from more subtle forms, such as stereotyping and microaggression to racial mocking. They were concerned about professionalism, not knowing how and when to respond to patients' racist behavior. They described gender discrimination and intersectional biases but felt compelled to put patients' interests first. They were unsure about how to respond to stereotyping or racism from staff because of perceived imbalances in the staff‐patient‐student triad relationship. They expressed fears of gaslighting and despondency. They also felt that the COVID‐19 pandemic and anonymity from virtual learning environments enabled racist behavior. Conclusion This study revealed a complex triad relationship between participants, staff and patients, and experience of intersectionality and three levels of racism: interpersonal, structural, and institutional. It highlighted the need for further research to develop actions including structural policies and equality and diversity training.
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Affiliation(s)
- Arefeh Ahmadifard
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sara Forouhi
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paula Waterhouse
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Vanessa Muirhead
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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23
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Yashadhana A, Howie A, Veber M, Cullen P, Withall A, Lewis E, McCausland R, Macniven R, Andersen M. Experiences and perceptions of ageing among older First Nations Australians: A rapid review. Australas J Ageing 2021; 41:8-19. [PMID: 34905642 DOI: 10.1111/ajag.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify and describe articles reporting the experiences and perceptions of ageing among older First Nations Australians. METHODS Following rapid review and PRISMA guidelines, we searched five databases for peer-reviewed articles published prior to October 2019 that reported qualitative accounts of ageing among older (≥ 45 years) First Nations Australians. Data were extracted and synthesised thematically. RESULTS Twenty-one articles were included in the final synthesis. Priorities in ageing highlighted the role of Elders, family, community, culture and connection to ancestral lands. Experiences and perceptions of ageing reflected cultural marginalisation in aged and health care services, and highlighted the importance of cultural identity, resilience and survival as key to ageing well. CONCLUSIONS Our review suggests that mainstream ageing frameworks do not fully reflect the priorities of older First Nations Australians. This has important implications for ageing policy and the design and delivery of culturally safe aged and health care services.
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Affiliation(s)
- Aryati Yashadhana
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Health Equity Training Research & Evaluation (CHETRE), University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Adam Howie
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Madelene Veber
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia Cullen
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Ngarruwan Ngadju, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Adrienne Withall
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ebony Lewis
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth McCausland
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Institute for Global Development, University of New South Wales, Sydney, New South Wales, Australia
| | - Rona Macniven
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Andersen
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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24
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Ferreira AP, Cardoso GCP, Nichele CDST, Girianelli VR, Silva AB, Godinho MR. Racial discrimination and health: health professionals' actions in providing care women in the induced abortion process. CIENCIA & SAUDE COLETIVA 2021; 26:4623-4633. [PMID: 34730649 DOI: 10.1590/1413-812320212610.10532021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/17/2021] [Indexed: 11/22/2022] Open
Abstract
This paper aims to evaluate the racial inequalities in the care provided by health professionals concerning induced abortion. This systematic review study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) model, based on the following bases: Brazilian Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine, and National Institutes of Health (PubMed), Science Direct, Capes periodicals portal, with the descriptors: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", selected via the DeCS and Medical Subject Heading (MeSH). Eighteen papers published between 2005 and 2020 in national and international literature were analyzed following the inclusion and exclusion criteria. Most studies found a significant relationship between racial discrimination and institutional violence, including access and quality of care for patients undergoing an induced abortion. Racial discrimination is a significant risk factor for adverse care outcomes.
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Affiliation(s)
- Aldo Pacheco Ferreira
- Departamento de Direitos Humanos, Saúde e Diversidade Cultural, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | | | | | - Vania Reis Girianelli
- Departamento de Direitos Humanos, Saúde e Diversidade Cultural, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Angélica Baptista Silva
- Departamento de Direitos Humanos, Saúde e Diversidade Cultural, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Marluce Rodrigues Godinho
- Departamento de Enfermagem Básica, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora. Juiz de Fora MG Brasil
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25
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Chan AW, Reid C, Skeffington P, Gorman E, Marriott R. Experiences of using the Edinburgh Postnatal Depression Scale in the context of antenatal care for Aboriginal mothers: Women and midwives' perspectives. Women Birth 2021; 35:367-377. [PMID: 34531165 DOI: 10.1016/j.wombi.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
PROBLEM Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended to promote early detection and preventative support for those who may be at risk of perinatal depression and anxiety. The cultural suitability of the EPDS has not been validated in the Aboriginal Australian context. BACKGROUND Marked differences in health outcomes and service access between Australian Aboriginal and non-Aboriginal women and infants continue to exist. AIM This study aimed to explore the cultural validity of the EPDS through understanding the experiences of Aboriginal women and midwives. METHODS Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based Aboriginal antenatal women and 10 non-Aboriginal midwives. FINDINGS Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed that, surprisingly, women expressed generally favourable views of the EPDS, especially when the relationships between women and midwives were focused on. Midwives, however, expressed reservations about administering the EPDS and used the EPDS as a conversation-starter rather than as a standardised, standalone tool. DISCUSSION In attempt to reconcile conflicting perspectives, analysis of recordings extended to evaluate micro-processes in the interviews. At the process level, it was clear that demand characteristics operated in some interviews, including socially desirable response biases, demand biases and acquiescent response styles. CONCLUSION This highlights the need for researchers and clinicians to be trained in non-leading interview questioning techniques and in yarning methodology. Researchers and clinicians should also be aware of the cognitive biases and demand characteristics that may influence responding, likely perpetuated by dominant forces of a colonised society.
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Affiliation(s)
| | - Corinne Reid
- Victoria University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
| | - Petra Skeffington
- Murdoch University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
| | | | - Rhonda Marriott
- Murdoch University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
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26
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Yashadhana A, Fields T, Burnett A, Zwi AB. Re-examining the gap: A critical realist analysis of eye health inequity among Aboriginal and Torres Strait Islander Australians. Soc Sci Med 2021; 284:114230. [PMID: 34315122 DOI: 10.1016/j.socscimed.2021.114230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal') Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.
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Affiliation(s)
- Aryati Yashadhana
- Vision Cooperative Research Centre, Sydney, Australia; Centre for Health Equity Training Research & Evaluation (CHETRE), UNSW, Australia; School of Social Sciences, UNSW, Australia; Ingham Institute for Applied Medical Research, Australia.
| | - Ted Fields
- Vision Cooperative Research Centre, Sydney, Australia
| | - Anthea Burnett
- Vision Cooperative Research Centre, Sydney, Australia; School of Optometry & Vision Science, UNSW, Australia
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27
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Kairuz CA, Casanelia LM, Bennett-Brook K, Coombes J, Yadav UN. Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review. BMC Public Health 2021; 21:1302. [PMID: 34217243 PMCID: PMC8254223 DOI: 10.1186/s12889-021-11363-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Racism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples. Methods A systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary. Results Of total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism. Conclusion Racism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11363-x.
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Affiliation(s)
- Camila A Kairuz
- Department of Public Health, Torrens University, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Lisa M Casanelia
- Department of Public Health, Torrens University, Sydney, Australia
| | | | | | - Uday Narayan Yadav
- Department of Public Health, Torrens University, Sydney, Australia. .,Centre for Primary Health Care and Equity, Faculty of Medicine and Health, UNSW, Sydney, Australia. .,Center for Research Policy and Implementation, Biratnagar, Nepal.
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28
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Experiences of Racism among Older Aboriginal and Torres Strait Islander People: Prevalence, Sources, and Association with Mental Health. Can J Aging 2021; 39:178-189. [PMID: 31230607 DOI: 10.1017/s071498081900031x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cet article présente une analyse inédite de l'association entre la discrimination raciale et la détresse psychologique chez les personnes âgées indigènes et insulaires du détroit de Torres. Les résultats indiquent : (1) qu'une minorité importante d'aînés appartenant aux populations indigènes et insulaires du détroit de Torres ont été victimes de racisme (tel qu'expérimenté et mesuré en fonction d'inégalités de traitement) et d'évitement ; (2) qu'une association entre les expériences de racisme ou d'évitement et la détresse psychologique peut être mise en évidence, et que cette relation demeure robuste malgré la considération d'une variété de facteurs confondants et de caractéristiques complexes associées à la conception des enquêtes ; et (3) les associations entre le racisme et la détresse sont amplifiées en fonction de l'intensité du racisme et des comportements d'évitement. L'association reste robuste ou se trouve renforcée lorsque le racisme et l'évitement se produisent dans le cadre de contextes cruciaux au développement du capital humain des personnes âgées (p. ex. soins de santé, éducation, milieu de travail). Nos résultats soulignent l'importance des programmes et des services sociaux et de santé culturellement sécuritaires, ainsi que la nécessité de contrer la discrimination sous toutes ses formes. This article presents the first nationally representative analysis of the association between racial discrimination and psychological distress among older Aboriginal and Torres Strait Islander people. Results show: (1) experiences of racism (as measured by unfair treatment) and avoidance are encountered by a significant minority of older Aboriginal and Torres Strait Islander people; (2) there is a clear association between experiences of racism and avoidance with psychological distress, with these results being robust to a range of confounding factors and complex survey design features; and (3) the associations between racism and distress are amplified by the severity of racism, and, when occurring, with avoidance. The association remains strong or is strengthened when racism and avoidance occur in contexts or situations crucial to the human capital development of older people (e.g., health care, education, and the workplace). Our findings underscore the importance of culturally safe health and social services/programs and further the imperative to address discrimination in all its forms.
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29
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Thurber KA, Colonna E, Jones R, Gee GC, Priest N, Cohen R, Williams DR, Thandrayen J, Calma T, Lovett R. Prevalence of Everyday Discrimination and Relation with Wellbeing among Aboriginal and Torres Strait Islander Adults in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126577. [PMID: 34207406 PMCID: PMC8296443 DOI: 10.3390/ijerph18126577] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
Abstract
Discrimination is a fundamental determinant of health and health inequities. However, despite the high prevalence of discrimination exposure, there is limited evidence specific to Indigenous populations on the link between discrimination and health. This study employs a validated measure to quantify experiences of everyday discrimination in a national sample of Aboriginal and Torres Strait Islander (Australia’s Indigenous peoples) adults surveyed from 2018 to 2020 (≥16 years, n = 8108). It quantifies Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for wellbeing outcomes by level of discrimination exposure, and tests if associations vary by attribution of discrimination to Indigeneity. Of the participants, 41.5% reported no discrimination, 47.5% low, and 11.0% moderate-high. Discrimination was more commonly reported by younger versus older participants, females versus males, and those living in remote versus urban or regional areas. Discrimination was significantly associated in a dose-response manner, with measures of social and emotional wellbeing, culture and identity, health behaviour, and health outcomes. The strength of the association varied across outcomes, from a 10–20% increased prevalence for some outcomes (e.g., disconnection from culture (PR = 1.08; 95% CI: 1.03, 1.14), and high blood pressure (1.20; 1.09, 1.32)), to a five-fold prevalence of alcohol dependence (4.96; 3.64, 6.76), for those with moderate-high versus no discrimination exposure. The association was of consistent strength and direction whether attributed to Indigeneity or not—with three exceptions. Discrimination is associated with a broad range of poor wellbeing outcomes in this large-scale, national, diverse cohort of Aboriginal and Torres Strait Islander adults. These findings support the vast potential to improve Aboriginal and Torres Strait Islander peoples’ wellbeing, and to reduce Indigenous-non-Indigenous inequities, by reducing exposure to discrimination.
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Affiliation(s)
- Katherine A. Thurber
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
- Correspondence:
| | - Emily Colonna
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Roxanne Jones
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90024, USA;
| | - Naomi Priest
- Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, ACT 2600, Australia;
- Population Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Rubijayne Cohen
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Tom Calma
- Poche Indigenous Health Network New South Wales, University of Sydney, Camperdown, NSW 2006, Australia;
- University of Canberra, Bruce, ACT 2617, Australia
- Ninti One, Hackney, SA 5071, Australia
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
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30
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Kader F, Smith CL. Participatory Approaches to Addressing Missing COVID-19 Race and Ethnicity Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6559. [PMID: 34207130 PMCID: PMC8296482 DOI: 10.3390/ijerph18126559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Varying dimensions of social, environmental, and economic vulnerability can lead to drastically different health outcomes. The novel coronavirus (SARS-CoV-19) pandemic exposes how the intersection of these vulnerabilities with individual behavior, healthcare access, and pre-existing conditions can lead to disproportionate risks of morbidity and mortality from the virus-induced illness, COVID-19. The available data shows that those who are black, indigenous, and people of color (BIPOC) bear the brunt of this risk; however, missing data on race/ethnicity from federal, state, and local agencies impedes nuanced understanding of health disparities. In this commentary, we summarize the link between racism and COVID-19 disparities and the extent of missing data on race/ethnicity in critical COVID-19 reporting. In addition, we provide an overview of the current literature on missing demographic data in the US and hypothesize how racism contributes to nonresponse in health reporting broadly. Finally, we argue that health departments and healthcare systems must engage communities of color to co-develop race/ethnicity data collection processes as part of a comprehensive strategy for achieving health equity.
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Affiliation(s)
- Farah Kader
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Clyde Lanford Smith
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Brigham and Women’s Hospital, Boston, MA 02115, USA
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31
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Campbell N, Moore L, Farthing A, Anderson J, Witt S, Lenthall S, Petrovic E, Lyons C, Rissel C. Characteristics of nursing and allied health student placements in the Northern Territory over time (2017-2019) and placement satisfaction. Aust J Rural Health 2021; 29:354-362. [PMID: 34133041 DOI: 10.1111/ajr.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote work Describe the characteristics of these students Examine changes in student characteristics over time. DESIGN A cross-sectional survey of students and a review of student placement data. SETTING Northern Territory, Australia. PARTICIPANTS Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019. MAIN OUTCOME MEASURE(S) Agreement with the statements 'This placement has encouraged me to consider living and working in a rural or remote location after I graduate' and 'Overall, I was satisfied with my placement.' The administrative record review examined student numbers, and placement length over time. RESULTS A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High-quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%). CONCLUSIONS The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings.
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Affiliation(s)
- Narelle Campbell
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Leigh Moore
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Annie Farthing
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Jessie Anderson
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Susan Witt
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Sue Lenthall
- Flinders Northern Territory, Flinders University, Katherine, NT, Australia
| | - Erica Petrovic
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Chloe Lyons
- Flinders Northern Territory, Flinders University, Gove District Hospital, Nhulunbuy, NT, Australia
| | - Chris Rissel
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
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32
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Mitchell O, Bourke L, Shaburdin ZM. A qualitative evaluation of the implementation of a cultural competence project in rural Victoria. Aust N Z J Public Health 2021; 45:227-234. [PMID: 33900657 DOI: 10.1111/1753-6405.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/01/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the complex factors influencing the implementation of cultural competency frameworks for Aboriginal and Torres Strait Islander peoples within rural, Victorian, mainstream health and community service organisations. METHODS Semi-structured telephone interviews were conducted with key individuals from 20 public health and community services in rural Victoria who had participated in the Koolin Balit Aboriginal Health Cultural Competence Project (KB-AHCC project). Interviews were recorded and transcribed verbatim and a content analysis was undertaken. The findings informed the selection of six case study sites for more in-depth analysis. Following this, an expert reference group provided feedback on the findings. Findings from the different data were triangulated to identify eight factors. RESULTS Key factors acting as barriers and/or enablers to implementing cultural competence frameworks were: comprehensive, structured tools; project workers; communication; organisational responsibility for implementation; prioritising organisational cultural competence resourcing; resistance to focussing on one group of people; and accountability. CONCLUSIONS Embedding cultural competence frameworks within rural, mainstream health and community services requires sustained government resourcing, prioritisation and formal accountability structures. Implications for public health: Findings will inform and guide the future development, implementation and evaluation of organisational cultural competence projects for rural public health and community services.
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Affiliation(s)
- Olivia Mitchell
- Department of Rural Health, The University of Melbourne, Victoria
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Victoria
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Balabanski AH, Dos Santos A, Woods JA, Thrift AG, Kleinig TJ, Suchy-Dicey A, Siri SR, Boden-Albala B, Krishnamurthi R, Feigin VL, Buchwald D, Ranta A, Mienna CS, Zavaleta C, Churilov L, Burchill L, Zion D, Longstreth WT, Tirschwell DL, Anand S, Parsons MW, Brown A, Warne DK, Harwood M, Katzenellenbogen JM. The Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review Protocol. Front Neurol 2021; 12:661570. [PMID: 33967945 PMCID: PMC8100239 DOI: 10.3389/fneur.2021.661570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations. Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including <10 Indigenous People, or with insufficient data to determine incidence, will be excluded. Two reviewers will independently validate the search strategies, screen titles and abstracts, and record reasons for rejection. Relevant articles will undergo full-text screening, with standard data extracted for all studies included. Quality assessment will include Sudlow and Warlow's criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and the CONSIDER checklist for Indigenous research. Results: Primary outcomes include crude, age-specific and/or age-standardized incidence of stroke. Secondary outcomes include overall stroke rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Within-population meta-analysis will be performed if, and where, methodologically sound and comparable studies allow this. Conclusion: We will undertake the first systematic review assessing disparities in stroke incidence in Indigenous populations of developed countries. Data outputs will be disseminated to relevant Indigenous stakeholders to inform public health and policy research.
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Affiliation(s)
- Anna H. Balabanski
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash Universit, Melbourne, VIC, Australia,Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia,*Correspondence: Anna H. Balabanski
| | - Angela Dos Santos
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia
| | - John A. Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash Universit, Melbourne, VIC, Australia
| | - Timothy J. Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Astrid Suchy-Dicey
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Susanna Ragnhild Siri
- Department of Community Medicine, Faculty of Health Sciences, Centre for Sami Health Research, UiT the Arctic University of Norway, Tromso, Norway
| | - Bernadette Boden-Albala
- Department of Population Health and Disease Prevention, Department of Epidemiology, University of California, Irvine, Irvine, CA, United States
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Carol Zavaleta
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia
| | - Luke Burchill
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Deborah Zion
- Human Research Ethics Committee, Victoria University, Melbourne, VIC, Australia
| | - W. T. Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, United States
| | - David L. Tirschwell
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, United States
| | - Sonia Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark W. Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia,University of New South Wales (UNSW) South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Donald K. Warne
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Matire Harwood
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Kimble-Hill AC. Incorporating Identity Safety into the Laboratory Safety Culture. ACS CHEMICAL HEALTH & SAFETY 2021; 28:103-111. [PMID: 33824687 DOI: 10.1021/acs.chas.0c00109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chemistry practitioners, particularly in educational settings, often associate building strong safety cultures with compliance or regulatory requirements around laboratory glass-ware, equipment, flammable and incompatible materials, signage, container labels, and safety data sheets. Other fields of science also emphasize biohazardous materials, animal handling, human subject, and ergonomics. However, little attention in the literature has gone toward describing the interpersonal interactions and behaviors affecting the physical and emotional safety and wellbeing of laboratory trainees and personnel from marginalized backgrounds. This work unifies known approaches of building strong safety cultures and principles for preventing identity cues that threaten safety within a laboratory environment. Specifically, this work uses the four principles of chemical safety RAMP model as a conceptual framework for integrating identity safety within the laboratory safety culture.
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Affiliation(s)
- Ann C Kimble-Hill
- Department of Biochemistry and Molecular Biology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
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Vass A, Adams K. Educator perceptions on teaching Indigenous health: Racism, privilege and self-reflexivity. MEDICAL EDUCATION 2021; 55:213-221. [PMID: 32776344 DOI: 10.1111/medu.14344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION General practitioners (GPs) and family medicine clinicians should respond to Indigenous peoples' health needs. However, medical graduates feel underprepared for this work. The foundational elements of racism, white privilege and cultural self-reflexivity remain conspicuously absent from medical education in general practice programmes, despite inclusion in curriculum frameworks. This study explored the perception and experiences of Australian GP educators in teaching this content. METHODS We undertook a qualitative study that gathered data through semi-structured interviews with GP educators (n = 12) at a medical school in Victoria, Australia. We utilised the Reflection learning domain of the Aboriginal and Torres Strait Islander Health Curriculum Framework to shape interview questions on racism, white privilege and cultural self-reflexivity. Data were analysed from constructivist and Critical Indigenous Theory paradigms to formulate key themes. RESULTS General practitioner educators were challenged by Reflection content, struggled to articulate a refined pedagogy for provision of anti-racist, self-reflexive learning and felt poorly qualified to teach Indigenous health, articulating preference for delegation of teaching to Indigenous peoples. They simultaneously stated the importance of inclusion of Reflection teaching in general practice, alongside expressing beliefs that appeared to devalue its perceived relevance. Students were perceived as being either disinterested or incapable of Reflection learning, or conversely, more engaged than previous generations with these topics. DISCUSSION The results call into question how skilled are GP educators to teach elements of Indigenous health education such as racism, white privilege and cultural self-reflexivity. Unskilled educators can reinforce colonialism in curricula, including through minimisation of content. Stronger anti-racist pedagogy is urgently required in medical education. Vital to this is active research on educator preparedness, evidence-based teaching models and accountable curriculum accreditation.
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Affiliation(s)
- Alyssa Vass
- Department of General Practice, Monash University, Melbourne, Vic., Australia
| | - Karen Adams
- Gukwonderuk Indigenous Health Unit, Monash University, Melbourne, Vic., Australia
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Longitudinal Follow Up of Early Career Midwives: Insights Related to Racism Show the Need for Increased Commitment to Cultural Safety in Aboriginal Maternity Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031276. [PMID: 33572624 PMCID: PMC7908636 DOI: 10.3390/ijerph18031276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/04/2022]
Abstract
Racism in health care undermines equitable service delivery, contributes to poorer health outcomes and has a detrimental effect on the Aboriginal workforce. In maternity care settings, Aboriginal women’s perceptions of discrimination are widespread, with the importance of cultural practices surrounding childbirth often not recognised. Efforts to build midwives’ cultural capabilities and address health disparities have seen Aboriginal content included in training programs but little is known about its application to clinical practice. This study reinterviewed midwives who had previously completed university midwifery training that aimed to increase understanding of Aboriginal people and cultural safety in health care. Participants were 14 non-Indigenous midwives and two Aboriginal midwives. Interviews explored the legacy of program initiatives on cultural capabilities and observations and experiences of racism in maternity care settings. Methods followed qualitative approaches for research rigour, with thematic analysis of transcribed interviews. Findings revealed the positive impact of well-designed content and placements, with non-Indigenous participants cognisant and responsive to casual racism but largely not recognising institutional racism. The Aboriginal midwives had experienced and were attuned to racism in all its guises and suggested initiatives to heighten awareness and dispel stereotypes. It is evident that greater attention must be paid to institutional racism in educational programs to increase its recognition and appropriate actions within health care settings.
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Thurber KA, Walker J, Batterham PJ, Gee GC, Chapman J, Priest N, Cohen R, Jones R, Richardson A, Calear AL, Williams DR, Lovett R. Developing and validating measures of self-reported everyday and healthcare discrimination for Aboriginal and Torres Strait Islander adults. Int J Equity Health 2021; 20:14. [PMID: 33407521 PMCID: PMC7788827 DOI: 10.1186/s12939-020-01351-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/09/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is well established that racism is a fundamental contributor to poor health and inequities. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools. We aim to validate instruments developed to measure interpersonal discrimination. METHODS Instruments were discussed at five focus groups and with experts, and field tested in developing Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing. Data from 7501 baseline survey participants were analysed. Acceptability was assessed according to extent of missingness, construct validity using exploratory and confirmatory factor analysis, and reliability using Cronbach's alpha. Associations between each instrument and outcomes conceptually understood to be closely (community-level racism) or less closely (family wellbeing) related were quantified to test convergent and discriminant validity. RESULTS An 8-item instrument captures experiences of discrimination in everyday life and a 4-item instrument experiences in healthcare, each followed by a global attribution item. Item missingness was 2.2-3.7%. Half (55.4%) of participants reported experiencing any everyday discrimination, with 65.7% attributing the discrimination to Indigeneity; healthcare discrimination figures were 34.1% and 51.1%. Items were consistent with two distinct instruments, differentiating respondents with varying experiences of discrimination. Scales demonstrated very good reliability and convergent and divergent validity. CONCLUSION These brief instruments demonstrate face validity and robust psychometric properties in measuring Aboriginal and Torres Strait Islander adults' experiences of interpersonal discrimination in everyday life and in healthcare. They can be used to quantify population-level experiences of discrimination, and associated wellbeing consequences, and monitor change.
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Affiliation(s)
- Katherine A Thurber
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia.
| | - Jennie Walker
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - Gilbert C Gee
- Department of Community Health, Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Jan Chapman
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia
| | - Naomi Priest
- Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Ellery Crescent, Acton, ACT, 2601, Australia
- Population Health, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Rubijayne Cohen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia
| | - Roxanne Jones
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia
| | - Alice Richardson
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia
- The Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS), 51 Lawson Cres, Acton ACT , 2601, Australia
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Bilal PI, Chan CKY, Somerset SM. Depression Mediates Association Between Perceived Ethnic Discrimination and Elevated Blood Glucose Levels Among Sub-Saharan African Migrants in Australia. J Immigr Minor Health 2021; 23:199-206. [PMID: 33385270 DOI: 10.1007/s10903-020-01131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Depression and perceived ethnic discrimination (PED) are both implicated in type 2 diabetes mellitus (T2DM) risk in some migrant populations. The role of these factors remains understudied in sub-Saharan African migrants, who comprise a significant at-risk group for T2DM in Australia. To assess interactions between PED, depression scores and elevated blood glucose levels among sub-Sahara African immigrants in North-Eastern Australia. Face to face surveys were used to assess PED and depressive tendencies in a purposive sample of 170 adults (aged ≥18 year). Fasting blood glucose levels (FBGL) were measured at the time of interviews. Prevalence of elevated FBGL (≥6.1 mmol/L), PED and severe depression (SD) were: 17.6% (n = 30), 14.7% (n = 25) and 18.8% (n = 32), respectively. Prevalence of elevated FBGL, PED and SD were all higher in males than females. The highest prevalence of elevated BGL, PED and SD each occurred in the 40-50 year age group. Strong positive correlations of both high level PED and SD with elevated FBGL were observed. There was also a strong positive association between PED and SD. Depression score was found to mediate partially the strong association between PED and elevated FBGL (β-value for PED dropped from β = 0.452 to β = 0.246, p < 0.01 and the associated between FBGL and SD remained strong β = 0.554, p < 0.01). The strong association between elevated FBGL and PED seems to be moderated by SD, indicating that interventions to attenuate depression and PED may be a useful adjunct to diabetes prevention programs in this population. Interventions targeted to specific age groups may also be warranted.
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Affiliation(s)
- P I Bilal
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - C K Y Chan
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - S M Somerset
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.
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Cave L, Cooper MN, Zubrick SR, Shepherd CCJ. Racial discrimination and allostatic load among First Nations Australians: a nationally representative cross-sectional study. BMC Public Health 2020; 20:1881. [PMID: 33287764 PMCID: PMC7720631 DOI: 10.1186/s12889-020-09978-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental, and health conditions to affect multisystem dysregulation in a First Nations population. METHODS We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background, and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes. RESULTS Our psychosocial, environmental, and health measures informed a four-class structure; 'Low risk', 'Challenged but healthy', 'Mental health risk' and 'Multiple challenges'. Mean allostatic load was highest in 'Multiple challenges' compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the 'Multiple challenges' class (t = 1.74, p = .04) and significantly lower in the 'Mental health risk' class (t = - 1.67, p = .05). CONCLUSIONS Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges.
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Affiliation(s)
- Leah Cave
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia.
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
- Centre for Child Health Research, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
- Ngangk Yira Research Centre for Aboriginal Health & Social Equity, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
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Developing the Australian Racism, Acceptance, and Cultural-Ethnocentrism Scale (RACES). EDUCATIONAL AND DEVELOPMENTAL PSYCHOLOGIST 2020. [DOI: 10.1017/edp.2015.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Calma T, Dudgeon P, Bray A. Aboriginal and Torres Strait Islander Social and Emotional Wellbeing and Mental Health. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12299] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tom Calma
- Poche Indigenous Health Network, Sydney Medical School, University of Sydney,
| | - Pat Dudgeon
- School of Indigenous Studies, The University of Western Australia,
| | - Abigail Bray
- School of Indigenous Studies, The University of Western Australia,
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Trauma and Violence Informed Care Through Decolonising Interagency Partnerships: A Complexity Case Study of Waminda's Model of Systemic Decolonisation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207363. [PMID: 33050193 PMCID: PMC7601198 DOI: 10.3390/ijerph17207363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022]
Abstract
Through the lens of complexity, we present a nested case study describing a decolonisation approach developed and implemented by Waminda South Coast Women’s Health and Welfare Aboriginal Corporation. Using Indigenous research methods, this case study has unfolded across three phases: (1) Yarning interviews with the workforce from four partner health services (n = 24); (2) Yarning circle bringing together key informants from yarning interviews to verify and refine emerging themes (n = 14); (3) Semi-structured interviews with a facilitator of Waminda’s Decolonisation Workshop (n = 1) and participants (n = 10). Synthesis of data has been undertaken in stages through collaborative framework and thematic analysis. Three overarching themes and eight sub-themes emerged that centred on enhancing the capabilities of the workforce and strengthening interagency partnerships through a more meaningful connection and shared decolonisation agenda that centres Aboriginal and Torres Strait Islander families and communities. Health and social services are complex systems that function within the context of colonisation. Waminda’s innovative, model of interagency collaboration enhanced workforce capability through shared language and collective learning around colonisation, racism and Whiteness. This process generated individual, organisational and systemic decolonisation to disable power structures through trauma and violence informed approach to practice.
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How does race play out in schools? A scoping review and thematic analysis of racial issues in Australian schools. SOCIAL PSYCHOLOGY OF EDUCATION 2020. [DOI: 10.1007/s11218-020-09589-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kairuz CA, Casanelia LM, Bennett-Brook K, Coombes J, Yadav UN. Impact of racism and discrimination on the physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: a protocol for a scoping review. Syst Rev 2020; 9:223. [PMID: 32988412 PMCID: PMC7523079 DOI: 10.1186/s13643-020-01480-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Racism is increasingly recognised internationally as a key factor contributing to health disparities. A comprehensive body of strong research from international authors has reported negative associations between racism and health outcomes. In Australia, although the literature is more limited, available findings follow global trends. Australia has an identified health gap between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians, and despite efforts to bridge this gap, health inequities continue to exist. This scoping review aims to assess, analyse and synthesise the relationship between racism and discrimination on the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. METHOD This is the study protocol for a scoping review. A systematic search will be conducted using five electronic databases: PubMed, CINAHL, Embase, Web of Science and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. The database search will include studies published between 2000 and 2020. Reference lists of the included articles will be searched. Outcome measures will include physical and mental health components including chronic conditions, depression and anxiety, psychological distress, social and emotional difficulties, suicide and health-related outcomes such as wellbeing and life satisfaction. Duplications will be removed, and titles and abstracts will be reviewed to select studies. Full-text screening of preselected studies will be performed by four reviewers independently, to select studies according to inclusion criteria. Included studies will be appraised for quality using appropriate tools tailored for each study design. Data will be extracted, and study findings and characteristics synthesised in a narrative summary. DISCUSSION Our scoping review will synthesise the evidence on the impacts of racism and discrimination in relation to the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. These findings could guide future health interventions by addressing the exposure of racism and racial discrimination in order to reduce health disparity. It is anticipated the findings to be of interest to policymakers, researchers, Aboriginal and Torres Strait Islander communities and community health organisations and other stakeholders interested in optimising public health interventions for and in partnership with Aboriginal and Strait Torres Islander communities of Australia. SCOPING REVIEW REGISTRATION The protocol for this review has been registered on the international prospective register of systematic reviews (PROSPERO). The registration ID is CRD42020186193 .
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Affiliation(s)
- Camila A Kairuz
- Department of Public Health, Torrens University, Sydney, Australia
| | - Lisa M Casanelia
- Department of Public Health, Torrens University, Sydney, Australia
| | | | | | - Uday Narayan Yadav
- Department of Public Health, Torrens University, Sydney, Australia.
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, Australia.
- School of Population Health, UNSW, Sydney, Australia.
- Forum for Health Research and Development, Dharan, Nepal.
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Bourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. AUST HEALTH REV 2020; 43:611-618. [PMID: 30458120 DOI: 10.1071/ah18062] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/06/2018] [Indexed: 01/22/2023]
Abstract
Objectives The aims of this study were to: (1) examine institutional racism's role in creating health outcome discrepancies for Aboriginal and Torres Strait Islander peoples; and (2) assess the management of institutional racism in an Australian hospital and health service (HHS). Methods A literature review informed consideration of institutional racism and the health outcome disparities it produces. Publicly available information, provided by an Australian HHS, was used to assess change in an Australian HHS in five key areas of institutional racism: inclusion in governance, policy implementation, service delivery, employment and financial accountability. These findings were compared with a 2014 case study. Results The literature concurs that outcome disparity is a defining characteristic of institutional racism, but there is contention about processes. Transformative change was detected in the areas of governance, service delivery and employment at an Australian HHS, but there was no change in financial accountability or policy implementation. Conclusions The health outcomes of some racial groups can be damaged by institutional racism. An external assessment tool can help hospitals and health services to change. What is known about the topic? Institutional racism theory is still developing. An external assessment tool to measure, monitor and report on institutional racism has been developed in Australia. What does this paper add? This study on institutional racism has useful propositions for healthcare organisations experiencing disparities in outcomes between racial groups. What are the implications for practitioners? The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation.
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Affiliation(s)
- Christopher John Bourke
- Australian Healthcare and Hospitals Association, Unit 8, 2 Phipps Close, Deakin, ACT 2600, Australia
| | - Henrietta Marrie
- CQ University, Office of Indigenous Engagement, corner of Abbott and Shields Streets, Cairns, Qld 4870, Australia. Email
| | - Adrian Marrie
- CQ University, Centre for Indigenous Health Equity and Research, corner of Abbott and Shields Streets, Cairns, Qld 4870, Australia. Email
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Ketheesan S, Rinaudo M, Berger M, Wenitong M, Juster RP, McEwen BS, Sarnyai Z. Stress, allostatic load and mental health in Indigenous Australians. Stress 2020; 23:509-518. [PMID: 32070158 DOI: 10.1080/10253890.2020.1732346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The aim of this narrative review was to demonstrate how the notion of allostatic load (AL) relates directly to the mental health disparities observed between Indigenous and non-Indigenous Australians. We also endeavored to synthesize the results of the limited number of studies examining stress and AL in Indigenous Australians in order to explore the potential public health benefits of the AL concept. A range of literature examining health inequalities, psychosocial determinants of mental illness and AL was explored to demonstrate the applicability of stress biology to the significant mental health burden faced by Indigenous Australians. Furthermore, all original studies indexed in MEDLINE that provided quantitative data on primary stress biomarkers in Indigenous Australians were selected for review. Evidence of hypothalamic-pituitary-adrenal axis dysregulation and increased AL is apparent even in the handful of studies examining stress biomarkers in Indigenous Australians. Urinary, salivary, hair and fingernail cortisol, hair cortisone, urinary epinephrine, heart rate variability and the cortisol awakening response are all AL parameters which have been shown to be dysregulated in Indigenous Australian cohorts. Furthermore, associations between some of these biomarkers, self-perceived discrimination, exposure to stressful life events and symptoms of psychiatric disorders in Indigenous Australians have also been demonstrated. The continued assessment of AL biomarkers and their relationship with past traumas, lifetime stressors and socio-economic factors amongst Indigenous Australians is important to addressing the mental health this population. Measurement of AL biomarkers in a culturally appropriate manner may lead to more targeted preventative measures, interventions and policies, which mitigate the effects of stress at both the individual and societal level.
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Affiliation(s)
- S Ketheesan
- Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine, James Cook University, Douglas, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - M Rinaudo
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - M Berger
- Department of Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - M Wenitong
- Apunipima Cape York Health Council, Cairns, Australia
- Queensland University of Technology, Brisbane, Australia
| | - R P Juster
- Department of Psychiatry and Addiction, University of Montreal, Canada
| | - B S McEwen
- Margeret Millikan Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, USA
| | - Z Sarnyai
- Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine, James Cook University, Douglas, Australia
- College of Public Health, Medical and Veterinary Sciences, Douglas, Australia
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Invisible or high-risk: Computer-assisted discourse analysis of references to Aboriginal and Torres Strait Islander people(s) and issues in a newspaper corpus about diabetes. PLoS One 2020; 15:e0234486. [PMID: 32525909 PMCID: PMC7289392 DOI: 10.1371/journal.pone.0234486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
This article employs computer-assisted methods to analyse references to Aboriginal and Torres Strait Islander people(s) and issues in a newspaper corpus about diabetes. The objectives are to identify both the frequency and quality of social representation. The dataset consisted of 694 items from 12 Australian newspapers in a five-year period (2013–2017). The quantitative analysis focused on frequency (raw/normalised) and range (number/percentage of texts). The qualitative analysis focused on the identification of semantic prosody (co-occurrence with negative/positive words and phrases) and on selective social actor analysis. The qualitative analysis also compared choices made by the press to language practices recommended in relevant reporting guidelines. Key results include that references to Aboriginal and Torres Strait Islander people(s) or matters appear to be extremely rare. In addition, newspapers’ language choices only partially align with guidelines. References that do occur can be classified into four categories: a) references to [groups of] people and other references to identity; b) names of services, institutions, professions, roles etc; c) non-human nouns related to health; d) non-human nouns related to culture. Qualitative analysis of the word COMMUNITY suggests that newspapers for the most part do recognise the existence of different communities at a national level. However, analysis of all references to [groups of] people shows that the vast majority occur in contexts to do with negativity, therefore having a negative semantic prosody. More specifically, there is a strong association with mentions of a higher risk, likelihood, or incidence of having or developing diabetes (or complications/effects). In sum, Aboriginal and Torres Strait Islander people(s) and issues lack in visibility in Australian diabetes coverage, and are associated with deficit framing, which can be disempowering. To change the discourse would require both an increased visibility as well as changing the deficit lens.
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Miller HM, Young C, Nixon J, Talbot-McDonnell M, Cutmore M, Tong A, Craig JC, Woolfenden S. Parents' and carers' views on factors contributing to the health and wellbeing of urban Aboriginal children. Aust N Z J Public Health 2020; 44:265-270. [PMID: 32510750 DOI: 10.1111/1753-6405.12992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify and describe caregiver perspectives on factors important for the health and wellbeing of urban Aboriginal children. METHODS Caregivers of Aboriginal children participating in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) were asked to describe the single most important factor that would help their children to be healthy and well. Responses were analysed using thematic and content analysis. RESULTS Of the 626 carers in SEARCH, 425 (68%) provided a response. We identified 13 factors related to: loving family relationships, culturally competent healthcare, food security, active living, community services, education, social and emotional connectedness, safety, breaking cycles of disadvantage, housing availability and affordability, positive Aboriginal role models, strong culture, and carer wellbeing. CONCLUSIONS Aligning with holistic concepts of health, caregivers believe that a broad range of child, family and environmental-level factors are needed to ensure the health and wellbeing of Aboriginal children. Implications for public health: This study highlights the importance of providing public health initiatives that enable equal access to the social determinants of health for carers of Aboriginal children. Affordable and adequate housing, food security, culturally appropriate healthcare, and family and community connectedness remain critical areas for targeted initiatives.
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Affiliation(s)
- Hilary M Miller
- Sydney School of Public Health, The University of Sydney, New South Wales.,Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Christian Young
- Sydney School of Public Health, The University of Sydney, New South Wales.,Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | | | | | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales.,Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, South Australia
| | - Susan Woolfenden
- School of Women's and Children's Health, University of New South Wales
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Lewis ME. The Effects of an Indigenous Health Curriculum for Medical Students. MEDICAL SCIENCE EDUCATOR 2020; 30:891-903. [PMID: 34457747 PMCID: PMC8368427 DOI: 10.1007/s40670-020-00971-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Indigenous patients experience a variety of healthcare challenges including accessing and receiving needed healthcare services, as well as experiencing disproportionate amounts of bias and discrimination within the healthcare system. In an effort to improve patient-provider interactions and reduce bias towards Indigenous patients, a curriculum was developed to improve first-year medical students' Indigenous health knowledge. METHOD Two cohorts of students were assessed for their Indigenous health knowledge, cultural intelligence, ethnocultural empathy, and social justice beliefs before the lecture series, directly after, and 6 months later. RESULTS Results of paired t test analysis revealed that Indigenous health knowledge significantly improved after the training and 6 months later. Some improvements were noted in the areas of cultural intelligence and ethnocultural empathy in the second cohort. CONCLUSIONS It is feasible to teach and improve Indigenous-specific health knowledge of medical students using a brief intervention of lectures. However, other critical components of culturally appropriate care including social justice beliefs and actions, ethnocultural empathy, and cultural humility may require increased and immersed cultural training.
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Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO USA
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Vargas C, Browne J, Hardy T, Moore E, Vally H, Gleeson D. Coverage of Aboriginal and Torres Strait Islander nutrition in the Koori Mail. Aust N Z J Public Health 2020; 44:180-185. [PMID: 32311197 DOI: 10.1111/1753-6405.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the extent and nature of coverage of nutrition in the Koori Mail. METHODS Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms 'nutrition∗', 'diet∗', 'food', 'eating', 'weight', 'tucker' or 'sugary drinks'. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples' voices and the framing of nutrition issues. RESULTS A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities. CONCLUSION Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health: Including more Aboriginal and Torres Strait Islander voices and using a strengths-based approach in press releases may improve media advocacy.
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Affiliation(s)
- Carmen Vargas
- School of Psychology and Public Health, La Trobe University, Victoria
| | | | - Tracy Hardy
- Faculty of Medicine, University of Queensland
| | | | - Hassan Vally
- School of Psychology and Public Health, La Trobe University, Victoria
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Victoria
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