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Yashadhana A, Zwi AB, Brady B, De Leeuw E, Kingsley J, O'Leary M, Raven M, Serova N, Topp SM, Fields T, Foster W, Jopson W, Biles B. Gaawaadhi Gadudha: understanding how cultural camps impact health, well-being and resilience among Aboriginal adults in New South Wales, Australia-a collaborative study protocol. BMJ Open 2023; 13:e073551. [PMID: 38135326 DOI: 10.1136/bmjopen-2023-073551] [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] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in 'cultural camps' held on sites of cultural significance promotes health and well-being. METHODS AND ANALYSIS The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples' t-tests or χ2 analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a 'Model of Cultural Health' that will be refined through a Delphi process with experts, stakeholders and policymakers. ETHICS AND DISSEMINATION The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders.
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Affiliation(s)
- Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony B Zwi
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Brooke Brady
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Evelyne De Leeuw
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- École de Santé Publique, l'Université de Montréal, Montréal, Quebec, Canada
| | - Jonathan Kingsley
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Michelle O'Leary
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Miri Raven
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Nina Serova
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie M Topp
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ted Fields
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Warren Foster
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Wendy Jopson
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Brett Biles
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Gee G, Hulbert C, Kennedy H, Dwyer J, Egan J, Holmes L, Mobourne A, Paradies Y. Development of an Aboriginal Resilience and Recovery Questionnaire - a collaboration between practitioners and help-seeking clients of a Victorian Aboriginal community controlled health service. BMC Med Res Methodol 2023; 23:290. [PMID: 38066427 PMCID: PMC10709844 DOI: 10.1186/s12874-023-02091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Indigenous experiences and perspectives of resilience, healing and recovery from trauma is gaining increasing attention, with a growing qualitative literature that spans multiple indigenous cultural groups. However, few quantitative measures are available. In this article, development of a preliminary version of the Aboriginal Resilience and Recovery Questionnaire is described. AIM The first aim of this study was to describe findings from two focus groups that provided theoretical knowledge and development of items for a draft version of an Aboriginal Resilience Recovery Questionnaire. The second aim of the study was to conduct a preliminary psychometric analysis of the properties of the measure. DESIGN Multi-method research design grounded in indigenous research methodologies. MEASURES Aboriginal Resilience and Recovery Questionnaire, Australian Aboriginal Version of the Harvard Trauma Questionnaire Trauma symptom subscale, Growth and Empowerment Measure. RESULTS (1) Two focus groups with six counselling staff from an Aboriginal health service were run that explored Victorian Aboriginal understandings of resilience, healing, and recovery from trauma. Sixty different protective factors viewed as potentially important to resilience, healing and recovery from trauma were identified by participants. (2) Following a review of the resilience literature, 75 items were reviewed and revised, with additional items developed by the focus group. (3) The final outcome was 60 items selected for a preliminary version of the Aboriginal Resilience Recovery Questionnaire, 50 of which made up 19 different subscales in addition to 10 single items. (4) Structured interviews were conducted with 81 help seeking Aboriginal clients recruited from the same health service. Preliminary psychometric assessment of the Aboriginal Resilience Recovery Questionnaire was undertaken using Principal Components Analysis. Two component subscales were extracted with adequate internal consistency and good convergent and discriminant validity. For both subscales there were moderate to strong positive associations with empowerment, and moderate to strong negative associations with trauma symptom severity. CONCLUSION The preliminary results are promising for a strength-based resilience measure developed from the knowledge of Aboriginal practitioners and staff of a counselling service. Further research to address some psychometric limitations in the measure is required. A larger sample size will allow for a common factor analysis to be conducted. The Aboriginal Resilience Recovery Questionnaire has potential to assist Aboriginal Community Controlled Health Organisations and other organisations to evaluate whether services and programs can effectively support community members to strengthen individual, relational, community and cultural resilience resources.
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Affiliation(s)
- Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
- Victorian Aboriginal Health Service, Fitzroy, VIC, Australia.
| | - Carol Hulbert
- School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Helen Kennedy
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Victorian Aboriginal Health Service, Fitzroy, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Joanne Dwyer
- Victorian Aboriginal Health Service, Fitzroy, VIC, Australia
| | - John Egan
- Victorian Aboriginal Health Service, Fitzroy, VIC, Australia
| | - Linda Holmes
- Victorian Aboriginal Health Service, Fitzroy, VIC, Australia
| | - Anita Mobourne
- Victorian Aboriginal Health Service, Fitzroy, VIC, Australia
- Victorian Aboriginal Child Care Agency, Preston, VIC, Australia
| | - Yin Paradies
- School of Humanities and Social Science, Faculty of Arts and Education, Deakin University, Burwood, VIC, Australia
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Gibson M, Stuart J, Leske S, Ward R, Vidyattama Y. Does community cultural connectedness reduce the influence of area disadvantage on Aboriginal & Torres Strait Islander young peoples' suicide? Aust N Z J Public Health 2021; 45:643-650. [PMID: 34761851 DOI: 10.1111/1753-6405.13164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The study aimed to examine associations of community cultural connectedness with Aboriginal and Torres Strait Islander young peoples' suicide rates in areas with elevated risk factors. METHODS Age-specific suicide rates (ASSRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander young people (aged 15-24 years) in Queensland from 2001-2015. Rate Ratios (RRs) compared young peoples' suicide rates in areas with high and low levels of cultural connectedness indicators (cultural social capital and Indigenous language use) within areas with elevated risk factors (high rates of discrimination, low socioeconomic resources, and remoteness). RESULTS Within low socioeconomically resourced areas and where Aboriginal and Torres Strait Islander people experienced more discrimination, greater engagement and involvement with cultural events, ceremonies and organisations was associated with 36% and 47% lower young peoples' suicide rates respectively (RR=1.57, 95%CI=1.13-2.21, p=<0.01; RR=1.88, 95%CI=1.25-2.89, p=<0.01). Within remote and regional areas, higher levels of community language use was associated with 26% lower suicide rates (RR=1.35, 95%CI=1-1.93, p=0.04), and in communities experiencing more discrimination, language use was associated with 34% lower rates (RR=1.53, 95%CI=1.01-2.37, p=0.04). CONCLUSION Cultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples' suicide rates in communities experiencing the most disadvantage. Implications for public health: This provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.
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Affiliation(s)
- Mandy Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland.,School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Jaimee Stuart
- School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland.,School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Raelene Ward
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland.,College for Indigenous Studies Education and Research, University of Southern Queensland, Toowomba, Queensland
| | - Yogi Vidyattama
- National Centre For Social And Economic Modelling (NATSEM), The Institute for Governance and Policy Analysis, University of Canberra, Australian Capital Territory
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Jones MP, Zhao Y, Guthridge S, Russell DJ, Ramjan M, Humphreys JS, Wakerman J. Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study. BMJ Open 2021; 11:e055635. [PMID: 34667018 PMCID: PMC8527144 DOI: 10.1136/bmjopen-2021-055635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff. DESIGN Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems). SETTING All 48 government primary healthcare clinics in remote communities in NT, Australia (2011-2015). PARTICIPANTS 25 413 patients drawn from participating clinics during the study period. OUTCOME MEASURES Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity. RESULTS The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction. CONCLUSIONS Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Yuejen Zhao
- Population and Digital Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Deborah J Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Mark Ramjan
- Clinical Governance, Darwin Region & Strategic Primary Health Care, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - John S Humphreys
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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Knudsen L, Lyons JG, O’Dea K, Christensen DL, Brimblecombe JK. Antioxidant biomarkers and cardiometabolic risk markers in an Aboriginal community in remote Australia: a cross-sectional study. Public Health Nutr 2021; 24:4937-4948. [PMID: 33261694 PMCID: PMC11082824 DOI: 10.1017/s1368980020004899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/11/2020] [Accepted: 11/26/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE High-quality diets, characterised by nutrient-rich foods, are one of the foundations for health and well-being. Indicators of diet quality, antioxidants, are associated with protection against cardiometabolic diseases. The current study explores relationships between plasma antioxidants and cardiometabolic risk among Aboriginal people in Australia. DESIGN As part of a community-driven health promotion programme, we conducted a cross-sectional study including a health-behaviour questionnaire, plasma antioxidants and cardiometabolic risk markers (anthropometric, blood pressure measurements, fasting glucose, glycated Hb (HbA1c), lipids, C-reactive protein and albumin-creatinine-ratio) continuous and categorised into population-specific cut-offs. Antioxidants (β-carotene, β-cryptoxanthin, lycopene, lutein-zeaxanthin, retinol and α-tocopherol measured using HPLC) were applied to a principal component analysis, which aggregated these into a single component. Linear regression models were applied to investigate associations between the antioxidant component and cardiometabolic risk markers. SETTING Community in a remote area in Northern Territory, Australia. PARTICIPANTS A total of 324 Aboriginal people, mean age 35·5 (range 15-75) years. RESULTS Antioxidant component levels were higher among individuals with higher self-reported vegetable intake (P < 0·01), higher among individuals with higher self-reported fruit intake (P = 0·05) and lower among current smokers (P = 0·06). Linear regression revealed an inverse association between the antioxidant component and C-reactive protein (β = -0·01, P < 0·01) after adjusting for confounders. CONCLUSION Higher plasma antioxidant levels, indicators of diet quality, were associated with lower levels of high-sensitivity C-reactive protein in this Aboriginal population in remote Australia. This association suggests plasma antioxidants may be protective against inflammation; however, longitudinal studies are needed to examine this potentially protective relationship.
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Affiliation(s)
- Lenette Knudsen
- Education Department, Steno Diabetes Center Copenhagen, 2820Gentofte, Denmark
| | - Jasmine G Lyons
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kerin O’Dea
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Dirk L Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Julie K Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
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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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Adegboye OA, McBryde ES, Eisen DP. Tropical Australian Health-Data Linkage Shows Excess Mortality Following Severe Infectious Disease Is Present in the Short-Term and Long-Term after Hospital Discharge. Healthcare (Basel) 2021; 9:901. [PMID: 34356279 PMCID: PMC8303504 DOI: 10.3390/healthcare9070901] [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: 06/15/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between 2006 and 2011. METHODS Age-sex standardised mortality rates (SMR) for different subgroups were estimated, and the Kaplan-Meier method was used to estimate and compare the survival experience among different groups. RESULTS Overall, the mortality rate in the hospital cohort was higher than expected in comparison with the Queensland population (SMR: 15.3, 95%CI: 14.9-15.6). The long-term mortality risks were significantly higher for severe infectious diseases than non-infectious diseases for male sex, Indigenous, residential aged care and elderly individuals. CONCLUSION In general, male sex, Indigenous status, age and comorbidity were associated with an increased hazard for all-cause deaths.
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Affiliation(s)
- Oyelola A. Adegboye
- World Health Organization Collaborating Center for Vector-Borne and Neglected Tropical Diseases, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia; (E.S.M.); (D.P.E.)
| | - Emma S. McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia; (E.S.M.); (D.P.E.)
| | - Damon P. Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia; (E.S.M.); (D.P.E.)
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
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Wright A, Yap M, Jones R, Richardson A, Davis V, Lovett R. Examining the Associations between Indigenous Rangers, Culture and Wellbeing in Australia, 2018-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3053. [PMID: 33809609 PMCID: PMC8002247 DOI: 10.3390/ijerph18063053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022]
Abstract
The centrality of culture to Indigenous peoples' health and wellbeing is becoming increasingly acknowledged in government policy. In Australia, the Indigenous Ranger program is a leading example of employment that supports increased cultural participation. In 2017, we demonstrated higher life satisfaction and family wellbeing among Indigenous Rangers compared to non-Rangers in Central Australia. Using an expanded national dataset, this present study aimed to: examine if associations between Ranger status and wellbeing continued to be observed in Central Australia; assess if these associations were observed among non-Central Australian Rangers; and, quantify the effect of mediating variables (Rangers status, cultural factors) on wellbeing outcomes. We analyzed Mayi Kuwayu baseline data (n = 9691 Aboriginal and Torres Strait Islander people) and compared participants who identified as past or currently employed Rangers compared to non-Rangers across two geographic locations (Central Australia, non-Central Australia). Ranger participation was significantly associated with very high life satisfaction and family wellbeing in Central Australia (high life satisfaction PR 1.31, 95% CI 1.09-1.57, and family wellbeing (PR 1.17, 95% CI 1.01-1.36) and non-Central Australia (high life satisfaction PR 1.29, 95% CI 1.06-1.57), family wellbeing (PR 1.37, 95% CI 1.14-1.65). These findings concord with those observed in the 2017 proof-of-concept study. Additionally, we found that Ranger status partially mediated the relationships between existing cultural practices (first language as your Indigenous language and living on your country) and the two wellbeing outcomes. Current cultural practices, spending time on country and speaking your Aboriginal language, also partially mediated the associations between Ranger status and high life satisfaction, and between Ranger status and high family wellbeing. This analysis supports evidence that both Ranger employment and cultural participation are contributors to wellbeing. Ranger work is not only good for land, but it is good for people. As such, determining policies that mutually acknowledge and enhance culture, health and wellbeing will likely have additional benefits for the broader Aboriginal and Torres Strait Islander population.
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Affiliation(s)
- Alyson Wright
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 64 Mills Road, Acton 2600, Australia; (R.J.); (R.L.)
| | - Mandy Yap
- Centre for Aboriginal Economic and Policy Research, The Australian National University, Acton 2600, Australia;
| | - Roxanne Jones
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 64 Mills Road, Acton 2600, Australia; (R.J.); (R.L.)
| | - Alice Richardson
- Statistical Consulting Unit, The Australian National University, Acton 2600, Australia;
| | - Vanessa Davis
- Tangentyere Council, 1 Elders St, Alice Springs 0870, Australia;
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 64 Mills Road, Acton 2600, Australia; (R.J.); (R.L.)
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Bliege Bird R, Bird DW. Climate, landscape diversity, and food sovereignty in arid Australia: The firestick farming hypothesis. Am J Hum Biol 2020; 33:e23527. [PMID: 33107161 DOI: 10.1002/ajhb.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Climate change has long been recognized as a significant driver of dietary diversity and dietary quality. An often overlooked aspect of climate change are shifts in fire regimes, which have the potential to drastically affect landscape diversity, species distributions, and ultimately, human diets. Here, we investigate whether the fire regimes shaped by Indigenous Australians change landscape diversity in ways that improve dietary quality, considering both the diversity and the quantity of traditional foods in the diet. METHODS We use structural equation modeling to explore two causal models of dietary quality, one focused on the direct effects of climate change and resource depression, the other incorporating the dietary effects of landscape diversity, itself a product of fire-created patchiness. We draw on a focal camp dataset covering 10 years of observations of Martu foraging income in the Western Desert of Australia. RESULTS We find strong support for the hypothesis that fire-created patchiness improves diet quality. Climate change (cumulative 2-year rainfall) has only an indirect effect on dietary quality; the availability of traditional foods is mediated primarily through the landscape diversity shaped by fire. CONCLUSIONS Our model suggests that the loss of the indigenous fire mosaic may lead to worsening availability of traditional foods, measured as both caloric intake and diet diversity. Because the effects of rainfall are mediated through landscape diversity, increased rainfall may not compensate for the recent changes in fire regimes resulting from the loss of Aboriginal fire from the landscape.
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Affiliation(s)
- Rebecca Bliege Bird
- Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Douglas W Bird
- Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania, USA
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"Language Breathes Life"-Barngarla Community Perspectives on the Wellbeing Impacts of Reclaiming a Dormant Australian Aboriginal Language. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203918. [PMID: 31618944 PMCID: PMC6843244 DOI: 10.3390/ijerph16203918] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022]
Abstract
Traditional languages are a key element of Indigenous peoples' identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors; connection to Country; connection to culture; connection to community; connection to family and kinship; connection to mind and emotions; and impacts upon identity and cultural pride at an individual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.
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Campbell MA, Hunt J, Scrimgeour DJ, Davey M, Jones V. Contribution of Aboriginal Community-Controlled Health Services to improving Aboriginal health: an evidence review. AUST HEALTH REV 2019; 42:218-226. [PMID: 28263705 DOI: 10.1071/ah16149] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
Abstract
Objective Aboriginal Community-Controlled Health Services (ACCHSs) deliver comprehensive, culturally appropriate primary health care to Aboriginal people and communities. The published literature acknowledging and supporting the roles of ACCHSs in improving Aboriginal health is limited. This paper seeks to collate and analyse the published evidence supporting the contribution of ACCHSs to improving the health of Aboriginal people. Methods A conceptual framework for exploring the contribution of ACCHSs was developed, drawing on the literature on the core functions of ACCHSs and the components of quality primary health care. This framework was used to structure the search strategy, inclusion criteria and analysis of the review. Results ACCHSs contribute to improving the health and well being of Aboriginal peoples through several pathways, including community controlled governance, providing employment and training, strengthening the broader health system and providing accessible, comprehensive primary health care. Conclusions ACCHSs make a range of important contributions to improving the health of Aboriginal peoples that are under-acknowledged. Consideration of the different ways ACCHSs contribute to improving Aboriginal health is of value in the design and evaluation of programs and policies that aim to improve the health of Aboriginal peoples. What is known about the topic? Aboriginal communities have long argued the vital role of ACCHSs in improving Aboriginal health. What does this paper add? This paper provides a comprehensive collation and analysis of the evidence supporting the contributions ACCHSs are making to improving Aboriginal health. What are the implications for practitioners? The conceptual framework and findings outlined in this paper illustrate that ACCHSs are making important contributions to improving Aboriginal health through several pathways. This information can be used to ensure actions to improve Aboriginal health are appropriate and effective. There are important gaps in the literature that researchers need to address.
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Affiliation(s)
- Megan Ann Campbell
- Aboriginal Health & Medical Research Council, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia.
| | - Jennifer Hunt
- Aboriginal Health & Medical Research Council, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia.
| | - David J Scrimgeour
- Spinifex Health Service, PMB 88, via Kalgoorlie, WA 6430, Australia. Email
| | - Maureen Davey
- Tasmanian Aboriginal Centre, 198 Elizabeth Street, Hobart, Tas. 7001, Australia. Email
| | - Victoria Jones
- Aboriginal Health & Medical Research Council, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia.
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The Contribution of Geogenic Particulate Matter to Lung Disease in Indigenous Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152636. [PMID: 31344807 PMCID: PMC6696434 DOI: 10.3390/ijerph16152636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 01/05/2023]
Abstract
Indigenous children have much higher rates of ear and lung disease than non-Indigenous children, which may be related to exposure to high levels of geogenic (earth-derived) particulate matter (PM). The aim of this study was to assess the relationship between dust levels and health in Indigenous children in Western Australia (W.A.). Data were from a population-based sample of 1077 Indigenous children living in 66 remote communities of W.A. (>2,000,000 km2), with information on health outcomes derived from carer reports and hospitalisation records. Associations between dust levels and health outcomes were assessed by multivariate logistic regression in a multi-level framework. We assessed the effect of exposure to community sampled PM on epithelial cell (NuLi-1) responses to non-typeable Haemophilus influenzae (NTHi) in vitro. High dust levels were associated with increased odds of hospitalisation for upper (OR 1.77 95% CI [1.02–3.06]) and lower (OR 1.99 95% CI [1.08–3.68]) respiratory tract infections and ear disease (OR 3.06 95% CI [1.20–7.80]). Exposure to PM enhanced NTHi adhesion and invasion of epithelial cells and impaired IL-8 production. Exposure to geogenic PM may be contributing to the poor respiratory health of disadvantaged communities in arid environments where geogenic PM levels are high.
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Carey TA, Sirett D, Russell D, Humphreys JS, Wakerman J. What is the overall impact or effectiveness of visiting primary health care services in rural and remote communities in high-income countries? A systematic review. BMC Health Serv Res 2018; 18:476. [PMID: 29921271 PMCID: PMC6009055 DOI: 10.1186/s12913-018-3269-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 06/01/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Visiting services address the problem of workforce deficit and access to effective primary health care services in isolated remote and rural locations. Little is known about their impact or effectiveness and thereby the extent to which they are helping to reduce the disparity in access and health outcomes between people living in remote areas compared with people living in urban regions of Australia. The objective of this study was to answer the question "What is the impact or effectiveness when different types of primary health care services visit, rather than reside in, rural and remote communities?" METHOD We conducted a systematic review of peer-reviewed literature from established databases. We also searched relevant websites for 'grey' literature and contacted several key informants to identify other relevant reference material. All papers were reviewed by at least two assessors according to agreed inclusion and exclusion criteria. RESULTS Initially, 345 papers were identified and, from this selection, 17 papers were considered relevant for inclusion. Following full paper review, another ten papers were excluded leaving seven papers that provided some information about the impact or effectiveness of visiting services. The papers varied with regard to study design (ranging from cluster randomised controlled trials to a case study), research quality, and the strength of their conclusions. In relation to effectiveness or impact, results were mixed. There was a lack of consistent data regarding the features or characteristics of visiting services that enhance their effectiveness or impact. Almost invariably the evaluations assessed the service provided but only two papers mentioned any aspect of the visiting features within which service provision occurred such as who did the visiting and how often they visited. CONCLUSIONS There is currently an inadequate evidence base from which to make decisions about the effectiveness of visiting services or how visiting services should be structured in order to achieve better health outcomes for people living in remote and rural areas. Given this knowledge gap, we suggest that more rigorous evaluation of visiting services in meeting community health needs is required, and that evaluation should be guided by a number of salient principles.
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Affiliation(s)
- Timothy A. Carey
- Centre for Remote Health, Flinders University, PO Box 4066, Alice Springs, NT 0871 Australia
| | - David Sirett
- Centre for Remote Health, Flinders University, PO Box 4066, Alice Springs, NT 0871 Australia
| | - Deborah Russell
- School of Rural Health, Monash University, Clayton, Australia
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15
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Senior K, Chenhall R, Hall J, Daniels D. Re-thinking the health benefits of outstations in remote Indigenous Australia. Health Place 2018; 52:1-7. [PMID: 29758440 DOI: 10.1016/j.healthplace.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/01/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022]
Abstract
The small, decentralised communities, known as outstations which satellite larger Indigenous Australian remote communities have often been conceptualised as places that are beneficial to health and well-being. This paper provides an exploration of the meaning of an outstation for one family and the benefits that this connection brings to them, which are expressed in a deep connection to the land, continuing relationships with ancestors and a safe refuge from the stresses of the larger community. We argue that the outstation provides a place for people to be in control of their lives and form hopes and plans for the future. These benefits are positioned in a context where the future liveability and sustainability of the outstation is both fragile and vulnerable.
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Affiliation(s)
- Kate Senior
- School of Health and Society, University of Wollongong, NSW 2522, Australia.
| | - Richard Chenhall
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Parkville, 3052 Victoria, Australia
| | - Julie Hall
- Centre for Health and Society, University of Wollongong, NSW 2522, Australia
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16
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Carson E, Sharmin S, Maier AB, Meij JJ. Comparing indigenous mortality across urban, rural and very remote areas: a systematic review and meta-analysis. Int Health 2018; 10:219-227. [DOI: 10.1093/inthealth/ihy021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/24/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edward Carson
- Department of Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sifat Sharmin
- Department of Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes J Meij
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Wiemers PD, Marney L, Yadav S, Tam R, Fraser JF. An Overview of Indigenous Australian Disadvantage in Terms of Ischaemic Heart Disease. Heart Lung Circ 2018; 27:1274-1284. [PMID: 29929920 DOI: 10.1016/j.hlc.2018.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/18/2017] [Accepted: 03/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Indigenous Australians experience poorer health outcomes than non-Indigenous Australians and a significant life expectancy gap exists. Ischaemic heart disease (IHD) represents the leading specific cause of death in Indigenous Australians and is a significant, if not the most significant, contributor to the mortality gap. With this narrative review we aim to describe the burden of IHD within the Indigenous Australian community and explore the factors driving this disparity. METHODS A broad search of the literature was undertaken utilising an electronic search of the PubMed database along with national agency databases-the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). RESULTS A complex interplay between multiple factors contributes to the excess burden of IHD in the Indigenous Australian population: CONCLUSIONS: In terms of IHD, Indigenous Australians experience disadvantage at multiple stages of the disease process. Ongoing efforts are needed to continue to inform clinicians of both this disadvantage and strategies to assist negating it. Further research is needed to develop evidence based practices which may help reduce this disparity in outcomes.
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Affiliation(s)
- Paul D Wiemers
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia; University of Queensland School of Medicine, Brisbane, Qld, Australia; Royal Brisbane & Women's Hospital, Herston, Qld, Australia.
| | - Lucy Marney
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia
| | - Robert Tam
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia; James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - John F Fraser
- University of Queensland School of Medicine, Brisbane, Qld, Australia; Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Qld, Australia
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Buergelt PT, Maypilama EL, McPhee J, Dhurrkay G, Nirrpuranydji S, Mänydjurrpuy S, Wunungmurra M, Skinner T, Lowell A, Moss S. Working Together with Remote Indigenous Communities to Facilitate Adapting to Using Energy Wisely: Barriers and Enablers. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.egypro.2017.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pretty J, Rogerson M, Barton J. Green Mind Theory: How Brain-Body-Behaviour Links into Natural and Social Environments for Healthy Habits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070706. [PMID: 28665327 PMCID: PMC5551144 DOI: 10.3390/ijerph14070706] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 12/15/2022]
Abstract
We propose a Green Mind Theory (GMT) to link the human mind with the brain and body, and connect the body into natural and social environments. The processes are reciprocal: environments shape bodies, brains, and minds; minds change body behaviours that shape the external environment. GMT offers routes to improved individual well-being whilst building towards greener economies. It builds upon research on green exercise and nature-based therapies, and draws on understanding derived from neuroscience and brain plasticity, spiritual and wisdom traditions, the lifeways of original cultures, and material consumption behaviours. We set out a simple metaphor for brain function: a bottom brain stem that is fast-acting, involuntary, impulsive, and the driver of fight and flight behaviours; a top brain cortex that is slower, voluntary, the centre for learning, and the driver of rest and digest. The bottom brain reacts before thought and directs the sympathetic nervous system. The top brain is calming, directing the parasympathetic nervous system. Here, we call the top brain blue and the bottom brain red; too much red brain is bad for health. In modern high-consumption economies, life has often come to be lived on red alert. An over-active red mode impacts the gastrointestinal, immune, cardiovascular, and endocrine systems. We develop our knowledge of nature-based interventions, and suggest a framework for the blue brain-red brain-green mind. We show how activities involving immersive-attention quieten internal chatter, how habits affect behaviours across the lifecourse, how long habits take to be formed and hard-wired into daily practice, the role of place making, and finally how green minds could foster prosocial and greener economies. We conclude with observations on twelve research priorities and health interventions, and ten calls to action.
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Affiliation(s)
- Jules Pretty
- School of Biological Sciences, University of Essex, Colchester CO4 3SQ, UK.
| | - Mike Rogerson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK.
| | - Jo Barton
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK.
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20
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Jongen CS, McCalman J, Bainbridge RG. The Implementation and Evaluation of Health Promotion Services and Programs to Improve Cultural Competency: A Systematic Scoping Review. Front Public Health 2017; 5:24. [PMID: 28289677 PMCID: PMC5327788 DOI: 10.3389/fpubh.2017.00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/08/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. METHODS This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. RESULTS The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. DISCUSSION Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.
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Affiliation(s)
- Crystal Sky Jongen
- School of Human Health and Social Sciences, Central Queensland University, Cairns, QLD, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, QLD, Australia
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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Cox A, Dudgeon P, Holland C, Kelly K, Scrine C, Walker R. Using participatory action research to prevent suicide in Aboriginal and Torres Strait Islander communities. Aust J Prim Health 2016; 20:345-9. [PMID: 25310135 DOI: 10.1071/py14043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/08/2014] [Indexed: 11/23/2022]
Abstract
The National Empowerment Project is an innovative Aboriginal-led community empowerment project that has worked with eight Aboriginal and Torres Strait Islander communities across Australia over the period 2012-13. The aim of the Project was to develop, deliver and evaluate a program to: (1) promote positive social and emotional well-being to increase resilience and reduce the high reported rates of psychological distress and suicide among Aboriginal and Torres Strait Islander people; and (2) empower communities to take action to address the social determinants that contribute to psychological distress, suicide and self-harm. Using a participatory action research approach, the communities were supported to identify the risk factors challenging individuals, families and communities, as well as strategies to strengthen protective factors against these challenges. Data gathered during Stage 1 were used to develop a 12-month program to promote social and emotional well-being and build resilience within each community. A common framework, based on the social and emotional well-being concept, was used to support each community to target community-identified protective factors and strategies to strengthen individual, family and community social and emotional well-being. Strengthening the role of culture is critical to this approach and marks an important difference between Aboriginal and Torres Strait Islander and non-Indigenous mental health promotion and prevention activities, including suicide prevention. It has significant implications for policy makers and service providers and is showing positive impact through the translation of research into practice, for example through the development of a locally run empowerment program that aims to address the social determinants of health and their ongoing negative impact on individuals, families and communities. It also provides a framework in which to develop and strengthen culture, connectedness and foster self-determination, through better-informed policy based on community-level holistic responses and solutions as opposed to an exclusive focus on single-issue deficit approaches.
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Affiliation(s)
- Adele Cox
- National Empowerment Project, The University of Western Australia, School of Indigenous Studies, M303 Shenton House, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Pat Dudgeon
- National Empowerment Project, The University of Western Australia, School of Indigenous Studies, M303 Shenton House, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | | | - Clair Scrine
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008, Australia
| | - Roz Walker
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008, Australia
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23
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He VYF, Condon JR, Ralph AP, Zhao Y, Roberts K, de Dassel JL, Currie BJ, Fittock M, Edwards KN, Carapetis JR. Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach. Circulation 2016; 134:222-32. [PMID: 27407071 PMCID: PMC4949009 DOI: 10.1161/circulationaha.115.020966] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/27/2016] [Indexed: 11/20/2022]
Abstract
Background: We investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. Methods: Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, we calculated ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates for 572 individuals diagnosed with ARF and 1248 with RHD in 1997 to 2013 (94.9% Indigenous). Results: ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis: heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents. Conclusions: This study provides important new prognostic information for ARF/RHD. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research.
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Affiliation(s)
- Vincent Y F He
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - John R Condon
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Anna P Ralph
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.).
| | - Yuejen Zhao
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Kathryn Roberts
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Jessica L de Dassel
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Bart J Currie
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Marea Fittock
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Keith N Edwards
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
| | - Jonathan R Carapetis
- From Menzies School of Health Research, Charles Darwin University, Darwin, Australia (V.Y.F.H., J.R.C., A.P.R., K.R., J.L.d.D., B.J.C.); Royal Darwin Hospital (A.P.R., K.R., B.J.C., K.N.E.) and Health Gains Planning Branch (Y.Z.), Northern Territory Government Department of Health, Darwin, Australia; Northern Territory Rheumatic Heart Disease Control Program, Centre for Disease Control, NT Department of Health, Darwin, Australia (M.F., K.N.E.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.); and Princess Margaret Hospital for Children, Perth, Australia (J.R.C.)
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Wakerman J, Shannon C. Strengthening primary health care to improve Indigenous health outcomes. Med J Aust 2016; 204:363-4. [DOI: 10.5694/mja16.00031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
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Campbell D. Economies through Application of Nonmedical Primary-Preventative Health: Lessons from the Healthy Country Healthy People Experience of Australia's Aboriginal People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:400. [PMID: 27482574 PMCID: PMC4847062 DOI: 10.3390/ijerph13040400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/24/2016] [Indexed: 12/02/2022]
Abstract
The World Health Organization reports noncommunicable disease as a global pandemic. While national and international health research/policy bodies, such as the World Health Organization and the Australian Institute of Health and Welfare, emphasize the importance of preventative health, there is a continuing distortion in the allocation of resources to curative health as a result of government failure. Government failure is, in part, the result of a political response to individual preference for certainty in receiving treatment for specific health conditions, rather than the uncertainty of population-based preventative intervention. This has led to a failure to engage with those primary causative factors affecting chronic disease, namely the psychosocial stressors, in which the socioeconomic determinants are an important component. Such causal factors are open to manipulation through government policies and joint government-government, government-private cooperation through application of nonmedical primary-preventative health policies. The health benefits of Aboriginal people in traditional land management, or caring-for-country, in remote to very remote Australia, is used to exemplify the social benefits of nonmedical primary-preventative health intervention. Such practices form part of the "healthy country, health people" concept that is traditionally relied upon by Indigenous peoples. Possible health and wider private good and public good social benefits are shown to occur across multiple disciplines and jurisdictions with the possibility of substantial economies. General principles in the application of nonmedical primary-preventative health activities are developed through consideration of the experience of Afboriginal people participation in traditional caring-for-country.
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Reeve C, Humphreys J, Wakerman J. A comprehensive health service evaluation and monitoring framework. EVALUATION AND PROGRAM PLANNING 2015; 53:91-98. [PMID: 26343490 DOI: 10.1016/j.evalprogplan.2015.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 08/17/2015] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. METHOD A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. RESULTS The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. CONCLUSION Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.
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Affiliation(s)
- Carole Reeve
- Centre for Remote Health, Flinders University & Charles Darwin University, PO Box 4066, Alice Springs 0871, NT, Australia; Western Australian Country Health Services, Kimberley Population Health Unit, Locked Bag 4011, Broome 6725, WA, Australia.
| | - John Humphreys
- Centre of Research Excellence in Rural and Remote Primary Care, Monash University School of Rural Health, Bendigo 3552, VIC, Australia
| | - John Wakerman
- Centre for Remote Health, Flinders University & Charles Darwin University, PO Box 4066, Alice Springs 0871, NT, Australia
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Campbell D. Aboriginal involvement in caring-for-country: an economic case study in primary preventative health. Australas Psychiatry 2015; 23:623-5. [PMID: 26498153 DOI: 10.1177/1039856215612985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Firstly, to demonstrate the involvement of Aboriginal people in caring-for-country as a case study of how appropriately targeted non-medical primary preventative health strategies can be a cost-effective approach to addressing chronic disease among Indigenous people. Secondly, to demonstrate the use of an analogous approach in addressing the global chronic disease pandemic. METHOD A review of prior biomedical and economic research based on the involvement of Aboriginal people in caring-for-country is used to: (a) exemplifying the cost effectiveness of a non-medical preventative health intervention; and (b) the process by which such an approach might be applied across a broader context. RESULTS The presented results demonstrate one non-medical primary preventative health approach to addressing the health burden affecting Indigenous peoples. CONCLUSIONS The suggested steps in optimising the cost effectiveness of such an approach demonstrate how it could be applied in addressing the global chronic disease pandemic.
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Affiliation(s)
- David Campbell
- Centre for Remote Health, Alice Springs, Flinders University, Alice Springs, NT, Australia
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Nutritional predictors of successful chronic disease prevention for a community cohort in Central Australia. Public Health Nutr 2015; 19:2475-83. [PMID: 26573342 DOI: 10.1017/s1368980015003262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate biomarkers of nutrition associated with chronic disease absence for an Aboriginal cohort. DESIGN Screening for nutritional biomarkers was completed at baseline (1995). Evidence of chronic disease (diabetes, CVD, chronic kidney disease or hypertension) was sought from primary health-care clinics, hospitals and death records over 10 years of follow-up. Principal components analysis was used to group baseline nutritional biomarkers and logistic regression modelling used to investigate associations between the principal components and chronic disease absence. SETTING Three Central Australian Aboriginal communities. SUBJECTS Aboriginal people (n 444, 286 of whom were without chronic disease at baseline) aged 15-82 years. RESULTS Principal components analysis grouped twelve nutritional biomarkers into four components: 'lipids'; 'adiposity'; 'dietary quality'; and 'habitus with inverse quality diet'. For the 286 individuals free of chronic disease at baseline, lower adiposity, lower lipids and better dietary quality components were each associated with the absence at follow-up of most chronic diseases examined, with the exception of chronic kidney disease. Low 'adiposity' component was associated with absence of diabetes, hypertension and CVD at follow-up. Low 'lipid' component was associated with absence of hypertension and CVD, and high 'dietary quality' component was associated with absence of CVD at follow-up. CONCLUSIONS Lowering or maintenance of the factors related to 'adiposity' and 'lipids' to healthy thresholds and increasing access to a healthy diet appear useful targets for chronic disease prevention for Aboriginal people in Central Australia.
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Thomas SL, Wakerman J, Humphreys JS. Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available? Int J Equity Health 2015; 14:111. [PMID: 26510998 PMCID: PMC4625941 DOI: 10.1186/s12939-015-0228-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Australians in rural and remote areas experience poorer health status compared with many metropolitan residents, due partly to inequitable access to primary health care (PHC) services. Building on recent research that identified PHC services which all Australians should be able to access regardless of where they live, this paper aims to define the population thresholds governing which PHC services would be best provided by a resident health worker, and to outline attendant implementation issues. METHODS A Delphi method comprising panellists with expertise in rural, remote and/or Indigenous PHC was used. Five population thresholds reflecting Australia's diverse rural and remote geography were devised. Panellists participated in two electronic surveys. Using a Likert scale, they were asked at what population threshold each PHC service should be provided by a resident health worker. A follow-up focus group identified important underlying principles which guided the consensus process. RESULTS Response rates were high. The population thresholds for core PHC services provided by a resident worker were less in remote communities compared with rural communities. For example, the population threshold for 'care of the sick and injured,' was ≤100 for remote compared with 101-500 for rural communities. For 'mental health', 'maternal/child health', 'sexual health' and 'public health' services in remote communities the population threshold was 101-500, compared to 501-1000 for rural communities. Principles underpinning implementation included the fundamental importance of equity; consideration of social determinants of health; flexibility, effective expenditure of resources, tailoring services to ensure consumer acceptability, prioritising services according to need, and providing services as close to home as possible. CONCLUSION This research can assist policy makers and service planners to determine the population thresholds at which PHC services should be delivered by a resident health worker, to allocate resources and provide services more equitably, and inform consumers about PHC services they can reasonably expect to access in their community. This framework assists in developing a systematic approach to strategies seeking to address existing rural-urban health workforce maldistribution, including the training of generalists as opposed to specialists, and providing necessary infrastructure in communities most in need.
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Affiliation(s)
- Susan L Thomas
- Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, Australia. .,Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia. .,Flinders University, Alice Springs, NT, Australia.
| | - John Wakerman
- Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia. .,Flinders Northern Territory, Darwin, Australia.
| | - John S Humphreys
- Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia. .,School of Rural Health, Monash University, Bendigo, Australia.
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Reeve C, Humphreys J, Wakerman J, Carter M, Carroll V, Reeve D. Strengthening primary health care: achieving health gains in a remote region of Australia. Med J Aust 2015; 202:483-7. [PMID: 25971572 DOI: 10.5694/mja14.00894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact of a comprehensive primary health care service model on key health performance indicators in a remote region of Australia. DESIGN AND SETTING A cross-sectional 6-year retrospective evaluation of the results of a health service partnership between an Aboriginal community controlled health service, a hospital and a community health service in north-west Western Australia. INTERVENTION Integration of health promotion, health assessments and chronic disease management with an acute primary health care service as a result of the formal partnership. MAIN OUTCOME MEASURES Cross-sectional data on use and outcomes of health care from 1 July 2006 to 30 June 2012 are reported in accordance with national key performance indicators. RESULTS There were increases in occasions of service (from 21 218 to 33 753), most notably in primary health care services provided to very remote outlying communities (from 863 to 11 338). Health assessment uptake increased from 13% of the eligible population to 61%, leading to 73% of those identified with diabetes being placed on a care plan. Quality-of-care indicators (glycated haemoglobin checks and proportion of people with diabetics receiving antihypertensives) showed improvements over the 6-year study period, and there was also a downward trend in mortality. CONCLUSIONS This study demonstrates that strengthening primary health care services by addressing key enablers and sustainability requirements can translate into population health gains consistent with the goals underpinning the National Health Care Reform and Closing the Gap policies, and may potentially reduce health inequity for remote-living Aboriginal Australians.
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Affiliation(s)
- Carole Reeve
- Kimberley Population Health Unit, Broome, WA, Australia.
| | | | | | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, WA, Australia
| | - Vicki Carroll
- Kimberley Population Health Unit, Broome, WA, Australia
| | - David Reeve
- Kimberley Population Health Unit, Broome, WA, Australia
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Wakerman J. Rural and remote health: a progress report. Med J Aust 2015; 202:461-2. [PMID: 25971557 DOI: 10.5694/mja15.00398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/21/2015] [Indexed: 11/17/2022]
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Bath J, Wakerman J. Impact of community participation in primary health care: what is the evidence? Aust J Prim Health 2015; 21:2-8. [PMID: 24176202 DOI: 10.1071/py12164] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/13/2013] [Indexed: 11/23/2022]
Abstract
Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.
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Affiliation(s)
- Jessamy Bath
- Centre of Research Excellence in Rural and Remote Primary Health Care, PO Box 666, Bendigo, Vic. 3552, Australia
| | - John Wakerman
- Centre of Research Excellence in Rural and Remote Primary Health Care, PO Box 666, Bendigo, Vic. 3552, Australia
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Oster RT, Grier A, Lightning R, Mayan MJ, Toth EL. Cultural continuity, traditional Indigenous language, and diabetes in Alberta First Nations: a mixed methods study. Int J Equity Health 2014; 13:92. [PMID: 25326227 PMCID: PMC4210509 DOI: 10.1186/s12939-014-0092-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/03/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction We used an exploratory sequential mixed methods approach to study the association between cultural continuity, self-determination, and diabetes prevalence in First Nations in Alberta, Canada. Methods We conducted a qualitative description where we interviewed 10 Cree and Blackfoot leaders (members of Chief and Council) from across the province to understand cultural continuity, self-determination, and their relationship to health and diabetes, in the Alberta First Nations context. Based on the qualitative findings, we then conducted a cross-sectional analysis using provincial administrative data and publically available data for 31 First Nations communities to quantitatively examine any relationship between cultural continuity and diabetes prevalence. Results Cultural continuity, or “being who we are”, is foundational to health in successful First Nations. Self-determination, or “being a self-sufficient Nation”, stems from cultural continuity and is seriously compromised in today’s Alberta Cree and Blackfoot Nations. Unfortunately, First Nations are in a continuous struggle with government policy. The intergenerational effects of colonization continue to impact the culture, which undermines the sense of self-determination, and contributes to diabetes and ill health. Crude diabetes prevalence varied dramatically among First Nations with values as low as 1.2% and as high as 18.3%. Those First Nations that appeared to have more cultural continuity (measured by traditional Indigenous language knowledge) had significantly lower diabetes prevalence after adjustment for socio-economic factors (p =0.007). Conclusions First Nations that have been better able to preserve their culture may be relatively protected from diabetes.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, 4100 Research Transition Facility, 8308 114 Street, Edmonton T6G 2V2, AB, Canada.
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Thomas SL, Zhao Y, Guthridge SL, Wakerman J. The cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities. Med J Aust 2014; 200:658-62. [PMID: 24938348 DOI: 10.5694/mja13.11316] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the costs and health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory. DESIGN, SETTING AND PARTICIPANTS A population-based retrospective cohort study from 1 January 2002 to 31 December 2011 among Indigenous NT residents ≥ 15 years of age with diabetes who attended one of five hospitals or 54 remote clinics in the NT. MAIN OUTCOME MEASURES Hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL). Variables included disease stage (new, established or complicated cases) and primary care use (low, medium or high). RESULTS 14 184 patients were eligible for inclusion in the study. Compared with the low primary care use group, the medium-use group (patients who used primary care 2-11 times annually) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases, this group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person [P < 0.001]) and PAH rate (0.72 v 3.64 per person [P < 0.001]). Death rate and YLL were also significantly lower (1.25 v 3.77 per 100 population [P < 0.001] and 0.29 v 1.14 per person-year [P < 0.001], respectively). The cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group. This compares to $2915, the average cost of one hospitalisation. CONCLUSION Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.
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Affiliation(s)
- Susan L Thomas
- Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT, Australia.
| | - Yuejen Zhao
- Health Gains Planning Branch, Department of Health, Darwin, NT, Australia
| | - Steven L Guthridge
- Health Gains Planning Branch, Department of Health, Darwin, NT, Australia
| | - John Wakerman
- Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT, Australia
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Wicklow BA, Sellers EAC. Maternal health issues and cardio-metabolic outcomes in the offspring: a focus on Indigenous populations. Best Pract Res Clin Obstet Gynaecol 2014; 29:43-53. [PMID: 25238683 DOI: 10.1016/j.bpobgyn.2014.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/13/2014] [Indexed: 01/28/2023]
Abstract
Non-communicable diseases (NCDs) including diabetes, obesity and cardiovascular disease are the leading causes of death worldwide. Indigenous populations are disproportionally affected. In an effort to halt the increasing disease burden, the mechanisms underlying the increasing rate of NCDs are an important area of study. Recent evidence has focused on the perinatal period as an influential period impacting the future cardio-metabolic health of the offspring. This concept has been defined as metabolic foetal programming and supports the importance of the developmental origins of health and disease in research and clinical practice, specifically in prevention efforts to protect future generations from NCDs. An understanding of the underlying mechanisms involved is not clear as of yet. However, an understanding of these mechanisms is imperative in order to plan effective intervention strategies. As much of the discussion below is gleaned from large epidemiological studies and animal studies, further research with prospective cohorts is necessary.
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Affiliation(s)
- Brandy A Wicklow
- Department of Paediatric and Child Health, University of Manitoba, FE- 307 685 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
| | - Elizabeth A C Sellers
- Department of Paediatric and Child Health, University of Manitoba, FE- 307 685 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
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Is hunting still healthy? Understanding the interrelationships between indigenous participation in land-based practices and human-environmental health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5751-82. [PMID: 24879487 PMCID: PMC4078546 DOI: 10.3390/ijerph110605751] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/05/2014] [Accepted: 05/13/2014] [Indexed: 11/16/2022]
Abstract
Indigenous participation in land-based practices such as hunting, fishing, ceremony, and land care has a long history. In recent years, researchers and policy makers have advocated the benefits of these practices for both Indigenous people and the places they live. However, there have also been documented risks associated with participation in these activities. Environmental change brought about by shifts in land use, climate changes, and the accumulation of contaminants in the food chain sit alongside equally rapid shifts in social, economic and cultural circumstances, preferences and practices. To date, the literature has not offered a wide-ranging review of the available cross-disciplinary or cross-ecozone evidence for these intersecting benefits and risks, for both human and environmental health and wellbeing. By utilising hunting as a case study, this paper seeks to fill part of that gap through a transdisciplinary meta-analysis of the international literature exploring the ways in which Indigenous participation in land-based practices and human-environmental health have been studied, where the current gaps are, and how these findings could be used to inform research and policy. The result is an intriguing summary of disparate research that highlights the patchwork of contradictory understandings, and uneven regional emphasis, that have been documented. A new model was subsequently developed that facilitates a more in-depth consideration of these complex issues within local-global scale considerations. These findings challenge the bounded disciplinary and geographic spaces in which much of this work has occurred to date, and opens a dialogue to consider the importance of approaching these issues holistically.
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Brown A, Carrington MJ, McGrady M, Lee G, Zeitz C, Krum H, Rowley K, Stewart S. Cardiometabolic risk and disease in Indigenous Australians: the heart of the heart study. Int J Cardiol 2013; 171:377-83. [PMID: 24388543 DOI: 10.1016/j.ijcard.2013.12.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/14/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study assessed the burden and determinants of cardiovascular and metabolic risk in a community sample of high risk Indigenous Australians. BACKGROUND Indigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear. METHODS The Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status. RESULTS Individuals with depression were twice as likely to have cardiovascular disease (OR 2.03; 1.07-3.88; p<0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p=0.069), but coronary artery disease did (p=0.035 for trend). Unemployed individuals were more likely to have cardiovascular disease (OR 2.32; 1.33-4.06; p<0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002; 0.01 and 0.04 respectively). CONCLUSION Participants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.
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Affiliation(s)
- Alex Brown
- Baker IDI Heart and Diabetes Institute, Alice Springs, NT, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia.
| | | | - Michele McGrady
- School of Public Health & Preventive Medicine, Monash University, Australia
| | - Geraldine Lee
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
| | | | - Henry Krum
- School of Public Health & Preventive Medicine, Monash University, Australia
| | - Kevin Rowley
- Melbourne School of Population Health, Melbourne University, Melbourne Australia
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
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Economic rationality in choosing between short-term bad-health choices and longer-term good-health choices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5971-88. [PMID: 24217181 PMCID: PMC3863881 DOI: 10.3390/ijerph10115971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 11/16/2022]
Abstract
Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses on the circumstance affecting the lifestyle or behavioral choices of Aboriginal and Torres Strait Islander peoples in remote-/very remote Australia. Poor behavioral choices are the result of endogenous characteristics that are influenced by a range of stressful exogenous variables making up the psychosocial determinants including social disenfranchisement, cultural loss, insurmountable tasks, the loss of volitional control and resource constraints. It is shown that poor behavioral choices can be economically rational; especially under highly stressful conditions. Stressful circumstances erode individual capacity to commit to long-term positive health alternatives such as self-investment in education. Policies directed at removing the impediments and providing incentives to behaviors involving better health choices can lead to reductions in smoking and alcohol consumption and improved health outcomes. Multijurisdictional culturally acceptable policies directed at distal variables relating to the psychosocial determinants of health and personal mastery and control can be cost effective. While the content of this paper is focused on the conditions of colonized peoples, it has broader relevance.
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Katzenellenbogen JM, Sanfilippo FM, Hobbs MST, Briffa TG, Knuiman MW, Dimer L, Thompson PL, Thompson SC. Complex impact of remoteness on the incidence of myocardial infarction in Aboriginal and non-Aboriginal people in Western Australia. Aust J Rural Health 2013. [PMID: 23181814 DOI: 10.1111/j.1440-1584.2012.01314.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the impact of remoteness on Aboriginal and non-Aboriginal myocardial infarction incidence rates in men and women of different ages. DESIGN Descriptive study. SETTING Western Australia. PARTICIPANTS Incident cases of myocardial infarction in Western Australia from 2000-2004 identified from person-linked files of hospital and mortality records. Analysis was undertaken for Aboriginal and non-Aboriginal populations, separately and combined, by broad age group, sex and remoteness. MAIN OUTCOME MEASURE Incidence of myocardial infarction. RESULTS In the combined analysis, age-standardised incidence was significantly higher for men in very remote areas (rate ratio 1.31: 95% confidence interval (CI), 1.19-1.45) and in women in both regional (rate ratio 1.12: 95% CI, 1.01-1.20) and very remote (rate ratio 2.05: 95% CI, 1.75-2.41) areas. Aboriginal rates were substantially higher than non-Aboriginal rates in all substrata. Compared with metropolitan people, regional Aboriginal men and very remote non-Aboriginal men aged 25-54 years had significantly higher incidence rates. For the remaining rural strata, there was either no geographical disadvantage or inconclusive findings. CONCLUSIONS Non-metropolitan disadvantage in myocardial infarction rates is confirmed in regional areas and women in very remote areas. This disadvantage is partly explained by the high rates in Aboriginal people. Non-metropolitan dwellers are not uniformly disadvantaged, reflecting the interplay of the many factors contributing to the complex relationship between myocardial infarction incidence and sex, age, Aboriginality and residence. Aboriginal Western Australians in all regions and young non-Aboriginal men living in very remote areas need to be targeted to reduce disparities in myocardial infarction.
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Affiliation(s)
- Judith M Katzenellenbogen
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia.
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d'Abbs P, Chenhall R. Spirituality and religion in response to substance misuse among indigenous Australians. Subst Use Misuse 2013; 48:1114-29. [PMID: 24041173 DOI: 10.3109/10826084.2013.800746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The ongoing quest for effective ways of preventing and managing alcohol and other drug use-related problems among Indigenous Australians has spawned a variety of approaches, including AA-based treatment, population health-based preventive approaches, and various forms of cultural healing. This paper examines two inter-related sources of ideas and strategies: firstly, the emergence since the 1970s of evangelical Christianity in some Aboriginal communities as a response to profound changes, including increased access to alcohol. The second is the attempt to invoke Indigenous spirituality as an alternative to both western Christianity and western biomedical intervention models. We also discuss the representation of Australian Indigenous spirituality within New Age and related discourses.
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Affiliation(s)
- Peter d'Abbs
- 1Menzies School of Health Research , Darwin , Australia
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Johnston L, Doyle J, Morgan B, Atkinson-Briggs S, Firebrace B, Marika M, Reilly R, Cargo M, Riley T, Rowley K. A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3518-42. [PMID: 23939388 PMCID: PMC3774452 DOI: 10.3390/ijerph10083518] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 11/15/2022]
Abstract
Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.
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Affiliation(s)
- Leah Johnston
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Joyce Doyle
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Bec Morgan
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC 3053, Australia; E-Mail:
| | | | - Bradley Firebrace
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Mayatili Marika
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Rachel Reilly
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Margaret Cargo
- School of Population Health, University of South Australia, Adelaide, SA 5000, Australia; E-Mail:
| | - Therese Riley
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC 3053, Australia; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-03-8344-0814
| | - Kevin Rowley
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
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Iyngkaran P, Majoni V, Nadarajan K, Haste M, Battersby M, Ilton M, Harris M. AUStralian Indigenous Chronic Disease Optimisation Study (AUSI-CDS) prospective observational cohort study to determine if an established chronic disease health care model can be used to deliver better heart failure care among remote Indigenous Australians: Proof of concept-study rationale and protocol. Heart Lung Circ 2013; 22:930-9. [PMID: 23689164 DOI: 10.1016/j.hlc.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/03/2013] [Accepted: 04/02/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The congestive heart failure syndrome has increased to epidemic proportions and is cause for significant morbidity and mortality. Indigenous patients suffer a greater prevalence with greater severity. Upon diagnosis patients require regular follow-up with medical and allied health services. Patients are prescribed life saving, disease modifying and symptom relieving therapies. This can be an overwhelming experience for patients. To compound this, remoteness, differentials in conventional health care and services pose special problems for Indigenous clients in accessing care. Additional barriers of language, culture, socio-economic disadvantage, negative attitudes towards establishment, social stereotyping, stigma and discrimination act as barriers to improved care. Recent focus supported by clinical evidence support the role of chronic disease self-management programs. A patient focused, problem identification, goal setting and psychosocial modification based program should in principal highlight these issues and help tailor a patient focused comprehensive care plan to complement guideline based care. At present there are no Indigenous focused chronic disease self-management programs. There is a need for research on ways to provide chronic disease management to this group. We therefore designed a study to assess a model of patient focussed comprehensive care for Indigenous Australians with heart failure. STUDY DESIGN AUSI-CDS is a prospective, cohort, observational study to evaluate the efficacy of the standard "Flinders Program of Chronic Condition Management" for Indigenous patients with chronic heart failure. Eligible patients will be Indigenous, suffering from chronic heart failure, in the Northern Territory. The primary end-point is the satisfaction score based on the PACIC. The study will recruit 20 patients and is expected to last 12 months. SUMMARY The rationale and design of the AUSI-CDS using the Flinders Model is described.
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Affiliation(s)
- P Iyngkaran
- Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, Bedford Park, SA 5001, Australia; Royal Darwin Hospital, Division of Medicine, Level 7 Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia.
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Lin IB, O'Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open 2013; 3:e002654. [PMID: 23575999 PMCID: PMC3641505 DOI: 10.1136/bmjopen-2013-002654] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To determine the low back pain beliefs of Aboriginal Australians; a population previously identified as protected against the disabling effects of low back pain due to cultural beliefs. DESIGN Qualitative study employing culturally appropriate methods within a clinical ethnographic framework. SETTING One rural and two remote towns in Western Australia. PARTICIPANTS Thirty-two Aboriginal people with chronic low-back pain (CLBP; 21 men, 11 women). Participants included those who were highly, moderately and mildly disabled. RESULTS Most participants held biomedical beliefs about the cause of CLBP, attributing pain to structural/anatomical vulnerability of their spine. This belief was attributed to the advice from healthcare practitioners and the results of spinal radiological imaging. Negative causal beliefs and a pessimistic future outlook were more common among those who were more disabled. Conversely, those who were less disabled held more positive beliefs that did not originate from interactions with healthcare practitioners. CONCLUSIONS Findings are consistent with research in other populations and support that disabling CLBP may be at least partly iatrogenic. This raises concerns for all populations exposed to Western biomedical approaches to examination and management of low back pain. The challenge for healthcare practitioners dealing with people with low back pain from any culture is to communicate in a way that builds positive beliefs about low back pain and its future consequences, enhancing resilience to disability.
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Affiliation(s)
- Ivan B Lin
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
- School of Physiotherapy, Curtin University, Perth, Australia
| | | | - Juli A Coffin
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia and Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Donna B Mak
- School of Medicine, The University of Notre Dame Australia, Perth, Australia
| | - Sandy Toussaint
- Anthropology and Sociology, The University of Western Australia, Perth, Australia
| | - Leon M Straker
- School of Physiotherapy, Curtin University, Perth, Australia
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Mortality in an Aboriginal Medical Service (Redfern) cohort. Popul Health Metr 2013; 11:2. [PMID: 23391275 PMCID: PMC3602118 DOI: 10.1186/1478-7954-11-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 12/26/2012] [Indexed: 12/03/2022] Open
Abstract
Background Published estimates of Aboriginal mortality and life expectancy (LE) for the eastern Australian states are derived from demographic modelling techniques to estimate the population and extent of under-recording of Aboriginality in death registration. No reliable empirical information on Aboriginal mortality and LE exists for New South Wales (NSW), the most populous Australian state in which 29% of Aboriginal people reside. This paper estimates mortality and LE in a large, mainly metropolitan cohort of Aboriginal clients from the Aboriginal Medical Service (AMS) Redfern, Sydney, NSW. Methods Identifying information from patient records accrued by the AMS Redfern since 1980 of definitely Aboriginal clients, without distinction between Aboriginal and Torres Strait Islander (n=24,035), was extracted and linked to the National Death Index (NDI) at the Australian Institute of Health and Welfare (AIHW). Age-specific mortality rates and LEs for each sex were estimated using the AMS patient population as the denominator, discounted for deaths. Directly age-standardised mortality and LEs were estimated for 1995–1999, 2000–2004 and 2005–2009, along with 95% confidence intervals. Comparisons were made with other estimates of Aboriginal mortality and LE and with the total Australian population. Results Mortality declined in the AMS Redfern cohort over 1995–2009, and the decline occurred mostly in the ≤44 year age range. Male LE at birth was estimated to be 64.4 years (95%CI:62.6-66.1) in 1995–1999, 65.6 years (95%CI:64.1-67.1) in 2000–2004, and 67.6 years (95%CI:65.9-69.2) for 2005–2009. In females, these LE estimates were 69.6 (95%CI:68.0-71.2), 71.1 (95%CI:69.9-72.4), and 71.4 (95%CI:70.0-72.8) years. LE in the AMS cohort was 11 years lower for males and 12 years lower for females than corresponding all-Australia LEs for the same periods. These were similar to estimates for Australian Aboriginal people overall for the same period by the Aboriginal Burden of Disease for 2009, using the General Growth Balance (GGB) model approach, and by the Australian Bureau of Statistics (ABS) for 2005–2007. LE in the AMS cohort was somewhat lower than these estimates for NSW Aboriginal people, and higher than ABS 2005–2007 estimates for Aboriginal people from Northern Territory, South Australia, and Western Australia. Conclusions The AMS Redfern cohort has provided the first empirically based estimates of mortality and LE trends in a large sample of Aboriginal people from NSW.
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Abstract
OBJECTIVES Lifetime risk of coronary heart disease (CHD) is an important yardstick by which policy makers, clinicians and the general public can assess and promote the awareness and prevention of CHD. The lifetime risk in Aboriginal people is not known. Using a cohort with up to 20 years of follow-up, we estimated the lifetime risk of CHD in Aboriginal people. DESIGN A cohort study. SETTING A remote Aboriginal region. PARTICIPANTS 1115 Aboriginal people from one remote tribal group who were free from CHD at baseline were followed for up to 20 years. MAIN OUTCOME MEASURES During the follow-up period, new CHD incident cases were identified through hospital and death records. We estimated the lifetime risks of CHD with and without adjusting for the presence of competing risk of death from non-CHD causes. RESULTS Participants were followed up for 17 126 person-years, during which 185 developed CHD and 144 died from non-CHD causes. The average age at which the first CHD event occurred was 48 years for men and 49 years for women. The risk of developing CHD increased with age until 60 years and then decreased with age. Lifetime cumulative risk without adjusting for competing risk was 70.7% for men and 63.8% for women. Adjusting for the presence of competing risk of death from non-CHD causes, the lifetime risk of CHD was 52.6% for men and 49.2% for women. CONCLUSIONS Lifetime risk of CHD is as high as one in two in both Aboriginal men and women. The average age of having first CHD events was under 50 years, much younger than that reported in non-Aboriginal populations. Our data provide useful knowledge for health education, screening and prevention of CHD in Aboriginal people.
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Affiliation(s)
- Zhiqiang Wang
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, Australia
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Bursell SE, Brazionis L, Jenkins A. Telemedicine and ocular health in diabetes mellitus. Clin Exp Optom 2012; 95:311-27. [PMID: 22594547 DOI: 10.1111/j.1444-0938.2012.00746.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Teleretinal/teleophthalmological programs that use existing health information technology infrastructure solutions for people with diabetes increase access to and adherence to appropriate eye care. Teleophthalmological studies indicate that the single act of patients viewing their own retinal images improves self-management behaviour and clinical outcomes. In some settings this can be done at lower cost and with improved visual outcomes compared with standard eye care. Cost-effective and sustainable teleretinal surveillance for detection of diabetic retinopathy requires a combination of an inexpensive portable device for taking low light-level retinal images without the use of pharmacological dilation of the pupil and a computer-assisted methodology for rapidly detecting and diagnosing diabetic retinopathy. A more holistic telehealth-care paradigm augmented with the use of health information technology, medical devices, mobile phone and mobile health applications and software applications to improve health-care co-ordination, self-care management and education can significantly impact a broad range of health outcomes, including prevention of diabetes-associated visual loss. This approach will require a collaborative, transformational, patient-centred health-care program that integrates data from medical record systems with remote monitoring of data and a longitudinal health record. This includes data associated with social media applications and personal mobile health technology and should support continuous interactions between the patient, health-care team and the patient's social environment. Taken together, this system will deliver contextually and temporally relevant decision support to patients to facilitate their well-being and to reduce the risk of diabetic complications.
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Affiliation(s)
- Sven-Erik Bursell
- The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
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Brown A. Addressing cardiovascular inequalities among indigenous Australians. Glob Cardiol Sci Pract 2012; 2012:2. [PMID: 25610833 PMCID: PMC4239816 DOI: 10.5339/gcsp.2012.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 04/12/2012] [Indexed: 12/21/2022] Open
Affiliation(s)
- Alex Brown
- Alice Springs Hospital, Gap Road, Alice Springs
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Anderson H, Kowal E. Culture, History, and Health in an Australian Aboriginal Community: The Case of Utopia. Med Anthropol 2012; 31:438-57. [DOI: 10.1080/01459740.2011.636411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lin I, O'Sullivan P, Coffin J, Mak D, Toussaint S, Straker L. ‘I am absolutely shattered’: The impact of chronic low back pain on Australian Aboriginal people. Eur J Pain 2012; 16:1331-41. [DOI: 10.1002/j.1532-2149.2012.00128.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - J.A. Coffin
- Combined Universities Centre for Rural Health; University of Western Australia; Geraldton; Western Australia
| | - D.B. Mak
- University of Notre Dame; Perth; Western Australia
| | - S. Toussaint
- The University of Western Australia; Perth; Western Australia
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Berry SL, Crowe TP, Deane FP. Preliminary development and content validity of a measure of Australian Aboriginal cultural engagement. ETHNICITY & HEALTH 2012; 17:325-336. [PMID: 22221309 DOI: 10.1080/13557858.2011.645157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Aboriginal people form one of the populations most in need of mental health and substance abuse services within Australia, although many services are not adequately sensitive to, or inclusive of, relevant aspects of Aboriginal culture in their programmes. The Aboriginal Cultural Engagement Survey (ACES) was developed with the objective of assessing the level of cultural engagement of Aboriginal clients. A measure of cultural engagement is an important step in establishing an association between culture and health benefits, so that future interventions may be designed which better meet the cultural needs of Aboriginal Australians within health services. DESIGN The process of development of the ACES involved four stages of scale development utilising a series of group discussions and reviews with Aboriginal consultants. Assessment of content validity is conducted using the Content Validity Index (CVI). RESULTS The ACES was found to have excellent content validity with CVIs over 0.80 for all items in the final version. CONCLUSION The ACES shows promise for being a useful tool in assessing the cultural engagement of Australian Aboriginal clients. There is a need for further psychometric assessment and field trials to assess its utility.
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Affiliation(s)
- Stacey L Berry
- Illawarra Institute for Mental Health, University of Wollongong, NSW, Australia.
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