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Fono M, Rambaldini B, Christie V, Gwynne K. Co-designing policy with Aboriginal and Torres Strait Islander peoples: a protocol. Public Health Res Pract 2024:34122404. [PMID: 38710581 DOI: 10.17061/phrp34122404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
Objectives and importance of study: In the public service context, co-design is novel and ever-expanding. Co-design brings together decision-makers and people impacted by a problem to unpack the problem and design solutions together. Government agencies are increasingly adopting co-design to understand and meet the unique needs of priority populations. While the literature illustrates a progressive uptake of co-design in service delivery, there is little evidence of co-design in policy development. We propose a qualitative study protocol to explore and synthesise the evidence (literary, experiential and theoretical) of co-design in public policy. This can inform a framework to guide policymakers who co-design health policy with Aboriginal and Torres Strait Islander people. Methods: The study design is informed by a critical qualitative approach that comprises five successive stages. The study commences with the set-up of a co-design brains trust (CBT), comprising people with lived experience of being Aboriginal and Torres Strait Islander who have either co-designed with public agencies and/or have health policymaking expertise (stage 1) The brains trust will play a key role in guiding the protocol's methodology, data collection, reporting and co-designing a 'Version 1' framework to guide policymakers in co-designing health policy with Aboriginal and Torres Strait Islander people (the framework). Two realist evaluations will explore co-design in health policy settings to understand how co-design works for whom, under what circumstances, and how (stages 2 and 3) The findings of the realist evaluations will guide the CBT in developing the framework (stage 4). A process evaluation of the CBT setup and framework development will assess the degree to which the CBT achieved its intended objectives (stage 5). Conclusion: The proposed study will produce much-needed evidence to guide policymakers to share decision-making power and privilege the voices of Aboriginal and Torres Strait Islander people when co-designing health policy. Learnings from this translational research will be shared via the CBT, academic papers, conference presentations and policy briefings.
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Affiliation(s)
- Margaret Fono
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Heart Research Institute (HRI), Sydney, NSW, Australia
| | - Boe Rambaldini
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Heart Research Institute (HRI), Sydney, NSW, Australia
| | - Vita Christie
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Heart Research Institute (HRI), Sydney, NSW, Australia
| | - Kylie Gwynne
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Heart Research Institute (HRI), Sydney, NSW, Australia
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Henson C, Rambaldini B, Freedman B, Carlson B, Parter C, Christie V, Skinner J, Meharg D, Kirwan M, Ward K, Speier SN'Ḵ', Gwynne K. Wearables for early detection of atrial fibrillation and timely referral for Indigenous people ≥55 years: mixed-methods protocol. BMJ Open 2024; 14:e077820. [PMID: 38199631 PMCID: PMC10806615 DOI: 10.1136/bmjopen-2023-077820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Digital health technologies have the potential to provide cost-effective care to remote and underserved populations. To realise this potential, research must involve people not traditionally included. No research focuses on the acceptability and feasibility of older Indigenous people using wearables for early atrial fibrillation (AF) detection. This protocol compares digital augmentation against standard practice to detect AF, evaluate heart health self-efficacy and health literacy changes and identify barriers in collaboration with Aboriginal Community Controlled Health Organisations. It will establish a framework for implementing culturally safe and acceptable wearable programmes for detecting and managing AF in Indigenous adults ≥55 years and older. METHODS This mixed-methods research will use the Rambaldini model of collective impact, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology to assess the cultural safety, acceptability, feasibility and efficacy of incorporating wearables into standard care for early AF detection. ANALYSIS Qualitative data will be analysed to create composite descriptions of participants' experiences and perspectives related to comfort, cultural safety, convenience, confidence, family reactions and concerns. Quantitative device data will be extracted and analysed via Statistical Product and Service Solutions (SPSS). CONCLUSION Prioritising perspectives of older Indigenous adults on using wearables for detecting and monitoring cardiovascular disease will ensure that the findings are effective, relevant and acceptable to those impacted. ETHICS AND DISSEMINATION Findings will be published in open-source peer-reviewed journals, shared at professional conferences, described in lay terms and made available to the public. The AHMRC HREC Reference Number approved 1135/15.
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Affiliation(s)
- Connie Henson
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Boe Rambaldini
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Ben Freedman
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Dept of Cardiology, Concord Clinical School, Concord Hospital, Sydney, NSW, Australia
| | - Bronwyn Carlson
- Indigenous Studies, Macquarie University Faculty of Arts, North Ryde, New South Wales, Australia
- Centre for Global Indigenous Futures, Macquarie University Faculty of Arts, North Ryde, New South Wales, Australia
| | - Carmen Parter
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Vita Christie
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - John Skinner
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - David Meharg
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Morwenna Kirwan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Katrina Ward
- Brewarrina Aboriginal Medical Service, Brewarrina, New South Wales, Australia
| | | | - Kylie Gwynne
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Henson C, Chapman F, Shepherd G, Carlson B, Rambaldini B, Gwynne K. Amplifying Older Aboriginal and Torres Strait Islander Women's Perspectives to Promote Digital Health Equity: Co-Designed Qualitative Study. J Med Internet Res 2023; 25:e50584. [PMID: 37847550 PMCID: PMC10618878 DOI: 10.2196/50584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/14/2023] [Accepted: 09/17/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Digital health is becoming ubiquitous, and we must ensure equity in access. Indigenous people across most high-income countries typically have not benefited as much as other citizens from usual health care systems and technologies. Despite Aboriginal and Torres Strait Islander people's clear interest in, and enthusiastic use of, new technologies, little research has examined the needs or interests of older Aboriginal and Torres Strait Islander women. OBJECTIVE This study prioritizes the perspectives of older Aboriginal and Torres Strait Islander women, tapping into their expertise associated with Indigenous ways of knowing, being, and doing, as well as their unique position within their families and communities, to design a model for using digital technologies to improve health for themselves and their families as well as their communities. METHODS Older Aboriginal and Torres Strait Islander women from 4 partner organizations were recruited for this study. This co-designed qualitative research included citizen scientists in shaping the protocol as well as collecting, analyzing, and interpreting data. We used yarning, an Indigenous research method validated for use in health research with Indigenous people and seen as respectful and culturally safe, as a primary research tool. The use of Indigenous methodologies and our iterative process enabled us to deeply explore and incorporate perspectives from all participants and ensure that the perspectives of Indigenous citizen scientists with lived experience were privileged. The data-checking methods also used a yarning methodology, which ensured that the findings and translational model derived from the findings were validated by the participants. RESULTS Participants comprised 24 Aboriginal and Torres Strait Islander women aged ≥41 years and including 3 generations that did not grow up with the internet: seniors, baby boomers, and Generation X. The key findings in this research were that older women use various digital technologies to improve health and well-being for themselves and their families as well as their communities. Older Aboriginal women want a culturally sensitive cyberspace that caters specifically to their needs and includes relevant content and functionality that are accessible and efficient. Our translational model highlights the conditions necessary for anyone to use digital health technologies, summarizes the essential elements needed to promote equity in digital health, and illuminates the unmet needs and requirements for older Aboriginal and Torres Strait Islander women to fully benefit from digital health technologies. CONCLUSIONS Health is a fundamental right. As we move toward greater reliance on digital health solutions, we must recognize and address the concerns of the smaller populations of people who differ in their needs. We must urgently address the financial, connectivity, and other limiting factors highlighted by older Aboriginal and Torres Strait Islander women in this study that limit equitable access to digital health tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076221084469.
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Affiliation(s)
- Connie Henson
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, Australia
| | - Felicity Chapman
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, Australia
| | - Gina Shepherd
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, Australia
| | - Bronwyn Carlson
- Centre for Global Indigenous Futures, Macquarie University, Macquarie University, Australia
- Department of Indigenous Studies, Faculty of Arts, Macquarie University, Macquarie University, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, Australia
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Ubrihien A, Lewis DA, Rambaldini B, Kirwan M, Gwynne K. Clinicians' perspectives on why young Aboriginal people are not testing for sexually transmissible infections in Western Sydney. Int J STD AIDS 2023; 34:803-808. [PMID: 37277965 DOI: 10.1177/09564624231179766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Incidence of sexually transmissible infections (STI) amongst young Aboriginal people in Australia are significantly higher compared to the wider population. Low levels of engagement with public sexual health services also exacerbates health inequity. This study sought to understand the access barriers facing Aboriginal People with local Sexual Health services from the perspective of local clinicians within Western Sydney. METHODS Six clinicians (six registered nurses, two medical practitioners) and two social workers, working in a Sexual Health service, were interviewed using a semi-structure questionnaire. Interviews were audio recorded and transcribed verbatim. Interview texts were analysed using NVIVO 12 and a thematic analysis undertaken. RESULTS Thematic analysis revealed three broad themes: personal, practical, and programmatic. Clinicians believed the involvement of Aboriginal people in service delivery would contribute to greater inclusion and more culturally competent services. Clinicians also considered that young Aboriginal people were unaware of the risks of untreated STIs, and that greater STI-related education regarding risk and prevention may reduce STI incidence and improve participation in services. Clinicians believed that culturally-competent STI education would be more effective if co-designed with the local Aboriginal community. Clinicians identified that Aboriginal young people were concerned about their privacy when accessing services, and that barriers could be reduced by greater community engagement in service delivery design and quality improvement initiatives. CONCLUSION The three themes identified in this study provide guidance for service providers about approaches that may enhance the access, participation, and cultural safety sexual health services for Aboriginal clients.
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Affiliation(s)
- Ashley Ubrihien
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, NSW, Australia
- Westmead Clinical School and Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Morwenna Kirwan
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Gwynne K, Jiang S, Venema R, Christie V, Boughtwood T, Ritha M, Skinner J, Ali N, Rambaldini B, Calma T. Genomics and inclusion of Indigenous peoples in high income countries. Hum Genet 2023; 142:1407-1416. [PMID: 37479894 PMCID: PMC10449672 DOI: 10.1007/s00439-023-02587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
Genomics research related to Indigenous people has been at worst exploitative and at best, retrospectively on a journey to improve effective engagement of Indigenous individuals and communities. Genomics can positively impact all stages of clinical management, and to improve genomic effectiveness researchers aggregate genomic data from diverse global sub-populations, such as shared ancestry groupings, as people within these groupings will have a greater proportion of shared DNA traits. While genomics is already being used worldwide to improve lives, its utility and effectiveness has not been maximized for individuals with Indigenous ancestry. Several large datasets of human genetic variation have been made publicly available, of which the most widely used is the Genome Aggregation Database (gnomAD), but none of these databases currently contain any population-specific data for Indigenous populations. There are many reasons why Indigenous people have been largely left out of genomics research and, because of this, miss out on the benefits offered. It is also clear that if research is to be effective, it needs to be done 'with' and not 'on' Indigenous communities. This systematic review of the literature regarding Indigenous peoples (in high income countries) and genomics aims to review the existing literature and identify areas of strength and weakness in study design and conduct, focusing on the effectiveness of Indigenous community engagement.
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Affiliation(s)
- Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Education and Research (Formerly Known as Poche Centre for Indigenous Health), Macquarie University, Walanga Muru Building, 6 First Walk, Sydney, NSW, 2113, Australia
| | - Shirley Jiang
- University of Toronto, 27 King's College Circuit, Toronto, Canada
| | - Robertson Venema
- University of Toronto, 27 King's College Circuit, Toronto, Canada
| | - Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Education and Research (Formerly Known as Poche Centre for Indigenous Health), Macquarie University, Walanga Muru Building, 6 First Walk, Sydney, NSW, 2113, Australia.
| | - Tiffany Boughtwood
- Australian Genomics, 50 Flemington Rd, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Marida Ritha
- Djurali Centre for Aboriginal and Torres Strait Islander Education and Research (Formerly Known as Poche Centre for Indigenous Health), Macquarie University, Walanga Muru Building, 6 First Walk, Sydney, NSW, 2113, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Education and Research (Formerly Known as Poche Centre for Indigenous Health), Macquarie University, Walanga Muru Building, 6 First Walk, Sydney, NSW, 2113, Australia
| | - Nyesa Ali
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Education and Research (Formerly Known as Poche Centre for Indigenous Health), Macquarie University, Walanga Muru Building, 6 First Walk, Sydney, NSW, 2113, Australia
| | - Tom Calma
- Djurali Centre for Aboriginal and Torres Strait Islander Education and Research (Formerly Known as Poche Centre for Indigenous Health), Macquarie University, Walanga Muru Building, 6 First Walk, Sydney, NSW, 2113, Australia
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Christie V, Riley L, Green D, Snook K, Henningham M, Rambaldini B, Amin J, Pyke C, Varlow M, Goss S, Skinner J, O'Shea R, McCowen D, Gwynne K. Does breast cancer policy meet the needs of Aboriginal and Torres Strait Islander women in Australia? a review. Int J Equity Health 2023; 22:129. [PMID: 37408069 DOI: 10.1186/s12939-023-01941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE To evaluate if existing Australian public policy related to screening, diagnosis, treatment and follow up care for breast cancer addresses the needs of and outcomes for Indigenous1 women? METHODS This review of policy employed a modified Delphi method via an online panel of experts (n = 13), who were purposively recruited according to experience and expertise. A series of online meetings and online surveys were used for data collection. The aims of the study were to: Identify all existing and current breast cancer policy in Australia; Analyse the extent to which consideration of Indigenous peoples is included in the development, design and implementation of the policy; and Identify policy gaps and make recommendations as to how they could be addressed. The policies were evaluated using 'A Guide to Evaluation under the Indigenous Evaluation Strategy, 2020'. RESULTS A list of current breast cancer policies (n = 7) was agreed and analysed. Five draft recommendations to improve breast cancer outcomes for Indigenous women were developed and refined by the panel. CONCLUSIONS Current breast cancer policy in Australia does not address the needs of Indigenous women and requires change to improve outcomes.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia.
| | - Lynette Riley
- Indigenous Studies & Aboriginal Education, The University of Sydney, Education Building (A36), Sydney, NSW, 2006, Australia
| | - Deb Green
- Armajun Aboriginal Health Service, Rusden Street, Armidale, NSW, 2350, Australia
| | - Kylie Snook
- BreastSurgANZ, Black Rock, Melbourne, Victoria, 3193, Australia
| | - Mandy Henningham
- Cancer Council Australia, Level 2, 320 Pitt Street, Sydney, NSW, 2000, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Chris Pyke
- Mater Hospital, Vulture Street, South Brisbane, QLD, 4101, Australia
| | - Megan Varlow
- Cancer Council Australia, Level 2, 320 Pitt Street, Sydney, NSW, 2109, Australia
| | - Sally Goss
- University of Sydney, Sydney, NSW, 2006, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia
| | - Ross O'Shea
- Foundation of Breast Cancer Care and Breast SurgANZ, Black Rock, Melbourne, Victoria, 3193, Australia
| | - Deb McCowen
- Armajun Aboriginal Health Service, Rivers St, Inverell, NSW, 2360, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia
- Indigenous Studies & Aboriginal Education, The University of Sydney, Education Building (A36), Sydney, NSW, 2006, Australia
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Christie V, Green D, Skinner J, Riley L, O'Shea R, Littlejohn K, Pyke C, McCowen D, Rambaldini B, Gwynne K. "Everyone needs a Deb": what Australian indigenous women say about breast cancer screening and treatment services. BMC Health Serv Res 2023; 23:672. [PMID: 37344905 DOI: 10.1186/s12913-023-09633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Breast cancer continues to be the second most diagnosed cancer overall and the most diagnosed cancer for women in Australia. While mortality rates overall have declined in recent years, Indigenous women continue to be diagnosed at more marginal rates (0.9 times) and are more likely to die (1.2 times). The literature provides a myriad of reasons for this; however, the voices of Indigenous women are largely absent. This study sets out to understand what is happening from the perspectives of Australian Indigenous women with a view to charting culturally safer pathways that improve participation in screening and treatment by Indigenous women. METHODS This co-design study was conducted using semi-structured, in-depth interviews and focus group discussions. Recruitment of study participants was via snowball sampling. Participants were subsequently consented into the study through the Aboriginal Health Service and the research team. Interviews were audio recorded and transcribed verbatim, and data coded in NVivo12 using inductive thematic analysis. RESULTS A total of 21 Indigenous women and 14 health service providers were interviewed predominantly from the same regional/rural area in NSW, with a small proportion from other states in Australia. Six major themes were identified: Access, Awareness, Community and Family, Lack of control, Negative feelings and associations and Role of services. CONCLUSION To improve access and participation of Indigenous women and ultimately improve mortality rates, breast cancer services must explicitly address cultural and community needs.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia.
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale and Inverell, NSW, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
| | - Lynette Riley
- Indigenous Studies & Aboriginal Education, The University of Sydney, Camperdown, NSW, Australia
| | - Ross O'Shea
- Foundation for Breast Cancer Care, Brisbane, Australia
| | | | | | - Debbie McCowen
- Armajun Aboriginal Health Service, Armidale and Inverell, NSW, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
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Nash K, Macniven R, Clague L, Coates H, Fitzpatrick M, Gunasekera H, Gwynne K, Halvorsen L, Harkus S, Holt L, Lumby N, Neal K, Orr N, Pellicano E, Rambaldini B, McMahon C. Ear and hearing care programs for First Nations children: a scoping review. BMC Health Serv Res 2023; 23:380. [PMID: 37076841 PMCID: PMC10116763 DOI: 10.1186/s12913-023-09338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs. METHOD A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services. RESULTS Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases. CONCLUSION The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
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Affiliation(s)
- Kai Nash
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia.
| | - Rona Macniven
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Liesa Clague
- Thurru Indigenous Unit, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Harvey Coates
- The University of Western Australia, Perth, Australia
| | | | | | - Kylie Gwynne
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | - Luke Halvorsen
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Leanne Holt
- Department of Indigenous Studies, Macquarie University, Sydney, Australia
| | - Noeleen Lumby
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Neil Orr
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Boe Rambaldini
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | - Catherine McMahon
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
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Henson C, Chapman F, Shepherd G, Carlson B, Rambaldini B, Gwynne K. How Older Indigenous Women Living in High-Income Countries Use Digital Health Technology: Systematic Review. J Med Internet Res 2023; 25:e41984. [PMID: 37071466 PMCID: PMC10155089 DOI: 10.2196/41984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/21/2022] [Accepted: 03/15/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Research associated with digital health technologies similar to the technologies themselves has proliferated in the last 2 decades. There are calls for these technologies to provide cost-effective health care for underserved populations. However, the research community has also underserved many of these populations. Older Indigenous women are one such segment of the population. OBJECTIVE Our objective is to systematically review the literature to consolidate and document what we know about how older Indigenous women living in high-income countries use digital health technology to enhance their health. METHODS We analyzed the peer-reviewed literature by systematically searching 8 databases in March 2022. We included studies published between January 2006 and March 2022 with original data specific to older Indigenous women from high-income countries that reported on the effectiveness, acceptability, and usability of some user-focused digital health technology. We incorporated 2 measures of quality for each study. We also conducted a thematic analysis and a lived experience analysis, which examined each paper from the perspectives of older Indigenous women. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study. RESULTS Three papers met the inclusion criteria. The key findings were that older Indigenous women do not see themselves reflected in mainstream health messaging or other digital health offerings. They prefer an approach that considers their uniqueness and diversity. We also identified 2 significant gaps in the literature. First, research reporting on older Indigenous women from high-income countries' experiences with digital health technology is minimal. Second, the limited research related to older Indigenous women has not consistently engaged Indigenous people in the research process or governance. CONCLUSIONS Older Indigenous women want digital health technologies to respond to their needs and preferences. Research is needed to understand their requirements and preferences to ensure equity as we move toward greater adoption of digital health technology. Engaging older Indigenous women throughout the research is essential to ensuring that digital health products and services are safe, usable, effective, and acceptable for older Indigenous women.
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Affiliation(s)
- Connie Henson
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Djurali Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Sydney, Australia
| | - Felicity Chapman
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Gina Shepherd
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Bronwyn Carlson
- Centre for Global Indigenous Futures, Macquarie University, Sydney, Australia
- Department of Indigenous Studies, Faculty of Arts, Macquarie University, Sydney, Australia
| | - Boe Rambaldini
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Djurali Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Sydney, Australia
| | - Kylie Gwynne
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Djurali Aboriginal and Torres Strait Islander Research and Education, Macquarie University, Sydney, Australia
- Centre for Global Indigenous Futures, Macquarie University, Sydney, Australia
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10
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Parter C, Rambaldini B, Wilson S, Gwynn J, C Skinner J, Calma Ao T. Heal country, heal our nation: Talking up racism ☆. Aust N Z J Public Health 2023; 47:100037. [PMID: 37023483 DOI: 10.1016/j.anzjph.2023.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Carmen Parter
- Department of Health Sciences, Faculty of Medicine, Health and Human Services, Djurali Aboriginal and Torres Strait Islander Research and Education, Six First Walk, Macquarie University, NSW, 2109, Australia.
| | - Boe Rambaldini
- Department of Health Sciences, Faculty of Medicine, Health and Human Services, Djurali Aboriginal and Torres Strait Islander Research and Education, Six First Walk, Macquarie University, NSW, 2109, Australia
| | - Shawn Wilson
- Irving K Barber Faculty of Arts + Social Science | Community, Culture, and Global Studies, University of British, Columbia, Okanagan, Canada; Gnibi College of Indigenous Australian Peoples, Southern Cross University, Australia
| | - Josephine Gwynn
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney, Australia
| | - John C Skinner
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences; Djurali Aboriginal and Torres Strait Islander Health Research and Education, Six First Walk Macquarie University, NSW, 2109, Australia
| | - Tom Calma Ao
- University of Sydney, Australia; Macquarie University, Australia
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11
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Meharg DP, Dennis SM, McNab J, Gwynne KG, Jenkins CR, Maguire GP, Jan S, Shaw T, McKeough Z, Rambaldini B, Lee V, McCowen D, Newman J, Monaghan S, Longbottom H, Eades SJ, Alison JA. A mixed methods study of Aboriginal health workers' and exercise physiologists' experiences of co-designing chronic lung disease 'yarning' education resources. BMC Public Health 2023; 23:612. [PMID: 36997963 PMCID: PMC10063331 DOI: 10.1186/s12889-023-15508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management. AIM To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management. METHODS AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework '8 Ways of learning', which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise is important; Managing breathlessness; Healthy eating; Managing anxiety and depression. After each session, AHWs with support from EPs, co-designed education 'yarning' resources using Aboriginal ways of learning to ensure topics were culturally safe for the local Aboriginal community and practiced delivering this at the following session. At the end of the program participants completed an anonymous online survey (5-point Likert scale) to assess satisfaction, and a semi-structured interview about their experience of the online education. RESULTS Of the 12 participants, 11 completed the survey (7 AHWs, 4 EPs). Most (90%) participants strongly agreed or agreed that the online sessions increased knowledge and skills they needed to support Aboriginal patients with COPD. All (100%) participants felt: their cultural perspectives and opinions were valued and that they were encouraged to include cultural knowledge. Most (91%) reported that delivering their own co-designed yarning scripts during the online sessions improved their understanding of the topics. Eleven participants completed semi-structured interviews about participating in online education to co-design Aboriginal 'yarning' resources. Themes identified were: revealing the Aboriginal lung health landscape; participating in online learning; structuring the online education sessions; co-designing with the facilitators. CONCLUSIONS Online education using co-design and 8 Ways of learning was rated highly by AHWs and EPs for improving COPD knowledge and valuing cultural perspectives. The use of co-design principles supported the cultural adaptation of COPD resources for Aboriginal people with COPD. TRIAL REGISTRATION PROSPERO (registration number: CRD42019111405).
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia.
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Justin McNab
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
- University of New South Wales, Sydney, Kensington, NSW, 2052, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Stephen Jan
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, 2800, Australia
| | - Scott Monaghan
- Bulgarr Ngaru Medical Aboriginal Corporation, Grafton, NSW, 2460, Australia
| | - Hayley Longbottom
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, NSW, 2541, Australia
| | - Sandra J Eades
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
- Centre for Epidemiology and Biostatistics, The School of Population and Global Health, The University of Melbourne, Carlton South, Victoria, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Western Avenue, Camperdown, NSW, 2006, Australia
- Sydney Local Health District, Camperdown, NSW, 2050, Australia
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12
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Meharg DP, Naanyu V, Rambaldini B, Clarke MJ, Lacey C, Jebasingh F, Lopez-Jaramillo P, Gould GS, Aceves B, Alison JA, Chaiton M, Chen J, Gonzalez-Salazar F, Goodyear-Smith F, Gwynne KG, Lee KS, MacKay D, Maple-Brown L, Mishara BL, Nigenda G, Ramani-Chander A, Sherwood SG, Thomas N, Thrift AG, Anderson M. The Global Alliance for Chronic Diseases researchers' statement on non-communicable disease research with Indigenous peoples. Lancet Glob Health 2023; 11:e324-e326. [PMID: 36796972 DOI: 10.1016/s2214-109x(23)00039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Affiliation(s)
- David P Meharg
- Sydney School of Health Sciences, University of Sydney, Sydney 2006, NSW, Australia; Faculty of Medicine and Health, and Poche Centre for Indigenous Health, University of Sydney, Sydney 2006, NSW, Australia.
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Marilyn J Clarke
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Cameron Lacey
- Māori Indigenous Health Innovation, University of Otago, Christchurch, New Zealand
| | - Felix Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Gillian S Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Benjamin Aceves
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jennifer A Alison
- Sydney School of Health Sciences, University of Sydney, Sydney 2006, NSW, Australia; Allied Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Jun Chen
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Francisco Gonzalez-Salazar
- Cytogenetics Department, Northeast Biomedical Research Center, Mexican Institute of Social Security, Monterrey, Mexico
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kylie S Lee
- The Edith Collins Centre, Sydney Local Health District, Sydney, NSW, Australia; National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Burnet Institute, Melbourne, VIC, Australia; Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney 2006, NSW, Australia
| | - Diana MacKay
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia; Department of Endocrinology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia; Department of Endocrinology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Brian L Mishara
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Stephen G Sherwood
- Fundación EkoRural, Quito, Ecuador and Wageningen University, Wageningen, Netherlands
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Michael Anderson
- Waakebiness Institute for Indigenous Health, University of Toronto, Toronto, ON, Canada
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13
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Henson C, Chapman F, Shepherd G, Carlson B, Chau JY, Gwynn J, McCowen D, Rambaldini B, Ward K, Gwynne K. Mature aged Aboriginal and Torres Strait Islander adults are using digital health technologies (original research). Digit Health 2022; 8:20552076221145846. [PMID: 36544536 PMCID: PMC9761236 DOI: 10.1177/20552076221145846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander people avidly use technology for a variety of purposes. Digital health technologies offer a new way to build on Aboriginal and Torres Strait Islander peoples propensity for early adoption and innovation with technology. Only limited research has focused on mature aged adults in non-urban locations as partners in digital health research and there is no research related to wearables for health tracking for this cohort. Objective This paper provides insights into mature aged Aboriginal and Torres Strait Islander adults interest, use and trust of social media, apps and wearables to gain health information and manage health. Methods This cross-sectional survey study was co-designed and co-implemented with Aboriginal Community Controlled Health Services (ACCHS) in three locations in New South Wales, Australia. The 13-item survey was administered via a semi-structured interview. Results Aboriginal and Torres Strait Islander adults (n = 78), in regional, rural and remote locations indicated their interest in and use of apps and wearables for health purposes. Mature aged participants, particularly women, used Facebook, ACCHS websites and YouTube for acquiring health-related information which they then shared online and in real life with a diversity of family, friends and colleagues. Conclusions Aboriginal and Torres Strait Islander people are using digital health technologies to acquire and share health information and want to use apps and wearables for health management. Co-designed research enables a greater understanding of the diverse needs for different cohorts and informs culturally responsible design. Broader use of co-design will foster effective user-focused digital health communication and health-management.
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Affiliation(s)
- Connie Henson
- Department of Health Sciences, Faculty of Medicine, Health and Human
Sciences, Macquarie
University, Sydney, New South Wales,
Australia,Djurali Aboriginal and Torres Strait Islander Health Research Group,
Sydney, Australia,Connie Henson, Faculty of Medicine, Health
and Human Sciences, Macquarie University, Level 3, 75 Talavera Rd, New South
Wales 2113, Australia.
| | - Felicity Chapman
- Department of Health Sciences, Faculty of Medicine, Health and Human
Sciences, Macquarie
University, Sydney, New South Wales,
Australia,Djurali Aboriginal and Torres Strait Islander Health Research Group,
Sydney, Australia
| | - Gina Shepherd
- Department of Health Sciences, Faculty of Medicine, Health and Human
Sciences, Macquarie
University, Sydney, New South Wales,
Australia,Djurali Aboriginal and Torres Strait Islander Health Research Group,
Sydney, Australia
| | - Bronwyn Carlson
- Centre for Global Indigenous Futures,
Macquarie
University, Sydney, New South Wales,
Australia,Department of Indigenous Studies, Faculty of Arts,
Macquarie
University, Sydney, New South Wales,
Australia
| | - Josephine Y Chau
- Department of Health Sciences, Faculty of Medicine, Health and Human
Sciences, Macquarie
University, Sydney, New South Wales,
Australia
| | - Josephine Gwynn
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of
Sydney, Sydney, New South Wales,
Australia,Poche Centre
for Indigenous Health, University of
Sydney, Sydney, New South Wales, Australia,Charles
Perkins Centre University of Sydney,
Sydney, New South Wales, Australia
| | - Deb McCowen
- Armajun Aboriginal Health Services, Inverell, New South Wales,
Australia
| | - Boe Rambaldini
- Department of Health Sciences, Faculty of Medicine, Health and Human
Sciences, Macquarie
University, Sydney, New South Wales,
Australia,Djurali Aboriginal and Torres Strait Islander Health Research Group,
Sydney, Australia
| | - Katrina Ward
- Brewarrina Aboriginal Medical Services, Brewarrina, New South Wales,
Australia
| | - Kylie Gwynne
- Department of Health Sciences, Faculty of Medicine, Health and Human
Sciences, Macquarie
University, Sydney, New South Wales,
Australia,Djurali Aboriginal and Torres Strait Islander Health Research Group,
Sydney, Australia
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14
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Calvin Z, Skinner J, Dimitropoulos Y, Stan G, Satur J, Cartwright S, Widmer RP, Schafer T, Williams R, Sohn W, Raphael S, Christian B, Parter C, Blatchford L, Rambaldini B, Partridge SR, Cain E, Gwynne K. The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol. Int J Environ Res Public Health 2022; 19:ijerph19159104. [PMID: 35897473 PMCID: PMC9331033 DOI: 10.3390/ijerph19159104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
Background: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. Methods: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. Discussion: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. Trial registration: TRN: ISRCTN15496753 Date of registration: 20 October 2021.
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Affiliation(s)
- Zac Calvin
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Anderson Stuart Building, The University of Sydney, Sydney, NSW 2006, Australia;
| | - John Skinner
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, Sydney, NSW 2006, Australia;
- Centre for Global Indigenous Futures, Macquarie University, 3/75 Talavera Road, Macquarie Park, NSW 2113, Australia; (B.R.); (K.G.)
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, Sydney, NSW 2006, Australia;
- Department of Linguistics, Macquarie University, 16 University Avenue, Macquarie Park, NSW 2113, Australia
- Correspondence:
| | - Gabriela Stan
- Kingswood TAFE, 12–44 O’Connell Street, Kingswood, NSW 2747, Australia;
| | - Julie Satur
- Melbourne Dental School, Level 5, 720 Swanston Street, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Susan Cartwright
- Colgate-Palmolive Company, Level 14, 345 George Street, Sydney, NSW 2001, Australia;
| | - Richard P. Widmer
- Paediatric Dentistry, The Children’s Hospital at Westmead, Corner of Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia;
| | - Tiarnee Schafer
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia;
| | - Rachel Williams
- Armajun Aboriginal Health Service, 1 Rivers Street, Inverell, NSW 2360, Australia;
| | - Woosung Sohn
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Darcy Road, Westmead, NSW 2145, Australia;
| | - Sarah Raphael
- Australian Dental Association NSW Branch, L1 1 Atchison Street, St Leonards, NSW 2065, Australia;
| | - Bradley Christian
- Western NSW Local Health District, Poplars Building, Bloomfield Campus, Forest Road, Orange, NSW 2800, Australia;
| | - Carmen Parter
- Poche Centre for Indigenous Health, 31 Upland Road, University of Queensland, St Lucia, QLD 4067, Australia;
| | - Lauren Blatchford
- Albury Wodonga Aboriginal Health Service, 664 Daniel Street, Glenroy, NSW 2640, Australia;
| | - Boe Rambaldini
- Centre for Global Indigenous Futures, Macquarie University, 3/75 Talavera Road, Macquarie Park, NSW 2113, Australia; (B.R.); (K.G.)
| | - Stephanie R. Partridge
- Engagement and Co-Design Hub, Faculty of Medicine and Health, The University of Sydney, Level 6, Block K, The University of Sydney at Westmead Hospital, Westmead, NSW 2145, Australia;
| | - Elyse Cain
- NSW Council of Social Service, Level 3, 52–58 William Street, Woolloomooloo, NSW 2011, Australia;
| | - Kylie Gwynne
- Centre for Global Indigenous Futures, Macquarie University, 3/75 Talavera Road, Macquarie Park, NSW 2113, Australia; (B.R.); (K.G.)
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15
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Meharg DP, Jenkins CR, Maguire GP, Jan S, Shaw T, Dennis SM, McKeough Z, Lee V, Gwynne KG, McCowen D, Rambaldini B, Alison JA. Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol). BMC Pulm Med 2022; 22:239. [PMID: 35729525 PMCID: PMC9210710 DOI: 10.1186/s12890-022-02033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD. METHODS Multi-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program. OUTCOMES AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests. DISCUSSION Pulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Kensington, NSW, 2052, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Stephan Jan
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia.
- Sydney Local Health District, Camperdown, NSW, 2050, Australia.
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Gwynne K, Rambaldini B, Christie V, Meharg D, Gwynn JD, Dimitropoulos Y, Parter C, Skinner JC. Applying collective impact in Aboriginal health services and research: three case studies tell an important story. Public Health Res Pract 2022; 32:3222215. [PMID: 35702748 DOI: 10.17061/phrp3222215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Co-design is the latest buzzword in healthcare services and research and is ubiquitous in Australian funding grants and policy documents. There are no standards for what constitutes co-design and it is often confused with less collaborative processes such as consultation. Collective impact is a co-design tool used for complex and entrenched problems. It uses a systematic approach and requires power and resource sharing. We applied collective impact to three research projects with Aboriginal communities. This paper explores how collective impact can enhance participation and outcomes in healthcare services and research. METHODS We evaluated the collective impact process and outcomes in three translational health research projects with Aboriginal people and communities using a case study approach. We adapted the model using an iterative co-design approach. RESULTS We adapted the collective impact model in three ways: 1) replaced the precondition of 'problems that are urgent' with 'problems that are complex and entrenched'; 2) added to the 'common agenda' the requirement to establish a planned exit and long-term sustainability strategy from the outset; and 3) added the delivery of a public policy outcome as a result of the collective impact process. CONCLUSIONS Aboriginal and Torres Strait Islander health is an important public policy priority that requires new and different approaches to service delivery and research. This study adapted the collective impact approach and developed the Rambaldini model through three translational health research case studies and found that a modified collective impact approach is an effective tool for engagement and outcomes.
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Affiliation(s)
- Kylie Gwynne
- Centre for Global Indigenous Futures, Macquarie University, Sydney, NSW, Australia; Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia;
| | - Boe Rambaldini
- Centre for Global Indigenous Futures, Macquarie University, Sydney, NSW, Australia; Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Poche Centre for Indigenous Health, University of Sydney, NSW, Australia
| | - Vita Christie
- Centre for Global Indigenous Futures, Macquarie University, Sydney, NSW, Australia; Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Poche Centre for Indigenous Health, University of Sydney, NSW, Australia
| | - David Meharg
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Josephine D Gwynn
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | | | - Carmen Parter
- Centre for Global Indigenous Futures, Macquarie University, Sydney, NSW, Australia; Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia
| | - John C Skinner
- Centre for Global Indigenous Futures, Macquarie University, Sydney, NSW, Australia; Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Perry C, Dimitropoulos Y, Skinner J, Bourke C, Miranda K, Cain E, Beaufils D, Christie V, Rambaldini B, Gwynne K. Availability of drinking water in rural and remote communities in New South Wales, Australia. Aust J Prim Health 2022; 28:125-130. [PMID: 35101161 DOI: 10.1071/py21119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
Many rural communities in New South Wales (NSW), Australia, have poor-quality water supplies. The lack of a palatable alternative increases the risk of the high consumption of sugar-sweetened beverages, a significant contributor to adverse health outcomes. This disproportionately effects Aboriginal people living in these towns, who are also profoundly affected by the social determinants of health. Therefore, examining health inequalities linked to water access is important. This study investigated the availability of drinking water fountains in rural and remote communities in NSW. Telephone interviewer-assisted surveys were conducted with 32 representatives from local government councils or Local Aboriginal Land Councils in NSW from communities with a population of <5000 and an Aboriginal population of at least 3%. The results were analysed descriptively. Towns and communities with a higher population of Aboriginal people and lower median weekly income were less likely to have access to free refrigerated and filtered water within the community or at local schools compared with towns and communities with a lower Aboriginal population and higher median weekly income. The availability of free, clean and refrigerated water in rural and remote communities is critical to reducing the consumption of sugar-sweetened beverages and the promotion of water as the preferred drink.
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Affiliation(s)
- Christina Perry
- Gallatin School of Individualized Study, New York University, New York, USA
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia; and Corresponding author
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia
| | - Chris Bourke
- Austrailan Healthcare and Hospitals Association, ACT 2600, Australia
| | - Kate Miranda
- Australian Dental Association, NSW 2065, Australia
| | - Elyse Cain
- New South Wales Council of Social Service, NSW 2011, Australia
| | | | - Vita Christie
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, NSW 2006, Australia
| | - Kylie Gwynne
- Garfield Barwick Chambers, NSW 2000, Australia; and Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
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18
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Henson C, Rambaldini B, Carlson B, Wadolowski M, Vale C, Gwynne K. A new path to address health disparities: How older Aboriginal & Torres Strait Islander women use social media to enhance community health (Protocol). Digit Health 2022; 8:20552076221084469. [PMID: 35273808 PMCID: PMC8902196 DOI: 10.1177/20552076221084469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Digital health offers a fresh avenue to address health disparities
experienced by Aboriginal and Torres Strait Islanders. Despite the scant
evidence about how Aboriginal and Torres Strait Islanders access and use
health technology, the Australian government has prioritised research that
uses technology to enable people to manage their health and promote better
health outcomes. Older Aboriginal and Torres Strait Islander women are
cultural leaders in their communities, enabling them to provide valuable
insights about the safety and efficacy of health care messaging. However, no
research has engaged older Aboriginal and Torres Strait Islander, women as
partners in digital health research. Objective This paper provides a protocol for co-designed translational research that
privileges older Aboriginal & Torres Strait Islander women’s cultural
expertise to design and test a framework for accessible, culturally safe and
feasible digital health technologies. Methods This mixed-methods research project will use the collective impact approach,
a user-centred, co-design methodology and yarning circles, a recognised
Indigenous research methodology. A series of yarning circles with three
different communities will elucidate enablers and barriers to access health
information; co-create a framework clarifying what works and does not work
for digital health promotion in their communities; and test the framework by
co-creating three digital health information programs. Conclusions Privileging the cultural expertise of older Aboriginal and Torres Strait
Islander women will provide a novel perspective and vital guidance that end
users and developers can trust and rely upon to create and evaluate
culturally safe and efficacious digital health promotion programs.
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Affiliation(s)
- Connie Henson
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia
| | - Boe Rambaldini
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Sydney, New South Wales, Australia
| | - Bronwyn Carlson
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Faculty of Arts, Macquarie University, New South Wales, Australia
| | - Monika Wadolowski
- Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia
| | | | - Kylie Gwynne
- Centre for Global Indigenous Futures, Macquarie University, New South Wales, Australia
- Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia
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19
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Calma T, Kong KM, Rambaldini B. How can we create equitable access to hearing healthcare in Australia? Interview with Prof. Tom Calma, Prof. Kelvin Kong and Hon. A/Prof. Boe Rambaldini. Public Health Res Pract 2021; 31:3152126. [PMID: 34873609 DOI: 10.17061/phrp3152126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Despite decades of research demonstrating that early intervention is critical to diagnosing and treating ear disease in Aboriginal and Torres Strait Islander children, not enough progress has been made in providing culturally safe, accessible and equitable hearing health services. In the discussion below, Aboriginal and Torres Strait Islander health leaders Professor Tom Calma, Professor Kelvin Kong and Associate Professor Boe Rambaldini examine the problems and solutions for creating better services to meet the needs of communities where hearing health problems are being neglected, often with catastrophic results for Aboriginal and Torres Strait Islander children and their families.
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Affiliation(s)
- Tom Calma
- Poche Indigenous Health Network, Sydney, NSW, Australia; University of Canberra, ACT, Australia; Macquarie University, Sydney, NSW, Australia; Poche Centre for Indigneous Health, University of Sydney, NSW, Australia
| | - Kelvin M Kong
- Macquarie University, Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Boe Rambaldini
- Macquarie University, Sydney, NSW, Australia; Poche Centre for Indigenous Health, University of Sydney, NSW, Australia;
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Nahdi S, Skinner J, Neubeck L, Freedman B, Gwynn J, Lochen M, Poppe K, Rambaldini B, Rolleston A, Stavrakis S, Gwynne K. One size does not fit all – a realist review of screening for asymptomatic atrial fibrillation in Indigenous communities in Australia, Canada, New Zealand and United States. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it is increasing in prevalence and incidence globally. True prevalence is underestimated because silent/asymptomatic AF is frequent and under-detected, but can cause stroke. Guidelines recommend opportunistic screening for AF in patients aged ≥65 years old. A growing body of evidence from hospital and community-based studies in Australia, New Zealand, Canada and United States indicates this age limit is lower for Indigenous people. Screening for AF meets the World Health Organisation (WHO) criteria for successful routine screening, yet little is known about successful implementation of AF screening in Indigenous communities in developed countries.
Purpose
The aim of this study is to use a realist approach to identify what works, how, for whom and under what circumstances for AF screening of Indigenous communities in Australia, Canada, New Zealand and United States.
Methods
In the realist review, eight databases were searched for studies targeted at AF screening in Indigenous communities. Realist analysis was used to identify context-mechanism-outcome configurations across 11 included records (reporting on 5 studies). Snowball referencing and grey literature were used to iteratively incorporate evidence to enhance the refined programme theory that was the product of the realist analysis.
Results
The realist review included studies using multiple screening strategies such as using tools to increase screening, using different screening environments and training screeners to provide culturally centred care. The realist analysis identified a number of mechanisms that can improve AF screening in Indigenous communities. The contextual factors enabling AF screening programs in Indigenous communities include wider community engagement, opportunistic non-clinical settings, using portable and easy to use devices, increasing knowledge, motivation and confidence in screening amongst Indigenous healthcare workers as well as improving follow-up protocols for abnormal results tailored to screen setting. Barriers to effective AF screening include time-poor working environments, conflicting cultural issues, navigating communication of abnormal results and logistical issues with device use (Figure 1).
Conclusion(s)
Since the life-course risk for AF in Indigenous population is different, a modified screening strategy needs to be put in place. This realist review provides lessons learned for successful implementation of AF screening programs for Indigenous communities. In order to tackle the gap in cardiovascular burden in Indigenous people, this study calls for action to develop AF screening guidelines for Indigenous populations and provides a guide for policy makers about timely and effective AF screening programs for Indigenous communities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Nahdi
- University of Sydney, Sydney, Australia
| | - J Skinner
- University of Sydney, Poche Centre for Indigenous Health, Sydney, Australia
| | - L Neubeck
- Edinburgh Napier University, Edinburgh, United Kingdom
| | - B Freedman
- Heart Research Institute, Sydney, Australia
| | - J Gwynn
- University of Sydney, Poche Centre for Indigenous Health, Sydney, Australia
| | - M.L Lochen
- UiT The Arctic University of Norway, Community Medicine, Tromso, Norway
| | - K Poppe
- The University of Auckland, Auckland, New Zealand
| | - B Rambaldini
- University of Sydney, Poche Centre for Indigenous Health, Sydney, Australia
| | - A Rolleston
- The University of Auckland, Auckland, New Zealand
| | - S Stavrakis
- University of Oklahoma Health Sciences Center, Cardiovascular research, Oklahoma City, United States of America
| | - K Gwynne
- University of Sydney, Poche Centre for Indigenous Health, Sydney, Australia
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21
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Skinner J, Dimitropoulos Y, Sohn W, Holden A, Rambaldini B, Spallek H, Ummer-Christian R, Marshall S, Raymond K, AO TC, Gwynne K. Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia. Healthcare (Basel) 2021; 9:healthcare9081029. [PMID: 34442166 PMCID: PMC8392282 DOI: 10.3390/healthcare9081029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.
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Affiliation(s)
- John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
- Correspondence: ; Tel.: +61-4889-27557
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
| | - Woosung Sohn
- The University of Sydney School of Dentistry, 2 Chalmers St, Surry Hills 2010, Australia; (W.S.); (A.H.); (H.S.)
| | - Alexander Holden
- The University of Sydney School of Dentistry, 2 Chalmers St, Surry Hills 2010, Australia; (W.S.); (A.H.); (H.S.)
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
| | - Heiko Spallek
- The University of Sydney School of Dentistry, 2 Chalmers St, Surry Hills 2010, Australia; (W.S.); (A.H.); (H.S.)
| | - Rahila Ummer-Christian
- Fluoride Varnish Initiative, Loddon Mallee Aboriginal Reference Group, Bendigo 3550, Australia;
| | - Stuart Marshall
- Statewide Dental Services, SA Dental, Level 5 Roma Mitchell House, 136 North Tce, Adelaide 5000, Australia;
| | - Kate Raymond
- Department of Health, Northern Territory Government, Level 7 Manunda Place, 38 Cavenagh Street, Darwin 0800, Australia;
| | - Tom Calma AO
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2113, Australia
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22
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Cheng YY, Nunn J, Skinner J, Rambaldini B, Boughtwood T, Calma T, Brown A, Meldrum C, Dinger ME, Byrne JA, McCowen D, Potter J, Faires K, Cooper S, Gwynne K. A Pathway to Precision Medicine for Aboriginal Australians: A Study Protocol. Methods Protoc 2021; 4:42. [PMID: 34205718 PMCID: PMC8293410 DOI: 10.3390/mps4020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 01/13/2023] Open
Abstract
(1) Background: Genomic precision medicine (PM) utilises people's genomic data to inform the delivery of preventive and therapeutic health care. PM has not been well-established for use with people of Aboriginal and Torres Strait Islander ancestry due to the paucity of genomic data from these communities. We report the development of a new protocol using co-design methods to enhance the potential use of PM for Aboriginal Australians. (2) Methods: This iterative qualitative study consists of five main phases. Phase-I will ensure appropriate governance of the project and establishment of a Project Advisory Committee. Following an initial consultation with the Aboriginal community, Phase-II will invite community members to participate in co-design workshops. In Phase-III, the Chief Investigators will participate in co-design workshops and document generated ideas. The notes shall be analysed thematically in Phase-IV with Aboriginal community representatives, and the summary will be disseminated to the communities. In Phase-V, we will evaluate the co-design process and adapt our protocol for the use in partnership with other communities. (3) Discussion: This study protocol represents a crucial first step to ensure that PM research is relevant and acceptable to Aboriginal Australians. Without fair access to PM, the gap in health outcome between Aboriginal and non-Aboriginal Australians will continue to widen.
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Affiliation(s)
- Yeu-Yao Cheng
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW 2050, Australia; (J.S.); (B.R.); (T.C.)
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW 2050, Australia
| | - Jack Nunn
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia;
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW 2050, Australia; (J.S.); (B.R.); (T.C.)
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW 2050, Australia; (J.S.); (B.R.); (T.C.)
| | - Tiffany Boughtwood
- Australian Genomics Health Alliance, Melbourne, VIC 3052, Australia;
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Tom Calma
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW 2050, Australia; (J.S.); (B.R.); (T.C.)
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia;
| | | | - Marcel E. Dinger
- School of Biotechnology and Biomolecular Sciences, UNSW, Sydney, NSW 2052, Australia;
| | - Jennifer A. Byrne
- New South Wales Health Statewide Biobank, New South Wales Health Pathology, Camperdown, NSW 2050, Australia;
- School of Medical Sciences, Faulty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, 1 Rivers Street, Inverell, NSW 2360, Australia; (D.M.); (J.P.); (K.F.)
| | - Jayden Potter
- Armajun Aboriginal Health Service, 1 Rivers Street, Inverell, NSW 2360, Australia; (D.M.); (J.P.); (K.F.)
| | - Kerry Faires
- Armajun Aboriginal Health Service, 1 Rivers Street, Inverell, NSW 2360, Australia; (D.M.); (J.P.); (K.F.)
| | - Sandra Cooper
- Kids Neuroscience Centre, Children’s Hospital at Westmead, Westmead, NSW 2145, Australia;
- Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW 2006, Australia
- The Children’s Medical Research Institute, Westmead, NSW 2145, Australia
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW 2050, Australia; (J.S.); (B.R.); (T.C.)
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2113, Australia
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23
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Gilroy J, Bulkeley K, Talbot F, Gwynn J, Gwynne K, Henningham M, Alcorso C, Rambaldini B, Lincoln M. Retention of the Aboriginal Health, Ageing, and Disability Workforce: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25261. [PMID: 34047698 PMCID: PMC8196347 DOI: 10.2196/25261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite a plethora of research into Aboriginal employment and recruitment, the extent and nature of the retention of frontline Aboriginal people in health, ageing, and disability workforces are currently unknown. In this application, frontline service delivery is defined as Aboriginal people who are paid employees in the health, ageing, and disability service sectors in roles that involve direct client, participant, or patient contact. There is a need to identify the factors that inhibit (push) and promote (pull) staff retention or departure of this workforce from the sectors. This study will provide additional insight about this topic. Objective The objective of this project is to uncover the factors that influence the retention of frontline Aboriginal workers in the health, ageing, and disability workforces in New South Wales (NSW) who do not have university qualifications. The aim of the proposed project aims to discover the push and pull factors for the retention of the frontline Aboriginal workforce in the health, ageing, and disability sectors in NSW in relation to their role, employment, and community and design evidence-based strategies for retaining the Aboriginal frontline workforce in the health, ageing, and disability sectors in NSW. Methods The proposed research will use a mixed methods approach, collecting both quantitative and qualitative data via surveys and interviews to capture and represent the voices and perspectives of Aboriginal people in a way that the participants chose. Results Indigenous research methodologies are a growing field in Aboriginal health research in Australia. A key strength of this study is that it is led by Aboriginal scholars and Aboriginal controlled organizations that apply an Indigenous methodological framework throughout the research process. Conclusions This study uses a mixed methods design. The survey and interview questions and model were developed in partnership with Aboriginal health, ageing, and disability service workers rather than relying only on research publications on the workforce, government policies, and human resources strategies. This design places a strong emphasis on generalizable findings together with an inductive approach that explores employers and workers’ lived experience of the Aboriginal health workforce in NSW. Excluding workers who have graduated from university places a strong focus on the workforce who have obtained either school or Technical and Further Education or registered training organizations qualifications. Data collection was conducted during the COVID-19 pandemic, and results will include the unique experiences of Aboriginal workers and employers delivering services in an extremely challenging organizational, community, and personal context. International Registered Report Identifier (IRRID) PRR1-10.2196/25261
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Affiliation(s)
- John Gilroy
- The University of Sydney, Sydney, NSW, Australia
| | - Kim Bulkeley
- The University of Sydney, Sydney, NSW, Australia
| | - Folau Talbot
- The University of Sydney, Sydney, NSW, Australia
| | | | - Kylie Gwynne
- The University of Sydney, Sydney, NSW, Australia
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24
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Parter C, Murray D, Mohamed J, Rambaldini B, Calma T, Wilson S, Hartz D, Gwynn J, Skinner J. Talking about the 'r' word: a right to a health system that is free of racism. Public Health Res Pract 2021; 31:3112102. [PMID: 33690783 DOI: 10.17061/phrp3112102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Australia's local, state, territory and federal governments have agreed that the 10-year life expectancy gap between Indigenous and non-Indigenous Australians will be closed by 2031. However, annual Closing the Gap reports tabled by the various prime ministers in the Australian Parliament (for the past 12 years) have consistently indicated that the life expectancy gap continues to widen. Australia has seen more than three decades of government policies since the landmark 1989 National Aboriginal health strategy. What has been missing from these policy commitments is the genuine enactment of the knowledges that are held by Indigenous Australians relating to their cultural ways of being, knowing and doing. Privileging Indigenous knowledges, cultures and voices must be front and centre in developing, designing and implementing policies and programs. The sharing of power, provision of resources, culturally informed reflective policy making, and program design are critical elements. In this paper, we provide a conceptual model of practice, working at the cultural interface where knowledges are valued and innovations can occur. This model of practice is where knowledges and cultures can co-exist, and it could be the answer to Closing the Gap in life expectancy by 2031. Despite a growing willingness and need to consider these models, there remains a deep-seated resistance to identifying and addressing institutional and systemic racism and racist attitudes, including unconscious biases held by individuals. Further, western non-Indigenous worldviews of ways of being, knowing and doing continue to dominate the decisions and actions of governments - and consequentially dominate public health policies and practices. There is an unacceptable standard approach, for and about Indigenous health instead of with Indigenous peoples, resulting in the neglectful dismissal of Indigenous knowledges and Indigenous cultures of ways of being, knowing and doing.
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Affiliation(s)
- Carmen Parter
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia;
| | - Donna Murray
- Indigenous Allied Health Australia, Canberra, ACT, Australia
| | | | - Boe Rambaldini
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia
| | - Tom Calma
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia
| | - Shawn Wilson
- Gnibi College of Indigenous Australian Peoples, Southern Cross University, Lismore, NSW, Australia
| | - Donna Hartz
- Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, NT, Australia
| | - Josephine Gwynn
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - John Skinner
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia
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25
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Gwynne K, Poppe K, McCowen D, Dimitropoulos Y, Rambaldini B, Skinner J, Blinkhorn A. A scope of practice comparison of two models of public oral health services for Aboriginal people living in rural and remote communities. Rural Remote Health 2021; 21:5821. [PMID: 33405940 DOI: 10.22605/rrh5821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW 2006, Australia; and Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Katrina Poppe
- Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Armidale, NSW 2350, Australia
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Anthony Blinkhorn
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW 2006, Australia
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Skinner J, Dimitropoulos Y, Moir R, Johnson G, McCowen D, Rambaldini B, Yaacoub A, Gwynne K. A graduate oral health therapist program to support dental service delivery and oral health promotion in Aboriginal communities in New South Wales, Australia. Rural Remote Health 2021; 21:5789. [PMID: 33497576 DOI: 10.22605/rrh5789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The early closure of the Voluntary Dental Graduate Year Program and the Oral Health Therapy Graduate Year Program by the Australian Government adversely impacted New South Wales (NSW) Aboriginal Community Controlled Health Services (ACCHSs). This led to the co-design of a small-scale oral health therapy graduate year program for ACCHSs known as the Dalang Project, which enabled oral health therapists to engage with local Aboriginal communities and implement culturally competent, practical and evidence-based oral health promotion activities. This article provides an overview of the Dalang Project and its evaluation. METHODS All graduates of the Dalang Project were invited via email and social media to complete an online survey. The survey included questions about their year in the Dalang Project, why they applied, what they liked and disliked about the project, where they planned to work post-placement, and examples of the most significant changes they observed in the communities where they were placed. Host sites were also surveyed and data were collated on clinical services performed as well as oral health promotion activity. RESULTS Prior to commencing the Dalang Project only 4 of the 15 respondents came from rural or regional areas. Nine of the 15 respondents were considering working in a regional, rural or remote area prior to applying for the Dalang Project. Twelve respondents were working at the time of the survey and half were working in regional, rural or remote locations in NSW and one in the Northern Territory. All reported that they would be more likely to work in an ACCHS as a result of being a part of the Dalang Project. The majority of respondents said they would recommend the program to future graduates. A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project. A total of 3250 toothbrushes and fluoride toothpastes were distributed to children and families through the Dalang Project. A key part of the program was the installation of refrigerated and filtered water fountains in schools where there was no free filtered or refrigerated water supply. The inclusion of this component in the program was part of the co-design process and links the program to the wider population health strategies in NSW to help prevent childhood obesity. CONCLUSION The Dalang Project is an example of a successful co-designed project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in ACCHSs. Overall, the Dalang Project was found to be a positive professional experience for the oral health therapists with many remaining in rural, remote and regional locations after completing the program.
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Affiliation(s)
- John Skinner
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, NSW 2006, Australia
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, NSW 2006, Australia
| | - Rachael Moir
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, NSW 2006, Australia
| | - George Johnson
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, 18 Marsden St, Camperdown, NSW 2050, Australia
| | - Debbie McCowen
- Chief Executive Office, Armajun Aboriginal Health Service, 1 Rivers Street, Inverell, NSW 2360, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, NSW 2006, Australia
| | - Albert Yaacoub
- Oral Health Service, Nepean Blue Mountains Local Health District, Nepean Hospital, Derby St, Penrith, NSW 2750, Australia
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, Room 224 Edward Ford Building, The University of Sydney, NSW 2006, Australia; and Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
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Macniven R, Jeffries TL, Meharg D, Talbot F, Rambaldini B, Edwards E, Hickie IB, Sloan M, Gwynne K. What Solutions Exist for Developmental Delays Facing Indigenous Children Globally? A Co-Designed Systematic Review. Children (Basel) 2020; 7:E285. [PMID: 33321773 PMCID: PMC7763469 DOI: 10.3390/children7120285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
Early childhood is important for future cognitive and educational outcomes. Programs overcoming barriers to engagement in early education for Indigenous children must address family cultural needs and target developmental delays. This systematic review identifies culturally adapted programs to improve developmental delays among young children, in response to an identified priority of a remote Indigenous community. Five databases (the Cochrane Library, Embase, Medline, Scopus and CINAHL) were searched for English language papers in January 2018. Study quality was assessed, and findings were analysed thematically. Findings were presented to the community at an event with key stakeholders, to determine their inclusion and face validity. Seven relevant studies, published between 1997 and 2013, were identified by the researchers and each study was supported by the community for inclusion. Three studies included on Native American children and four studies included children from non-Indigenous disadvantaged backgrounds. Findings were reported narratively across four themes: storytelling to improve educational outcomes; family involvement improved development; culturally adapted cognitive behavioural therapy to reduce trauma; rewards-based teaching to improve child attention. Limited published research on culturally adapted and safe interventions for children with developmental delays exists but these four themes from seven studies identify useful components to guide the community and early childhood program development.
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Affiliation(s)
- Rona Macniven
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- Poche Centre for Indigenous Health, Faculty of Health and Medicine, The University of Sydney, Sydney 2006, Australia; (T.L.J.J.); (D.M.); (F.T.); (B.R.); (K.G.)
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia
| | - Thomas Lee Jeffries
- Poche Centre for Indigenous Health, Faculty of Health and Medicine, The University of Sydney, Sydney 2006, Australia; (T.L.J.J.); (D.M.); (F.T.); (B.R.); (K.G.)
| | - David Meharg
- Poche Centre for Indigenous Health, Faculty of Health and Medicine, The University of Sydney, Sydney 2006, Australia; (T.L.J.J.); (D.M.); (F.T.); (B.R.); (K.G.)
| | - Folau Talbot
- Poche Centre for Indigenous Health, Faculty of Health and Medicine, The University of Sydney, Sydney 2006, Australia; (T.L.J.J.); (D.M.); (F.T.); (B.R.); (K.G.)
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, Faculty of Health and Medicine, The University of Sydney, Sydney 2006, Australia; (T.L.J.J.); (D.M.); (F.T.); (B.R.); (K.G.)
| | - Elaine Edwards
- Toomelah Public School, Boggabilla 2409, Australia; (E.E.); (M.S.)
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney 2006, Australia;
| | - Margaret Sloan
- Toomelah Public School, Boggabilla 2409, Australia; (E.E.); (M.S.)
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, Faculty of Health and Medicine, The University of Sydney, Sydney 2006, Australia; (T.L.J.J.); (D.M.); (F.T.); (B.R.); (K.G.)
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia
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Skinner J, Dimitropoulos Y, Masoe A, Yaacoub A, Byun R, Rambaldini B, Christie V, Gwynne K. Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia. Aust J Rural Health 2020; 28:500-505. [PMID: 32969074 DOI: 10.1111/ajr.12657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/13/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022] Open
Abstract
PROBLEM There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting. DESIGN A mixed-methods approach including auditing the number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system. SETTING Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study. KEY MEASURES FOR IMPROVEMENT Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported. STRATEGIES FOR CHANGE In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications. EFFECTS OF CHANGE Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision. LESSONS LEARNT This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride Varnish Program is examining the feasibility of including the apply fluoride varnish skillset in its existing Aboriginal Dental Assistant Scholarship Program.
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Affiliation(s)
- John Skinner
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
- School of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
- School of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Angela Masoe
- Centre for Oral Health Strategy, NSW Ministry of Health, St Leonards, NSW, Australia
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Roy Byun
- Centre for Oral Health Strategy, NSW Ministry of Health, St Leonards, NSW, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
| | - Vita Christie
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Easteal S, Arkell RM, Balboa RF, Bellingham SA, Brown AD, Calma T, Cook MC, Davis M, Dawkins HJS, Dinger ME, Dobbie MS, Farlow A, Gwynne KG, Hermes A, Hoy WE, Jenkins MR, Jiang SH, Kaplan W, Leslie S, Llamas B, Mann GJ, McMorran BJ, McWhirter RE, Meldrum CJ, Nagaraj SH, Newman SJ, Nunn JS, Ormond-Parker L, Orr NJ, Paliwal D, Patel HR, Pearson G, Pratt GR, Rambaldini B, Russell LW, Savarirayan R, Silcocks M, Skinner JC, Souilmi Y, Vinuesa CG, Baynam G. Equitable Expanded Carrier Screening Needs Indigenous Clinical and Population Genomic Data. Am J Hum Genet 2020; 107:175-182. [PMID: 32763188 PMCID: PMC7413856 DOI: 10.1016/j.ajhg.2020.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation, including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically, research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently underrepresented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here, we discuss this issue in relation to the implementation of ECS in Australia, which is currently being evaluated as part of the national Government's Genomics Health Futures Mission. We argue that significant effort is required to build an evidence base and genomic reference data so that ECS can bring significant clinical benefit for many Aboriginal and/or Torres Strait Islander Australians. These efforts are essential steps to achieving the Australian Government's objectives and its commitment "to leveraging the benefits of genomics in the health system for all Australians." They require culturally safe, community-led research and community involvement embedded within national health and medical genomics programs to ensure that new knowledge is integrated into medicine and health services in ways that address the specific and articulated cultural and health needs of Indigenous people. Until this occurs, people who do not have European ancestry are at risk of being, in relative terms, further disadvantaged.
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Affiliation(s)
- Simon Easteal
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia.
| | - Ruth M Arkell
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2600, Australia
| | - Renzo F Balboa
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia
| | - Shayne A Bellingham
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia
| | - Alex D Brown
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Tom Calma
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Matthew C Cook
- Department of Immunology, Canberra Hospital, Canberra, ACT 2606, Australia
| | - Megan Davis
- UNSW Law, University of New South Wales, Sydney, NSW 2052, Australia
| | - Hugh J S Dawkins
- HBF Health Limited, Perth, WA 6000, Australia; School of Medicine, The University of Notre Dame Australia, Sydney, NSW 2010, Australia; Sir Walter Murdoch School of Policy and International Affairs, Murdoch University, Murdoch, WA 6150, Australia; Division of Genetics, School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6008, Australia; Centre for Population Health Research, Curtin University of Technology, Bentley, WA 6102, Australia
| | - Marcel E Dinger
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Michael S Dobbie
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; John Curtin School of Medical Research, Australian National University, Canberra, ACT 2600, Australia
| | - Ashley Farlow
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; Melbourne Integrative Genomics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Kylie G Gwynne
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2113, Australia
| | - Azure Hermes
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia
| | - Wendy E Hoy
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Misty R Jenkins
- Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; La Trobe Institute of Molecular Science, La Trobe University, Bundoora, VIC 3086, Australia
| | - Simon H Jiang
- Department of Immunology, Canberra Hospital, Canberra, ACT 2606, Australia
| | - Warren Kaplan
- Informatics, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
| | - Stephen Leslie
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; Melbourne Integrative Genomics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Bastien Llamas
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; Centre of Excellence in Australian Biodiversity and Heritage, School of Biological Sciences, The Environment Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Graham J Mann
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2600, Australia
| | - Brendan J McMorran
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2600, Australia
| | - Rebekah E McWhirter
- Centre for Law and Genetics, Faculty of Law, University of Tasmania, Hobart, TAS 7001, Australia
| | | | - Shivashankar H Nagaraj
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Saul J Newman
- Biological Data Science Institute, Australian National University, Canberra, ACT 2600, Australia
| | - Jack S Nunn
- Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Lyndon Ormond-Parker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Neil J Orr
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Devashi Paliwal
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; John Curtin School of Medical Research, Australian National University, Canberra, ACT 2600, Australia
| | - Hardip R Patel
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia
| | - Glenn Pearson
- Aboriginal Health, Telethon Kids Institute, Perth, WA 6009, Australia
| | - Greg R Pratt
- Aboriginal and Torres Strait Islander Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Lynette W Russell
- Centre of Excellence in Australian Biodiversity and Heritage, Monash Indigenous Studies Centre, Monash University, Melbourne, VIC 3800, Australia
| | - Ravi Savarirayan
- Victorian Clinical Genetic Services, Murdoch Children's Research Institute, and University of Melbourne, Parkville, VIC 3052, Australia
| | - Matthew Silcocks
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; Melbourne Integrative Genomics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - John C Skinner
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Yassine Souilmi
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT 2600, Australia; School of Biological Sciences, The Environment Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Carola G Vinuesa
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2600, Australia
| | - Gareth Baynam
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, WA 6004, Australia; The Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, WA 6004, Australia; School of Medicine, Division of Paediatrics and Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia.
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Gwynn J, Gwynne K, Rodrigues R, Thompson S, Bolton G, Dimitropoulos Y, Dulvari N, Finlayson H, Hamilton S, Lawrence M, MacNiven R, Neubeck L, Rambaldini B, Taylor K, Wright D, Freedman B. Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings. Heart Lung Circ 2020; 30:267-274. [PMID: 32807629 DOI: 10.1016/j.hlc.2020.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Circulatory diseases continue to be the greatest cause of mortality for Australian Aboriginal and Torres Strait Islander people, and a major cause of persistently lower life expectancy compared with non-Aboriginal Australians. The limited information that exists on atrial fibrillation (AF) prevalence in Aboriginal and Torres Strait Islander communities is mostly based on hospital admission data. This shows AF as principal or additional admission diagnosis was 1.4 times higher compared to non-Aboriginal Australians, a higher incidence of AF across the adult life span after age 20 years and a significantly higher prevalence among younger patients. Our study estimates the first national community prevalence and age distribution of AF (including paroxysmal) in Australian Aboriginal people. A handheld single-lead electrocardiograph (ECG) device (iECG), known to be acceptable in this population, was used to record participant ECGs. METHODS This co-designed, descriptive cross-sectional study was conducted in partnership with 16 Aboriginal Community Controlled Health organisations at their facilities and/or with their services delivered elsewhere. The study was also conducted at one state community event. Three (3) Australian jurisdictions were involved: New South Wales, Western Australia and the Northern Territory. Study sites were located in remote, regional and urban areas. Opportunistic recruitment occurred between June 2016 and December 2017. People <45 years of age were excluded. RESULTS Thirty (30) of 619 Aboriginal people received a 'Possible AF' and 81 an 'Unclassified' result from a hand-held smartphone ECG device. A final diagnosis of AF was made in 29 participants (4.7%; 95%CI 3.0-6.4%), 25 with known AF (five paroxysmal), and four with previously unknown AF. Three (3) of the four with unknown AF were aged between 55-64 years, consistent with a younger age of AF onset in Aboriginal people. Estimated AF prevalence increased with age and was higher in those aged >55 years than the general population (7.2% compared with 5.4%). Slightly more men than women were diagnosed with AF. CONCLUSIONS This study is a significant contribution to the evidence which supports screening for AF in Aboriginal and Torres Strait Islander people commencing at a younger age than as recommended in the Australian guidelines (>65 years). We recommend the age of 55 years. Consideration should be given to the inclusion of AF screening in the Australian Government Department of Health annual 'Aboriginal and Torres Strait Islander Health Assessment'. CLINICAL TRIAL REGISTRATION ACTRN12616000459426.
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Affiliation(s)
- Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia; Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Rhys Rodrigues
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
| | - Sandra Thompson
- WA Centre for Rural Health, University of Western Australia, Perth, WA, Australia
| | - Graham Bolton
- Brewarrina Multipurpose Service, Brewarrina, NSW, Australia
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
| | - Norman Dulvari
- Albury Wodonga Aboriginal Health Service, Albury Wodonga, NSW, Australia
| | | | - Sandra Hamilton
- WA Centre for Rural Health, University of Western Australia, Perth, WA, Australia
| | - Monica Lawrence
- Poche Centre for Indigenous Health, Flinders University, Adelaide, SA, Australia
| | - Rona MacNiven
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | | | - Boe Rambaldini
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
| | - Kerry Taylor
- Poche Centre for Indigenous Health, Flinders University, Adelaide, SA, Australia
| | - Darryl Wright
- Tharawal Aboriginal Corporation, Sydney, NSW, Australia
| | - Ben Freedman
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; Heart Research Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Kong AC, Ramjan L, Sousa MS, Gwynne K, Goulding J, Jones N, Srinivas R, Rambaldini B, Moir R, George A. The oral health of Indigenous pregnant women: A mixed-methods systematic review. Women Birth 2020; 33:311-322. [PMID: 31501053 DOI: 10.1016/j.wombi.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Western models of care to improve the oral health of pregnant women have been successfully implemented in the healthcare setting across various developed countries. Even though Indigenous women experience poorer pregnancy and birth outcomes compared to other women, these models have not been developed with Indigenous communities to address the oral health needs of Indigenous pregnant women. This review aimed to understand the oral health knowledge, practices, attitudes and challenges of Indigenous pregnant women globally. METHODS A comprehensive search including six electronic databases and grey literature up to September 2018 was undertaken (PROSPERO Registration Number: 111402). Quantitative and qualitative evidence exploring at least one of the four oral health domains relating to Indigenous pregnant women worldwide, including women pregnant with an Indigenous child, were retrieved. RESULTS Eleven publications related to nine studies were included. Indigenous pregnant women's attitudes, practices and challenges relating to their oral health were influenced by socioeconomic and psychosocial factors, and their healthcare context. Availability of dental services varied depending on the healthcare model, whether services were public or private, and whether services met their needs. Although there was little evidence related to oral health knowledge, the literature suggests some misconceptions within this population. CONCLUSIONS The availability of culturally appropriate dental services that fulfilled the needs of Indigenous pregnant women varied between developed countries. This review highlighted the need for community-tailored dental services and a care coordinator to provide both education and assistance to those navigating services.
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Affiliation(s)
- Ariana C Kong
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District / Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Lucie Ramjan
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District / Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Mariana S Sousa
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District / Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, University of Sydney, Camperdown 2050, Australia.
| | - Joanne Goulding
- Primary and Community Health, South Western Sydney Local Health District, NSW, Australia.
| | - Nathan Jones
- Aboriginal Health Unit, South Western Sydney Local Health District, NSW, Australia.
| | - Ravi Srinivas
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District / Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; Oral Health Services, South Western Sydney Local Health District, Australia; School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown 2050, Australia.
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, University of Sydney, Camperdown 2050, Australia.
| | - Rachael Moir
- Poche Centre for Indigenous Health, University of Sydney, Camperdown 2050, Australia.
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District / Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown 2050, Australia; Translational Health Research Institute, Campbelltown, NSW, Australia.
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Gwynn J, Skinner J, Dimitropoulos Y, Masoe A, Rambaldini B, Christie V, Sohn W, Gwynne K. Community based programs to improve the oral health of Australian Indigenous adolescents: a systematic review and recommendations to guide future strategies. BMC Health Serv Res 2020; 20:384. [PMID: 32375764 PMCID: PMC7204065 DOI: 10.1186/s12913-020-05247-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact. METHODS Data sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied. RESULTS Nine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth. CONCLUSIONS Few good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.
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Affiliation(s)
- Josephine Gwynn
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Angela Masoe
- NSW Ministry of Health Centre for Oral Health Strategy, 30 Christie Street, Wollstonecraft, Australia
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Vita Christie
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
| | - Woosung Sohn
- The University of Sydney School of Dentistry, 1 Mons Road, Westmead, Australia
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, Australia
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Macniven R, Gwynn J, Fujimoto H, Hamilton S, Thompson SC, Taylor K, Lawrence M, Finlayson H, Bolton G, Dulvari N, Wright DC, Rambaldini B, Freedman B, Gwynne K. Feasibility and acceptability of opportunistic screening to detect atrial fibrillation in Aboriginal adults. Aust N Z J Public Health 2019; 43:313-318. [DOI: 10.1111/1753-6405.12905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/01/2018] [Accepted: 03/01/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rona Macniven
- Faculty of Medicine and Health, Sydney Medical School, Poche Centre for Indigenous HealthThe University of Sydney New South Wales
- Charles Perkins Centre D17The University of Sydney New South Wales
| | - Josephine Gwynn
- Faculty of Medicine and Health, Sydney Medical School, Poche Centre for Indigenous HealthThe University of Sydney New South Wales
- Charles Perkins Centre D17The University of Sydney New South Wales
| | - Hiroko Fujimoto
- Faculty of Medicine and Health, Sydney Medical School, Poche Centre for Indigenous HealthThe University of Sydney New South Wales
| | - Sandy Hamilton
- Poche Centre for Indigenous Health, School of Indigenous StudiesThe University of Western Australia Crawley Western Australia
| | - Sandra C. Thompson
- Poche Centre for Indigenous Health, School of Indigenous StudiesThe University of Western Australia Crawley Western Australia
| | - Kerry Taylor
- Poche Centre for Indigenous Health Alice Springs Northern Territory
| | - Monica Lawrence
- Poche Centre for Indigenous HealthFlinders University of South Australia Adelaide South Australia
| | | | - Graham Bolton
- Brewarrina Multipurpose Service Brewarrina New South Wales
| | - Norman Dulvari
- Albury Wodonga Aboriginal Health Service Glenroy New South Wales
| | | | - Boe Rambaldini
- Faculty of Medicine and Health, Sydney Medical School, Poche Centre for Indigenous HealthThe University of Sydney New South Wales
| | - Ben Freedman
- Faculty of Medicine and Health, Sydney Medical School, Poche Centre for Indigenous HealthThe University of Sydney New South Wales
- Charles Perkins Centre D17The University of Sydney New South Wales
| | - Kylie Gwynne
- Faculty of Medicine and Health, Sydney Medical School, Poche Centre for Indigenous HealthThe University of Sydney New South Wales
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Dimitropoulos Y, Blinkhorn A, Irving M, Skinner J, Naoum S, Holden A, Masoe A, Rambaldini B, Christie V, Spallek H, Gwynne K. Enabling Aboriginal dental assistants to apply fluoride varnish for school children in communities with a high Aboriginal population in New South Wales, Australia: a study protocol for a feasibility study. Pilot Feasibility Stud 2019; 5:15. [PMID: 30693095 PMCID: PMC6341707 DOI: 10.1186/s40814-019-0399-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/10/2019] [Indexed: 11/06/2022] Open
Abstract
Background Australian Aboriginal children experience high levels of dental caries (tooth decay) and are less likely to access preventive dental health services. High-strength fluoride varnish has been shown to reduce the incidence of dental caries and is commonly used in community-based preventive dental health service programs. In New South Wales, Australia, the application of fluoride varnish is restricted to dental and medical professionals. This is problematic in communities with a high Aboriginal population and limited access to oral health services, contributing to the increased risk of developing dental caries in Aboriginal children. Dental assistants are essential members of the oral health team; however, they do not have a defined scope of practice in Australia. Other countries have created formal scopes of practice for dental assistants to include the application of fluoride varnish. This protocol presents a pathway for qualified Aboriginal dental assistants to undertake additional training to legally apply fluoride varnish in New South Wales. The primary objective of this study will be to evaluate the feasibility and acceptability of utilising Aboriginal dental assistants to apply fluoride varnish to Aboriginal children in a school setting at regular 3-month intervals. Methods Six schools across New South Wales (NSW) that enrol at least 12% Aboriginal children will be invited to participate in the 12-month study. Aboriginal children aged 5–12 years enrolled in these schools will be enrolled in the study. Six Aboriginal dental assistants will undertake training to apply fluoride varnish. Fluoride varnish (Duraphat) will be applied at 3-month intervals by the dental assistants to the teeth using a small brush. An evaluation will be undertaken to determine the feasibility and cost-effectiveness of this innovative approach. This study protocol has been approved by the NSW Aboriginal Health and Medical Research Council and the NSW State Education Research Application Process. Discussion A qualified Aboriginal dental assistant workforce in NSW (or Australia) legally approved to apply fluoride varnish may increase the sustainability and scalability of fluoride varnish programs and improve the oral health of Aboriginal children in Australia. Trial registration ISRCTN26746753. Electronic supplementary material The online version of this article (10.1186/s40814-019-0399-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yvonne Dimitropoulos
- 1Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, 2006 Australia.,2Faculty of Medicine and Health, The University of Sydney School of Dentistry, 1 Mons Road, Westmead, NSW 2145 Australia
| | - Anthony Blinkhorn
- 2Faculty of Medicine and Health, The University of Sydney School of Dentistry, 1 Mons Road, Westmead, NSW 2145 Australia
| | - Michelle Irving
- 1Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, 2006 Australia.,2Faculty of Medicine and Health, The University of Sydney School of Dentistry, 1 Mons Road, Westmead, NSW 2145 Australia
| | - John Skinner
- 2Faculty of Medicine and Health, The University of Sydney School of Dentistry, 1 Mons Road, Westmead, NSW 2145 Australia
| | - Steven Naoum
- 1Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, 2006 Australia
| | - Alexander Holden
- 2Faculty of Medicine and Health, The University of Sydney School of Dentistry, 1 Mons Road, Westmead, NSW 2145 Australia
| | - Angela Masoe
- NSW Centre for Oral Health Strategy, 73 Miller Street, North Sydney, NSW 2060 Australia
| | - Boe Rambaldini
- 1Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, 2006 Australia
| | - Vita Christie
- 1Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, 2006 Australia
| | - Heiko Spallek
- 2Faculty of Medicine and Health, The University of Sydney School of Dentistry, 1 Mons Road, Westmead, NSW 2145 Australia
| | - Kylie Gwynne
- 1Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney, 2006 Australia
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Poppe K, Rambaldini B, Rolleston A, Løchen ML, Stavrakis S, Einarsson SB, Freedman B, Gwynne K. Atrial Fibrillation Among Indigenous Populations Globally. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.05.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gwynne K, Gwynn J, Finlayson H, Hamilton S, Lawrence M, MacNiven R, Neubeck L, Rambaldini B, Rodrigues R, Taylor K, Thompson S, Freedman B. Atrial Fibrillation and Indigenous Australians: A Way Forward for Timely and Effective Screening and Treatment. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gwynne K, Irving MJ, McCowen D, Rambaldini B, Skinner J, Naoum S, Blinkhorn A. Developing a Sustainable Model of Oral Health Care for Disadvantaged Aboriginal People Living in Rural and Remote Communities in NSW, Using Collective Impact Methodology. J Health Care Poor Underserved 2017; 27:46-53. [PMID: 26853198 DOI: 10.1353/hpu.2016.0032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A sustainable model of oral health care for disadvantaged Aboriginal people living in rural and remote communities in New South Wales was developed using collective impact methodology. Collective impact is a structured process which draws together organizations to develop a shared agenda and design solutions which are jointly resourced, measured and reported upon.
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