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Mackenzie L, Gwynn J, Gilroy J. Experiences of occupational therapy students undertaking an Aboriginal and Torres Strait Islander health module: embedding cultural responsiveness in professional curricula. AUST HEALTH REV 2024:AH23217. [PMID: 38740052 DOI: 10.1071/ah23217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
ObjectiveAlong with other Australian health professionals, occupational therapy students need to understand Aboriginal and Torres Strait Islander culture and health issues to develop their capacity to work effectively with this community and meet accreditation standards. The study aimed to explore the learning experiences of occupational therapy students during a module focused on Aboriginal and Torres Strait Islander peoples' health issues and approaches.MethodsA qualitative descriptive method was used. Individual interviews were audiotaped, transcribed and analysed thematically following the module. Participants were asked about their prior experience with Aboriginal and Torres Strait Islander peoples, feelings about undertaking the module, difficulties and highlights of the module, and how the module contributed to their learning.ResultsIn all, 18 students participated in interviews. Interview themes were (1) student context of learning about Aboriginal and Torres Strait Islander peoples' heath and culture, (2) experiencing the module with others and (3) student learning gains following the module.ConclusionStudents developed in their self-awareness and understanding of Aboriginal and Torres Strait Islander peoples' issues of relevance to occupational therapy. Further research is needed to evaluate educational activities with occupational therapy and other health professional students across Australia, and ongoing culturally responsiveness training for health professionals (post-registration).
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Parter C, Gwynn J, Wilson S, Skinner JC, Rix E, Hartz D. Putting Indigenous Cultures and Indigenous Knowledges Front and Centre to Clinical Practice: Katherine Hospital Case Example. Int J Environ Res Public Health 2023; 21:3. [PMID: 38276792 PMCID: PMC10815878 DOI: 10.3390/ijerph21010003] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
The inclusion of Indigenous cultures, known as the cultural determinants of health, in healthcare policy and health professional education accreditation and registration requirements, is increasingly being recognised as imperative for improving the appalling health and well-being of Indigenous Australians. These inclusions are a strengths-based response to tackling the inequities in Indigenous Australians' health relative to the general population. However, conceptualising the cultural determinants of health in healthcare practice has its contextual challenges, and gaps in implementation evidence are apparent. In this paper, we provide a case example, namely the Katherine Hospital, of how healthcare services can implement the cultural determinants of health into clinical practice. However, to be effective, health professionals must concede that Australia's Indigenous peoples' knowledges involving cultural ways of being, knowing and doing must co-exist with western and biomedical knowledges of health practice. We use the Katherine Hospital ABC Radio National Background Briefing interview, which was mentioned by two research participants in a 2020 study, as an example of good practice that we can learn from. Additionally, the six Aboriginal and Torres Strait Islander Health actions contained in the 2nd Edition of the Australian National Safety and Quality Health Service Standards provide governance and accountability examples of how to enable Indigenous people's cultures and their knowledges in the provision of services. The role of non-Indigenous clinical allies and accomplices is imperative when embedding and enacting Indigenous Australians' cultures in service systems of health. When Indigenous Peoples access mainstream hospitals, deep self-reflection by allies and accomplices is necessary to enable safe, quality care, and treatment that is culturally safe and free from racism. Doing so can increase cultural responsiveness free of racism, thereby reducing the inherent power imbalances embedded within mainstream health services.
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Affiliation(s)
- Carmen Parter
- Djurali Centre for Aboriginal & Torres Strait Islander Education and Health Research, Heart Research Institute, Newtown, NSW 2042, Australia;
| | - Josephine Gwynn
- Charles Perkins Centre, Faculty of Health Sciences, University of Sydney, Sydney, NSW 2006, Australia;
| | - Shawn Wilson
- Department of Community, Culture and Global Studies, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - John C. Skinner
- Djurali Centre for Aboriginal & Torres Strait Islander Education and Health Research, Heart Research Institute, Newtown, NSW 2042, Australia;
| | - Elizabeth Rix
- Adelaide Nursing School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Donna Hartz
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
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Davies A, Gwynn J, Allman-Farinelli M, Flood V, Dickson M, Turner N, Porykali B, Lock Ngiyampaa M. Programs Addressing Food Security for First Nations Peoples: A Scoping Review. Nutrients 2023; 15:3127. [PMID: 37513545 PMCID: PMC10384335 DOI: 10.3390/nu15143127] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Access to food is a right that every individual must have to ensure a standard of living that is sufficient for maintaining good health and wellbeing. This review, developed and implemented by a team of First Nations and non-First Nations peoples, aimed to scope the literature on programs addressing food security for First Nations peoples in Australia, Aotearoa/New Zealand, Canada, and the United States of America. Collectively, First Nations groups share continued traumas, disadvantages, and devastation brought upon them as a result of British colonisation. Despite the impacts of colonial conquest, the resilience of First Nations peoples continues through the fight for self-determination, sovereignty, equity, and equality. Three databases and grey literature were searched from 2010. Two reviewers completed screening, data extraction, and critical appraisal. Nine food security programs were included in this review. Five were from the United States of America and four from Canada, with no program from Australia or Aotearoa/New Zealand meeting the inclusion criteria. The programs that appear to be most suitable for addressing food security for First Nations peoples were participatory in design, had community governance, integrated cultural knowledge and food systems to increase the accessibility and availability of cultural foods, incorporated educational components, and utilized collaborations among various agencies. Findings showed that while it is important to address short-term emergency food relief, the aim should be sustainable food security through a longer-term system and policy change underpinned by co-designed research and evaluation.
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Affiliation(s)
- Alyse Davies
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Josephine Gwynn
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, The University of Sydney, Lismore, NSW, 2480, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Nicole Turner
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Bobby Porykali
- Aboriginal and Torres Strait Islander Health Program, George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Mark Lock Ngiyampaa
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC 3220, Australia
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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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Macniven R, Delbaere K, Lewis E, Radford K, Canuto K, Dickson M, Richards J, Gwynn J, Withall A. Community co-selection of measures to evaluate the health and wellbeing impact of Aboriginal and Torres Strait Islander community running groups. Health Promot J Austr 2023; 34:17-23. [PMID: 35343009 PMCID: PMC10084330 DOI: 10.1002/hpja.600] [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: 12/14/2020] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED Physical activity participation can improve the physical health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. The evaluation of physical activity programmes can elicit a clearer understanding of where these impacts occur and to what extent. We describe applying a collaborative approach to the selection of a set of measures that can be used to examine health and wellbeing impacts of Indigenous community running groups. METHODS Physical activity, health and wellbeing measurement tools previously used with Aboriginal and Torres Strait Islander peoples were collated. Participants in the collaborative process were nine female running group members aged 30+ years from a regional New South Wales (NSW) town. The Indigenous research method, Yarning, explored views of participating in the group on health and wellbeing and how these could be measured using those collated measurement tools. RESULTS Runners described participating for holistic physical, mental and social reasons and stated the importance of the group participating together and providing social support to each other. There was broad support for the identified physical activity, lifestyle, physical health, and social and emotional wellbeing measures, with social networks and sports injuries identified as additionally relevant. CONCLUSIONS Co-selecting measures to evaluate a physical activity programme for Aboriginal and Torres Strait Islander participants can better inform the development of relevant future healthy lifestyle programme evaluation, revealing factors that may be missed as relevant by researchers. SO WHAT?: This process presents an example of determining evaluation measures with Aboriginal and Torres Strait Islander participants that could be applied more broadly to evaluation design.
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Affiliation(s)
- Rona Macniven
- School of Population Health, UNSW Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Kim Delbaere
- School of Population Health, UNSW Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Ebony Lewis
- School of Population Health, UNSW Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Kylie Radford
- Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Karla Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia.,Aboriginal Health Equity, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Michelle Dickson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Justin Richards
- Faculty of Health, Te Herenga Waka - Victoria University Wellington, Wellington, New Zealand
| | - Josephine Gwynn
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
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6
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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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7
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Osborn E, Ritha M, Macniven R, Agius T, Christie V, Finlayson H, Gwynn J, Hunter K, Martin R, Moir R, Taylor D, Tobin S, Ward K, Gwynne K. "No One Manages It; We Just Sign Them Up and Do It": A Whole System Analysis of Access to Healthcare in One Remote Australian Community. Int J Environ Res Public Health 2022; 19:2939. [PMID: 35270632 PMCID: PMC8910080 DOI: 10.3390/ijerph19052939] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. SETTING A remote community in New South Wales, Australia. PARTICIPANTS Aboriginal and non-Aboriginal health and education professionals performing various roles in healthcare provision in the community. DESIGN Case study. METHODOLOGY The study was co-designed with the community. A mixed-methods methodology was utilised. Data were gathered through structured interviews. Descriptive statistics were used to analyse the availability of 40 health services in the community, whilst quotations from the qualitative research were used to provide context for the quantitative findings. RESULTS Service availability was mapped for 40 primary, specialised, and allied health services. Three key themes emerged from the analysis: (1) there are instances of both underservicing and overservicing which give insight into systemic barriers to interagency cooperation; (2) nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; and (3) visiting and telehealth services are critical components of the system that must be linked to existing community-led primary care services. CONCLUSION The study identified factors influencing service availability, accessibility and interagency cooperation in remote healthcare services and systems that can be used to guide future service and system planning and resourcing.
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Affiliation(s)
- Eloise Osborn
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Marida Ritha
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Rona Macniven
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Tim Agius
- Durri Aboriginal Corporation Medical Service, Kempsey, NSW 2440, Australia
| | - Vita Christie
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Josephine Gwynn
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Kate Hunter
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Robyn Martin
- Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Rachael Moir
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Donna Taylor
- Pius X Aboriginal Medical Service, Moree, NSW 2400, Australia
| | - Susannah Tobin
- Honorary Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Katrina Ward
- Brewarrina Aboriginal Medical Service, Brewarrina, NSW 2839, Australia
| | - Kylie Gwynne
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, 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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9
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Allen B, Canuto K, Evans JR, Lewis E, Gwynn J, Radford K, Delbaere K, Richards J, Lovell N, Dickson M, Macniven R. Facilitators and Barriers to Physical Activity and Sport Participation Experienced by Aboriginal and Torres Strait Islander Adults: A Mixed Method Review. Int J Environ Res Public Health 2021; 18:ijerph18189893. [PMID: 34574816 PMCID: PMC8468807 DOI: 10.3390/ijerph18189893] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Physical activity has cultural significance and population health benefits. However, Aboriginal and Torres Strait Islander adults may experience challenges in participating in physical activity. This mixed methods systematic review aimed to synthetize existing evidence on facilitators and barriers for physical activity participation experienced by Aboriginal and Torres Strait Islander adults in Australia. The Joanna Briggs Institute methodology was used. A systematic search was undertaken of 11 databases and 14 grey literature websites during 2020. The included studies reported physical activity facilitators and barriers experienced by Aboriginal or Torres Strait Islander participants aged 18+ years, living in the community. Twenty-seven studies met the inclusion criteria. Sixty-two facilitators were identified: 23 individual, 18 interpersonal, 8 community/environmental and 13 policy/program facilitators. Additionally, 63 barriers were identified: 21 individual, 17 interpersonal, 15 community/environmental and 10 policy/program barriers. Prominent facilitators included support from family, friends, and program staff, and opportunities to connect with community or culture. Prominent barriers included a lack of transport, financial constraints, lack of time, and competing work, family or cultural commitments. Aboriginal and Torres Strait Islander adults experience multiple facilitators and barriers to physical activity participation. Strategies to increase participation should seek to enhance facilitators and address barriers, collaboratively with communities, with consideration to the local context.
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Affiliation(s)
- Bridget Allen
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- Correspondence: (B.A.); (R.M.)
| | - Karla Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia;
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - John Robert Evans
- School of Public Health, University of Technology, Ultimo, NSW 2007, Australia;
| | - Ebony Lewis
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW 2052, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
| | - Josephine Gwynn
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.D.)
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
- School of Psychology, UNSW Science, Kensington, NSW 2052, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW 2052, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
| | - Justin Richards
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.D.)
- Faculty of Health, Te Herenga Waka—Victoria University Wellington, Wellington 6012, New Zealand
| | - Nigel Lovell
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
- Faculty of Engineering, Graduate School of Biomedical Engineering, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Michelle Dickson
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.D.)
| | - Rona Macniven
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW 2052, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Correspondence: (B.A.); (R.M.)
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10
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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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Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R, Ward K, Tobin S, Gwynne K. Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia. Int J Environ Res Public Health 2021; 18:ijerph18063014. [PMID: 33804104 PMCID: PMC7999419 DOI: 10.3390/ijerph18063014] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. Three communities were selected for their high proportion of Aboriginal people and diverse regional and remote locations. Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted in the three communities (n = 5 coastal, n = 13 remote, and n = 13 border) and six themes identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.
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Affiliation(s)
- Davida Nolan-Isles
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
| | - Rona Macniven
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence:
| | - Kate Hunter
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia;
| | - Josephine Gwynn
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Michelle Lincoln
- Faculty of Health, The University of Canberra, Bruce, ACT 2617, Australia;
| | - Rachael Moir
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
| | - Yvonne Dimitropoulos
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
| | - Donna Taylor
- Pius X Aboriginal Health Service, Moree, NSW 2400, Australia;
| | - Tim Agius
- Durri Aboriginal Corporation Medical Service, 15-19 York Lane, Kempsey, NSW 2440, Australia;
| | - Heather Finlayson
- Brewarrina Multipurpose Health Service, 56 Doyle Street, Brewarrina, NSW 2839, Australia;
| | - Robyn Martin
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Katrina Ward
- Brewarrina Aboriginal Health Service, 5-7 Sandon Street, Brewarrina, NSW 2839, Australia;
| | - Susannah Tobin
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
| | - Kylie Gwynne
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia; (D.N.-I.); (J.G.); (R.M.); (Y.D.); (S.T.); (K.G.)
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
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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: 14] [Impact Index Per Article: 4.7] [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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Macniven R, Coombes J, Wilson R, Simon A, Mackean T, Hunter K, Ma T, Gwynn J, Sherrington C, Tiedemann A, Hill AM, Delbaere K, Lewis C, Bennett-Brook K, Howie A, Stewart G, Shakespeare M, Rogers K, Ivers RQ, Clapham K. Understanding implementation factors and participant experiences of a cluster randomised controlled trial to prevent falls among older Aboriginal people: a process evaluation protocol. Inj Prev 2021; 27:injuryprev-2020-043980. [PMID: 33402353 DOI: 10.1136/injuryprev-2020-043980] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Process evaluations examining programme implementation are often conducted in conjunction with effectiveness studies. Their inclusion in studies with Aboriginal participants can give an understanding of programme delivery in Aboriginal community contexts. The Ironbark: Standing Strong and Tall programme was codesigned with Aboriginal communities and includes exercise and facilitated 'yarning' discussion about fall risk and prevention strategies. The programme pilot showed favourable outcomes and acceptability for Aboriginal people aged 45 years and over. The Ironbark: Standing Strong and Tall programme is now being compared with a 'Healthy Community' programme in a cluster randomised controlled trial within Aboriginal health and community services. An embedded process evaluation aims to explore relationships between participation and programme outcomes and the quality of programme implementation. METHODS AND ANALYSIS The process evaluation will use a mixed methods design, guided by Indigenous research methodology. It will evaluate quantitative data (number of completed sessions, site coaching checklist tool, participant and facilitator questionnaire data and a participant habit formation scale), as well as qualitative data (open-ended responses from project and site staff and semistructured interviews using yarning with study participants and site managers). A programme logic model was developed to explain the intended inputs, activities, outputs and outcomes, which guided this process evaluation design. CONCLUSION This process evaluation of a fall prevention programme for older Aboriginal people using a mixed methods design and data triangulation will allow for a comprehensive understanding of study findings. Multiple study sites allow for generalisability of findings and exploration of variation across sites. TRIAL REGISTRATION NUMBER ACTRN12619000349145.
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Affiliation(s)
- Rona Macniven
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julieann Coombes
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Roland Wilson
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Aaron Simon
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Tamara Mackean
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Kate Hunter
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Tracey Ma
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Josephine Gwynn
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, Australia
| | - Kim Delbaere
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Carolyn Lewis
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, Australia
| | - Keziah Bennett-Brook
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Howie
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia Stewart
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Madison Shakespeare
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Kris Rogers
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Rebecca Q Ivers
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, 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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Conte KP, Gwynn J, Turner N, Koller C, Gillham KE. Making space for Aboriginal and Torres Strait Islander community health workers in health promotion. Health Promot Int 2020; 35:562-574. [PMID: 31155649 PMCID: PMC7307184 DOI: 10.1093/heapro/daz035] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite a clear need, 'closing the gap' in health disparities for Aboriginal and Torres Strait Islander communities (hereafter, respectfully referred to as Aboriginal) continues to be challenging for western health care systems. Globally, community health workers (CHWs) have proven effective in empowering communities and improving culturally appropriate health services. The global literature on CHWs reflects a lack of differentiation between the types of roles these workers carry out. This in turn impedes evidence syntheses informing how different roles contribute to improving health outcomes. Indigenous CHW roles in Australia are largely operationalized by Aboriginal Health Workers (AHWs)-a role situated primarily within the clinical health system. In this commentary, we consider whether the focus on creating professional AHW roles, although important, has taken attention away from the benefits of other types of CHW roles particularly in community-based health promotion. We draw on the global literature to illustrate the need for an Aboriginal CHW role in health promotion; one that is distinct from, but complementary to, that of AHWs in clinical settings. We provide examples of barriers encountered in developing such a role based on our experiences of employing Aboriginal health promoters to deliver evidence-based programmes in rural and remote communities. We aim to draw attention to the systemic and institutional barriers that persist in denying innovative employment and engagement opportunities for Aboriginal people in health.
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Affiliation(s)
- Kathleen P Conte
- University Centre for Rural Health and the Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Level 2, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
| | - Josephine Gwynn
- Faculty of Health Sciences and the Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Nicole Turner
- University of Canberra, Canberra, Australia
- Rural Doctors Network, New South Wales, Australia
| | - Claudia Koller
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Wallsend, 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, Richards J, Turner N, Blunden S, Bauman A, Wiggers J, Gwynn J. Understanding physical activity patterns among rural Aboriginal and non-Aboriginal young people. Rural Remote Health 2019; 19:4876. [PMID: 31466453 DOI: 10.22605/rrh4876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Physical activity across the lifespan is essential to good health but participation rates are generally lower in rural areas and among Aboriginal Australians. Declines in moderate-to-vigorous physical activity (MVPA) commence before adolescence but descriptive epidemiology of patterns of physical activity among Aboriginal children is limited. MVPA variation by season, setting and type at two time points among rural Aboriginal and non-Aboriginal Australian children was examined. METHODS Children aged 10-14 years in 38 schools in two rural New South Wales towns during 2007-2008 (T1) and 2011-2012 (T2) self-reported time spent engaged in MVPA for different types, settings and seasons, totalling 14 components: organised, non-organised, club, school, travel to/from school, after school and weekend - in both summer and winter. Linear mixed models assessed MVPA mean minutes and 95% confidence intervals for Aboriginal and non-Aboriginal children and between-group mean differences over time. RESULTS A total of 1545 children (246 Aboriginal) at T1 and 923 children (240 Aboriginal) at T2 provided data. Overall MVPA, travel to/from school (summer and winter) and after-school activity (winter) declined over time in both groups (p≤0.005). Significant declines occurred in non-organised, school (summer and winter) and organised (winter) activity among Aboriginal children only. There were differences according to Aboriginality from T1 to T2 for school (summer and winter; p<0.001), weekend (summer; p=0.02) and winter organised (winter; p<0.001) activity . CONCLUSIONS While overall physical activity declines occurred between 2007-208 (T1) and 2011-2012 (T2) in both Aboriginal and non-Aboriginal rural-dwelling children, declines in particular components of physical activity were greater among Aboriginal compared to non-Aboriginal children. A multi-strategy, holistic approach to increase physical activity during the critical time of adolescence is necessary.
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Affiliation(s)
- Rona Macniven
- Prevention Research Collaboration, Sydney School of Public Health, Level 6 The Hub, The Charles Perkins Centre (D17), The University of Sydney, NSW, 2006, Australia and Poche Centre for Indigenous Health, Sydney Medical School, Rm 224 Edward Ford Building A27, The University of Sydney, NSW, 2006 Australia and School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052, Australia
| | - Justin Richards
- Prevention Research Collaboration, Sydney School of Public Health, Level 6 The Hub, The Charles Perkins Centre (D17), The University of Sydney, NSW 2006, Australia
| | - Nicole Turner
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia and Australian National University, Canberra, ACT 0200, Australia
| | - Steve Blunden
- Casino Aboriginal Medical Service, 43 Johnston Street, Casino, NSW 2470, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, Level 6 The Hub, The Charles Perkins Centre (D17), The University of Sydney, NSW 2006, Australia and Charles Perkins Centre, (D17), The University of Sydney, NSW 2006, Australia
| | - John Wiggers
- Hunter New England Local Health District, Locked Bag 1, New Lambton NSW 2305, Australia and The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Josephine Gwynn
- Poche Centre for Indigenous Health, Sydney Medical School, Rm 224 Edward Ford Building A27, The University of Sydney, NSW 2006, Australia and Charles Perkins Centre, (D17), The University of Sydney, NSW 2006, Australia and Faculty of Health Sciences, The University of Sydney, NSW 2006, 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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Gwynn J, Sim K, Searle T, Senior A, Lee A, Brimblecombe J. Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review. BMJ Open 2019; 9:e025291. [PMID: 30948579 PMCID: PMC6500365 DOI: 10.1136/bmjopen-2018-025291] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people. STUDY DESIGN Systematic review of peer-reviewed literature. DATA SOURCES MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet. STUDY SELECTION Peer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots. RESULTS Thirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes. CONCLUSIONS Store-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation. PROSPERO REGISTRATION NUMBER CRD42015029551.
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Affiliation(s)
- Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kyra Sim
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tania Searle
- Department of Sociology, Flinders University, Adelaide, South Australia, Australia
| | - Alistair Senior
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
- School of Life and Environmental Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Lee
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
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Fletcher R, Hammond C, Faulkner D, Turner N, Shipley L, Read D, Gwynn J. Stayin' on Track: the feasibility of developing Internet and mobile phone-based resources to support young Aboriginal fathers. Aust J Prim Health 2019; 23:329-334. [PMID: 28449728 DOI: 10.1071/py16151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/19/2017] [Indexed: 11/23/2022]
Abstract
Young Aboriginal fathers face social and emotional challenges in the transition to fatherhood, yet culturally appropriate support mechanisms are lacking. Peer mentoring to develop online- and mobile phone-based resources and support may be a viable approach to successfully engage these young men. This feasibility study engaged two trusted Aboriginal mentors and researchers to partner with one regional and two rural Aboriginal communities in New South Wales, Australia. Early in the research process, 20 young Aboriginal fathers were recruited as co-investigators. These fathers were integral in the development of web-based resources and testing of mobile phone-based text messaging and mood-tracking programs tailored to provide fathering and mental health support. Overwhelmingly positive feedback from evaluations reinforced community pride in and ownership of the outcomes. The young men's involvement was instrumental in not only developing culturally appropriate support, but also in building their capacity as role models for other fathers in the community. The positive results from this feasibility study support the adoption of participatory approaches in the development of resources for Aboriginal communities.
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Affiliation(s)
- Richard Fletcher
- Family Action Centre, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Craig Hammond
- Family Action Centre, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Darren Faulkner
- Hunter New England Local Health District, Tara Lodge, 72 Watt Street, Newcastle, NSW 2300, Australia
| | - Nicole Turner
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia
| | - Lisa Shipley
- School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia
| | - Josephine Gwynn
- Faculty of Health Sciences, Charles Perkins Centre, Poche Centre for Indigenous Health, University of Sydney, NSW 2006, Australia
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21
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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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Macniven R, Plater S, Canuto K, Dickson M, Gwynn J, Bauman A, Richards J. The "ripple effect": Health and community perceptions of the Indigenous Marathon Program on Thursday Island in the Torres Strait, Australia. Health Promot J Austr 2018; 29:304-313. [PMID: 29569761 DOI: 10.1002/hpja.43] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/04/2017] [Accepted: 02/06/2018] [Indexed: 11/12/2022] Open
Abstract
ISSUE ADDRESSED Physical inactivity is a key health risk among Aboriginal and Torres Strait Islander (Indigenous) Australians. We examined perceptions of the Indigenous Marathon Program (IMP) in a remote Torres Strait island community. METHODS Semi-structured interviews with community and program stakeholders (n = 18; 14 Indigenous) examined barriers and enablers to running and the influence of the IMP on the community. A questionnaire asked 104 running event participants (n = 42 Indigenous) about their physical activity behaviours, running motivation and perceptions of program impact. Qualitative data were analysed using thematic content analysis, and quantitative data were analysed using descriptive statistics. RESULTS Interviews revealed six main themes: community readiness, changing social norms to adopt healthy lifestyles, importance of social support, program appeal to hard-to-reach population groups, program sustainability and initiation of broader healthy lifestyle ripple effects beyond running. Barriers to running in the community were personal (cultural attitudes; shyness) and environmental (infrastructure; weather; dogs). Enablers reflected potential strategies to overcome described barriers. Indigenous questionnaire respondents were more likely to report being inspired to run by IMP runners than non-Indigenous respondents. CONCLUSIONS Positive "ripple" effects of the IMP on running and broader health were described to have occurred through local role modelling of healthy lifestyles by IMP runners that reduced levels of "shame" and embarrassment, a common barrier to physical activity among Indigenous Australians. A high initial level of community readiness for behaviour change was also reported. SO WHAT?: Strategies to overcome this "shame" factor and community readiness measurement should be incorporated into the design of future Indigenous physical activity programs.
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Affiliation(s)
- Rona Macniven
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, The Charles Perkins Centre (D17), Sydney, NSW, Australia.,Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Suzanne Plater
- Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Karla Canuto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Apunipima Cape York Health Council, Westcourt, QLD, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Josephine Gwynn
- Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, NSW, Australia.,Faculty of Health Sciences, The Charles Perkins Centre, The University of Sydney, The Charles Perkins Centre (D17), NSW, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, The Charles Perkins Centre (D17), Sydney, NSW, Australia
| | - Justin Richards
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, The Charles Perkins Centre (D17), Sydney, NSW, Australia
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23
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Whalan S, Farnbach S, Volk L, Gwynn J, Lock M, Trieu K, Brimblecombe J, Webster J. What do we know about the diets of Aboriginal and Torres Strait Islander peoples in Australia? A systematic literature review. Aust N Z J Public Health 2017; 41:579-584. [PMID: 28898509 DOI: 10.1111/1753-6405.12721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/01/2017] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide an overview of published research on the dietary intake of Aboriginal and Torres Strait Islander peoples. METHODS Peer-reviewed literature from 1990 to October 2016 was searched to identify studies that measured the dietary intake of Australian Aboriginal and Torres Strait Islander populations. Study quality was assessed using a purposely devised quality appraisal tool. Meta-analysis was not possible due to the heterogeneity in dietary intake assessment methods. A narrative synthesis of study findings, where key themes were compared and contrasted was completed. RESULTS Twenty-five articles from twenty studies with outcome measures related to dietary intake were included. Dietary intake was assessed by electronic store sales, store turnover method, 24-hour dietary recall, food frequency questionnaire and short questions. Consistent findings were low reported intakes of fruit and vegetables and high intakes of total sugar and energy-dense, nutrient-poor food and beverages. CONCLUSIONS While differences between studies and study quality limit the generalisability of the findings, most studies suggest that the diets of Aboriginal and Torres Strait Islander peoples are inadequate. Implications for public health: A more concerted approach to understanding dietary patterns of Aboriginal and Torres Strait Islander peoples is required to inform policy and practice to improve diet and nutrition.
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Affiliation(s)
- Sarah Whalan
- Menzies School of Health Research, Northern Territory
| | - Sara Farnbach
- The George Institute for Global Health, New South Wales
| | - Lena Volk
- The George Institute for Global Health, New South Wales
| | - Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, New South Wales
| | - Mark Lock
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Kathy Trieu
- The George Institute for Global Health, New South Wales
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Mah B, Weatherall L, Burrows J, Blackwell CC, Gwynn J, Wadhwa P, Lumbers ER, Smith R, Rae KM. Post-traumatic stress disorder symptoms in pregnant Australian Indigenous women residing in rural and remote New South Wales: A cross-sectional descriptive study. Aust N Z J Obstet Gynaecol 2017; 57:520-525. [PMID: 28386930 DOI: 10.1111/ajo.12618] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pregnancy can be a stressful time for many women. There is ample evidence of numerous physical and mental health inequities for Indigenous Australians. For those Indigenous women who are pregnant, it is established that there is a higher incidence of poor physical perinatal outcomes when compared with non-Indigenous Australians. However, little evidence exists that examines stressful events and post-traumatic stress disorder (PTSD) symptoms in pregnant women who are members of this community. AIMS To quantify the rates of stressful events and PTSD symptoms in pregnant Indigenous women. METHODS One hundred and fifty rural and remote Indigenous women were invited to complete a survey during each trimester of their pregnancy. The survey measures were the stressful life events and the Impact of Events Scale. RESULTS Extremely high rates of PTSD symptoms were reported by participants. Approximately 40% of this group exhibited PTSD symptoms during their pregnancy with mean score 33.38 (SD = 14.37) significantly higher than a study of European victims of crisis, including terrorism attacks (20.6, SD = 18.5). CONCLUSIONS The extreme levels of PTSD symptoms found in the women participating in this study are likely to result in negative implications for both mother and infant. An urgent response must be mounted at government, health, community development and research levels to address these findings. Immediate attention needs to focus on the development of interventions to address the high levels of PTSD symptoms that pregnant Australian Indigenous women experience.
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Affiliation(s)
- Beth Mah
- HMRI Brain and Mental Health Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Loretta Weatherall
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Julie Burrows
- Department of Rural Health, Faculty of Health, University of Newcastle, Tamworth, New South Wales, Australia
| | | | - Josephine Gwynn
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Pathik Wadhwa
- UC Irvine Development, Health and Disease Research Program, School of Medicine University of California, Irvine, California, USA
| | - Eugenie R Lumbers
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre Reproduction, University of Newcastle, Newcastle, New South Wales, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre Reproduction, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kym M Rae
- Department of Rural Health, Faculty of Health, University of Newcastle, Tamworth, New South Wales, Australia.,Priority Research Centre Reproduction, University of Newcastle, Newcastle, New South Wales, Australia
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Sapkota S, Brien JAE, Gwynn J, Flood V, Aslani P. Perceived impact of Nepalese food and food culture in diabetes. Appetite 2017; 113:376-386. [PMID: 28288801 DOI: 10.1016/j.appet.2017.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/20/2016] [Revised: 01/31/2017] [Accepted: 03/07/2017] [Indexed: 01/17/2023]
Abstract
Consuming a healthy diet forms an important component of diabetes management; however, adhering to a healthy diet is challenging. Dietary behaviour is often guided by socio-cultural, environmental and emotional factors, and not necessarily by physical and nutritional needs. This study explored Nepalese patients' perceptions of the impact of diet, diet management requirement for diabetes and how Nepalese food culture in particular influenced diet management. Interviews were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu; and data was thematically analysed. Diet was recognized as a cause of, and a key treatment modality, in diabetes. Besides doctors, participants in Nepal received a large amount of dietary information from the community. Dietary changes formed a major component of lifestyle modifications adopted after diagnosis, and mostly consisted of removal of foods with added sugar and foods with high total sugar content from the diet, and a reduction in overall quantity of foods consumed. Perceived dietary restriction requirements created social and emotional discomfort to patients. Most participants perceived the Nepalese food culture as a barrier to effective diet management. Meals high in carbohydrates, limited food choices, and food preparation methods were identified as barriers, particularly in Nepal. In Australia, participants reported greater availability and easier access to appropriate food, and healthier cooking options. The socio-cultural aspects of food behaviour, mainly, food practices during social events were identified as significant barriers. Although diet was acknowledged as an important component of diabetes care, and most adopted changes in their diet post-diagnosis, effective and sustained changes were difficult to achieve. Future public health campaigns and education strategies should focus on improving diet knowledge, awareness of food options for diabetes, and effective dietary management.
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Affiliation(s)
- Sujata Sapkota
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia.
| | - Jo-Anne E Brien
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia; St. Vincent's Hospital, Clinical School, UNSW, NSW 2010, Australia.
| | - Josephine Gwynn
- St. Vincent's Hospital, Clinical School, UNSW, NSW 2010, Australia; Charles Perkins Center, The University of Sydney, NSW 2006, Australia; Faculty of Health Sciences, The University of Sydney, NSW 2006, Australia.
| | - Victoria Flood
- St. Vincent's Hospital, Clinical School, UNSW, NSW 2010, Australia; Charles Perkins Center, The University of Sydney, NSW 2006, Australia; Faculty of Health Sciences, The University of Sydney, NSW 2006, Australia.
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia.
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Gwynn J, Lock M, Turner N, Dennison R, Coleman C, Kelly B, Wiggers J. Aboriginal and Torres Strait Islander community governance of health research: Turning principles into practice. Aust J Rural Health 2015; 23:235-42. [DOI: 10.1111/ajr.12182] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Josephine Gwynn
- Centre for Rural and Remote Mental Health; University of Newcastle; Newcastle Australia
| | - Mark Lock
- School of Medicine and Public Health, Faculty of Medicine and Health; University of Newcastle; Moree Australia
| | - Nicole Turner
- Centre for Rural and Remote Mental Health; University of Newcastle; Newcastle Australia
| | - Ray Dennison
- St Pius Aboriginal Medical Service; Moree Australia
| | - Clare Coleman
- Sydney Centre for Aboriginal and Torres Strait Islander Statistics; University of Sydney; Sydney
| | - Brian Kelly
- School of Medicine and Public Health, Faculty of Medicine and Health; University of Newcastle; Moree Australia
| | - John Wiggers
- School of Medicine and Public Health, Faculty of Medicine and Health; University of Newcastle; Moree Australia
- Hunter New England Local Health District; New South Wales Australia
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27
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Louie JCY, Gwynn J, Turner N, Cochrane J, Wiggers J, Flood V. Dietary glycemic index and glycemic load among Indigenous and non-Indigenous children aged 10–12 years. Nutrition 2012; 28:e14-22. [DOI: 10.1016/j.nut.2011.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/13/2011] [Accepted: 12/15/2011] [Indexed: 11/16/2022]
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Louie JCY, Flood V, Turner N, Everingham C, Gwynn J. Methodology for adding glycemic index values to 24-hour recalls. Nutrition 2011; 27:59-64. [DOI: 10.1016/j.nut.2009.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 12/14/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022]
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McCluskey A, Gwynn J. Occupational therapists working with indigenous Australians use communication strategies, assessment tools and assistive devices that are more culturally appropriate for this population. Aust Occup Ther J 2005. [DOI: 10.1111/j.1440-1630.2005.00482.x] [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: 12/01/2022]
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Battaglini J, Picket R, Barefoot S, Johnson G, Gwynn J. The prevalence of hyperlipidemia in patients with advanced peripheral arterial disease. Curr Surg 1980; 37:291-3. [PMID: 7398368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Gwynn J, Fry JR, Bridges JW. The effects of paracetamol and other foreign compounds on protein synthesis in isolated adult rat hepatocytes [proceedings]. Biochem Soc Trans 1979; 7:117-9. [PMID: 437252 DOI: 10.1042/bst0070117] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Fry JR, Wiebkin P, Kao J, Jones CA, Gwynn J, Bridges JW. A comparison of drug-metabolizing capability in isolated viable rat hepatocytes and renal tubule fragments. Xenobiotica 1978; 8:113-20. [PMID: 626003 DOI: 10.3109/00498257809060390] [Citation(s) in RCA: 42] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
1. The metabolism of a number of xenobiotics has been investigated in isolated viable rat hepatocytes and kidney tubule fragments in suspension. 2. The level of Phase I metabolism was very low in the kidney cells although such cells possess appreciable Phase II metabolic capacity. 3. These findings are discussed in relation to the physiological role of cytochrome P-450 and the conjugating enzymes, and the value of intact cells systems in assessing inter-organ differences in xenobiotic metabolism.
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