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English M, Canuto K, Schulenkorf N, Evans J, Curry C, Slater C, Caperchione CM. Co-designing a health promotion program for Australian Aboriginal and Torres Strait Islander girls: lessons learnt. Health Promot Int 2023; 38:7066949. [PMID: 36857610 DOI: 10.1093/heapro/daad011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Despite progression in the ethical and methodological conduct of Aboriginal and Torres Strait Islander health research, disparities still pervade, indicating limitations in knowledge translation. One identified gap is a lack of documented experiences detailing how ethical guidelines may be practically applied. This paper aims to (i) describe the research processes involved in co-designing a physical activity and psychosocial health program for Aboriginal and Torres Strait Islander girls and (ii) highlight learnings of the collaborative research journey. The Criteria for Strengthening Reporting of Health Research involving Indigenous Peoples (CONSIDER) statement was used to document participatory research activities undertaken with an Aboriginal community partner. Building upon the CONSIDER statement, Aboriginal (N = 3), Torres Strait Islander (N = 1) and non-Indigenous (N = 4) research team members engaged in critical reflection to identify lessons learnt. Researchers identified a tension between participatory research principles and the expectations of funding agencies and research institutions. Consequently, timelines must be flexible to foster meaningful community engagement and participatory processes. Additionally, researchers and community stakeholders are encouraged to embrace tensions that may associated with participatory research or the pressures Aboriginal and Torres Strait Islander researchers face from their community and organization. Furthermore, differences in professional (i.e. occupational) and cultural knowledge systems need to be acknowledged and accounted for within the early stages of a project to ensure informed decision-making. Identified lessons will assist relevant stakeholders in the development of future Aboriginal and Torres Strait Islander health programming, ensuring the most appropriate health solutions are devised with community.
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Affiliation(s)
- Madeleine English
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Karla Canuto
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory, Australia
| | - Nico Schulenkorf
- Business School, University of Technology Sydney, Sydney, New South Wales, Australia
| | - John Evans
- Moondani Toombadool Centre, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Christina Curry
- Centre for Educational Research & School of Education, Western Sydney University, Penrith, New South Wales, Australia
| | - Cain Slater
- KARI Foundation, Sydney Olympic Park, NSW, Australia
| | - Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
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Canuto K, Prehn J, Canuto K, Neate R, Gee G, Kennedy C, Gaweda C, Black O, Smith J, Brown A. Further investment in Aboriginal and Torres Strait Islander men's health research funding is urgently required. Aust N Z J Public Health 2023; 47:100025. [PMID: 36965316 DOI: 10.1016/j.anzjph.2023.100025] [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: 06/28/2022] [Accepted: 12/28/2022] [Indexed: 03/27/2023] Open
Affiliation(s)
- Kootsy Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia; Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Jacob Prehn
- Academic Division, University of Tasmania, TAS, Australia
| | - Karla Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia; Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Rosie Neate
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Graham Gee
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia; School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Corey Kennedy
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Celina Gaweda
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Oliver Black
- Menzies School of Health Research, Darwin, NT, Australia
| | - James Smith
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Alex Brown
- Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia
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Field P, Franklin RC, Barker R, Ring I, Leggat P, Canuto K. Commentary: Improving access to cardiac rehabilitation (Heart: Road for health) for Aboriginal and Torres Strait Islander peoples in rural and remote areas of North Queensland. Aust J Rural Health 2023; 31:152-158. [PMID: 36214639 DOI: 10.1111/ajr.12932] [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: 02/20/2022] [Revised: 08/13/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To focus on the needs, challenges and opportunities to improve access to cardiac rehabilitation (CR) (Heart: Road to health [HRH]) for Aboriginal and Torres Strait Islander peoples in rural and remote (R&R) areas of North Queensland. CONTEXT It is known that there is insufficient access to HRH for Aboriginal and Torres Strait Islander peoples in R&R areas of NQ, who have the highest rates of heart disease and socioeconomic disadvantage mainly due to poor social determinants of health. However, at least in part due to the impact of colonialism and predominantly western medicalised approach to health care, few gains have been made. APPROACH This commentary draws on recent research and literature and reflects on cultural issues that impact on improving access to an HRH for Aboriginal and Torres Strait Islander peoples in R&R areas. The underutilisation of the skills of Aboriginal and Torres Strait Islander Health Workers (ATSIHW) and a lack of a defined process to ensure access to culturally responsive HRH are discussed. Finally, a way forward is proposed that includes the development of policies, pathways and guidelines to ensure that appropriate support is available in the client's home community. CONCLUSION It is proposed that culturally responsive, accessible and effective HRH is achievable through the reorientation of current health systems that include a continuous client-centred pathway from hospital to home. In this model, ATSIHW will take a lead or partnership role in which their clinical, cultural brokerage and health promotion skills are fully utilised.
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Affiliation(s)
- Patricia Field
- College of Public health, Medicine and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- College of Public health, Medicine and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| | - Ian Ring
- Division of Tropical Health & Medicine, James Cook University, Townsville, Queensland, Australia
| | - Peter Leggat
- College of Public health, Medicine and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Faculty of Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Karla Canuto
- Rural and Remote Health, Flinders University, Darwin, Northwest Territories, Australia
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Smith JA, Canuto K, Canuto K, Bonevski B, Mahoney R, Ryder C, Smith L, Brickley B, Edmunds M, Crawford G. Health promotion is central to the establishment of an Australian Centre for Disease Control. Health Promot J Austr 2023; 34:6-8. [PMID: 36617814 DOI: 10.1002/hpja.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Affiliation(s)
- James A Smith
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia.,Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Karla Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Kootsy Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ray Mahoney
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Courtney Ryder
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Le Smith
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia.,Heart Foundation, Darwin, NT, Australia
| | - Bryce Brickley
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Melinda Edmunds
- Australian Health Promotion Association, Adelaide, SA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Gemma Crawford
- Australian Health Promotion Association, Adelaide, SA, Australia.,Curtin School of Population Health, Curtin University, Perth, WA, 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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Westhead S, Appleby Q, Andrews B, Brodie T, Brown A, Canuto K, Cooke J, Garay M, Harrington T, Hunter D, Kennedy C, Lenoy J, Lester O, McCleary H, Pearson O, Randall L, Reilly R, Rose H, Rosendale D, Telfer J, Azzopardi P. The need for a roadmap to guide actions for Aboriginal and Torres Strait Islander adolescent health: youth governance as an essential foundation. Med J Aust 2022; 217:13-15. [PMID: 35661364 PMCID: PMC9543177 DOI: 10.5694/mja2.51592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Seth Westhead
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Quinton Appleby
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Brittney Andrews
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Tina Brodie
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Alex Brown
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Karla Canuto
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Josh Cooke
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Mahlia Garay
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Thomas Harrington
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Djai Hunter
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Corey Kennedy
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Jaeda Lenoy
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Olivia Lester
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Hannah McCleary
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Odette Pearson
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Lorraine Randall
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Rachel Reilly
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Hamish Rose
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Daniel Rosendale
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Jakirah Telfer
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
| | - Peter Azzopardi
- Aboriginal Health Equity South Australian Health and Medical Research Institute Adelaide SA
- Burnet Institute Melbourne VIC
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7
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Canuto K, Preston R, Rannard S, Felton-Busch C, Geia L, Yeomans L, Turner N, Thompson Q, Carlisle K, Evans R, Passey M, Larkins S, Redman-MacLaren M, Farmer J, Muscat M, Taylor J. How and why do women's groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature. BMJ Open 2022; 12:e055756. [PMID: 35190438 PMCID: PMC8862452 DOI: 10.1136/bmjopen-2021-055756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This systematic review was undertaken to assist the implementation of the WOmen's action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women's group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outcomes, and we were interested in understanding how and why this occurs. The following questions guided the review: (1) What are the characteristics, contextual influences and group processes associated with the MCH outcomes of WGs? (2) What are the theoretical and conceptual approaches to WGs? (3) What are the implications likely to inform Aboriginal and Torres Strait Islander WGs? METHODS We systematically searched electronic databases (MEDLINE (Ovid); CINAHL (Ebsco); Informit health suite, Scopus, Emcare (Ovid) and the Cochrane Library and Informit), online search registers and grey literature using the terms mother, child, group, participatory and community and their variations during all time periods to January 2021. The inclusion criteria were: (1) Population: studies involving community WGs in any country. (2) Intervention: a program/intervention involving any aspect of community WGs planning, acting, learning and reviewing MCH improvements. (3) Outcome: studies with WGs reported a component of: (i) MCH outcomes; or (ii) improvements in the quality of MCH care or (iii) improvements in socioemotional well-being of mothers and/or children. (4) Context: the primary focus of initiatives must be in community-based or primary health care settings. (5) Process: includes some description of the process of WGs or any factors influencing the process. (6) Language: English. (7) Study design: all types of quantitative and qualitative study designs involving primary research and data collection.Data were extracted under 14 headings and a narrative synthesis identified group characteristics and analysed the conceptual approach to community participation, the use of theory and group processes. An Australian typology of community participation, concepts from Aboriginal and Torres Strait Islander group work and an adapted framework of Cohen and Uphoff were used to synthesise results. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. RESULTS Thirty-five (35) documents were included with studies conducted in 19 countries. Fifteen WGs used participatory learning and action cycles and the remainder used cultural learning, community development or group health education. Group activities, structure and who facilitated groups was usually identified. Intergroup relationships and decision-making were less often described as were important concepts from an Aboriginal or Torres Strait Islander perspective (the primacy of culture, relationships and respect). All but two documents used an explicit theoretical approach. Using the typology of community participation, WGs were identified as predominantly developmental (22), instrumental (10), empowerment (2) and one was unclear. DISCUSSION A framework to categorise links between contextual factors operating at micro, meso and macro levels, group processes and MCH improvements is required. Currently, despite a wealth of information about WGs, it was difficult to determine the methods through which they achieved their outcomes. This review adds to existing systematic reviews about the functioning of WGs in MCH improvement in that it covers WGs in both high-income and low-income settings, identifies the theory underpinning the WGs and classifies the conceptual approach to participation. It also introduces an Australian Indigenous perspective into analysis of WGs used to improve MCH. PROSPERO REGISTRATION NUMBER CRD42019126533.
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Affiliation(s)
- Karla Canuto
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Naghir Tribe of the Kulkagul Clan, Torres Strait, Queensland, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Sam Rannard
- Library and Information Services, James Cook University, Bebegu Yumba, Townsville, Queensland, Australia
| | - Catrina Felton-Busch
- Murtupuni Centre Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
- Yangkaal and Gangaidda, Mount Isa, Queensland, Australia
| | - Lynore Geia
- College of Healthcare Sciences, James Cook University, Bebegu Yumba, Townsville, Queensland, Australia
- Bwgcolman, Palm Island, Queensland, Australia
| | - Lee Yeomans
- Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - Nalita Turner
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
- Anmatyerre/Jaru, Northern Territory, Northern Territory, Australia
| | - Quitaysha Thompson
- Gurindji Aboriginal Corporation, Kalkaringi, Northern Territory, Australia
- Gurindji woman, Kalkaringi, Northern Territory, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, Nguma-bada, Cairns, Queensland, Australia
| | - Jane Farmer
- Swinburne Social Innovation Research Institute, Centre for Social Impact, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melody Muscat
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
- Bijara, Charleville, Queensland, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
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Lew JB, Feletto E, Worthington J, Roder D, Canuto K, Miller C, D’Onise K, Canfell K. The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: modelling study. J Cancer Policy 2022; 32:100325. [DOI: 10.1016/j.jcpo.2022.100325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Smith JA, Canuto K, Canuto K, Campbell N, Schmitt D, Bonson J, Smith L, Connolly P, Bonevski B, Rissel C, Aitken R, Dennis C, Williams C, Dyall D, Stephens D. Advancing health promotion in rural and remote Australia: Strategies for change. Health Promot J Austr 2022; 33:3-6. [PMID: 34989041 DOI: 10.1002/hpja.569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- James A Smith
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Karla Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Kootsy Canuto
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Narelle Campbell
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Dagmar Schmitt
- Northern Territory Department of Health, Darwin, NT, Australia
| | - Jason Bonson
- Northern Territory Department of Health, Darwin, NT, Australia
| | - Le Smith
- Northern Territory Primary Health Network, Darwin, NT, Australia
| | - Paul Connolly
- Northern Territory Primary Health Network, Darwin, NT, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Chris Rissel
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Robyn Aitken
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Christine Dennis
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Carmel Williams
- Centre for Health in All Policies Research Translation, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Danielle Dyall
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
| | - Donna Stephens
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
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10
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Field P, Franklin RC, Barker R, Ring I, Leggat P, Canuto K. Importance of cardiac rehabilitation in rural and remote areas of Australia. Aust J Rural Health 2021; 30:149-163. [PMID: 34932825 DOI: 10.1111/ajr.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/15/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess implementation of in-patient cardiac rehabilitation (Phase-1-cardiac rehabilitation), impact on people in rural and remote areas of Australia and potential methods for addressing identified weaknesses. DESIGN Exploratory case study methodology using qualitative and quantitative methods. Qualitative data collection via semi-structured interviews, using thematic analysis, augmented by quantitative data collection via a medical record audit. SETTING Four regional hospitals (2 Queensland Health and 2 private) providing tertiary health care. PARTICIPANTS (a) Hospital in-patients with heart disease ≥18 years. (b) Staff responsible for their care. OUTCOME MEASURES Implementation of Phase-1-cardiac rehabilitation in tertiary hosptials in North Queensland and the impact on in-patients discharge planning and post discharge care. Recommentations and implications for practice are proposed to address deficits. RESULTS Phase-1-cardiac rehabilitation implementation rates, in-patient understanding and multidisciplinary team involvement were low. The highest rates of Phase-1-cardiac rehabilitation were for in-patients with a length of stay three days or more in cardiac units with cardiac educators. Rates were lower in cardiac units with no cardiac educators, and lowest for in-patients in all areas of all hospitals with length of stay of two days or less days. Low Phase-1-cardiac rehabilitation implementation rates resulted in poor in-patient understanding about their disease, treatment and post-discharge care. Further, medical discharge summaries rarely mentioned cardiac rehabilitation/secondary prevention or risk factor management resulting in a lack of information for health care providers on cardiac rehabilitation and holistic health care. CONCLUSION Implementation of Phase-1-cardiac rehabilitation in regional hospitals in this study fell short of recommended best practice, resulting in patients' poor preparation for discharge, and insufficient information on holistic care for health care providers in rural and remote areas. These factors potentially impact on holistic care for people returning home following treatment for heart disease.
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Affiliation(s)
- Patricia Field
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Richard C Franklin
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, QLD, Australia
| | - Ian Ring
- Division of Tropical Health & Medicine, James Cook University, Townsville, QLD, Australia
| | - Peter Leggat
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Faculty of Health Sciences, Flinders University, Adelaide, QLD, Australia
| | - Karla Canuto
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,South Australian Health and Medical Research Institute, Wardliparingga Aboriginal Health Equity, Adelaide, SA, Australia
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11
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Field PE, Franklin RC, Barker R, Ring I, Leggat P, Canuto K. Improving access to cardiac rehabilitation in rural and remote areas: a protocol for a community-based qualitative case study. International Journal of Therapy and Rehabilitation 2021. [DOI: 10.12968/ijtr.2020.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Heart disease is the largest single cause of death and contributes to poor quality of life and high healthcare costs in Australia. There are higher rates of heart disease in rural and remote areas, with the highest rates in Aboriginal and Torres Strait Islander people. Cardiac rehabilitation is known to improve health outcomes for people with heart disease but referral rates remain low (30.2% overall and 46% following acute coronary syndrome) in Australia. Further, access to cardiac rehabilitation in rural and remote areas is affected by there being few centre-based services, and poor use of home-based services. The aim of this protocol is to investigate: (i) understanding of cardiac rehabilitation by health staff, community leaders and community participants discharged from hospital following treatment for heart disease; (ii) access and support for cardiac rehabilitation in rural and remote areas via health service availability in each community. Methods A qualitative case study methodology, using an interpretive descriptive framework, will be used together with content analysis that will encompass identification of themes through a deductive/inductive process. Conclusions To improve access to services and health outcomes in rural and remote areas, a strong evidence base is essential. To achieve this, as well as having appropriate methodology, it is necessary to build relationships and trust with local communities and healthcare providers. This research protocol describes a qualitative community-based case study, together with processes to build sound relationships required for effective data collection through semi-structured interviews or focus groups. Each step of the pre-research planning data collection and analysis is described in detail for the guidance of future researchers.
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Affiliation(s)
- Patricia E Field
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Richard C Franklin
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - Ian Ring
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Peter Leggat
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Australia
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Karla Canuto
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Australia
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
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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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13
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Rohit A, McCarthy L, Mack S, Silver B, Turner S, Baur LA, Canuto K, Boffa J, Dabelea D, Sauder KA, Maple-Brown L, Kirkham R. The Adaptation of a Youth Diabetes Prevention Program for Aboriginal Children in Central Australia: Community Perspectives. Int J Environ Res Public Health 2021; 18:ijerph18179173. [PMID: 34501765 PMCID: PMC8430517 DOI: 10.3390/ijerph18179173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
This study reports on integrating community perspectives to adapt a family-focused, culturally appropriate behavioural intervention program to prevent diabetes among Aboriginal children (6–11 years) in Central Australia. A participatory action research approach was used to engage a range of service providers, cultural advisors, and family groups. Appropriateness, acceptability, content, and delivery of a prevention program within the Central Australian context were discussed through a series of workshops with twenty-five service providers and seven family groups separately. The data obtained were deductively coded for thematic analysis. Main findings included: (i) the strong need for a diabetes prevention program that is community owned, (ii) a flexible and culturally appropriate program delivered by upskilling community members as program facilitators, and (iii) consideration of social and environmental factors when implementing the program. It is recommended that a trial of the adapted prevention program for effectiveness and implementation is led by an Aboriginal community-controlled health service.
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Affiliation(s)
- Athira Rohit
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
| | - Leisa McCarthy
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
| | - Shiree Mack
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
| | - Bronwyn Silver
- Aboriginal Community-Controlled Health Organization, Central Australian Aboriginal Congress, Alice Springs 0870, Australia; (B.S.); (S.T.); (J.B.)
| | - Sabella Turner
- Aboriginal Community-Controlled Health Organization, Central Australian Aboriginal Congress, Alice Springs 0870, Australia; (B.S.); (S.T.); (J.B.)
| | - Louise A. Baur
- Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney 2006, Australia;
| | - Karla Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide 5001, Australia;
| | - John Boffa
- Aboriginal Community-Controlled Health Organization, Central Australian Aboriginal Congress, Alice Springs 0870, Australia; (B.S.); (S.T.); (J.B.)
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Centre, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.A.S.)
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Centre, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.A.S.)
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
- Department of Endocrinology, Royal Darwin Hospital, Darwin 0810, Australia
- Correspondence: (L.M.-B.); (R.K.)
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
- Correspondence: (L.M.-B.); (R.K.)
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14
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Evans J, Canuto K, Kelly R, Caperchione C, Macniven R. Physical activity interventions to prevent and manage type 2 diabetes among Aboriginal and Torres Strait Islander peoples: a systematic review protocol. JBI Evid Synth 2021; 19:177-183. [PMID: 32881733 DOI: 10.11124/jbies-20-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This systematic review aims to synthesize evidence to determine the effect of physical activity on the prevention and management of type 2 diabetes among Aboriginal and Torres Strait Islander Australians. INTRODUCTION Physical activity interventions have been shown to have a positive influence in the prevention and management of type 2 diabetes. A body of evidence for the impact among Aboriginal and Torres Strait Islander people is emerging, but a definitive understanding is yet to be realized. INCLUSION CRITERIA The review will include studies with Aboriginal and Torres Strait Islander populations of any age group and from any setting or region in Australia. Studies will be included if they report on physical activity interventions, programs, or activities to prevent or manage type 2 diabetes. Studies may compare physical activity interventions to usual care, alternate treatments, or no intervention, or may be pre-post studies. This review will consider studies that measure change in physical activity or exercise levels and/or change in HbA1c level. METHODS Nine databases will be searched, and studies published in English will be included. No date limits will be set. Methodological quality will be determined using critical appraisal checklists appropriate to the study design and the CREATE Critical Appraisal Tool to appraise research from Aboriginal and Torres Strait Islander perspectives. Data extracted will include population group, study design, methods, intervention components, and physical activity-related outcomes. Quantitative data will be pooled where possible to enable a meta-analysis to be conducted. Heterogeneous studies will be synthesized narratively.
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Affiliation(s)
- John Evans
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Sydney School of Education and Social Work, The University of Sydney, Camperdown, NSW, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Health Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Ray Kelly
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Rona Macniven
- School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Kensington, NSW, Australia.,Faculty of Medicine and Health, Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, Australia
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Backholer K, Baum F, Finlay SM, Friel S, Giles-Corti B, Jones A, Patrick R, Shill J, Townsend B, Armstrong F, Baker P, Bowen K, Browne J, Büsst C, Butt A, Canuto K, Canuto K, Capon A, Corben K, Daube M, Goldfeld S, Grenfell R, Gunn L, Harris P, Horton K, Keane L, Lacy-Nichols J, Lo SN, Lovett RW, Lowe M, Martin JE, Neal N, Peeters A, Pettman T, Thoms A, Thow AMT, Timperio A, Williams C, Wright A, Zapata-Diomedi B, Demaio S. Australia in 2030: what is our path to health for all? Med J Aust 2021; 214 Suppl 8:S5-S40. [PMID: 33934362 DOI: 10.5694/mja2.51020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.
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Harfield S, Pearson O, Morey K, Kite E, Canuto K, Glover K, Gomersall JS, Carter D, Davy C, Aromataris E, Braunack-Mayer A. Assessing the quality of health research from an Indigenous perspective: the Aboriginal and Torres Strait Islander quality appraisal tool. BMC Med Res Methodol 2020; 20:79. [PMID: 32276606 PMCID: PMC7147059 DOI: 10.1186/s12874-020-00959-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [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: 04/29/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background The lack of attention to Indigenous epistemologies and, more broadly, Indigenous values in primary research, is mirrored in the standardised critical appraisal tools used to guide evidence-based practice and systematic reviews and meta-syntheses. These critical appraisal tools offer no guidance on how validity or contextual relevance should be assessed for Indigenous populations and cultural contexts. Failure to tailor the research questions, design, analysis, dissemination and knowledge translation to capture understandings that are specific to Indigenous peoples results in research of limited acceptability and benefit and potentially harms Indigenous peoples. A specific Aboriginal and Torres Strait Islander Quality Appraisal Tool is needed to address this gap. Method The Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) was developed using a modified Nominal Group and Delphi Techniques and the tool’s validity, reliability, and feasibility were assessed over three stages of independent piloting. National and international research guidelines were used as points of reference. Piloting of the Aboriginal and Torres Strait Islander QAT with Aboriginal and Torres Strait Islander and non-Indigenous experts led to refinement of the tool. Results The Aboriginal and Torres Strait Islander QAT consists of 14 questions that assess the quality of health research from an Aboriginal and Torres Strait Islander perspective. The questions encompass setting appropriate research questions; community engagement and consultation; research leadership and governance; community protocols; intellectual and cultural property rights; the collection and management of research material; Indigenous research paradigms; a strength-based approach to research; the translation of findings into policy and practice; benefits to participants and communities involved; and capacity strengthening and two-way learning. Outcomes from the assessment of the tool’s validity, reliability, and feasibility were overall positive. Conclusion This is the first tool to appraise research quality from the perspective of Indigenous peoples. Through the uptake of the Aboriginal and Torres Strait Islander QAT we hope to improve the quality and transparency of research with Aboriginal and Torres Strait Islander peoples, with the potential for greater improvements in Aboriginal and Torres Strait Islander health and wellbeing.
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Affiliation(s)
- Stephen Harfield
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia. .,School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Odette Pearson
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia
| | - Elaine Kite
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia
| | - Karen Glover
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Judith Streak Gomersall
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Drew Carter
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Carol Davy
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia
| | | | - Annette Braunack-Mayer
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia.,School of Public Health, The University of Adelaide, Adelaide, Australia.,Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
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17
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Field P, Franklin RC, Barker R, Ring I, Leggat P, Canuto K. Heart disease, hospitalisation and referral: Coaching to Achieving Cardiovascular Health through cardiac rehabilitation in Queensland. Aust J Rural Health 2020; 28:51-59. [PMID: 31957132 DOI: 10.1111/ajr.12588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To describe rates of hospitalisation and Coaching on Achieving Cardiovascular Health referral, for Queensland's adults with heart and related disease, and comparisons between Aboriginal and Torres Strait Islander and non-Indigenous peoples in northern Queensland. DESIGN Descriptive retrospective epidemiological study of Queensland Health Patient Admission Data Collection for adults with heart and related disease, and Coaching on Achieving Cardiovascular Health referral data. Relative risk and age standardisation were calculated for Aboriginal and Torres Strait Islander and non-Indigenous peoples. PARTICIPANTS Queensland's adults ≥20 years, hospitalised with heart and related disease (1 January 2012-31 December 2016). SETTING Queensland, Australia. MAIN OUTCOME MEASURES Queensland Health Hospital and Health Services' hospitalisation and Coaching on Achieving Cardiovascular Health referral rates for heart and related disease. RESULTS Queensland's Aboriginal and Torres Strait Islander peoples have a higher hospitalisation rate for heart and related disease, with higher rates for northern Queensland. Queensland's overall Coaching on Achieving Cardiovascular Health referral rates were low, but higher for Aboriginal and Torres Strait Islander peoples. Deficiencies in documentation of Aboriginal and Torres Strait Islander people's status affected results in some areas. CONCLUSION Queensland's Aboriginal and Torres Strait Islander peoples were more likely to be admitted to hospital for heart and related disease and referred to Coaching on Achieving Cardiovascular Health than non-Indigenous peoples. However, hospitalisation and Coaching on Achieving Cardiovascular Health referral rates are unlikely to reflect the needs of Aboriginal and Torres Strait Islander peoples especially in rural and very remote areas given their higher mortality and morbidity rates and fewer services.
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Affiliation(s)
- Patricia Field
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| | - Ian Ring
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Peter Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Banham D, Roder D, Eckert M, Howard NJ, Canuto K, Brown A. Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study. BMC Health Serv Res 2019; 19:771. [PMID: 31665005 PMCID: PMC6820943 DOI: 10.1186/s12913-019-4534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. METHODS Cancers registered among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death. RESULTS Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59-0.98; have surgery UOR = 0.65; 95%CI = 0.53-0.80; systemic therapies UOR = 0.64; 95%CI = 0.52-0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63-0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25-0.47 and SHR = 0.35; 95%CI = 0.25-0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26-2.63. CONCLUSION The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia North Terrace, Adelaide, Australia
| | - Natasha J Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
- Aboriginal Health Research Group, Cancer Research Institute, University of South Australia, Adelaide, Australia
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Preston R, Rannard S, Felton-Busch C, Larkins S, Canuto K, Carlisle K, Evans R, Redman-MacLaren M, Taylor J, Turner NN, Yeomans L, Sanguineti E, Passey M, Farmer J. How and why do participatory women's groups (PWGs) improve the quality of maternal and child health (MCH) care? A systematic review protocol. BMJ Open 2019; 9:e030461. [PMID: 31492787 PMCID: PMC6731784 DOI: 10.1136/bmjopen-2019-030461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Community-based Participatory Women's Groups (PWGs) have proven to be an effective intervention to improve maternal and child health (MCH) outcomes in low/middle-income countries (LMICs). Less is known about how PWGs exert their effects in LMICs and virtually nothing is known about the contextual issues, processes and power relationships that affect PWG outcomes in high resource settings. The aim of this systematic review is to synthesise and critically analyse the current evidence on how and why PWGs improve the quality of MCH care. We aim to demonstrate how PWGs function and why PWG interventions contribute to social and health outcomes. METHODS AND ANALYSIS The protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The databases Medline (Ovid): Cumulative Index to Nursing and Allied Health Literature (Ebsco); Informit health suite Scopus, Australian HealthInfoNet, the Cochrane Library and other sources will be searched under broad categories: intervention, context and outcomes to 30 June 2019. ETHICS AND DISSEMINATION As only secondary data will be analysed; ethical approval is not required. The review will be disseminated to relevant organisations and presented in peer-reviewed papers and at conferences. This will be the first attempt to summarise the current available evidence on the characteristics, contextual influences and mechanisms that are associated with the outcomes and effectiveness of PWGs. PROSPERO REGISTRATION NUMBER CRD42019126533.
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Affiliation(s)
- Robyn Preston
- School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Queensland, Australia
- College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Sam Rannard
- Library and Information Services, James Cook University, Townsville, Queensland, Australia
| | - Catrina Felton-Busch
- Mt Isa Centre for Rural and Remote Health and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Mount Isa, Queensland, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Karla Canuto
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Michelle Redman-MacLaren
- College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Cairns, Queensland, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | | | - Lee Yeomans
- Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - Emma Sanguineti
- Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - Megan Passey
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Jane Farmer
- Centre for Social Impact, Swinburne University of Technology, Melbourne, Victoria, Australia
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Macniven R, Canuto K, Wilson R, Bauman A, Evans J. The impact of physical activity and sport on social outcomes among Aboriginal and Torres Strait Islander people: A systematic scoping review. J Sci Med Sport 2019; 22:1232-1242. [PMID: 31281075 DOI: 10.1016/j.jsams.2019.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/13/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify and describe existing evidence of the impact of sport and physical activity programs on social outcomes among Aboriginal and Torres Strait Islander people. DESIGN Systematic scoping review. METHODS Nine scientific databases (MEDLINE, Scopus, SPORTSDiscus, PsycINFO, Informit, Database of Abstracts of Reviews of Effects (DARE), The Cochrane Library, The Campbell Library, ProQuest Dissertations and Theses) and grey literature were systematically searched for programs or activities that target Aboriginal and Torres Strait Islander people and use physical activity and sport participation to improve one or more of six social and community outcomes of: (i) education; (ii) employment; (iii) culture; (iv) social and emotional wellbeing; (v) life skills; (vi) crime reduction. RESULTS Of the 1160 studies identified, 20 met the inclusion criteria and were published between 2003 and 2018. Most studies reported positive findings across multiple, broad outcomes of education (N = 11), employment (N = 1), culture (N = 9), social and emotional wellbeing (N = 12), life skills (N = 5) and crime reduction (N = 5). Some evidence was found for increased school attendance and improved self-esteem resulting from physical activity and sport participation as well as enhanced aspects of culture, such as cultural connections, connectedness, values and identity. CONCLUSIONS There is some evidence of benefit across the six social outcomes from physical activity and sport programs. This promotes their continuation and development, although critical appraisal of their methods is needed to better quantify benefits, as well as the generation of new evidence across indicators where gaps currently exist, particularly for employment and crime reduction outcomes.
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Affiliation(s)
- Rona Macniven
- University of New South Wales, School of Public Health and Community Medicine, Australia; The University of Sydney, Faculty of Medicine and Health, Poche Centre for Indigenous Health, Australia.
| | - Karla Canuto
- South Australian Health & Medical Research Institute, Wardliparingga Aboriginal Health Unit, Australia
| | - Rachel Wilson
- The University of Sydney, Sydney School of Education & Social Work, Australia
| | - Adrian Bauman
- The University of Sydney, Prevention Research Collaboration, The Charles Perkins Centre, Sydney School of Public Health, Australia
| | - John Evans
- The University of Sydney, Sydney School of Education & Social Work, Australia; University of Technology Sydney, Faculty of Health, Australia
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21
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Banham D, Roder D, Keefe D, Farshid G, Eckert M, Howard N, Canuto K, Brown A. Disparities in breast screening, stage at diagnosis, cancer treatment and the subsequent risk of cancer death: a retrospective, matched cohort of aboriginal and non-aboriginal women with breast cancer. BMC Health Serv Res 2019; 19:387. [PMID: 31200700 PMCID: PMC6570827 DOI: 10.1186/s12913-019-4147-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/02/2018] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
Background Australia’s Aboriginal and Torres Strait Islander women have poorer survival and twice the disease burden from breast cancer compared to other Australian women. These disparities are influenced, but not fully explained, by more diagnoses at later stages. Incorporating breast screening, hospital and out of hospital treatment and cancer registry records into a person-linked data system can improve our understanding of breast cancer outcomes. We focussed one such system on a population-based cohort of Aboriginal women in South Australia diagnosed with breast cancer and a matched cohort of non-Aboriginal women with breast cancer. We quantify Aboriginal and non-Aboriginal women’s contact with publicly funded screening mammograms; quantify exposure to a selection of cancer treatment modalities; then assess the relationship between screening, treatment and the subsequent risk of breast cancer death. Methods Breast cancers registered among Aboriginal women in South Australia in 1990–2010 (N = 77) were matched with a random selection of non-Aboriginal women by birth and diagnostic year, then linked to screening records, and treatment 2 months before and 13 months after diagnosis. Competing risk regression summarised associations of Aboriginality, breast screening, cancer stage and treatment with risk of breast cancer death. Results Aboriginal women were less likely to have breast screening (OR = 0.37, 95%CIs 0.19–0.73); systemic therapies (OR = 0.49, 95%CIs 0.24–0.97); and, surgical intervention (OR = 0.35, 95%CIs 0.15–0.83). Where surgery occurred, mastectomy was more common among Aboriginal women (OR = 2.58, 1.22–5.46). Each of these factors influenced the risk of cancer death, reported as sub-hazard ratios (SHR). Regional spread disease (SHR = 34.23 95%CIs 6.76–13.40) and distant spread (SHR = 49.67 95%CIs 6.79–363.51) carried more risk than localised disease (Reference SHR = 1). Breast screening reduced the risk (SHR = 0.07 95%CIs 0.01–0.83). So too did receipt of systemic therapy (SHR = 0.06 95%CIs 0.01–0.41) and surgical treatments (SHR = 0.17 95%CIs 0.04–0.74). In the presence of adjustment for these factors, Aboriginality did not further explain the risk of breast cancer death. Conclusion Under-exposure to screening and treatment of Aboriginal women with breast cancers in South Australia contributed to excess cancer deaths. Improved access, utilisation and quality of effective treatments is needed to improve survival after breast cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.,University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Dorothy Keefe
- SA Cancer Services, SA Health, Hindmarsh Square, Adelaide, SA, 5000, Australia.,Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
| | - Gelareh Farshid
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
| | - Marion Eckert
- School of Nursing and Midwifery, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Natasha Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.,School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.,University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.,School of Health Sciences, Aboriginal Health Research Group, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
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Macniven R, Canuto K, Wilson R, Bauman A, Evans J. Impact of physical activity and sport on social outcomes among Aboriginal and Torres Strait Islander people: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:1305-1311. [PMID: 31082940 DOI: 10.11124/jbisrir-2017-004023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and describe existing research on the impact of sport and physical activity programs on social outcomes among Aboriginal and Torres Strait Islander people in Australia. INTRODUCTION Physical activity can be particularly beneficial for groups such as Indigenous populations, who have increased rates of chronic disease. Systematic reviews have demonstrated the positive impact of physical activity on a range of health indicators, and there is also support for the positive impact of physical activity on wider social outcomes. However, there is a lack of evidence for the benefits of physical activity for broader social outcomes among Aboriginal and Torres Strait Islander people. INCLUSION CRITERIA This scoping review will consider studies that include Aboriginal and Torres Strait Islander people of any age from any setting or region of Australia. Studies will be considered if they report on programs or activities that use physical activity and sport participation as a component or tool to improve one or more of six social and community outcomes: education, employment, culture, social wellbeing, life skills and crime prevention. METHODS Nine databases will be searched, as well as a selection of websites containing resources related to physical activity, sport and social outcomes for Aboriginal and Torres Strait Islander people. Studies published in English will be included. No date limits will be set. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data extraction will be presented in a table with accompanying narrative.
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Affiliation(s)
- Rona Macniven
- Sydney School of Public Health, Faculty of Medicine and Health, Prevention Research Collaboration, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, Poche Centre for Indigenous Health, The University of Sydney, Camperdown, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Health Unit, South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Rachel Wilson
- Sydney School of Education & Social Work, The University of Sydney, Camperdown, Australia
| | - Adrian Bauman
- Sydney School of Public Health, Faculty of Medicine and Health, Prevention Research Collaboration, The University of Sydney, Camperdown, Australia
| | - John Evans
- Sydney School of Education & Social Work, The University of Sydney, Camperdown, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, Australia
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23
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Brown C, Laws C, Leonard D, Campbell S, Merone L, Hammond M, Thompson K, Canuto K, Brimblecombe J. Healthy Choice Rewards: A Feasibility Trial of Incentives to Influence Consumer Food Choices in a Remote Australian Aboriginal Community. Int J Environ Res Public Health 2019; 16:ijerph16010112. [PMID: 30609836 PMCID: PMC6339254 DOI: 10.3390/ijerph16010112] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022]
Abstract
Poor diet including inadequate fruit and vegetable consumption is a major contributor to the global burden of disease. Aboriginal and Torres Strait Islander Australians experience a disproportionate level of preventable chronic disease and successful strategies to support Aboriginal and Torres Strait Islander people living in remote areas to consume more fruit and vegetables can help address health disadvantage. Healthy Choice Rewards was a mixed methods study to investigate the feasibility of a monetary incentive: store vouchers, to promote fruit and vegetable purchasing in a remote Australian Aboriginal community. Multiple challenges were identified in implementation, including limited nutrition workforce. Challenges related to the community store included frequent store closures and amended trading times, staffing issues and poor infrastructure to support fruit and vegetable promotion. No statistically significant increases in fruit or vegetable purchases were observed in the short time frame of this study. Despite this, community members reported high acceptability of the program, especially for women with children. Optimal implementation including, sufficient time and funding resources, with consideration of the most vulnerable could go some way to addressing inequities in food affordability for remote community residents.
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Affiliation(s)
- Clare Brown
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Cara Laws
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, 4870 Cairns, Australia.
| | - Sandy Campbell
- Centre for Indigenous Health Equity Research, Central Queensland University, 4870 Cairns, Australia.
| | - Lea Merone
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | | | - Kani Thompson
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Karla Canuto
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
- Wardliparingga Aboriginal Health, South Australian Health and Medical Research Institute, 5001 Adelaide, Australia.
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, 3168 Melbourne, Australia.
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Canuto K, Aromataris E, Lockwood C, Tufanaru C, Brown A. Aboriginal and Torres Strait Islander health promotion programs for the prevention and management of chronic diseases: a scoping review protocol. ACTA ACUST UNITED AC 2018; 15:10-14. [PMID: 28085721 DOI: 10.11124/jbisrir-2016-003021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVES The scoping review project will identify and describe the existing research on health promotion programs and activities focusing on modifying risk factors (specifically to reduce smoking and alcohol consumption, increase physical activity and improve nutrition and social and emotional wellbeing) and/or improving the management of chronic diseases (specifically obesity, type 2 diabetes, chronic kidney disease and cardiovascular disease) for Aboriginal and Torres Strait Islander peoples across a diverse range of health and community settings.
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Affiliation(s)
- Karla Canuto
- 1Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute 2Faculty of Health and Medical Sciences, Joanna Briggs Institute, University of Adelaide, Adelaide, Australia
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Campbell S, McCalman J, Redman-MacLaren M, Canuto K, Vine K, Sewter J, McDonald M. Implementing the Baby One Program: a qualitative evaluation of family-centred child health promotion in remote Australian Aboriginal communities. BMC Pregnancy Childbirth 2018; 18:73. [PMID: 29573747 PMCID: PMC5866524 DOI: 10.1186/s12884-018-1711-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A healthy start predicts better health in later life. Many remote-living Aboriginal and Torres Strait Islander Australian families lack access to consistent, culturally-safe health services. This paper presents a study of implementation of the Baby One Program (BOP). The BOP was designed as a family-centred, Indigenous Healthworker-led, home-visiting model of care focused on promoting family health to give children the best start to life. It was developed by Aboriginal community-controlled Apunipima Cape York Health Council and delivered in Queensland Cape York remote communities. We aimed to determine how the BOP was implemented, enablers, strategies used and formative implementation outcomes. METHODS The qualitative approach utilised theoretical and purposive sampling to explore people's experiences of a program implementation process. Data were generated from semi-structured interviews with four family members enrolled in the BOP and 24 Apunipima staff members. In addition, twenty community members, including two program users, participated in a men's community focus group. The findings are presented according to themes arising from the data. RESULTS The BOP was rolled out in nine remote Cape York communities between July 2014 and December 2015 and there was high uptake. Indigenous Healthworkers were supported by midwives and maternal and child health nurses to deliver health education to 161 eligible families. The key to effective implementation of family-centred care appeared to be the relationships formed between health practitioners, especially Indigenous Healthworkers, and families. The data revealed the following themes: challenging environments for new families and valuing cultural ways, resourcing program delivery, working towards a team approach, negotiating the cultural interface, engaging families, exchanging knowledge through 'yarning', strengthening the workforce, and seeing health changes in families. Healthworker education and training, and knowledge exchange between Healthworkers, midwives and nurses was critical to program effectiveness. The program continues to grow despite substantial logistic, financial and practical challenges. CONCLUSIONS This study describes an evolving process and explores how health providers connect with families and how the program responds to family and cultural issues. Program development is ongoing; strengthened by more community-level involvement, embedded strategies for ongoing self-evaluation and continuous quality improvements that are responsive to family needs.
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Affiliation(s)
- Sandra Campbell
- Centre for Chronic Disease Prevention, College of Public Health, Medical & Veterinary Sciences, James Cook University, PO Box 6811, Cairns, QLD 4870 Australia
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Central Queensland University, PO Box 7815, Cairns, QLD 4870 Australia
- Apunipima Cape York Health Council, PO Box 12045, Westcourt, Cairns, QLD 4870 Australia
| | - Janya McCalman
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Central Queensland University, PO Box 7815, Cairns, QLD 4870 Australia
- The Cairns Institute, James Cook University, PO Box 6811, Cairns, QLD 4870 Australia
| | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, PO Box 6811, Cairns, QLD 4870 Australia
| | - Karla Canuto
- Apunipima Cape York Health Council, PO Box 12045, Westcourt, Cairns, QLD 4870 Australia
| | - Kristina Vine
- Apunipima Cape York Health Council, PO Box 12045, Westcourt, Cairns, QLD 4870 Australia
| | - Jenny Sewter
- Apunipima Cape York Health Council, PO Box 12045, Westcourt, Cairns, QLD 4870 Australia
| | - Malcolm McDonald
- Centre for Chronic Disease Prevention, College of Public Health, Medical & Veterinary Sciences, James Cook University, PO Box 6811, Cairns, QLD 4870 Australia
- Apunipima Cape York Health Council, PO Box 12045, Westcourt, Cairns, QLD 4870 Australia
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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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Gomersall JS, Canuto K, Aromataris E, Braunack-Mayer A, Brown A. Systematic review to inform prevention and management of chronic disease for Indigenous Australians: overview and priorities. Aust N Z J Public Health 2015; 40:22-9. [DOI: 10.1111/1753-6405.12476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/01/2015] [Accepted: 07/01/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Judith Streak Gomersall
- Joanna Briggs Institute; University of Adelaide; South Australia
- SAHMRI Wardliparingga Aboriginal Research Unit; South Australia
- School of Public Health; University of Adelaide; South Australia
| | - Karla Canuto
- SAHMRI Wardliparingga Aboriginal Research Unit; South Australia
| | | | | | - Alex Brown
- SAHMRI Wardliparingga Aboriginal Research Unit; South Australia
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Gomersall JS, Aromataris E, Brown A, Dwyer J, Stephenson M, O'Donnell K, Canuto K, Carter D, Gibson O. Characteristics and value of Aboriginal Community Controlled Health Organizations' primary health care and their financing needs: a protocol for systematic evidence reviews. ACTA ACUST UNITED AC 2015; 13:139-67. [PMID: 26455751 DOI: 10.11124/jbisrir-2015-2277] [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: 04/20/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 10/31/2022]
Affiliation(s)
- Judith Streak Gomersall
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia..,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange
| | - Edoardo Aromataris
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia..,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange
| | - Judith Dwyer
- Health Care Management, School of Medicine, Flinders University, Adelaide, Australia
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia..,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange
| | - Kim O'Donnell
- Health Care Management, School of Medicine, Flinders University, Adelaide, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange
| | - Drew Carter
- School of Public Health, Faculty of Health Sciences, University of Adelaide, Australia
| | - Odette Gibson
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange
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Gomersall JS, Aromataris E, Brown A, Dwyer J, Stephenson M, OʼDonnell K, Canuto K, Carter D, Gibson O. Characteristics and value of Aboriginal Community Controlled Health Organizationsʼ primary health care and their financing needs: a protocol for systematic evidence reviews. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513060-00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Canuto K, McDermott R, Cargo M. Participant views on participating in a pragmatic randomised controlled trial: the Aboriginal and Torres Strait Islander Women's Fitness Program. Int J Equity Health 2014; 13:77. [PMID: 25192793 PMCID: PMC4172823 DOI: 10.1186/s12939-014-0077-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 08/27/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction The inequity of randomising participants to control groups in randomised controlled trials (RCTs) is often considered inappropriate, especially for research trials that include vulnerable populations such as Indigenous peoples. The Aboriginal and Torres Strait Islander Women’s Fitness Program conducted a trial that randomly assigned participants to ‘active’ and ‘waitlisted’ groups. This paper reports on participant views of the randomisation protocol. Methods A pragmatic RCT was conducted in an urban setting to assess the effectiveness of the 12-week Aboriginal and Torres Strait Islander Women’s Fitness Program on metabolic health outcomes and waist circumference. Qualitative interviews were conducted at follow-up, one of the objectives was to explore participant perspectives on the research protocol, including participant randomisation to ‘Active’ and ‘Waitlisted’ groups. Results A total of 49 interviews were conducted (26 Active and 23 Waitlisted participants). Two key factors influenced participant views on the protocol: 1) group assignment; and 2) how well they understood the research design, including the justification for randomisation. ‘Active’ participants were concerned about the inequity of the randomisation process but overall supported the study protocol. Although most Waitlisted participants were disappointed about having to wait 12-months for the program, some participants derived motivation from being waitlisted, whilst others lost motivation. Well-informed participants were more likely to express both support for the randomisation process and an understanding of the research benefits than participants not attending an information session prior to registration. Conclusions Participants were more accepting of the research protocol if it was clearly explained to them, if they understood the randomisation process and felt the randomisation was justified in terms of the potential for the results to benefit other Aboriginal and Torres Strait Islander women. Our study suggests that the time and resources required to adequately explain the research protocol in research trials should not be undervalued. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12610000224022).
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Canuto K, Cargo M, Li M, D'Onise K, Esterman A, McDermott R. Pragmatic randomised trial of a 12-week exercise and nutrition program for Aboriginal and Torres Strait Islander women: clinical results immediate post and 3 months follow-up. BMC Public Health 2012; 12:933. [PMID: 23114379 PMCID: PMC3608991 DOI: 10.1186/1471-2458-12-933] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 10/17/2012] [Indexed: 12/21/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander women experience higher rates of heart disease and type 2 diabetes than non-Indigenous Australian women. Increasing physical activity, improving diets and losing weight have been shown to reduce cardio metabolic risk. The primary aim was to evaluate the effectiveness of a 12-week structured exercise and nutrition program in a cohort of urban Indigenous Australian women on waist circumference, weight and biomedical markers of metabolic functioning from baseline (T1) to program completion (T2). The secondary aim assessed whether these outcomes were maintained at 3-month follow-up. Methods One hundred Aboriginal and/or Torres Strait Islander women aged 18–64 years living in the Adelaide metropolitan area were recruited. The program included two 60-minute group cardiovascular and resistance training classes per week, and four nutrition education workshops. Participants were randomly assigned to an ‘active’ group or ‘waitlisted’ control group. Body weight, height, waist and hip circumference, blood pressure, fasting glucose, fasting insulin, glycated haemoglobin (HbA1C), lipid profile and C-reactive protein (CRP) were assessed at baseline (T1), immediately after the program (T2) and three months post program (T3). Results The active group showed modest reductions in weight and body mass index (BMI). Compared to the waitlisted group, the active group had a statistically significantly change in weight and BMI from baseline assessments; at T2, -1.65 kg and -0.66 kg/m2 and at T3, -2.50 kg and -1.03 kg/m2, respectively. Systolic and diastolic blood pressure also had a statistically significant difference from baseline in the active group compared to the waitlisted group at T2, -1.24 mmHg and -2.46 mmHg and at T3, -4.09 mmHg and -2.17 mmHg, respectively. The findings were independent of the baseline measure of the outcome variable, age, households with children and employment status. Changes in waist circumference and other clinical measures were not significant at T2 or T3. The primary outcome measure, waist circumference, proved problematic to assess reliably. Missing data and participants lost to follow-up were significant. Conclusions This 12-week exercise program demonstrated modest reductions in weight, BMI and blood pressure at T2, which improved further at 3-month follow-up (T3). Positive intervention effects were observed despite low attendance at exercise classes. Structured exercise programs implemented in community settings require attention to understanding the barriers to participation for this high risk group. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000224022
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Affiliation(s)
- Karla Canuto
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
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