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1
Laugharne, Jonathan. "Poverty and mental health in Aboriginal Australia." Psychiatric Bulletin 23, no. 6 (June 1999): 364–66. http://dx.doi.org/10.1192/pb.23.6.364.
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When the Australian Governor General, Sir William Deane, referred in a speech in 1996 to the “appalling problems relating to Aboriginal health” he was not exaggerating. The Australia Bureau of Statistics report on The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (McLennan & Madden, 1997) outlines the following statistics. The life expectancy for Aboriginal Australians is 15 to 20 years lower than for non-Aboriginal Australians, and is lower than for most countries of the world with the exception of central Africa and India. Aboriginal babies are two to three times more likely to be of lower birth weight and two to four times more likely to die at birth than non-Aboriginal babies. Hospitalisation rates are two to three times higher for Aboriginal than non-Aboriginal Australians. Death rates from infectious diseases are 15 times higher among Aboriginal Australians than non-Aboriginal Australians. Rates for heart disease, diabetes, injury and respiratory diseases are also all higher among Aboriginals – and so the list goes on. It is fair to say that Aboriginal people have higher rates for almost every type of illness for which statistics are currently recorded.
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Barnes, Rosanne, Asha C. Bowen, Roz Walker, Steven Y. C. Tong, Jodie McVernon, Patricia T. Campbell, Parveen Fathima, et al. "454. Perinatal Risk Factors Associated with Skin Infection Hospitalisation in Western Australian Aboriginal and Non-Aboriginal Children." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S223. http://dx.doi.org/10.1093/ofid/ofz360.527.
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Abstract Background Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA. We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalization in WA children, focusing on Aboriginal children aged <17 years. Methods We conducted a retrospective population-based cohort study with linked perinatal and hospitalization data on WA-born children (1996–2012), of whom 31,348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to the first hospitalization with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year. Results Overall, 5,439 (17.4%) Aboriginal and 6,750 (1.5%) non-Aboriginal children were hospitalized at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalization rate (63.2/1,000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth and multi-parity (≥3 previous pregnancies) accounting for 24%, 23% and 15% of skin infection hospitalizations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy and low birthweight. Conclusion We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalizations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalizations. Our evidence supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families. Disclosures All authors: No reported disclosures.
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Rege, Sanil. "State of indigenous mental health in Australia - a colonial legacy?" International Psychiatry 6, no. 4 (October 2009): 98–100. http://dx.doi.org/10.1192/s1749367600000801.
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The Aboriginal culture of Australia is one of the oldest cultures on earth, dating back 50 000 years. The Aboriginal and Torres Strait Islander (ATSI) people are the indigenous inhabitants of Australia, constituting 2.4% of the population. The health status of these ‘First Australians’ has been described as a source of national shame, with the life expectancy approximately 17 years lower than that of other Australians (Eades, 2000). This gap in life expectancy is also significantly larger than that of other countries with indigenous populations and a history of colonisation, such as the USA, Canada and New Zealand (Ring & Firman, 1998). This paper offers an overview of the impact of colonisation and its subsequent influence on the social and emotional well-being of ATSI people.
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Dudgeon, Pat, and Roz Walker. "Decolonising Australian Psychology: Discourses, Strategies, and Practice." Journal of Social and Political Psychology 3, no. 1 (August 21, 2015): 276–97. http://dx.doi.org/10.5964/jspp.v3i1.126.
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Colonisation in Australia has had a devastating and lasting impact on the wellbeing of Aboriginal and Torres Strait Islander peoples in Australia (herein referred to as Indigenous Australians). This paper discusses the role of psychology in Australia and the negative impact that certain disciplinary theories and practices have had on Indigenous Australians. The impact has been further exacerbated by the failure of mainstream policy makers and mental health practitioners to recognise the key, distinctive cultural and social determinants that contribute to Aboriginal health and wellbeing. There is a growing response by Aboriginal psychologists, critical social theorists, and their allies to decolonise psychological theory and practice to redress this situation. This paper outlines key decolonising strategies that have been effective in interrupting those aspects of psychology that are inimical to Aboriginal wellbeing.
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Emden, Carolyn, Inge Kowanko, Charlotte de Crespigny, and Helen Murray. "Better medication management for Indigenous Australians: findings from the field." Australian Journal of Primary Health 11, no. 1 (2005): 80. http://dx.doi.org/10.1071/py05011.
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This paper reports findings from interviews and focus groups conducted within a multi-dimensional action research project concerning medication management among Indigenous Australians. Participants were Aboriginal people with mental health problems, carers and family members, and health and social service workers from different regions in South Australia. A meta-analysis of findings from each regional project component was conducted, and major themes conceptualised and developed into a coherent summary. The findings revealed problems of a magnitude not previously realised - mental health problems (including alcohol and drug problems) and medication management among Aboriginal people clearly are major issues requiring immediate and sustained attention if the health and welfare of the Australian Indigenous population are to be improved. Findings concerned eight major areas: social and emotional wellbeing issues; stressors on Aboriginal health services and providers; training for the Aboriginal health workforce; mainstream health services for Aboriginal people; trust and confidentiality within Aboriginal health services; English language literacy and numeracy skills of Aboriginal clients; remote living arrangements for many Aboriginal people; problems with alcohol use; and institutionalised and individual racism in the community at large.
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Durey, A., D. McAullay, B. Gibson, and L. M. Slack-Smith. "Oral Health in Young Australian Aboriginal Children." JDR Clinical & Translational Research 2, no. 1 (September 27, 2016): 38–47. http://dx.doi.org/10.1177/2380084416667244.
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Despite dedicated government funding, Aboriginal Australians, including children, experience more dental disease than other Australians, despite it being seen as mostly preventable. The ongoing legacy of colonization and discrimination against Aboriginal Australians persists, even in health services. Current neoliberal discourse often holds individuals responsible for the state of their health, rather than the structural factors beyond individual control. While presenting a balanced view of Aboriginal health is important and attests to Indigenous peoples’ resilience when faced with persistent adversity, calling to account those structural factors affecting the ability of Aboriginal people to make favorable oral health choices is also important. A decolonizing approach informed by Indigenous methodologies and whiteness studies guides this article to explore the perceptions and experiences of Aboriginal parents ( N = 52) of young children, mainly mothers, in Perth, Western Australia, as they relate to the oral health. Two researchers, 1 Aboriginal and 1 non-Aboriginal, conducted 9 focus group discussions with 51 Aboriginal participants, as well as 1 interview with the remaining individual, and independently analyzed responses to identify themes underpinning barriers and enablers to oral health. These were compared, discussed, and revised under key themes and interpreted for meanings attributed to participants’ perspectives. Findings indicated that oral health is important yet often compromised by structural factors, including policy and organizational practices that adversely preclude participants from making optimal oral health choices: limited education about prevention, prohibitive cost of services, intensive marketing of sugary products, and discrimination from health providers resulting in reluctance to attend services. Current government intentions center on Aboriginal–non-Aboriginal partnerships, access to flexible services, and health care that is free of racism and proactively seeks and welcomes Aboriginal people. The challenge is whether these good intentions are matched by policies and practices that translate into sustained improvements to oral health for Aboriginal Australians. Knowledge Transfer Statement: Slow progress in reducing persistent oral health disparities between Aboriginal and non-Aboriginal Australians calls for a new approach to this seemingly intractable problem. Findings from our qualitative research identified that structural factors—such as cost of services, little or no education on preventing oral disease, and discrimination by health providers—compromised Aboriginal people’s optimum oral health choices and access to services. The results from this study can be used to recommend changes to policies and practices that promote rather than undermine Aboriginal health and well-being and involve Aboriginal people in decisions about their health care.
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Cosh, Suzanne, Lauren Maksimovic, Kerry Ettridge, David Copley, and Jacqueline A. Bowden. "Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia." Australian Journal of Primary Health 19, no. 2 (2013): 113. http://dx.doi.org/10.1071/py11152.
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Smoking prevalence among Indigenous Australians far exceeds that of non-Indigenous Australians and is considered the greatest contributor to burden of disease for Indigenous Australians. The Quitline is a primary intervention for facilitating smoking cessation and, given the health implications of tobacco use, maximising its effectiveness for Indigenous Australians is imperative. However, the utilisation and effectiveness of this service within the Indigenous Australian population has not been examined. This study explores the utilisation of the South Australian Quitline by smokers identifying as Indigenous Australian. Quitline counsellors collected data regarding demographic characteristics, and smoking and quitting behaviour from Quitline callers in 2010. Results indicated that the proportion of Indigenous and non-Indigenous smokers who registered for the service was comparable. Demographic variables and smoking addiction at time of registration with the Quitline were similar for Indigenous and non-Indigenous callers. However, results indicated that Indigenous callers received significantly fewer callbacks than non-Indigenous callers and were significantly less likely to set a quit date. Significantly fewer Indigenous callers reported that they were still successfully quit at 3 months. Thus, Indigenous Australian callers may be less engaged with the Quitline and further research is required exploring whether the service could be tailored to make it more engaging for Indigenous Australians who smoke.
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McEwen, E. C., T. J. Boulton, and R. Smith. "Can the gap in Aboriginal outcomes be explained by DOHaD." Journal of Developmental Origins of Health and Disease 10, no. 1 (February 2019): 5–16. http://dx.doi.org/10.1017/s2040174418001125.
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AbstractIn Australia, there are two distinct populations, each with vastly disparate health outcomes: Aboriginal and Torres Strait Islander People and non-Aboriginal Australians. Aboriginal Australians have significantly higher rates of health and socioeconomic disadvantage, and Aboriginal babies are also more likely to be born low birth weight or growth restricted. The Developmental Origins of Health and Disease (DOHaD) hypothesis advocates that a sub-optimal intrauterine environment, often manifested as diminished foetal growth, during critical periods of foetal development has the potential to alter the risk of non-communicable disease in the offspring. A better understanding of the role of the intrauterine environment and subsequent developmental programming, in response to both transgenerational and immediate stimuli, in Aboriginal Australians remains a relatively unexplored field and may provide insights into the prevailing health disparities between Aboriginal and non-Aboriginal children. This narrative review explores the role of DOHaD in explaining the ongoing disadvantage experienced by Aboriginal People in today’s society through a detailed discussion of the literature on the association between foetal growth, as a proxy for the quality of the intrauterine environment, and outcomes in the offspring including perinatal health, early life development and childhood education. The literature largely supports this hypothesis and this review therefore has potential implications for policy makers not only in Australia but also in other countries that have minority and Indigenous populations who suffer disproportionate disadvantage such as the United States, Canada and New Zealand.
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Donato, Ronald, and Leonie Segal. "Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?" Australian Health Review 37, no. 2 (2013): 232. http://dx.doi.org/10.1071/ah12186.
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This paper provides an analysis of the national Indigenous reform strategy – known as Closing the Gap – in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance. The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare. What is known about the topic? Notwithstanding the intention of previous policies, considerable health disparity exists between Indigenous and non-Indigenous Australians. Australia has now embarked on its most ambitious national Indigenous health reform strategy, but there has been little academic analysis of whether such reforms are capable of eliminating health disadvantage for Aboriginal people. What does the paper add? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians. What are the implications for practitioners? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia’s First Peoples provides the opportunity for policymakers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.
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Ames, David. "Australia (Melbourne)." Psychiatric Bulletin 16, no. 9 (September 1992): 552–54. http://dx.doi.org/10.1192/pb.16.9.552.
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Australia is a unique, geologically ancient island continent. Its flora and fauna are unlike those found anywhere else and the same may be said of its people, politics and health services. The population of 17.3 millions represents a multicultural mix, with an anglo-celtic core conflated by sustained post-war immigration from southern Europe, Turkey, southeast Asia and south America. One in five current Australians was born elsewhere, one in ten comes from a non-English speaking background, and a quarter of those born here have a parent who was born overseas. Aboriginals and Torres Strait Islanders form 1.4% of the total population. They have third world mortality figures but die of first world diseases, their life expectancy being 20 years less than that of other Australians. Two hundred and four years after what they see as the British invasion, their standard of living lags far behind all other socio-cultural groups in the country. Most members of the Aboriginal community do not live long enough to develop Alzheimer's disease, but it and other age-related diseases are emerging as the major determinants of health costs as Australia moves towards the 21st century.
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David Lum, Gary. "Problems in diagnosing sexually transmitted infections in remote Australia." Microbiology Australia 28, no. 1 (2007): 18. http://dx.doi.org/10.1071/ma07017.
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Times are changing. The National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008 provides current commentary on the problems facing Australia?s Indigenous population. While the rates of sexually transmitted infections have always been higher in Indigenous Australians, there is some evidence of increasing rates of HIV infection. The rate of Chlamydia infection in non-Indigenous Australians has doubled between 1999 and 2003, while the rate of infection in some populations of Indigenous Australians has moved from 658 per 100 000 to 1140 per 100 000 population. Indigenous Australians are forty-times more likely to be infected with the gonococcus than non-Indigenous Australian men and women. It should not be surprising that Indigenous Australian rates of syphilis are unacceptably high at ~250 per 100 000 population and almost non-existent in the non-Indigenous population.
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Lavrencic, Louise M., Holly A. Mack, Gail Daylight, Sharon Wall, Margaret Anderson, Sue Hoskins, Emily Hindman, Gerald A. Broe, and Kylie Radford. "Staying in touch with the community: understanding self-reported health and research priorities in older Aboriginal Australians." International Psychogeriatrics 32, no. 11 (November 21, 2019): 1303–15. http://dx.doi.org/10.1017/s1041610219001753.
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ABSTRACTObjectives:Aboriginal Australians experience higher rates of non-communicable chronic disease, injury, dementia, and mortality than non-Aboriginal Australians. Self-reported health is a holistic measure and may fit well with Aboriginal views of health and well-being. This study aimed to identify predictors of self-reported health in older Aboriginal Australians and determine acceptable research methodologies for future aging research.Design:Longitudinal, population-based study.Setting:Five communities across New South Wales, Australia (two urban and three regional sites).Participants:Aboriginal and Torres Strait Islander people (n = 227; 60–88 years, M = 66.06, SD = 5.85; 145 female).Measurements:Participants completed baseline (demographic, medical, cognitive, mental health, and social factors) and follow-up assessments (self-reported health quantified with 5-point scale; sharing thoughts on areas important for future research). Predictors of self-reported health were examined using logistic regression analyses.Results:Self-reported health was associated with sex, activities of daily living, social activity participation, resilience, alcohol use, kidney problems, arthritis, falls, and recent hospitalization. Arthritis, kidney problems, and resilience remained significant in multiple logistic regression models.Conclusions:Perceived resilience and the absence of certain chronic age-related conditions predict older Aboriginal peoples’ self-reported health. Understanding these factors could inform interventions to improve well-being. Findings on acceptable research methodologies suggest that many older Aboriginal people would embrace a range of methodologies within long-standing research partnerships, which is an important consideration for Indigenous population research internationally.
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Chynoweth, J., B. Daveson, M. McCambridge, J. Coutts, H. Zorbas, and K. Whitfield. "A National Priority: Improving Outcomes for Aboriginal and Torres Strait Islander People With Cancer Through an Optimal Care Pathway." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 243s. http://dx.doi.org/10.1200/jgo.18.97700.
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Background and context: Cancer survival rates in Australia are among the best in the world, yet Aboriginal and Torres Strait Islander (indigenous) people continue to experience disparities in the distribution and burden of cancer, and unwarranted variations in outcomes. Indigenous Australians are 40% more likely to die of cancer than non-Indigenous Australians. Cancer Australia developed the National Aboriginal and Torres Strait Islander Cancer Framework (the framework), which identified 7 national priorities to address disparities in cancer outcomes experienced by indigenous Australians. An ongoing collaboration with indigenous Australians was integral to developing this shared agenda. Priority 5 in the framework highlights the need to ensure indigenous Australians affected by cancer receive optimal and culturally appropriate treatment, services, and supportive and palliative care. Aim: To improve cancer outcomes for indigenous Australians through the development and national endorsement of a population-specific Optimal Care Pathway (OCP) to guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. Strategy/Tactics: Cancer Australia formed a partnership with the Victorian Department of Health and Human Services (DHHS) to address Priority 5 and develop the OCP. The approach to development was underpinned by Cancer Australia's Model of Engagement for Aboriginal and Torres Strait Islander People and guided by the national Leadership Group on Aboriginal and Torres Strait Islander Cancer Control (Leadership Group). Program/Policy process: Cancer Australia, in collaboration with DHHS: • reviewed experiences of care and the framework's comprehensive evidence base • developed a draft OCP to complement tumor-specific pathways • facilitated an Expert Working Group, comprising indigenous health sector leaders and consumers to refine and validate the draft OCP • undertook national public consultation, including with the indigenous health sector and community, health professionals and professional colleges • received an indication of support to proceed to endorsement from the Leadership Group. Outcomes: The first population-specific OCP for Aboriginal and Torres Strait Islander people with cancer received national endorsement. It will guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. What was learned: Key elements of optimal care include: addressing the cultural appropriateness of the healthcare environment; improving cross-cultural communication; relationship building with local community; optimizing health literacy; recognition of men's and women's business; and the need to use culturally appropriate resources. The national priority in the framework informed and unified high-level direction, which was integral to effective OCP development and endorsement. The evidence-based, step-wise development approach contributed to its relevance, utility and quality.
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Rashidi, Amineh, Peter Higgs, and Susan Carruthers. "Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: a mixed-methods study." Australian Health Review 44, no. 5 (2020): 755. http://dx.doi.org/10.1071/ah19194.
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ObjectiveThe aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. MethodsThis study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. ResultsAnalysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. ConclusionThis mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic?Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add?This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners?Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment.
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Bell, Lorraine, Kate Anderson, Afaf Girgis, Samar Aoun, Joan Cunningham, Claire E. Wakefield, Shaouli Shahid, et al. "“We Have to Be Strong Ourselves”: Exploring the Support Needs of Informal Carers of Aboriginal and Torres Strait Islander People with Cancer." International Journal of Environmental Research and Public Health 18, no. 14 (July 7, 2021): 7281. http://dx.doi.org/10.3390/ijerph18147281.
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Informal carers provide an important role in supporting people with cancer. Aboriginal and Torres Strait Islander peoples experience higher cancer mortality than other Australians. To date, very little is known about the support needs of carers of Aboriginal and Torres Strait Islander adults with cancer. This article explored these needs through a qualitative study. Twenty-two semi-structured qualitative interviews and one focus group were conducted with carers of Aboriginal and Torres Strait Islander adults with cancer (n = 12) and Aboriginal and Torres Strait Islander cancer survivors (n = 15) from Queensland, Australia. Half of the carers interviewed were Aboriginal or Torres Strait Islander Australians. Interviews were transcribed, coded and thematically analysed following an interpretive phenomenological approach. Thematic analysis of carer and survivor interviews revealed four key themes relating to carers’ needs: managing multiple responsibilities; maintaining the carer’s own health and wellbeing; accessing practical support and information; and engaging with the health system. Within these overarching themes, multiple needs were identified including specific needs relevant for carers of Aboriginal and Torres Strait Islander peoples, such as advocating for the patient; accessing Indigenous support services and health workers; and ensuring that the cultural needs of the person are recognised and respected. Identifying the needs of informal carers of Aboriginal and Torres Strait Islander cancer patients will enable greater understanding of the support that carers require and inform the development of strategies to meet these areas of need.
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Nolan-Isles, Davida, Rona Macniven, Kate Hunter, Josephine Gwynn, Michelle Lincoln, Rachael Moir, Yvonne Dimitropoulos, et al. "Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia." International Journal of Environmental Research and Public Health 18, no. 6 (March 15, 2021): 3014. http://dx.doi.org/10.3390/ijerph18063014.
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Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. Three communities were selected for their high proportion of Aboriginal people and diverse regional and remote locations. Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted in the three communities (n = 5 coastal, n = 13 remote, and n = 13 border) and six themes identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.
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Lucero, Adam A., Danielle M. Lambrick, James A. Faulkner, Simon Fryer, Michael A. Tarrant, Melanie Poudevigne, Michelle A. Williams, and Lee Stoner. "Modifiable Cardiovascular Disease Risk Factors among Indigenous Populations." Advances in Preventive Medicine 2014 (2014): 1–13. http://dx.doi.org/10.1155/2014/547018.
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Objective. To identify modifiable cardio-metabolic and lifestyle risk factors among indigenous populations from Australia (Aboriginal Australians/Torres Strait Islanders), New Zealand (Māori), and the United States (American Indians and Alaska Natives) that contribute to cardiovascular disease (CVD).Methods. National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized, and synthesized.Results. Compared to their non-indigenous counterparts, indigenous populations exhibit lower life expectancies and a greater prevalence of CVD. All indigenous populations have higher rates of obesity and diabetes, hypertension is greater for Māori and Aboriginal Australians, and high cholesterol is greater only among American Indians/Alaska Natives. In turn, all indigenous groups exhibit higher rates of smoking and dangerous alcohol behaviour as well as consuming less fruits and vegetables. Aboriginal Australians and American Indians/Alaska Natives also exhibit greater rates of sedentary behaviour.Conclusion. Indigenous groups from Australia, New Zealand, and the United States have a lower life expectancy then their respective non-indigenous counterparts. A higher prevalence of CVD is a major driving force behind this discrepancy. A cluster of modifiable cardio-metabolic risk factors precede CVD, which, in turn, is linked to modifiable lifestyle risk factors.
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Graham, Simon, Catherine C. O'Connor, Stephen Morgan, Catherine Chamberlain, and Jane Hocking. "Prevalence of HIV among Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis." Sexual Health 14, no. 3 (2017): 201. http://dx.doi.org/10.1071/sh16013.
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Background Aboriginal and Torres Strait Islanders (Aboriginal) are Australia’s first peoples. Between 2006 and 2015, HIV notifications increased among Aboriginal people; however, among non-Aboriginal people, notifications remained relatively stable. This systematic review and meta-analysis aims to examine the prevalence of HIV among Aboriginal people overall and by subgroups. Methods: In November 2015, a search of PubMed and Web of Science, grey literature and abstracts from conferences was conducted. A study was included if it reported the number of Aboriginal people tested and those who tested positive for HIV. The following variables were extracted: gender; Aboriginal status; population group (men who have sex with men, people who inject drugs, adults, youth in detention and pregnant females) and geographical location. An assessment of between study heterogeneity (I2 test) and within study bias (selection, measurement and sample size) was also conducted. Results: Seven studies were included; all were cross-sectional study designs. The overall sample size was 3772 and the prevalence of HIV was 0.1% (I2 = 38.3%, P = 0.136). Five studies included convenient samples of people attending Australian Needle and Syringe Program Centres, clinics, hospitals and a youth detention centre, increasing the potential of selection bias. Four studies had a sample size, thus decreasing the ability to report pooled estimates. Conclusions: The prevalence of HIV among Aboriginal people in Australia is low. Community-based programs that include both prevention messages for those at risk of infection and culturally appropriate clinical management and support for Aboriginal people living with HIV are needed to prevent HIV increasing among Aboriginal people.
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Martin, Robyn, Christina Fernandes, Cheryl Taylor, Amanda Crow, Desmond Headland, Nicola Shaw, and Simone Zammit. "“We Don’t Want to Live Like This”: The Lived Experience of Dislocation, Poor Health, and Homelessness for Western Australian Aboriginal People." Qualitative Health Research 29, no. 2 (September 10, 2018): 159–72. http://dx.doi.org/10.1177/1049732318797616.
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Many policy interventions have attempted to address the entrenched disadvantage of Aboriginal Australians1; however, sustained improvement in social, cultural, physical, and emotional well-being is not evident. This disadvantage is compounded by paternalistic practices which do not promote Aboriginal self-determination or empowerment. This article presents the lived experience and voice of Aboriginal Australians spending time in parks in Perth, Western Australia. A community-based participatory action research approach informed by critical Indigenous methodologies involving collaboration between Aboriginal and non-Aboriginal service providers was used. Participants experienced disconnection from kin and country, serious risk to personal safety, homelessness, and problematic health; all related to, and intersecting with, time spent in the parks. The participants’ narratives highlight the enduring impacts of colonization, dispossession, and racism. These lived experiences are situated within contexts of rising moral panic from politicians, residents and mass media, and siloed policy and service delivery responses.
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Der Vartanian, Carolyn, Vivienne Milch, Gail Garvey, Cleola Anderiesz, Jane Salisbury, Candice-Brooke Woods, Melissa Austen, Rhona Wang, and Dorothy Mary Kate Keefe. "COVID-19 and cancer: Strategic health promotion for indigenous Australians during a pandemic." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e24028-e24028. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24028.
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e24028 Background: Given the impact of COVID-19 on Indigenous and ethnic minority populations observed globally, keeping COVID-19 out of vulnerable Aboriginal and Torres Strait Islander (Indigenous Australian) communities remains a priority. Compared to non-Indigenous Australians, Indigenous Australians experience disparities in cancer incidence and outcomes due to social disadvantage, increased cancer-related modifiable risk factors, poorer access to health services and lower participation in screening. During the pandemic, cancer-related investigations and treatment reduced significantly in Australia, leading to potential decreases in cancer diagnoses and consequences for future survival outcomes. Concerned about the risk of morbidity and mortality due to COVID-19 for Indigenous Australians, as well as worsening cancer outcomes, Cancer Australia undertook strategic health promotion initiatives, to inform and support optimal cancer care. Methods: In consultation with respected Indigenous colleagues to ensure cultural appropriateness of language and information, we published a dedicated webpage titled ‘ Cancer and COVID-19 – what it means for our Mob*’ with tailored information, advice, and links to key resources and support services for Indigenous Australians. We also released a video titled ‘ Act early for our Mob’s Health’, providing targeted, culturally appropriate, consumer-friendly information to encourage Indigenous Australians to see their doctor or Aboriginal Health Worker with symptoms that may be due to cancer. Results: The information hub has been well-received among the Indigenous Australian community, receiving over 3,200 visits, and the social media campaigns have received over 1.4 million impressions and 46,000 video views between mid-March 2020 to mid-February 2021. This campaign has supported proactivity among the Indigenous population in keeping their communities safe during the pandemic, maintaining a population rate of COVID-19 of less than one percent of all confirmed cases in Australia. Conclusions: Culturally appropriate information and resources developed through the process of co-design can help to influence positive health behaviour change in Indigenous populations. We predict that our strategic, multi-channel health promotion campaign is contributing to keeping the Indigenous Australian community safe and informed during the pandemic, with additional work needed to monitor cancer rates and outcomes and address the ongoing information needs of the community. *Mob is a colloquial term to identify a group of Indigenous Australians associated with a family or community from a certain place.
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Debattista, Joseph, Susan Hutton, and Peter Timms. "Chlamydial infections and Indigenous health." Microbiology Australia 30, no. 5 (2009): 197. http://dx.doi.org/10.1071/ma09197.
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Chlamydia are obligate, intracellular, bacterial pathogens that cause three main diseases in humans worldwide: sexually transmitted disease (infertility and pelvic inflammatory disease), trachoma and respiratory infections. Rates of sexually transmitted infections (STIs) due to C. trachomatis are increasing (a 61% increase in notifications in Australia between 2003 and 2007) and the levels in Indigenous Australians continue to be unacceptably high: nearly five times higher than in non-Indigenous people. C. trachomatis also causes the ocular disease trachoma and, unfortunately, this condition continues to be common in Indigenous Australians, a situation that is unacceptable in a developed country. The other chlamydial species that infects humans is C. pneumoniae. While clinically less severe, the Australian Aboriginal population in the Top End have high rates of serologically diagnosed C. pneumoniae infection, which may contribute to the higher rates of respiratory disease observed in this group.
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Graham, Simon, Lucy Watchirs Smith, Christopher K. Fairley, and Jane Hocking. "Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis." Sexual Health 13, no. 2 (2016): 99. http://dx.doi.org/10.1071/sh15171.
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Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12–29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4–13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5–14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0–22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5–26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I2 <97.5%, P < 0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.
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Lloyd, Jane E., and Marilyn J. Wise. "Efficient funding: a path to improving Aboriginal healthcare in Australia?" Australian Health Review 34, no. 4 (2010): 430. http://dx.doi.org/10.1071/ah09760.
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Objectives. To identify the factors that contribute to the under-resourcing of Aboriginal health and to explore the impact that funding arrangements have on the implementation of Aboriginal health policy. Design, settings and participants. Qualitative study based on 35 in-depth interviews with a purposive sample of frontline health professionals involved in health policy and service provision in the Northern Territory. Results. Participants described three factors that contributed to the under-resourcing of Aboriginal health: inefficient funding arrangements, mainstream programs being inappropriate for Aboriginal Australians, and competing interests determining the allocation of resources. Insufficient capacity within the healthcare system undermines the multilevel implementation process whereby organisations need to have the capacity to recognise new policy ideas, assess their relevance to their existing work and strategic plan and to be able to incorporate the relevant new ideas into day-to-day practice. Conclusion. Insufficient resources for Aboriginal health were found to be a barrier to implementing Aboriginal health policy. Inadequate resources result from the cumbersome allocation of funding rather than simply the amount of funding provided to Aboriginal healthcare. Monitoring government performance and ensuring the efficient allocation of funds would allow us to develop the delivery system for Aboriginal healthcare and therefore provide greater opportunities to capitalise on current interventions and future efforts. What is known about the topic? The extent to which Aboriginal health interventions are funded is variable, and the funding of the Aboriginal healthcare system is an important and topical issue. What does this paper add? The argument surrounding funding for Aboriginal health can be understood in several ways. Firstly, there is insufficient money being invested to address the need. By need we are referring to addressing community illness and injury as well as the need for a quality and accessible primary healthcare system. Secondly, there may be enough money being invested, but because of complicated and inflexible funding arrangements it is not being spent efficiently. Thirdly, there may be enough money invested, but not in effective interventions, and not in building the healthcare system, for example the local workforce. Finally, there may be enough money invested, but decisions about its distribution at the community level are not sufficiently in the control of communities. What are the implications for practitioners? To implement Aboriginal health policy, an effective delivery system is needed. Funding alone can be of limited value in achieving this aim over the long term unless it is used to build the capacity of a sustained delivery system for Aboriginal health care. Monitoring and facilitating government performance on how funds are invested, as well as the amount spent, is an important step towards the more effective implementation of Aboriginal health policy.
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Thompson, Sandra C., Emma Haynes, John A. Woods, Dawn C. Bessarab, Lynette A. Dimer, Marianne M. Wood, Frank M. Sanfilippo, Sandra J. Hamilton, and Judith M. Katzenellenbogen. "Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care." SAGE Open Medicine 4 (January 1, 2016): 205031211668122. http://dx.doi.org/10.1177/2050312116681224.
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Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.
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Kruger, Estie, Irosha Perera, and Marc Tennant. "Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia." Australian Journal of Primary Health 16, no. 4 (2010): 291. http://dx.doi.org/10.1071/py10028.
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Australians living in rural and remote areas have poorer access to dental care. This situation is attributed to workforce shortages, limited facilities and large distances to care centres. Against this backdrop, rural and remote Indigenous (Aboriginal) communities in Western Australia seem to be more disadvantaged because evidence suggests they have poorer oral health than non-Indigenous people. Hence, provision of dental care for Aboriginal populations in culturally appropriate settings in rural and remote Western Australia is an important public health issue. The aim of this research was to compare services between the Aboriginal Medical Services (AMS)-based clinics and a typical rural community clinic. A retrospective analysis of patient demographics and clinical treatment data was undertaken among patients who attended the dental clinics over a period of 6 years from 1999 to 2004. The majority of patients who received dental care at AMS dental clinics were Aboriginal (95.3%), compared with 8% at the non-AMS clinic. The rate of emergency at the non-AMS clinic was 33.5%, compared with 79.2% at the AMS clinics. The present study confirmed that more Indigenous patients were treated in AMS dental clinics and the mix of dental care provided was dominated by emergency care and oral surgery. This indicated a higher burden of oral disease and late utilisation of dental care services (more focus on tooth extraction) among rural and remote Indigenous people in Western Australia.
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Armstrong, Elizabeth, Deborah Hersh, Judith M. Katzenellenbogen, Juli Coffin, Sandra C. Thompson, Natalie Ciccone, Colleen Hayward, Leon Flicker, Deborah Woods, and Meaghan McAllister. "Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians." Brain Impairment 16, no. 2 (July 20, 2015): 145–56. http://dx.doi.org/10.1017/brimp.2015.15.
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Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.
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Radford, Kylie, Holly A. Mack, Brian Draper, Simon Chalkley, Kim Delbaere, Gail Daylight, Robert G. Cumming, Hayley Bennett, and Gerald A. Broe. "Comparison of Three Cognitive Screening Tools in Older Urban and Regional Aboriginal Australians." Dementia and Geriatric Cognitive Disorders 40, no. 1-2 (2015): 22–32. http://dx.doi.org/10.1159/000377673.
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Background: Validated cognitive screening tools for use in urban and regional Aboriginal populations in Australia are lacking. Methods: In a cross-sectional community-based study, 235 participants were assessed on the Mini-Mental State Examination (MMSE), the Rowland Universal Dementia Assessment Scale (RUDAS) and an urban modification of the Kimberley Indigenous Cognitive Assessment (mKICA). Performance on these cognitive screening tools was compared to dementia diagnosis by clinical consensus. Results: All tests were culturally acceptable with good psychometric properties. Receiver operating characteristic curve analyses revealed that the MMSE and mKICA were the most accurate. Conclusion: The MMSE is an effective cognitive screening tool in urban Aboriginal populations. The mKICA is a good alternative when illiteracy, language or cultural considerations deem it appropriate. The RUDAS also has adequate validity in this population.
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Paul, David. "It's not as Easy as just Walking in the Door': Interpretations of Indigenous People's Access to Health Care." Australian Journal of Primary Health 4, no. 1 (1998): 66. http://dx.doi.org/10.1071/py98007.
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Discussion about the on-going poor health status of Aboriginal and Torres Strait Island peoples in Australia needs to be better informed about both history, and the nature of health determining factors. Access is only one of many factors of importance in health seeking behaviour. This paper explores how the cultural appropriateness of health care services is a determinant of whether they are accessed or not. Contemporary attitudes, and their historical roots, are key issues which need to be addressed by health care providers and services. The onus is on health care providers to be informed and to act appropriately in all their interactions with health care consumers. The Royal Commission into Aboriginal Deaths in Custody provides some useful suggestions for improving the quality of health care services for Indigenous Australians.
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Wotherspoon, Craig, and Cylie M. Williams. "Exploring the experiences of Aboriginal and Torres Strait Islander patients admitted to a metropolitan health service." Australian Health Review 43, no. 2 (2019): 217. http://dx.doi.org/10.1071/ah17096.
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Objective There continue to be disparate health outcomes for people who are Aboriginal and Torres Strait Islander. The aim of the present study was to measure whether there were any differences in in-patient experiences between Aboriginal and Torres Strait Islander people and those without an Aboriginal or Torres Strait Islander background. Methods Random samples of people were invited to complete a survey following admission at the hospitals at Peninsula Health, Victoria, Australia. This survey was based on the Victorian Patient Satisfaction Monitor. Open-ended questions were also asked to gauge perspectives on how the services could better meet needs of Aboriginal and Torres Strait Islander patients. Results A total of 154 responses was obtained. There were differences between the two groups of participants in the following variables: respect of privacy, representation of culture, assistance with meals and access to a culturally specific worker if needed. This was reflected in thematic analysis, with three main themes identified: (1) interactions with staff; (2) the challenging environment; and (3) not just about me, but my family too. Conclusion There were systemic differences in in-patient experiences. Healthcare services have a responsibility to make systemic changes to improve the health care of all Australians by understanding and reforming how services can be appropriately delivered. What is known about the topic? There is a disparity in health outcomes between Aboriginal and Torres Strait Islander Australians and those who do not identify as Aboriginal and/or Torres Strait Islander. In addition, Aboriginal and Torres Strait Islanders have different interactions within healthcare services. Many rural health services have models that aim to deliver culturally appropriate services, but it is unknown whether the same challenges apply for this group of Australians within metropolitan health services. What does this paper add? This paper identifies the structural supports that are required to help close the gap in health care provision inequality. Many of the key issues identified are not people but system based. Healthcare administrators should consider the factors identified and address these at a whole-of-service level. What are the implications for practitioners? Many practitioners are aware of the challenges of providing culturally appropriate services. This research raises awareness of how traditional healthcare is not a one size fits all and flexibility is required to improve health outcomes.
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Henderson, Scott. "Focus on psychiatry in Australia." British Journal of Psychiatry 176, no. 1 (January 2000): 97–101. http://dx.doi.org/10.1192/bjp.176.1.97.
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Humankind has been present on the Australian continent for at least 40 000, some say 60 000 years, remarkably adapted to the environment and having a cultural tradition appreciated by few Caucasians. White people have been here for only 200 years; and psychiatry for about half of that. We know nothing about the mental health of pre-contact indigenous peoples; but we now know a little about the ways in which mental disorders are explained and treated by traditional methods. In two centuries, the Aboriginal and Torres Strait Islands communities, which are very diverse, have been steadily reduced to become only 1.5% of the population. From settlement in 1788 until the 1950s, most non-aboriginal Australians were of Anglo-Saxon or Celtic origin. Since the Second World War, the pattern of immigration has greatly enriched Australian life, first through large numbers of people from the Mediterranean littoral, Western Europe and the Balkans, and more recently from south-east Asia. Ethnic diversity is now evident in most peoples' daily lives – whom you see in the street, whom you work alongside, who your friends are, what you eat and who you have as patients. So the present Australian population of 18 million has undergone a marked change in demography and lifestyle within only two generations. Like the people, psychiatry is also changing rapidly. Where are the changes taking place? What is it like to be a psychiatrist here at present? Where has there been success and where has there been failure? Where is there lots of action?
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Devine, Kit. "On country: Identity, place and digital place." Virtual Creativity 11, no. 1 (June 1, 2021): 111–23. http://dx.doi.org/10.1386/vcr_00045_1.
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Place is central to the identity of Aboriginal and Torres Strait Islander peoples. The Narrabeen Camp Project explores the use of immersive technologies to offer opportunities to engage with Indigenous histories, Storytelling and cultural heritage in ways that privilege place. While nothing can replace being ‘on Country’, the XR technologies of AR and VR support different modalities of engagement with real, and virtual, place. The project documents the Stories, Language and Lore associated with the Gai-mariagal clan and, in particular, with the Aboriginal Camp that existed on the north-western shore of Narrabeen Lakes from the end of the last ice age to 1959 when it was demolished to make way for the Sydney Academy of Sports and Recreation. The project will investigate evolving Aboriginal Storytelling dynamics when using immersive digital media to teach culture and to document a historically important site that existed for thousands of years prior to its demolition in the mid-twentieth century. It expects to generate new knowledge about Aboriginal Storytelling and about the history of urban Aboriginals. Expected outcomes include a schema connecting Aboriginal Storytelling with immersive digital technologies, and truth-telling that advances understanding of modern Australia and urban Aboriginal people. The research should promote better mental, social and emotional health and wellbeing for Indigenous Australians and benefit all Australians culturally, socially and economically.
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Rock, Daniel Joseph, and Joachim Franz Hallmayer. "The Seasonal Risk for Deliberate Self-Harm." Crisis 29, no. 4 (July 2008): 191–201. http://dx.doi.org/10.1027/0227-5910.29.4.191.
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Groups at seasonal risk for deliberate self-harm (DSH) vary according to their geographic location. It is unknown, however, if seasonal risk factors for DSH are associated with place of birth or place of residence as these are confounded in all studies to date. In order to disaggregate place of birth from place of residence we examined general and seasonal risk factors for DSH in three different population birth groups living in Western Australia: Australian Aborigines, Australian born non-Aborigines, and UK migrants. We found Aborigines are at much higher general risk for DSH than non-Aborigines, but are not at seasonal risk, whereas non-Aboriginal Australians and UK migrants are. For UK migrants, this is only found for females. For all groups at seasonal risk this peaks during the austral (southern hemisphere) spring/summer. Furthermore, non-Aboriginal Australians and UK migrants show a consistent pattern of increased case fatality with increasing age. In contrast, case fatality does not increase with age among Australian Aborigines. Overall, despite living in the same environment, the three birth groups show different patterns of seasonal risk for DSH. In particular, the sex difference found between UK migrants and non-Aboriginal Australian birth groups suggests that predisposition toward seasonal risk for DSH is established early in life, but when present this is expressed according to local conditions.
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Smith, K., L. Flicker, D. Atkinson, A. Dwyer, N. T. Lautenschlager, J. Thomas, O. P. Almeida, and D. LoGiudice. "The KICA Carer: informant information to enhance the Kimberley Indigenous Cognitive Assessment." International Psychogeriatrics 28, no. 1 (August 14, 2015): 101–7. http://dx.doi.org/10.1017/s1041610215001283.
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ABSTRACTBackground:A quality dementia-screening tool is required for older remote Aboriginal Australians who have high rates of dementia and limited access to appropriate medical equipment and clinicians. The Kimberley Indigenous Cognitive Assessment (KICA Cog) is a valid cognitive test for dementia in Aboriginal and Torres Strait Islander peoples. The KICA cognitive informant questionnaire (KICA Carer) had yet to be analyzed to determine validity alone or in combination with the KICA Cog.Methods:The KICA Carer was completed by nominated informants of 349 remote-living Aboriginal Australians in the Kimberley region, Western Australia. Validity was assessed by comparing KICA Carer with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-10) consensus diagnoses based on a blinded specialist review. KICA Carer and KICA Cog were then compared to determine joint validity.Results:A KICA Carer score of ≥3/16 gave optimum sensitivity (76.2%) and specificity (81.4%), area under curve (AUC) 0.89 (95% CI = 0.85, 0.94) with positive predictive value (PPV) of 35.8%, and negative predictive value (NPV) of 96.2%. A KICA Cog score of ≤33/39 gave a sensitivity of 92.9% and specificity of 89.9%, AUC 0.96 (95% CI = 0.94, 0.98), with PPV of 55.6% and NPV of 98.9%. Cut-off scores of KICA Cog ≤ 33/39 and KICA Carer ≥ 2/16 in series indicate possible dementia, with sensitivity of 90.5% and specificity of 93.5%. In this setting, PPV was 66.5% and NPV was 98.6%.Conclusions:The KICA Carer is an important tool to accurately screen dementia in remote Aboriginal Australians when the KICA Cog is unable to be used for a patient. It is readily accepted by caregivers.Key points:•For the best practice in the cognitive assessment of an Aboriginal Australian aged over 45 years, KICA Cog should be utilized.•In cases where Aboriginal patients are not assessed directly, KICA Carer should be conducted with an informant. A cut-off score of ≥3/16 should be used (these tools can be downloaded fromwww.wacha.org.au/kica.html).
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Carey, Timothy A., James M. Fauth, and George C. Tremblay. "Rethinking Evaluation for Improved Health Outcomes: Implications for Remote Australia." American Journal of Evaluation 41, no. 2 (February 14, 2019): 234–54. http://dx.doi.org/10.1177/1098214018824040.
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Despite enduring and unacceptable disparities in health outcomes for Aboriginal and Torres Strait Islander Australians as well as people living in rural and remote locations, evidence indicates that health services are not routinely evaluated. This article describes an exploration of a context where evaluators and community partners have achieved considerable success in implementing and sustaining ongoing monitoring and evaluation for enhanced service effectiveness in rural and underserved communities of New Hampshire. The purpose of this project was to establish the principles supporting this success and to set the stage for future research investigating the applicability of these principles to the remote Australian context. Semistructured interviews were conducted with 15 people from different organizations and in different positions within those organizations. The results invite a reconsideration of the way in which evidence-based practice is conceptualized as well as the role of external evaluators. The study has important implications and recommendations for both policy and practice.
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Firebrace, Shirley, Daryl Nayler, and Penny Bisset. "Austin Health Celebrates Collaboration with Aboriginal People during NAIDOC Week in 2006." Australian Journal of Primary Health 12, no. 2 (2006): 13. http://dx.doi.org/10.1071/py06017b.
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Austin Health is one of Victoria's largest health care providers. It is a 950-bed major teaching and research hospital affiliated with the University of Melbourne. Austin Health employs more than 6,500 staff over three sites (the Repatriation Hospital, the Royal Talbot, and the Austin Hospital), and is renowned for providing high quality, comprehensive public health services. These services are provided to a significant number of the Aboriginal and Torres Strait Islander (ATSI) population. Throughout Australia, Aboriginal people are dying at almost three times the rate of other Australians and have a life expectancy 17 years lower than the rest of the population. All State-funded hospitals are required to give special attention to the needs of ATSI people by ensuring services are provided in a culturally appropriate way and meet the needs of ATSI people.
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Dimer, Lyn, Ted Dowling, Jane Jones, Craig Cheetham, Tyra Thomas, Julie Smith, Alexandra McManus, and Andrew J. Maiorana. "Build it and they will come: outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service." Australian Health Review 37, no. 1 (2013): 79. http://dx.doi.org/10.1071/ah11122.
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Objective. Cardiovascular disease (CVD) is the leading disease burden in Aboriginal Australians, but culturally appropriate cardiac rehabilitation programs are lacking. We evaluated the uptake and effects on lifestyle, and cardiovascular risk factors, of cardiac rehabilitation at an Aboriginal Medical Service (AMS). Methods. The program involved weekly exercise and education sessions (through ‘yarning’) for Aboriginal people with or at risk of CVD. Participants’ perceptions of the program and the impact on risk factors were evaluated following 8 weeks of attendance. Results. In twenty-eight participants (20 females) who completed 8 weeks of sessions, body mass index (34.0 ± 5.1 v. 33.3 ± 5.2 kg m–2; P < 0.05), waist girth (113 ± 14 v. 109 ± 13 cm; P < 0.01) and blood pressure (135/78 ± 20/12 v. 120/72 ± 16/5 mmHg; P < 0.05) decreased and 6- min walk distance increased (296 ± 115 v. 345 ± 135 m; P < 0.01). ‘Yarning’ helped identify and address a range of chronic health issues including medication compliance, risk factor review and chest pain management. Conclusions. AMS-based cardiac rehabilitation was well attended, and improved cardiovascular risk factors and health management. An AMS is an ideal location for managing cardiovascular health and provides a setting conducive to addressing a broad range of chronic conditions. What is known about the topic? Cardiovascular disease is the leading cause of morbidity and mortality in Aboriginal Australians, but less than 5% of eligible Aboriginal people attend hospital-based cardiac rehabilitation. What does this paper add? This is the first study to describe a culturally appropriate cardiac rehabilitation program conducted in a metropolitan Aboriginal Medical Service. It provides a detailed account of the program’s components and its effects on physical and psychosocial determinants of cardiovascular health in participants. What are the implications for practitioners? Health management programs similar to the one evaluated in this study could be developed to suit the specific needs of other Indigenous communities around Australia to address a range of chronic conditions.
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Thomas, David P., Ian P. Anderson, and Margaret A. Kelaher. "Accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people." Australian Health Review 32, no. 4 (2008): 648. http://dx.doi.org/10.1071/ah080648.
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Objectives: To examine the accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people compared with other Australians. Methods: We examined 2004?05 data from the National Non-admitted Patient Emergency Department Care database from the Northern Territory and Western Australia, the only jurisdictions where Indigenous identification in the database was considered acceptable. Results: In the NT, Indigenous people were 1.7 times as likely to present to an emergency department as non-Indigenous people. Indigenous patients in the NT and WA do not appear to use EDs for ?primary care? problems more than non- Indigenous patients. More NT Indigenous patients walked out before being seen or before their treatment was completed. However, Indigenous patients generally waited a similar time, and often slightly shorter, to be seen as similar non-Indigenous patients in WA and the NT. Conclusions: We recommend the regular monitoring of equity in the accessibility and quality of ED care for Indigenous people compared with other Australians. Indigenous identification in the database needs to improve so monitoring of ED performance can extend beyond WA and the NT.
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Gatwiri, Kathomi, Darlene Rotumah, and Elizabeth Rix. "BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia." International Journal of Environmental Research and Public Health 18, no. 9 (April 21, 2021): 4399. http://dx.doi.org/10.3390/ijerph18094399.
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Despite decades of evidence showing that institutional and interpersonal racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience ‘epidemic’ levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of ‘doing’ healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.
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Miller, Geoffrey, Robyn McDermott, Brad McCulloch, Dympna Leonard, Kerry Arabena, and Reinhol Muller. "The Well Person's Health Check: a population screening program in indigenous communities in north Queensland." Australian Health Review 25, no. 6 (2002): 136. http://dx.doi.org/10.1071/ah020136b.
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The National Indigenous Australians Sexual Health Strategy 1996-97 to 1998-99 provided the impetus and resources to assess the health of the large population of Aboriginal and Torres Strait Islander people living in rural and remote communities in northern Queensland, Australia. This paper describes the development, implementation and results of a community based screening program designed to detect and treat sexually transmissible infections and a range of non-communicable conditions and attendant risk factors. The Well Person's Health Check, conducted between March 1998 and December 2000,demonstrated a high prevalence of largely preventable health problems and initiated the development of a sustainable early detection strategy for the region.
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Garvey, Gail, Kate Anderson, Alana Gall, Tamara L. Butler, Joan Cunningham, Lisa J. Whop, Michelle Dickson, et al. "What Matters 2 Adults (WM2Adults): Understanding the Foundations of Aboriginal and Torres Strait Islander Wellbeing." International Journal of Environmental Research and Public Health 18, no. 12 (June 8, 2021): 6193. http://dx.doi.org/10.3390/ijerph18126193.
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Aboriginal and Torres Strait Islander people experience a greater range of health and social disadvantages compared to other Australians. Wellbeing is a culturally-bound construct, and to date, a national evidence base around the components of wellbeing for Aboriginal and Torres Strait Islander people is lacking. Understanding and measurement of wellbeing for this population is critical in achieving health equity. This paper aims to identify and describe the foundations of wellbeing for Aboriginal and Torres Strait Islander adults. This national qualitative study was underpinned by an Indigenist research approach which privileges the voices of Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander adults were purposively recruited from around Australia between September 2017 and September 2018 to participate in Yarning Circles, led by Aboriginal and Torres Strait Islander researchers. Yarning Circles were audio recorded, transcribed and analyzed. A Collaborative Yarning Methodology was used, which incorporated reflexive thematic analysis to identify and describe the foundations of wellbeing reported by participants. A total of 359 Aboriginal and Torres Strait Islander adults participated. Our analysis revealed five foundations of wellbeing: belonging and connection; holistic health; purpose and control; dignity and respect; and basic needs. These foundations were deeply interwoven by three interconnected aspects of Aboriginal and Torres Strait Islander life: family, community and culture. The findings of this study will substantially aid our efforts to develop a new wellbeing measure for Aboriginal and Torres Strait Islander adults. The iterative Indigenist methods used in this study provide a robust research methodology for conducting large-scale, nationally-relevant qualitative research with Aboriginal and Torres Strait Islander people. Policies and practices that are informed by our results have the potential to address outcomes that are meaningful for Aboriginal and Torres Strait Islander people.
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Williams, Martin, and John Allan. "Reducing smoking in Australia: how to include Aboriginal and Torres Strait Islander people." Cosmopolitan Civil Societies: An Interdisciplinary Journal 11, no. 2 (November 27, 2019): 37–54. http://dx.doi.org/10.5130/ccs.v11.i2.6642.
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Issue addressed: Australia has succeeded in lowering the overall prevalence of tobacco smoking in the last four decades and has enjoyed a worldwide reputation for innovative policy. However, this success has not extended to Indigenous Australians.
Method: Narrative review and critique of literature from government, public health, health promotion, marketing and communication on smoking cessation in Australia.
Main points: We first consider the history of government anti-smoking measures including legislation and communication initiatives including advertising and sponsorship bans, health warnings and ‘no smoking’ rules affecting anti-smoking norms, culminating in the banning of branding and the advent of tobacco plain packaging. We also review the effects of excise increases and smoking cessation aids such as quit lines and nicotine replacement therapy. For each type of intervention, both population-wide and those specifically directed at Indigenous people, we consider the probable reasons for the failure to reach Aboriginal and Torres Strait Islander people or alter their smoking patterns, and make suggestions for improvements in interventions and their evaluation.
Conclusion: The history of anti-smoking initiatives in Australia suggests that community-based health initiatives are likely to be more effective in addressing Indigenous people and helping smokers to quit.
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Bygrave, Annie, Kate Whittaker, Christine Paul, Elizabeth A. Fradgley, Megan Varlow, and Sanchia Aranda. "Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 5 (March 2, 2021): 2422. http://dx.doi.org/10.3390/ijerph18052422.
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(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2) Methods: A systematic review, following the Preferring Reporting Items for Systematic Reviews and Meta-Analyses, was conducted. Cumulative Index of Nursing and Allied Health Literature and PubMed were searched. The primary outcome was financial burden among cancer patients and their families in Australia. The secondary outcome was out-of-pocket costs associated with cancer care and treatment within the population sample, and the impact of financial burden. (3) Results: Nineteen studies were included, covering more than 70,000 Australians affected by cancer. Out-of-pocket costs varied by cancer type and ranged from an average of AUD 977 for breast cancer and lymphoedema patients to AUD 11,077 for prostate cancer patients. Younger aged patients (≤65 years), Aboriginal and Torres Strait Islander people, people in rural and/or remote areas, households with low income, those who were unemployed and people with private health insurance were at increased risk of experiencing out-of-pocket costs, financial burden or a combination of both. (4) Conclusions: Australians diagnosed with cancer frequently experience financial burden, and the health and financial consequences are significant. Focusing efforts on the costs of care and options about where to have care within the context of informed decisions about cancer care is necessary.
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Hall, Nina Lansbury. "Challenges of WASH in remote Australian Indigenous communities." Journal of Water, Sanitation and Hygiene for Development 9, no. 3 (June 3, 2019): 429–37. http://dx.doi.org/10.2166/washdev.2019.154.
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Abstract Health and well-being are influenced by access and quality to safe drinking water, wastewater treatment, and hygiene practices and settings. This is recognised in the United Nations' Sustainable Development Goals for water and health. As a signatory to the UN Goals, Australia has a commitment to ensure the access and quality of these resources is attained for all, including Indigenous Australians living in remote communities. This research sought to identify the status of water, sanitation and hygiene services within remote communities on mainland Australia. Interviews were conducted with representatives of organisations providing water, sanitation and/or hygiene to communities. The quality and access of WASH services in remote Indigenous communities were revealed in this research as lacking at times in many communities. The qualitative results indicate that drinking water supplies can be contaminated by microbes or naturally occurring chemicals, wastewater treatment can be poorly maintained with irregular monitoring, and the health of residents is negatively impacted by crowding in houses, which affects residents' ability to maintain healthy hygiene levels of people, clothing, bedding and infrastructure. Effective responses require a collaborative and systemic approach by the respective government agencies responsible that effectively partner with – and adequately fund – Indigenous communities to provide options that are ‘fit for purpose, place and people’.
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Wheeler, Amanda J., Jean Spinks, Fiona Kelly, Robert S. Ware, Erica Vowles, Mike Stephens, Paul A. Scuffham, and Adrian Miller. "Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia." BMJ Open 8, no. 11 (November 2018): e026462. http://dx.doi.org/10.1136/bmjopen-2018-026462.
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IntroductionThe age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers.Methods and analysisThis study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition/pregnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure.Ethics and disseminationThe protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals.Trial registration numberACTRN12618000188235; Pre-results.
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Somerville, Craig, Kirra Somerville, and Frances Wyld. "Martu Storytellers: Aboriginal Narratives Within the Academy." Australian Journal of Indigenous Education 39, S1 (2010): 96–102. http://dx.doi.org/10.1375/s1326011100001186.
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AbstractThe Martu people originate from the Pilbara region in Western Australia. Despite policies of removal, incarceration in prison and the need to leave community fo health services, Martu maintain identity and connection to country. Their narratives have used to inform a wider Australian audience about the history and culture of Aboriginal people. But the stories have also received criticism and been the subject of a Westernised anthropological view. With the emergence of storytelling as method in the academy, a new space is being created for Aboriginal and non-Aboriginal people to find a more robust foothold within the Social Sciences to story our world. This paper is written by three Martu people who position storytelling as transmission and preservation of cultural knowledge and to privilege a voice to speak back to Western academics. Storytelling also brings an opportunity to engage with an Aboriginal worldview, to use narrative as an inquiry into ontology and one's connection to people and place. This brings benefits to all Australians seeking stories of country, connection and identity.
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Esgin, Tuguy, Deborah Hersh, Kevin Rowley, Rona Macniven, Kristen Glenister, Alan Crouch, and Robert Newton. "Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ)." International Journal of Environmental Research and Public Health 18, no. 11 (June 2, 2021): 5969. http://dx.doi.org/10.3390/ijerph18115969.
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Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18–25, 26–44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.
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Thomas, David P., Nadia Lusis, Anke E. Van der Sterren, and Ron Borland. "Electronic Cigarette Use and Understanding Among a National Sample of Australian Aboriginal and Torres Strait Islander Smokers." Nicotine & Tobacco Research 21, no. 10 (July 19, 2018): 1434–40. http://dx.doi.org/10.1093/ntr/nty154.
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Abstract Introduction Adult daily smoking prevalence in the Aboriginal and Torres Strait Islander population is 2.8 times that of other Australians. There is little data on prevalence of electronic cigarette (e-cigarette) use among Aboriginal and Torres Strait Islander peoples. We measured e-cigarette use and beliefs about their harmfulness in national samples of Aboriginal and Torres Strait Islander smokers and of all Australian smokers. Methods The Talking About the Smokes project interviewed a nationally representative quota sample of 1301 Aboriginal and Torres Strait Islander smokers between August 2013 and August 2014. The Australian Wave 9 survey of the long-running International Tobacco Control Project interviewed 1093 smokers between February and May 2013. Estimates for all Australian smokers were standardized to the age and sex distribution of Aboriginal and Torres Strait Islander smokers. Results Fewer Aboriginal and Torres Strait Islander than all Australian smokers had tried an e-cigarette (21% vs. 30%). This was in part because of more Aboriginal and Torres Strait Islander smokers having not heard of e-cigarettes. Fewer Aboriginal and Torres Strait Islander smokers than all Australian smokers agreed that e-cigarettes are less harmful than conventional cigarettes (22% vs. 50%). Conclusions Many Aboriginal and Torres Strait Islander smokers have used e-cigarettes. However, there is considerable misunderstanding about the relative harm of e-cigarettes compared with conventional cigarettes, in part because of the tight regulatory environment in Australia. Implications The study describes e-cigarette use and understanding in national samples of Aboriginal and Torres Strait Islander smokers and of all Australian smokers. Only small studies have reported on e-cigarette use in this high smoking prevalence population. Fewer Aboriginal and Torres Strait Islander smokers than all Australian smokers had tried an e-cigarette and fewer agreed that e-cigarettes are less harmful than conventional cigarettes. Australian governments, health authorities, health professionals, and e-cigarette regulations should provide clearer messages that e-cigarettes are less harmful.
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Shephard, Mark, Christopher O'Brien, Anthony Burgoyne, Jody Croft, Trevor Garlett, Kristina Barancek, Heather Halls, Bridgit McAteer, Lara Motta, and Anne Shephard. "Review of the cultural safety of a national Indigenous point-of-care testing program for diabetes management." Australian Journal of Primary Health 22, no. 4 (2016): 368. http://dx.doi.org/10.1071/py15050.
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In Australia, Aboriginal and Torres Strait Islander people have approximately three-fold higher rates of diabetes than non-Indigenous Australians. Point-of-care testing, where pathology tests are conducted close to the patient, with results available during the patient consultation, can potentially deliver several benefits for both the Indigenous client and the health professional team involved in their care. Currently, point-of-care testing for diabetes management is being conducted in over 180 Aboriginal and Torres Strait Islander Medical Services as part of a national program called Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS). The cultural safety of the Program was reviewed by sourcing the views of the QAAMS Indigenous Leaders Team in a focus group setting and by surveying the point-of-care testing operators enrolled in QAAMS, via an electronic questionnaire. The current study confirms that QAAMS remains a culturally safe program that fills a permanent and positive niche within the Indigenous health sector. The study demonstrates that QAAMS provides a convenient and accessible ‘one-stop’ pathology service for Indigenous clients with diabetes and empowers Aboriginal Health Workers to have a direct role in the care of their diabetes clients.
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Katzenellenbogen, Judith M., Laura J. Miller, Peter Somerford, Suzanne McEvoy, and Dawn Bessarab. "Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia." Australian Health Review 39, no. 4 (2015): 429. http://dx.doi.org/10.1071/ah14102.
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Objectives The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. Methods A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006–11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. Results There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital re-admissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Conclusions Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes. What is known about the topic? The health gap between Aboriginal and non-Aboriginal Australians is well documented. Aboriginal people have significantly higher hospital utilisation rates, as well as higher rates of complications, comorbidities and discharges against medical advice (DAMA). Aboriginal patients receive most of their specialist services in hospital; however, detailed person-based analyses are limited and planning is often based on crude data. What does this paper add? This is the first analysis of linked data focusing on Aboriginal patient flows and volume and 28-day health system outcomes following hospital admission for all causes in a large metropolitan setting. Because the data were linked, admissions belonging to a single episode of care were combined, ensuring that transfers were not counted as re-admissions. Linkage also allowed follow up across time. The results highlight the main disease groups for which Aboriginal patients are admitted, how this varies by age and the high proportion of patients returning to (any) hospital within 28 days, either through EDs or as booked (pre-arranged) admissions. These data aid in the planning of hospital-based Aboriginal health liaison services. What are the implications for practitioners? The paper outlines the complexity with which many Aboriginal patients present to hospital and the risk of DAMA and re-admission. Clinical and organisational strategies can be put in place in hospitals to address these risks and ensure improved continuity of care with community-based primary health services. The Western Australian South Metropolitan Health Service is reviewing these data and will monitor the impact of the hospital-based AHLO program.
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Fitts, Michelle S., Katrina Bird, John Gilroy, Jennifer Fleming, Alan R. Clough, Adrian Esterman, Paul Maruff, Yaqoot Fatima, and India Bohanna. "A Qualitative Study on the Transition Support Needs of Indigenous Australians Following Traumatic Brain Injury." Brain Impairment 20, no. 2 (August 22, 2019): 137–59. http://dx.doi.org/10.1017/brimp.2019.24.
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AbstractObjective:A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced.Methods and Procedure:Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis.Results:Five major themes were identified within the data. These were labelled ‘hospital experiences’, ‘engaging with medical and community-based supports’, ‘health and wellbeing impacts from the injury’, ‘everyday living’ and ‘family adjustments post-injury’.Conclusions:While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an individualised, coordinated transition support, may reduce the risks for re-admission with further head injuries.