Dissertations / Theses on the topic 'Aboriginal Australians – Health and hygiene'
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1
Lee, Amanda (Amanda Joan). "Survival tucker : aboriginal dietary intake and a successful community-based nutrition intervention project." Thesis, The University of Sydney, 1992. http://hdl.handle.net/2123/9463.
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Jaross, Nandor. "Diabetic retinopathy in the Katherine region of the Northern Territory." Title page, contents and abstract only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phj376.pdf.
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"January 2003." Bibliography: 10.1-10.11 leaves. This thesis presents results from the Katherine Region Diabetic Retinopathy Study (1993-1996). These results provide the first detailed information on the basic epidemiology of diabetic retinopathy and impaired vision in an Aboriginal diabetic population.
3
Peiris, Priyajit David. "Building better primary care systems for indigenous peoples : a multimethods analysis." Thesis, The University of Sydney, 2010. http://hdl.handle.net/2123/12717.
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Paul, David. "Casting shadows and struggling for control : silence, resistance and negotiation in Australian Aboriginal health." University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0015.
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Self determination has been recognised as a basic human right both internationally and, to an extent, locally, but it is yet to be fully realised for Aboriginal Peoples in Australia. The assertion of Aboriginal community control in Aboriginal health has been at the forefront of Aboriginal peoples' advocacy for self determination for more than thirty years. Aboriginal Community Controlled Health Services and their representative organisations have been the site of considerable resistance and contestation in the struggles involved in trying to improve Aboriginal health experiences. Drawing on some of these experiences I explore the apparent inability of policy and decision makers to listen to systematic voices calling for change from the Aboriginal Community Controlled Health sector. It is government inability to act more fully on clear and repeated messages that is a source of much disquiet within representative Aboriginal organisations. Such disquiet is grounded in a belief that colonial notions continue to influence decision making at policy, practice and research levels resulting in a significant impediment to the realisation of self determination and associated human rights in Aboriginal health matters and Aboriginal Affairs more broadly.
5
Aldrich, Rosemary Public Health & Community Medicine Faculty of Medicine UNSW. "Flesh-coloured bandaids: politics, discourse, policy and the health of Aboriginal and Torres Strait Islander Peoples 1972-2001." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/27276.
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This thesis concerns the relationship between ideology, values, beliefs, politics, language, discourses, public policy and health outcomes. By examining the origins of federal health policy concerning Aboriginal and Torres Strait Islander Peoples 1972-2001 I have explored the idea that the way a problem is constructed through language determines solutions enacted to solve that problem, and subsequent outcomes. Despite three decades of federal policy activity Aboriginal and Torres Strait Islander children born at the start of the 21st Century could expect to live almost 20 years less than non-Indigenous Australians. Explanations for the gap include that the colonial legacy of dispossession and disease continues to wreak social havoc and that both health policy and structures for health services have been fundamentally flawed. The research described in this thesis focuses on the role of senior Federal politicians in the health policy process. The research is grounded in theory which suggests that the values and beliefs of decision makers are perpetuated through language. Using critical discourse analysis the following hypotheses were tested: 1. That an examination of the language of Federal politicians responsible for the health of Aboriginal and Torres Strait Islander Peoples over three decades would reveal their beliefs, values and discourses concerning Aboriginal and Torres Strait Islander Peoples and their health 2. That the discourses of the Federal politicians contributed to policy discourses and frames in the Aboriginal and Torres Strait Islander health policy environment, and 3. That there is a relationship between the policy discourses of the Aboriginal and Torres Strait Islander health policy environment and health outcomes for Aboriginal and Torres Strait Islander Peoples. The hypotheses were proven. I concluded that there was a relationship between the publicly-expressed values and beliefs of politicians responsible for health, subsequent health policy and resulting health outcomes. However, a model in which theories of discourse, social constructions of people and problems, policy development and organisational decision-making were integrated did not adequately explain the findings. I developed the concept of "policy imagination" to explain the discrete mechanism by which ideology, politics, policy and health were related. My research suggests that the ideology and values which drove decision-making by Federal politicians responsible for the health of all Australians contributed to the lack of population-wide improvement in health outcomes for Aboriginal and Torres Strait Islander Peoples in the late 20th Century.
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Walton, Shelley Faye. "Sarcoptes scabiei : a molecular approach to immunological and epidemiological aspects." Thesis, The University of Sydney, 1999. https://hdl.handle.net/2123/27676.
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The aim of this project was to account for and characterise the extent of genetic variation within and between sympatfic host-associated populations of dog-derived and human-derived Sarcoptes scabiei.
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Wilks, Kathryn. "Canine zoonoses in Aboriginal communities : the effects of a canine breeding program in the Kimberley Region, Western Australia." Murdoch University, 1999. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20060829.145909.
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The hypothesis central to this study is that the implementation of a canine breeding and parasite
control program in Aboriginal communities results in a reduction in the reservoir of zoonotic
parasites within communities. The effect of the parasite and breeding control program on the
health status of dogs as well as the population characteristics of dogs in communities was also
investigated.
The study was conducted in 17 Aboriginal communities of the Kimberley region of Western
Australia, divided into three regions according to cultural and geographical attributes. All dogs
from each community were permanently identified using a microchip system. Owners of dogs
were asked the usual location of their animals, the origins of their dogs and the whereabouts of
any missing animals at subsequent visits. Every three months dogs were treated with 200ygikg
iverrnectin (a potent endo- and ecto-parasiticide) subcutaneously and adult female dogs were
treated with an injectable contraceptive (10-30mgkg proligestone) at the request of their
owners. At the time of treatment, dogs were assessed for ecto-parasites and photographs taken
for later comparison and diagnosis of alopecic skin conditions. Faecal and blood samples were
collected every three to six months and skin scrapings were collected from dogs that were
refractory to treatment. The samples were used to determine internal parasite prevalence (using
formal ethyl acetate sedimentation), blood parameters (for anaemia status) and evidence of
scabies or Demodex infestation.
A pilot study at one group of communities, involving weekly assessment of dogs after one
iverrnectin treatment, showed that the treatment was effective in reducing the prevalence of
scabies (as determined by clinical evaluation), hookworm and ticks. The treatment resulted in
improvement in animal health as evidenced by a reduction in the number of dogs with anaemia.
The long-term use of the ivermectin treatments at the other communities showed that over a
period of three years, the prevalence of scabies and hookworm had reduced at most areas. The
initial scabies prevalence varied from 17 to 52% and reduced to below 10% for all communities.
The hookworm infection rates were affected by seasonal factors, as was evidenced by a seasonal
variance in prevalence. Animals that were treated with ivermectin, though, had lower
prevalences of hookworm than those that were not.
There was a reasonable compliance rate for contraceptive treatments for female dogs (greater
than 60% at each visit) and fewer puppies were born within communities when compared with
rates before and after the establishment of the treatment program. High rates of acquisition of
puppies from other communities continued to maintain the dog population numbers despite the
reduction in breeding within communities.
The dog population was young, biased towards male dogs, and very unstable (almost 50% of
dogs died or went missing in a one year period). The rate of dog ownership across the
Kimberley varied according to the region investigated and always remained higher or equal to
ownership rates at the town centres of the Kimberley Region (as determined by a survey
conducted during the study).
Overall the canine parasite and breeding control program resulted in a reduction in scabies and
hookworm prevalence in dogs (and hence a reduction in the potential zoonotic transmission), a
reduction in dog breeding within communities, an improvement in dog health, and an
understanding in the dynamics and health status of dogs within communities.
8
Smith, Kathryn Elizabeth. "Assessment and prevalence of dementia in indigenous Australians." University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0062.
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Until recently, there was no dementia screening tool for Indigenous Australians and a paucity of information on the extent of dementia in Indigenous Australians. This thesis describes the development and validation of a tool to assess cognitive impairment in remote Indigenous Australians with the primary purpose of determining the prevalence of dementia and other associated conditions in this population. The tool was reevaluated with the larger prevalence sample and a short version of the tool was developed and evaluated. The Kimberley Indigenous Cognitive Assessment (KICA) tool was validated with Indigenous Australians aged over 45 years from the Kimberley region of Western Australia (n=70). The results were later confirmed in a larger sample from the remote Kimberley (n=363), and an additional sample in rural and remote areas of the Northern Territory (n=47). The KICA results were compared to independent consensus diagnoses using DSM-IV and ICD-10. Interpreters were used whenever participants were not proficient in English. These data led to the determination of a cut-off score of 33/34 out of a possible total score of 39 for the cognitive component of the KICA (KICA-Cog), with a sensitivity of 0.93 and specificity of 0.95 and AUC of 0.98. The tool is now widely used within remote areas of Australia. A short version of the KICACog (sKICA-Cog) was developed and found to be a valid brief screening tool for dementia in the Kimberley population, and had a cut-off score of 20/21 out of a possible 25, with a sensitivity of 0.89, specificity of 0.95 and AUC of 0.98. The sKICA-Cog should be used in combination with the KICA cognitive informant questionnaire (KICA-IQ). The KICA-IQ cut-off score of 2/3 out of a possible 16 was determined, with a sensitivity of 0.76 and specificity of 0.84 and AUC of 0.91. Using the validated KICA, the prevalence of dementia and cognitive impairment not dementia (CIND) was determined in a semi-purposive sample consisting of 363 Indigenous Australians aged over 45 years from 6 Aboriginal communities and one town in the Kimberley region. Participants were screened with the full KICA and 165 participants had an independent specialist review with consensus diagnoses. The prevalence of dementia was 12.4%, 5.2 times greater than the Australian prevalence of 2.4%, after age adjustment. The prevalence of CIND was 8.0%. Characteristics associated with dementia included older age, male gender (OR 3.1, 95% CI 1.4, 6.8), no formal education (OR 2.7, 95% CI 1.1, 6.7), smoking (OR 4.5, 95% CI 1.1, 18.6), previous stroke (OR 17.9, 95% CI 5.9, 49.7), epilepsy (OR 33.5, 95% CI 4.8, 232.3) and head injury (OR 4.0, 95% CI 1.7, 9.4). Other factors associated with dementia included incontinence, falls and poor mobility. The KICA is a valid assessment tool for rural and remote Indigenous Australians. The prevalence of dementia amongst Indigenous Australians is substantially higher than generally found in non - Indigenous Australians and other populations in the developed and developing world.
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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006." Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/3538.
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As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.
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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006." University of Sydney, 2007. http://hdl.handle.net/2123/3538.
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Master of PhilosophyAs Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.
11
Stocks, Nigel. "Trachoma and visual impairment in the Anangu Pitjantjatjara of South Australia /." Title page, contents and abstract only, 1992. http://web4.library.adelaide.edu.au/theses/09MD/09mds865.pdf.
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Owen, Julie. "Development of a culturally sensitive program delivering cardiovascular health education to indigenous Australians, in South-West towns of Western Australia with lay educators as community role models." University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0061.
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[Truncated abstract] Indigenous Australians suffer cardiovascular disease (CVD) at a rate six times greater than the general population in Australia and while the incidence of CVD has been reduced dramatically amongst the majority of non-indigenous Australians and amongst Indigenous populations in other countries in the last 30 years, there has been little change in the figures for Aboriginal Australians, showing that heart health campaigns have little impact, for this group of people. Aims : The principal aims of this study were firstly, to determine and record the barriers to the development and delivery of CVD prevention programs amongst Indigenous Australians and secondly, to develop an alternative, effective and culturally sensitive method of delivering heart health messages. Methods and results : The study was qualitative research undertaken in three South-West towns of Western Australia where the incidence of CVD was high amongst the Aboriginal community members. The use of semi-formal interviews, informal individual consultation, observation, and focus groups were methods implemented to obtain information. The first phase of the research was to identify the barriers which affected the Aboriginal Health Workers’ ability to deliver specialist educational programs. Questionnaires and interviews with the Aboriginal Health Workers and other health professionals in the towns, and community focus groups were undertaken in this phase of the study. The second phase of the research was aimed at developing an alternative strategy for delivering heart health messages. The focus changed to adopt more traditional ways of passing on information in Indigenous communities. The idea of small gatherings of friends or family with a trusted community member presenting the health message was developed. The third phase of the research was to implement this new approach. Lay educators who had been identified within focus groups and by Aboriginal Health Workers were trained in each of the towns and a protocol involving discussions of health issues, viewing a video on CVD, produced by the National Heart Foundation, sharing in a ‘heart healthy’ lunch and partaking in a ‘heart health’ knowledge game which was developed specifically for the gatherings. Several of these gatherings were held in each of the towns and they became known as ‘HeartAware parties’.
13
Haysom, Leigh. "Antecedents of renal disease in aboriginal children (ARDAC study)." Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/7298.
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Loff, Beatrice. "Health and human rights : case studies in the potential contribution of a human rights framework to the analysis of health questions." Monash University, Dept. of Epidemiology and Preventive Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/5291.
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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery towards better health outcomes for Aboriginal peoples /." University of Sydney. Public Health and Community Medicine, 2003. http://hdl.handle.net/2123/609.
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The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery: towards better health outcomes for Aboriginal peoples." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/609.
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The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
17
Sevo, Goran. "A multidimensional assessment of health and functional status in older Aboriginal Australians from Katherine and Lajamanu, Northern Territory /." View thesis entry in Australian Digital Theses Program, 2003. http://thesis.anu.edu.au/public/adt-ANU20051021.144853/index.html.
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Parsons, Meg. "Spaces of disease the creation and management of Aboriginal health and disease in Queensland 1900-1970 /." Connect to full text, 2008. http://hdl.handle.net/2123/5572.
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Thesis (Ph. D.)--University of Sydney, 2009.Degree awarded 2009; thesis submitted 2008. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept.of History, Faculty of Arts. Title from title screen (viewed 3 December, 2009). Includes graphs and tables. List of tables: leaf 9. List of illustrations: leaves 10-12. Includes bibliographical references. Also available in print form.
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Bartlett, Ben. "Origins of persisting poor Aboriginal health an historical exploration of poor Aboriginal health and the continuities of the colonial relationship as an explanation of the persistence of poor Aboriginal health /." Connect to full text, 1998. http://setis.library.usyd.edu.au/~thesis/adt-NU/public/adt-NU1999.0016/index.html.
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Thesis (M.P.H.)--Dept. of Public Health & Community Medicine, Faculty of Medicine, University of Sydney, 1999."An historical exploration of poor aboriginal health and the continuities of the colonial relationship as an explanation of the persistence of poor aboriginal health " Includes bibliographical references (leaves 334-349).
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Lansingh, Van Charles. "Primary health care approach to trachoma control in Aboriginal communities in Central Australia." Connect to thesis, 2005. http://repository.unimelb.edu.au/10187/984.
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This study concerned a primary health care approach to trachoma control in two Central Australian Aboriginal communities. The World Health Organization (WHO) has advocated that the best method to control trachoma is the SAFE strategy (Surgery, Antibiotics, Facial hygiene, and Environmental improvements), and this approach was adopted.The communities, Pipalyatjara and Mimili, with populations slightly less than 300 each, are located in the Anangu Pitjantjatjara (AP) lands of Central Australia, in the northwest corner of the South Australia territory. At Pipalyatjara, a full SAFE-type intervention was undertaken, with the ‘E’ component designed and implemented by the NHC (Nganampa Health Council Inc.). At Mimili, only a SAF-type of intervention was implemented.
Baseline data was gathered for 18 months from March 1999 through September 2000 (five visits to Pipalyatjara and four at Mimili), and included determining trachoma prevalence levels using the WHO system, facial cleanliness, and nasal discharge parameters. A trachoma health program was implemented at the end of this period and a one-time dose of azithromycin was given in September of 2000. The chief focus of the study was children under 15 years of age.
Improvements in road sealing, landscaping, and the creation of mounds were started to improve dust control. Concurrently, efforts were made in the houses of the residents to improve the nine healthy living practices, which were scored in two surveys, in March 1999 and August 2001. Trachoma prevalence, and levels of facial cleanliness and nasal discharge were determined at 3, 6, and 12 months following antibiotic administration.
In children less than 15 years of age, the pre-intervention prevalence level of TF (Trachoma Follicular) was 42% at Pipalyatjara, and 44% at Mimili. For the 1-9 year age group, the TF prevalence was 47% and 54% respectively. For TI (Trachoma Intense), the pre-intervention prevalence was 8% for Pipalyatjara, and 9% for Mimili. The TF prevalence, adjusted for clustering, and using only individuals present at baseline and follow-up (3, 6, and 12 months post-intervention), was 41.5%, 21.2%, 20.0%, and 20.0% at Pipalyatjara respectively. For Mimili, the corresponding prevalence figures were 43.5%, 18.2%, 18.2%, and 30%.
In the 1-9 year age group, a lower TF prevalence existed between the pre-intervention and 12-month post-intervention points at Pipalyatjara compared to Mimili. The TF prevalence after the intervention was also lower for males compared to females, when the cohorts were grouped by gender, rather than community. It is posited that reinfection was much higher at Mimili within this age group, however, in both communities, there appeared to be a core of females whose trachoma status did not change. This is speculated as mainly being caused by prolonged inflammation, though persistent infection C. Trachomatis cannot be ruled out.
Facial cleanliness and nasal discharge continued to improve throughout the intervention at both communities, but at the 3-month post-intervention point no longer became a good predictor of trachoma.
It is not known whether the improvements in the environment at Pipalyatjara were responsible for the reduction in trachoma prevalence 12 months after the intervention, relative to Mimili.
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Priestly, Jacqueline Rita. "Growing stronger together : cross-cultural nutrition partnerships in the Northern Territory 1974-2000 /." View thesis, 2003. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20031219.105829/index.html.
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McCoy, Brian Francis. "Kanyirninpa : health, masculinity and wellbeing of desert Aboriginal men." Access full text, 2004. http://repository.unimelb.edu.au/10187/2416.
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Kanyirninpa, or holding, exists as a deeply embedded value amongst desert Aboriginal peoples (Puntu). It is disclosed as authority with nurturance, where older generations assume the responsibility to care for and look after younger people. Kanyirninpa also holds in balance two other key cultural patterns of desert life, autonomy and relatedness. These values are transmitted across generations where they provide desert society with identity, cohesion and strength. While kanyirninpa can be identified in the nurturance provided a child after birth, its presence and power is particularly disclosed at ceremonial time. Here, the meanings of the ancestral tjukurrpa (dreaming) are celebrated and renewed. Desert society is reproduced as the deeper, social and cosmic meanings around ngurra (land), walytja (family) and tjukurrpa are gathered, ritualised and re-enacted. The older generations of men and women enable this holding to occur. When boys (marnti) become men (wati) the manner of kanyirninpa changes. No longer do young men seek to be held by their mothers and female relations. Instead, they seek to be held by older men: brothers, uncles and other males. By holding them older men induct younger men into the social meanings and behaviours of desert, male adulthood. A generative and generational male praxis is disclosed.
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Hughes, Ian. "Self-Determination: Aborigines and the State in Australia." Thesis, The University of Sydney, 1997. http://hdl.handle.net/2123/931.
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This thesis is an inquiry into the possibility of Aboriginal autonomy under the regime of a state policy which commands self determination. Debate about policy has been dominated by Western scientific, political and professional knowledge, which is challenged by indigenous paradigms grounded in the Dreaming. A recognition of the role of paradox leads me to an attempt at reconciliation between the old and the new Australian intellectual traditions. The thesis advances the theory of internal colonialism by identifying self-determination as its current phase. During more than 200 years of colonial history the relationship between Aborigines and the state has been increasingly contradictory. The current policy of self-determination is a political paradox. Aboriginal people must either conform to the policy by disobeying it, or reject the policy in obedience to it. Through the policy of self-determination the state constructs a relationship of dependent autonomy with Aboriginal people. In a two-year (1994-95) action research project Kitya Aboriginal Health Action Group was set up to empower a local community to establish an Aboriginal health service despite opposition from the Government Health Service. In collaboration with local general practitioners and volunteers the action group opened a health centre. After the end of formal field work government funding and support for the health service was granted. The project illustrated the paradox of dependent autonomy. What appeared as successful community development was not development, and what appeared as destructive factionalism was empowering. Strategies for change made use of contradictions and paradoxes within the state. As an innovation in the practice of social change, the thesis begins the construction of a model for indigenous community action for self-determination in health.
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Paradies, Yin Carl. "Race, racism, stress and indigenous health /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002514.
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Priestly, Jacqueline Rita. "Growing stronger together : cross-cultural nutrition partnerships in the Northern Territory 1974-2000." Thesis, View thesis, 2003. http://handle.uws.edu.au:8081/1959.7/266.
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This thesis incorporates social history and consultative action research to analyse the development of cross-cultural nutrition services for Indigenous communities in the Northern Territory from 1974-2000 and promote the development of stronger partnerships in 1999-2001.The historical development of nutrition services is analysed against current theory and a model of capacity building for health promotion. Nutrition infrastructure and services have developed systematically, incrementally and substantially. Strengths include the development of enduring and successful inter-cultural partnerships and leadership.Two facilitative narratives which aim to improve inter-cultural knowledge sharing, strengthen capacity and promote participatory action in community based projects were developed, implemented and partially evaluated. Services can be further strengthened by long-term commitments to examining power issues, promoting improved Indigenous control and problem solving and comprehensive bi cultural evaluation that identifies significant indicators to improving outcomes. Participatory action research, facilitative story telling, capacity building, Indigenous education theory and critical social science can inform and guide these efforts in complementary ways.
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Constable, S. E. "Knowledge-sharing education and training to enhance dog health initiatives in remote and rural indigenous communities in Australia." Thesis, The University of Sydney, 2012. http://hdl.handle.net/2123/9270.
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Grootjans, John. "Both ways and beyond : in Aboriginal and Torres Strait Islander health worker education /." View thesis, 1999. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030725.103057/index.html.
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Priestly, Jacqueline Rita, University of Western Sydney, College of Social and Health Sciences, and School of Sociology and Justice Studies. "Growing stronger together : cross-cultural nutrition partnerships in the Northern Territory 1974-2000." THESIS_CSHS_SJS_Priestly_J.xml, 2003. http://handle.uws.edu.au:8081/1959.7/266.
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This thesis incorporates social history and consultative action research to analyse the development of cross-cultural nutrition services for Indigenous communities in the Northern Territory from 1974-2000 and promote the development of stronger partnerships in 1999-2001.The historical development of nutrition services is analysed against current theory and a model of capacity building for health promotion. Nutrition infrastructure and services have developed systematically, incrementally and substantially. Strengths include the development of enduring and successful inter-cultural partnerships and leadership.Two facilitative narratives which aim to improve inter-cultural knowledge sharing, strengthen capacity and promote participatory action in community based projects were developed, implemented and partially evaluated. Services can be further strengthened by long-term commitments to examining power issues, promoting improved Indigenous control and problem solving and comprehensive bi cultural evaluation that identifies significant indicators to improving outcomes. Participatory action research, facilitative story telling, capacity building, Indigenous education theory and critical social science can inform and guide these efforts in complementary ways.Master of Arts (Hons) (Critical Social Science)
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Richmond, Chantelle Anne Marie. "Social support, material circumstance and health : understanding the links in Canada's aboriginal population." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=103286.
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Societies that foster high quality social environments and integration produce healthier populations. The mechanisms underlying the protective effect of social integration appear to be through various forms of social support. In the Canadian Aboriginal context, few authors have explored the relationship between health and social support. This gap in understanding is significant because Aboriginal frameworks of health point to the salience of larger social structures (i.e., family), yet patterns of population health point to distinctly social causes of morbidity and mortality (e.g., violence, alcoholism). An interesting paradox emerges: patterns of Aboriginal health suggest that social support is not working to promote health. This dissertation explores this paradox through a mixed-methods approach to describe the value of social support for Aboriginal health, and to critically examine the social-structural processes and mechanisms through which social support influences Aboriginal health at the community level.Principal components analyses of the 2001 Aboriginal Peoples Survey (APS) identified social support as a consistent dimension of Metis and Inuit health, and multivariable logistic regression modelling of the 2001 APS identified social support to be a significant determinant of thriving health among Indigenous men and women (e.g., those reporting their health as excellent/very good versus good/fair/poor). The results also indicate a distinct social gradient in thriving health status and social support among Aboriginal Canadians.
Narrative analyses of 26 interviews with Aboriginal Community Health Representatives point to two key explanations for the health-support paradox: (i) social support is not a widely accessible resource; and (ii) the negative health effects of social support can outweigh the positive ones. The formation of health behaviours and cultural norms - which underpin social supports - are inextricably tied to the poor material circumstances that characterize Canada's Aboriginal communities. The thesis concludes with a critical examination of the processes through which environmental dispossession has influenced the determinants of Aboriginal health, broadly speaking. Effects are most acute within the material and social environments of Aboriginal communities. More research attention should focus on identifying the pathways through which the physical, material and social environments interact to influence the health of Aboriginal Canadians.
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Sevo, Goran, and sevo1984@yubc net. "A multidimensional assessment of health and functional status in older Aboriginal Australians from Katherine and Lajamanu, Northern Territory." The Australian National University. Faculty of Arts, 2003. http://thesis.anu.edu.au./public/adt-ANU20051021.144853.
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Human health is multidimensional: apart from physical, mental, and social aspects, it also
incorporates subjective perceptions of health, and functional status (FS). Given that elderly
persons have very distinctive health and social needs, multidimensional assessment (MA)
of health proves particularly useful in this age group.¶
Aboriginal populations suffer poor health, and there are relatively few studies addressing
the health problems of older Aboriginal Australians, mainly because of their distinctive
demographic structure, and the low proportion of their elderly. Also, there is no prior
information available on MA of health in this Australian population group.¶
This thesis offers a MA of health in older Aboriginal persons from two, urban and
rural/isolated, locations in the NT, Katherine and Lajamanu (the NT survey).¶
This thesis specifically addresses the following questions:
- what is the physical health, FS, subjective perception of health, and social
functioning amongst the NT survey participants?
- what are the possible similarities and differences in various dimensions of health
between the two major survey locations, what age and gender patterns are
observed, and what are the reasons for these patterns, similarities and
differences?
- how do various dimensions of health relate to each other, and why?
- how do current findings relate to broader Aboriginal and non-Aboriginal
populations, and why?
- what can MA add to a better understanding of various aspects of morbidity and
health care use?
- what are its possible implications for health planning?¶
Findings from this work indicate poor physical health amongst participants in almost all
investigated aspects, comparable to information available from other Aboriginal
populations. These are accompanied by low levels of ability for physical functioning. Despite this, subjective perception of health is rather optimistic amongst participants, and
levels of social functioning high. Use of health services is mainly related to available health
infrastructure. Important health differences exist between Katherine and Lajamanu, and
they became particularly visible when all dimensions of health are considered together.¶
The Main conclusions from the current work are that 1) poor physical health is not
necessarily accompanied by similar level of deterioration in other dimensions of health:
even though participants from the isolated community of Lajamanu experience most
chronic diseases, their ability for physical functioning is better, self-perceived health (SPH)
more optimistic and levels of social functioning highest 2) institutionalised participants from
Katherine suffer by far the worst health of all sample segments in this study; at least some
of the poor health outcomes are potentially avoidable, and could be improved by more
appropriate residential choices for Aboriginal elderly 3) better health infrastructure does
not necessarily bring better health in all its dimensions, suggesting that other factors
(primarily socio-economic and cultural) should be addressed in conjunction with this in
solving complex health problems of Aboriginal Australians, and 4) it provides strong
support that MA can become a useful tool in comprehensive health assessment of older
Aboriginals.
31
Ohtsuka, Thai, and thai_ohtsuka@hotmail com. "Impact of cultural change and acculturation on the health and help seeking behaviour of Vietnamese-Australians." Swinburne University of Technology, 2005. http://adt.lib.swin.edu.au./public/adt-VSWT20051013.095125.
Full textAbstract:
This study investigated the influence of cultural change and acculturation on
health-related help seeking behaviour of Vietnamese-Australians. Using convenience
sampling, 94 Vietnamese-Australians, 106 Anglo-Australians, and 49 Vietnamese in Vietnam participated in the study. Beliefs about health and health-related help-seeking behaviours were assessed through measures of common mental health symptoms, illness expression (somatisation, psychologisation), symptom causal attributions (environmental, psychological, biological), and choice of help seeking (self-help, family/friends, spiritual, mental health, Western medicine, Eastern medicine).Vietnamese-Australian data was compared with that of the Anglo-Australian and Vietnamese-in Vietnam. Results revealed that the help seeking behaviours and health related cognitions of Vietnamese-Australians, while significantly different from those of Anglo-Australians, were similar to those of Vietnamese in Vietnam. Specifically, both Vietnamese groups were less likely than Anglo-Australians to somatise and
psychologise or attribute the cause of symptoms to environmental, psychological or biological causes. However, the two Vietnamese groups were not different from each other in their style of illness expression or in their symptom causal attributions. The Vietnamese-Australians reported experiencing more mental health symptoms than the Vietnamese in Vietnam but fewer than the Anglo-Australians. In relation to help seeking, the Anglo-Australians chose self-help more than the Vietnamese, but there were few other differences between the cultural groups.
To investigate the influence of acculturation on health-related beliefs and help seeking behaviour, Vietnamese-Australians were compared according to their modes of acculturation (integration, assimilation, separation, and marginalisation). Generally, results showed a distinct pattern of response. Those with high levels of acculturation towards the Australian culture (the integration and the assimilation) were found to be most similar (in that they scored the highest in most areas measured) to the Anglo-Australians, while few differences were found between the separated and the
marginalised groups. Further, cultural orientation was a powerful predictor of help
seeking. In that, original cultural orientation predicted selection of help seeking from
Western and Eastern medicine, whereas, the host cultural orientation was a more robust predictor of the other variables. However, neither cultural orientation predicted preference for mental health help. Finally, the study found that, although the combination of symptom score, modes of illness expression, and symptom causal
attribution were strong predictors of choice of help seeking of Vietnamese-Australians,
acculturation scores further improved predictive power. The results were discussed in terms of the various limitations and constraints on interpretation of this complex data set.
32
Lea, Teresa Sue. "Between the pen and the paperwork : a native ethnography of learning to govern indigenous health in the Northern Territory." Thesis, University of Sydney, 2002. http://hdl.handle.net/2123/1891.
Full text
33
Grootjans, John. "Both ways and beyond : in Aboriginal and Torres Strait Islander health worker education." Thesis, View thesis, 1999. http://handle.uws.edu.au:8081/1959.7/445.
Full textAbstract:
During 1987 my essential beliefs about the nature of the world were challenged by a chance event which led to my arrival in Arnhemland. Working with Aboriginal people allowed me to see first hand the failings of Western ideas in Aboriginal education and health. This is how a 12 year collaboration with Aboriginal people began. The aim was to search for answers to the question, 'Why so many ideas that had been successfully used in the Western world, fail to meet the needs of aboriginal people? My experiences prior to 1995 had led me to believe that Both Ways, an education pedagogy developed in teacher education, was the best approach for empowering Aboriginal Health Workers. I believed Both Ways gave Aboriginal Health Workers a means to develop solutions to aboriginal health issues which valued and respected their aboriginal knowledge. I needed to describe and evaluate the practice of both ways with Aboriginal Health workers for the purpose of proving the benefit of this pedagogy for other educators in this field. This thesis describes how I came to think Both Ways was a good idea; how I defined Both ways; and how I put it into practice. It also provides a description of the issues raised in my critique of Both Ways and in my attempts to provide answers to these issues. Several years of collecting data, including records from action research group discussions, participant observation, interviews with peers and students, and formal evaluations left me with many concerns about Both Ways. As educators follow my journey of discovery I hope that they will recognise experiences and insights that they themselves have shared. The descriptions and discussions in this thesis will add significantly to the overall discourse about health worker education. Similarly, the exploration of ideas beyond Both Ways will add significantly to the overall body knowledge about the power relationships involved in teaching in a cross cultural setting
34
Best, Odette Michel, and n/a. "Community Control Theory and Practice: a Case Study of the Brisbane Aboriginal and Islander Community Health Service." Griffith University. School of Arts, Media and Culture, 2004. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20060529.144246.
Full textAbstract:
It is accepted protocol among Indigenous communities to identify one's link to land. I was born and raised in Brisbane. My birth grandmother is a Goreng Goreng woman, my birth grandfather is a Punthamara man. However, I was adopted by a Koombumberri man and an anglo-celtic mother after being removed at birth under the Queensland government policy of the day. The action of my removal and placement has had profound effects upon my growing and my place within my community today. For the last 15 years I have worked in the health sector. My current position is as a Lecturer within the Department of Nursing, Faculty of Science, University of Southern Queensland, Toowoomba. My areas of expertise are Indigenous Health and Primary Health Care. I have been employed in this capacity since January 2000. Prior to my full time employment as a nursing academic I have primarily been located within three areas of health which have directly impacted upon my current research. I was first positioned within health by undertaking my General Nurse Certificate through hospital-based training commenced in the late 1980s. For me this training meant being immersed within whiteness and specifically the white medical model. This meant learning a set of skills in a large institutionalised health care service with the provision of doctors, nurses, and allied medical staff through a hospital. Within this training there was no Indigenous health curriculum. The lectures provided on 'differing cultures' and health were on Muslim and Hindu beliefs about death. At that point I was painfully aware of the glaring omission of any representation of Indigenous health and of acknowledgment of the current outstanding health differentials between Indigenous and non-Indigenous Australians. I knew that the colonisation process inflicted upon Indigenous Australians was one of devastation. The decline in our health status at the time of colonisation had been felt immediately. Since this time our health has been in decline. While in the 1980s it was now no longer acceptable to shoot us, poison our waterholes, and incarcerate us on missions, we were still experiencing the influence of the colonisation process, which had strong repercussions for our current health status. Our communities were and remain rife with substance abuse, violence, unemployment, and much more. For Indigenous Australians these factors cannot be separated from our initial experience of the colonisation process but are seen as the continuation of it. However, there was no representation of this and I received my first health qualification.
35
Best, Odette Michel. "Community Control Theory and Practice: a Case Study of the Brisbane Aboriginal and Islander Community Health Service." Thesis, Griffith University, 2004. http://hdl.handle.net/10072/366110.
Full textAbstract:
It is accepted protocol among Indigenous communities to identify one's link to land. I was born and raised in Brisbane. My birth grandmother is a Goreng Goreng woman, my birth grandfather is a Punthamara man. However, I was adopted by a Koombumberri man and an anglo-celtic mother after being removed at birth under the Queensland government policy of the day. The action of my removal and placement has had profound effects upon my growing and my place within my community today. For the last 15 years I have worked in the health sector. My current position is as a Lecturer within the Department of Nursing, Faculty of Science, University of Southern Queensland, Toowoomba. My areas of expertise are Indigenous Health and Primary Health Care. I have been employed in this capacity since January 2000. Prior to my full time employment as a nursing academic I have primarily been located within three areas of health which have directly impacted upon my current research. I was first positioned within health by undertaking my General Nurse Certificate through hospital-based training commenced in the late 1980s. For me this training meant being immersed within whiteness and specifically the white medical model. This meant learning a set of skills in a large institutionalised health care service with the provision of doctors, nurses, and allied medical staff through a hospital. Within this training there was no Indigenous health curriculum. The lectures provided on 'differing cultures' and health were on Muslim and Hindu beliefs about death. At that point I was painfully aware of the glaring omission of any representation of Indigenous health and of acknowledgment of the current outstanding health differentials between Indigenous and non-Indigenous Australians. I knew that the colonisation process inflicted upon Indigenous Australians was one of devastation. The decline in our health status at the time of colonisation had been felt immediately. Since this time our health has been in decline. While in the 1980s it was now no longer acceptable to shoot us, poison our waterholes, and incarcerate us on missions, we were still experiencing the influence of the colonisation process, which had strong repercussions for our current health status. Our communities were and remain rife with substance abuse, violence, unemployment, and much more. For Indigenous Australians these factors cannot be separated from our initial experience of the colonisation process but are seen as the continuation of it. However, there was no representation of this and I received my first health qualification.Thesis (Masters)
Master of Philosophy (MPhil)
School of Arts, Media and Culture
Full Text
36
Wright, Heathcote R. "Trachoma in Australia : an evaluation of the SAFE strategy and the barriers to its implementation /." Connect to thesis, 2007. http://eprints.unimelb.edu.au/archive/00003844.
Full textAbstract:
Thesis (Ph.D.)--University of Melbourne, Dept. of Opthalmology, 2007.Typescript. SAFE Strategy refers to Surgery for trichiasis, Antibiotics for active infection, Facial cleanliness and Environmental improvements. Includes bibliographical references (leaves 233-253). Also available electronically: http://eprints.unimelb.edu.au/archive/00003844.
37
Mills, David. "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia /." Title page, table of contents and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09MD/09mdm6571.pdf.
Full textAbstract:
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).
38
Fox, Terri-Lynn, and University of Lethbridge Faculty of Arts and Science. "Intergenerational communication & well-being in Aboriginal life." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2004, 2004. http://hdl.handle.net/10133/257.
Full textAbstract:
This thesis discusses intergenerational communication and well-being in Aboriginal life, using a literature review and research conducted in relation to the Blood people and culture. It addresses issues concerning lack of communication of traditional ways of knowing, teaching, and being. Interviews were used to better understand the dynamics of intergenerational communication and well-being. It is historically know by First Nations communities that the older people of the clan or tribe taught the children from infancy to adolescence. This, unfortunately, is not the case in many First Nations communities today, due to colonization, assimilation, and segregation. It is hoped this research will assist those who wish to develop, implement and enhance future social, educational, and health programs for the well-being of the First Nations child, family and community. The results also suggest ways in which to enhance and foster the value of elders in the community.218 leaves : ill. ; 29 cm.
39
Rheault, Haunnah. "Examining the chronic disease health literacy of First Nations Australians: A mixed methods study." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/228618/8/Haunnah%20Rheault%20Thesis.pdf.
Full textAbstract:
Chronic disease is the most significant contributor to the mortality gap between Australia’s First Nations people and the overall Australian population. This study explored chronic disease self-management and health literacy in First Nations adults living in remote Queensland. Key findings were poor communication by healthcare providers coupled with limited health literacy abilities of individuals were the major barriers to active engagement with managing chronic disease. Providing a supportive health literacy environment and the provision of appropriate health information delivered in a cultural safe way using clinical yarning, may assist with closing the gap in First Nations people.
40
Beale, B. L. "Maternity services for urban Aboriginal women : experiences of six women in Western Sydney /." View thesis, 1996. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030613.161127/index.html.
Full text
41
McPhail-Bell, Karen. ""We don't tell people what to do": An ethnography of health promotion with Indigenous Australians in South East Queensland." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/91587/1/Karen%20McPhail-Bell%20Thesis.pdf.
Full textAbstract:
This thesis contributes to the decolonisation of health promotion by examining Indigenous-led health promotion practice in an urban setting. Using critical ethnography, the study revealed dialogical, identity-based approaches that centred relationship, community control and choice. Based on the findings, the thesis proposes four interrelated principles for decolonising health promotion and argues that Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian mainstream health promotion practice.
42
Helen, Maureen. "Other people's country: A memoir; and, Developing a trustworthy narrator: An essay." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2006. https://ro.ecu.edu.au/theses/1796.
Full textAbstract:
This thesis comprises two interrelated sections. The first section is a substantial piece of creative writing, which l have cailed 'Other People's Country: A Memoir, in the genre of travel memoir, and an essay. The memoir borrows techniques from fiction, drama and poetry to tell a story of a middle-aged, middle-class city nurse, who travels to a remote settlement at the edge of the Western Desert of Western Australia to provide health care for a fluctuating population of around 400 people, for whom English is a third or fourth language.
Writing that includes stories about vulnerable people from another culture, whose lives have touched those of the writer, demands sensitivity to differences, as well as an ethical approach. Writing about Aboriginal people also demands an awareness of what is appropriate when writing about cultural material. To achieve the voice of a trustworthy narrator is a challenge that faces all writers of narrative non-fiction, including memoir. The truth is subjective; perception is unreliable; memory can be distorted; error slips in unwittingly; deliberate falsification is possible. In spite of all this, a writer of memoir makes a contract with the reader that the story is significant, and that it is the writer's truth, told as honestly as possible. The pivotal concern of this thesis is the question, 'What are some of the important considerations for a memoirist who is attempting to develop the voice of an ethical and trustworthy narrator writing about experiences encountered when living and working within an unfamiliar culture?
The second part of the thesis is an essay which develops a theoretical framework in response to some of the major dilemmas I encountered in this undertaking. It embraces memory, aspects of Aboriginal vulnerability, and ethics through which to explore the concepts of truth and honesty in memoir-writing.
43
Sibthorpe, Beverly. ""All our people are dyin' ": diet and stress in an urban Aboriginal community." Phd thesis, 1988. http://hdl.handle.net/1885/109811.
Full textAbstract:
This is primarily a study of dietary practices and nutrient intakes in
relation to health in an urban Aboriginal community in New South Wales.
It examines the assumption that poor diet is one of the major, if not
the major, contributing factors in poor Aboriginal health. The data
indicate that in the community studied dietary patterns were consistent
with those of the wider society. Intakes of nutrients were not always
optimal compared with recommended dietary intakes (RDIs) for Australia,
but compared to the rest of the Australian population, and different
sub-sections within it, they were not as poor as expected. In
particular, the high fat, high sugar, largely vitamin deficient diet
frequently assumed to be ubiquitous in Aboriginal communities is not
supported by this study. Consequently, it is argued that the importance
of the role of diet in poor Aboriginal health may have been over-stated.
In re-evaluating the current emphasis on diet and other 'lifestyle'
factors it is suggested that the scope of the analysis needs to be
considerably broadened to include other factors which may be more
ambiguous in terms of their effects on health. What seems particularly
important is the high level of stress evident in the community studied.
This stress seems to be derived from a particular set of historical and
contemporary social conditions which, it is argued, need to be more
fully considered as part of the totality of environmental factors which
impinge on the health of Aborigines in settled Australia.
44
Veale, Antony John. "Chronic lung disease in Australian Aborigines." Phd thesis, 1993. http://hdl.handle.net/1885/144192.
Full text
45
Cocks, Trevor J. "Screening for alcohol related brain damage among Australian aboriginals with drinking problems." Master's thesis, 1992. http://hdl.handle.net/1885/141424.
Full text
46
Brady, Margaret Ann. "Difference and indifference : Australian policy and practice in indigenous substance abuse." Phd thesis, 1999. http://hdl.handle.net/1885/109778.
Full textAbstract:
This research addresses the ways in which alcohol problems among indigenous
Australians have been conceptualised and acted upon by the people themselves, and by
government policy-makers. The thesis considers two main questions. First, how has it
eventuated that Aborigines have become excluded from national and international
innovation in the management of drug and alcohol problems? Second, are mainstream
models of best practice for alcohol intervention, particularly secondary prevention
activities, acceptable to and feasible for Aboriginal people?
I examine how the growth of the indigenous rights movement came to underpin
assertions of cultural difference from other Australians, which in turn influenced the
growth of separate community-controlled health and other organisations. National policymakers
found it difficult to deal with demands for the recognition of cultural difference
through the provision of special funds and separate services. As a result of this increased
sensitivity, national policies often gave inadequate consideration to indigenous issues.
Alcohol problems in particular received little expert attention, and the division of
community-controlled alcohol programs from health services for Aborigines exacerbated
these shortcomings. Aboriginal approaches to alcohol were influenced by a small group
of charismatic activists who pursued a unitary position and remained insulated from the
changes in policy and practice available to the wider population. While the health
services came to be influenced by an all encompassing 'Aboriginal' definition of health -
associated with the broad WHO definition of health emanating from the Alma-Ata
Declaration of 1978 - alcohol programs maintained a narrow, disease-based focus.
Cultural difference is presented throughout the thesis as being a crucial issue, and it is
analysed as a political construct with continuing salience in the face of the unequal
distribution of resources. The constructions of difference are discussed and contested in
the areas of culture and healing, in health, and in approaches to alcohol problems. I
demonstrate that the politics of difference has masked the fact that many Aboriginal
dependent drinkers manage to give up drinking, either on their own or with the
encouragement of a health professional, just as do others in the population. The politics
of difference is also implicated in the rejection of innovative and varied approaches to
alcohol problems emanating from mainstream treatment research. This has deprived
Aboriginal people experiencing serious alcohol problems of access to a range of
interventions which could assist them much earlier in their drinking careers. Some
relevant approaches include brief and opportunistic interventions delivered by health
professionals, which are found to be relevant and feasible for use with Aboriginal clients
of primary health care services.
47
Senior, Kate Adèle. "A Gudbala Laif? : health and wellbeing in a remote Aboriginal community - what are the problems and where lies responsibility?" Phd thesis, 2003. http://hdl.handle.net/1885/109708.
Full textAbstract:
The the sis is a study of a single community, its health, expectations and
aspirations. It is a study of understand in g and responsibility in the
context of dependence. The primarily ethnographic work for this thesis
was undertaken in Ngukurr over thirteen months between 1999 and
2002. Ngukurr is a remote town on the south east border of Arnhem Land in
Australia’s Northern Territory. Its long term residents are Aboriginal
people. The thesis presented here examines these people’s
understanding of health and illness in their community and their
attainment of a good life. My study focuses on issues around people’s
engagement with and disengagement from, the management of their
health and health service delivery.
My thesis is guided by the following questions:
• how do people assess their health status?
• how a republic health services perceived?
• what expectations does the community have about the type and
quality of the services provided ?
• do people seek an active role in the management of their
health ?
People’s attitudes to and expectations for their health are examined in
the context of a history of direct welfare dependence till the mid nineteen
seventies; followed by local self government in which fiscal and
administrative responsibility were held by Government or outside
individuals. The evidence for health status, morbidity, and mortality among the
remote indigenous population is significantly worse than non indigenous
Australians and h a s been the subject of extensive Commonwealth and
State health programs to little obvious effect.
The literature I survey shows that people in poor communities rate their
health more highly than the objective data suggests. Ngukurr residents
rate their health in a similar way, b u t their apparent satisfaction masks
complex beliefs about illness and concerns about health.
I demonstrate that the community believes that outside influences are
more important than personal actions as a cause of poor health, that
there is little respect for the community’s view of health or health
services, and in consequence there is little point in taking personal or
collective responsibility.
Ngukurr residents are not disinterested in health. They are acutely
aware of the patterns of morbidity and mortality in their community and
consider these to have a negative impact on their quality of life. Their
ability to bring about changes in these patterns is limited by different
paradigms of health and illness which sometimes appear as fatalism,
powerlessness in the non-Aboriginal domain, loss of confidence due to
poor communication with non indigenous providers, and consequent low
expectations with regard to personal and community health.
This creates a challenge for current policies to devolve management
responsibility for health services to local communities. Policy makers
should make considerable efforts to u n d e rs tan d local health beliefs and
value systems and ensure that changes are appropriate, rather than
making changes in health systems based on non-indigenous
understandings of needs.
48
Longstreet, Diane Alicia. "Magnesium and diabetes : it’s implications for the health of indigenous Australians." 2008. http://hdl.handle.net/2440/55477.
Full textAbstract:
Diabetes in Indigenous Australians occurs at a younger age and at almost four times the rate of non-Indigenous Australians. While the cause for this health disparity is multi-factorial, recent studies suggest that nutrition, and particularly magnesium intake, may play a role in onset of diabetes and related pathologies. No study has ever examined whether there is any relationship between diabetes and magnesium intake in Indigenous Australians, and the present study therefore sought to establish whether any such interrelationship existed. As part of this study, dietary magnesium intake was estimated in an urban cohort of Aboriginal and Torres Strait Islander subjects and compared to the average Australian dietary intake. An ecological study then explored environmental correlates, and specifically the magnesium level in drinking water, to diabetes mortality. Finally, total and free serum magnesium concentrations were determined to identify any differences in magnesium status between diabetic and non-diabetic Indigenous and non-Indigenous Australians, and also to compare which of the two parameters was a more sensitive measure of magnesium status and diabetic risk. All Aboriginal and Torres Strait Islander people that were recruited for this study were patients of the Townsville Aboriginal and Islander Health Services, Townsville, North Queensland, who presented for health monitoring and subsequently required fasting blood tests as part of that routine care. Additional non-Indigenous people were recruited from five GP practices in the Townsville area. Inclusion criteria included persons over the age of 15 (Tanner Stage 5) who had lived in the Townsville area for at least ten days. Exclusion criteria included chronic diarrhoea, alcoholism or binge drinking in the past two weeks, use of diuretics, consumption of magnesium supplements, reduced renal function (urinary albumin to creatinine ratio exceeding > 2.5 mg/mmol in men and > 3.5 mg/mmol in women), severe mental illness, pregnancy, or breastfeeding. Our results indicated that 60% of the Indigenous people assessed in this study had a dietary intake of magnesium that was below the estimated average magnesium requirement for half the national population. Additionally, the average magnesium intake in Indigenous Australians was significantly less than the intake of non-Indigenous Australians (p<0 .001). A significant negative correlation was found between the incidence of diabetes related mortality and the concentration of magnesium in drinking water in Queensland, confirming previous reports from the USA that drinking water magnesium may be an important factor in development of diabetes. The needs assessment study confirmed that diabetes in both Indigenous and non-Indigenous Australians was associated with reduced levels of total serum magnesium, and more importantly, that total serum magnesium was lower in Indigenous Australians who did not have diabetes compared with their non-Indigenous counterparts (p=<0.001). In the absence of diabetes, the prevalence of hypomagnesaemia was 17.2% for the non-Indigenous but 36.9% for the Indigenous subjects. Finally, the ionic serum magnesium analysis confirmed the results of the total serum magnesium study, and demonstrated that ionic magnesium was strongly correlated to the total magnesium concentration (r: 0.75. p < 0.001), with the relationship being apparent irrespective of either diabetic (r: 0.66 to 0.81. p<0.001) or ethnicity (r = 0.71 to 0.81. p<0.001)." We conclude that although not causal, the evidence suggests that magnesium may be a significant contributing factor to diabetes in Australia, especially for Aboriginal and Torres Strait Islander peoples, and that further investigation of the potential relationship between magnesium and diabetes in the Australian Indigenous populations, and possible corrective interventions, is highly warranted.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1348469
Thesis (Ph.D.) - University of Adelaide, School of Medical Sciences, 2008
49
Reath, Jennifer. "The training and support of general practitioners in Aboriginal and Torres Strait Islander health." Thesis, 2019. http://hdl.handle.net/1959.7/uws:58228.
Full textAbstract:
The body of work presented in this portfolio addresses the research question: “What is best practice in training and support for General Practitioners in Aboriginal and Torres Strait Islander health?” My 13 papers and monographs describe general practice training and related research conducted from 1998-2018, using a range of methodologies. The research is grounded in partnerships with Aboriginal and Torres Strait Islander peoples and organisations, and rigorous, evidence based research approaches. In this portfolio I discuss the rationale for training health professionals as a strategy for addressing Indigenous health inequity and provide an organisational context in the Australian general practice training setting. My discussion of the papers and monographs is informed by a comprehensive review of the current literature. Reflecting on my research and the current literature, six themes are identified as framing best practice in general practice training in Aboriginal and Torres Strait Islander health, and recommendations for best practice are described under each. The themes are Indigenous leadership and partnerships; organisational commitment; systemic approach; learning approaches; learning content; and assessment and evaluation.
50
Randall, Deborah. "Multilevel modelling of routine data to investigate individual and contextual influences on disparities in myocardial infarction rates and outcomes for Aboriginal people." Thesis, 2015. http://hdl.handle.net/1959.7/uws:36596.
Full textAbstract:
Background: Heart disease is a leading cause of the health gap between Aboriginal and non-Aboriginal people in Australia. Higher incidence of acute myocardial infarction (AMI) and higher mortality from AMI are major contributors to the greater burden of disease in Aboriginal people. Much of the research on reducing rates of AMI focuses on individual risk factors, such as smoking, physical activity, cholesterol level and diabetes. However, broader contextual and structural factors, including features of the geographic areas where individuals live, and the hospitals they attend, can have an important impact on health outcomes. Identifying and quantifying contextual and individual factors that influence the higher rates of AMI events and mortality in Aboriginal people will assist in better development and targeting of interventions to tackle these disparities. In this thesis, I develop methods for classifying Aboriginal people in routinely collected hospital data, and use these data to investigate the influence of individual, area of residence, and hospital factors on rates of AMI, mortality from AMI, and procedures after AMI, in Aboriginal people in New South Wales (NSW), Australia. Methods: Routinely collected hospital data for the entire NSW population for the period July 2000 to December 2008 were linked to mortality data from July 2000 to December 2009 using probabilistic methods. Firstly, I investigated the recording of Aboriginal status in the hospital and deaths data, and used linked data to develop and test algorithms to enhance the reporting of Aboriginal status. Then I used (i) multilevel Poisson regression models to estimate the relative rates of first AMI events, accounting for area of residence; (ii) multilevel logistic regression models to estimate the relative mortality after AMI admission, accounting for hospital and admission; and (iii) multilevel Cox proportional hazards models to estimate the relative procedure rates after AMI admission, accounting for hospital of admission. I also sequentially accounted for other individual risk factors, such as the presence of comorbid conditions, to determine their influence on the disparities in outcomes for Aboriginal people. Results: Sixty per cent of the variation in recording of Aboriginal status in routinely collected hospital data was due to the hospital of admission, and status recording was worse in major city compared with more regional and remote hospitals, and in private compared with public hospitals. The number of people reported as Aboriginal, and estimated admission rates and mortality ratios, varied according to the algorithm used to enhance the reporting of Aboriginal status. After accounting for age, sex, and year of admission, rates of AMI in Aboriginal people were more than two times those in non- Aboriginal people, even when comparing within areas of residence. The disparities were particularly large for women and those in younger age groups. There was significant variation in AMI rates by geographic area, with higher rates outside of major city areas and in areas of lower socioeconomic status. The relative Aboriginal to non-Aboriginal disparity in rates was also particularly large in these areas. Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients, after adjusting for age, sex, year and hospital, but a higher risk of dying within one year. The latter difference became non-significant after adjustment for comorbid conditions. There was a higher 30-day mortality risk for patients admitted to smaller, more remote hospitals without on-site angiography facilities compared with larger hospitals and those with on-site angiography, respectively. Aboriginal patients had a revascularisation rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission, and AMI type, but a rate 18% lower within the same hospital. Adjustment for comorbid conditions, such as diabetes and renal disease and other individual factors, explained the remaining disparity. Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness, and facilities. Conclusions: Hospital-level interventions, such as better training of staff, are required to improve the recording of Aboriginal status, particularly in major city and private hospitals. Data linkage of routine administrative data can improve reporting of Aboriginal status, although the impact of the algorithm used to enhance reporting should be explored using sensitivity analysis. My research identified the importance of contextual influences when examining disparities in rates of AMI, and in mortality and procedures after admission for AMI. There was significant variation in overall AMI rates by area, which was partly explained by area-level disadvantage. Even when comparing within areas, Aboriginal people had higher rates of AMI than their non-Aboriginal counterparts. Priority areas for area-level interventions were those with a higher than average disparity and a higher than average rate of AMI for Aboriginal people. While disparities in longer-term mortality and procedure rates within hospitals did not persist after fully adjusting for individual risk factors such as comorbidities, these disparities will remain as long as Aboriginal people have higher rates of comorbid conditions (e.g. diabetes and renal disease) that complicate treatment and survival. For residents of rural and regional areas, both Aboriginal and non- Aboriginal, improving access to larger hospitals or those with specialist treatment facilities could improve surgical rates and outcomes after AMI. However, the main priority must be reducing the early onset of AMI and comorbid chronic conditions, such as diabetes and renal disease, and the subsequent early mortality among Aboriginal Australians. This will require major efforts in primordial, primary and secondary prevention. Priorities include targeting individual risk behaviours, such as smoking, improving the management of early symptoms of cardiac disease, reducing barriers to accessing primary care and cardiac rehabilitation services, and changing community norms about smoking and health behaviours. Interventions must acknowledge the wider historical and contextual causes of the current Aboriginal health disadvantage, and must deal with macro, contextual and individual levels of influence in order to have a significant impact.