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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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Grimshaw, Patricia. "“That we may obtain our religious liberty…”: Aboriginal Women, Faith and Rights in Early Twentieth Century Victoria, Australia*." Journal of the Canadian Historical Association 19, no. 2 (July 23, 2009): 24–42. http://dx.doi.org/10.7202/037747ar.
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Abstract The paper, focused on a few years at the end of the First World War, explores the request of a group of Aborigines in the Australian state of Victoria for freedom of religion. Given that the colony and now state of Victoria had been a stronghold of liberalism, the need for Indigenous Victorians to petition for the removal of outside restrictions on their religious beliefs or practices might seem surprising indeed. But with a Pentecostal revival in train on the mission stations to which many Aborigines were confined, members of the government agency, the Board for the Protection of the Aborigines, preferred the decorum of mainstream Protestant church services to potentially unsettling expressions of charismatic and experiential spirituality. The circumstances surrounding the revivalists’ resistance to the restriction of Aboriginal Christians’ choice of religious expression offer insight into the intersections of faith and gender within the historically created relations of power in this colonial site. Though the revival was extinguished, it stood as a notable instance of Indigenous Victorian women deploying the language of Christian human rights to assert the claims to just treatment and social justice that would characterize later successful Indigenous activism.
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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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Hedges, S., M. Davidson, S. Forrester, A. Casey, V. Pridmore, A. Cooper, A. Beauchamp, and N. McGrath. "A Breast Screening Shawl to Help Aboriginal Women Feel More Comfortable and Culturally Safe." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 40s. http://dx.doi.org/10.1200/jgo.18.11200.
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Background: It is recommended that Australian women aged 50-74 have a breast screen every two years. Aboriginal women have lower breast screening participation than the general population, and face barriers at a system, service and individual level including: • Cultural: lack of cultural awareness/safety at screening services • Fear: historical apprehension about health services due to the after effects of colonization and intergenerational trauma • Shame: feeling embarrassment/shame at being undressed in front of a stranger • Past experience: having a past unpleasant breast screen, or hearing about someone else' • Knowledge: lack of knowledge about screening • Logistics: not knowing service provider locations or limited access to transport During a 2016 project between BreastScreen Victoria (BSV) and Women's Health West, Aboriginal women discussed the need for a shawl to cover them during screening. This idea is based on a successful New Zealand model. Based on this, the Victorian Aboriginal Health Service (VAHS), Victorian Aboriginal Community Controlled Health Organization (VACCHO) and BSV formed a partnership to trial a breast screening shawl with Aboriginal women. A key principle underpinning the project is that success will reflect the degree to which this is an Aboriginal-led initiative, driven by the needs of Aboriginal women, and steered by community-based Aboriginal health organizations. Project aims: • Assess whether a cultural, strength based screening process increases engagement of Aboriginal women • Determine whether a screening shawl enhances comfort and culturally safety • Encourage breast screening services to develop culturally safe screening practices • Develop a flexible model that can be easily adapted by other Aboriginal health services to reproduce the shawl, in recognition of the diversity of Aboriginal communities Methods: This project adopted the following strategies: • A project steering group was established • The shawl will be trialled via a group booking at one BSV clinic • Before the group booking, BSV clinic staff will attend culturally safety training • On the trial day, women will attend an information session at VAHS about breast screening and receive their shawl, travel to the BSV clinic together for screening, and return to VAHS to discuss their experiences Results: The trial will be fully evaluated in 2018 to determine whether project aims were achieved. Conclusion: Key learnings to date are: • Breast screening interventions for Aboriginal women must be community-led to ensure they are culturally appropriate, safe and acceptable • Aboriginal women face a number of barriers to breast screening at a system, service and individual level • Health services play a critical role in adopting culturally safe screening practices • Developing a flexible model that can be easily adapted by other Aboriginal health services is critical in ensuring the sustainability and acceptability of the shawl.
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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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Bamblett, Muriel, and Peter Lewis. "Detoxifying the Child and Family Welfare System for Australian Indigenous Peoples: Self-determination, Rights and Culture as the Critical Tools." First Peoples Child & Family Review 3, no. 3 (May 19, 2020): 43–56. http://dx.doi.org/10.7202/1069396ar.
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The toxic environment that is colonized Australia has broken many of the traditional circles of care for Indigenous children and created a service system which waits for Indigenous families to become dysfunctional before there is any response. The Victorian Aboriginal Child Care Agency (VACCA) encourages an approach to Indigenous children and families which is culturally respectful, culturally appropriate and framed according to the need to respect self-determination and human rights. VACCA has developed early childhood and family welfare policies which identify how cultural-strengthening works as a preventative measure to address risk factors for Indigenous children. With the ongoing reforms to Child and Family Welfare arising from the Children, Youth and Families Act, the Victoria State Government in Australia has an historic opportunity to lead the nation in creating an Indigenous-led child and family service system which focuses on issues of prevention and early intervention. The new Act prioritizes cultural and community connection in the best interest principles for Indigenous children, recognizes self-determination and requires generalist children’s welfare services to be culturally competent. The only way to ensure that every Indigenous child is effectively cared for is by developing the capacity of Indigenous communities to look after their own by strengthening Indigenous organizations and agencies. It is Indigenous agencies who are best placed to deliver innovative programs which are culturally embedded and carefully targeted to restore the circles of care for Indigenous kids. Aculturally competent service system is what is needed to ensure better outcomes for Indigenous children.
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Springall, Tanisha, Della Anne Forster, Helen L. McLachlan, Pamela McCalman, and Touran Shafiei. "Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study." BMJ Open 13, no. 1 (January 2023): e066978. http://dx.doi.org/10.1136/bmjopen-2022-066978.
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ObjectivesThere is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model.DesignWomen having a First Nations infant booking for pregnancy care between March 2017 and November 2020 were invited to participate. Surveys at recruitment and 3 months post partum were developed with input from the First Nations Advisory Committee. We explored breast feeding intention, initiation, maintenance and reasons for stopping and factors associated with breast feeding.SettingThree tertiary maternity services in Melbourne, Australia.ParticipantsOf 479/926 eligible women approached, 343 (72%) completed the recruitment survey, and 213/343 (62%) the postnatal survey.OutcomesPrimary: breast feeding initiation and maintenance. Secondary: breast feeding intention and reasons for stopping breast feeding.ResultsMost women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving ‘any’ (95% CI 0.65 to 0.78) and 48% were giving ‘only’ breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR ‘any’: 2.69, 95% CI 1.29 to 5.60; ‘only’: 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR ‘any’: 2.48, 95% CI 1.05 to 5.86; ‘only’: 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR ‘any’: 0.36, 95% CI 0.13 to 0.98; ‘only’: 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR ‘any’: 0.26, 95% CI 0.11 to 0.58) with lower odds.ConclusionsBreast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.
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Gwynne, Kylie, Thomas Jeffries Jr, and Michelle Lincoln. "Improving the efficacy of healthcare services for Aboriginal Australians." Australian Health Review 43, no. 3 (2019): 314. http://dx.doi.org/10.1071/ah17142.
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Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.
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Daws, Karen, Amanda Punch, Michelle Winters, Sonia Posenelli, John Willis, Andrew MacIsaac, Muhammad Aziz Rahman, and Linda Worrall-Carter. "Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care." Australian Health Review 38, no. 5 (2014): 552. http://dx.doi.org/10.1071/ah13211.
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Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients’ admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. What is known about the topic? Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. What does this paper add? This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working together to improve hospital care and attendance at cardiac rehabilitation services for Aboriginal Australians with acute coronary syndrome. What are the implications for practitioners? The working together model of care could be implemented across mainstream health services where Aboriginal people attend for specialist care.
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Martin-Kerry, Jacqueline M., Martin Whelan, John Rogers, Anil Raichur, Deborah Cole, and Andrea M. de Silva. "Addressing disparities in oral disease in Aboriginal people in Victoria: where to focus preventive programs." Australian Journal of Primary Health 25, no. 4 (2019): 317. http://dx.doi.org/10.1071/py18100.
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The aim of this study is to determine where Aboriginal people living in Victoria attend public oral health services; whether they access Aboriginal-specific or mainstream services; and the gap between dental caries (tooth decay) experience in Aboriginal and non-Aboriginal people. Analysis was undertaken on routinely collected clinical data for Aboriginal patients attending Victorian public oral health services and the distribution of Aboriginal population across Victoria. Approximately 27% of Aboriginal people attended public oral health services in Victoria across a 2-year period, with approximately one in five of those accessing care at Aboriginal-specific clinics. In regional Victoria, 6-year-old Aboriginal children had significantly higher levels of dental caries than 6-year-old non-Aboriginal children. There was no significant difference in other age groups. This study is the first to report where Aboriginal people access public oral health care in Victoria and the disparity in disease between Aboriginal and non-Aboriginal users of the Victorian public oral healthcare system. Aboriginal people largely accessed mainstream public oral healthcare clinics highlighting the importance for culturally appropriate services and prevention programs to be provided across the entire public oral healthcare system. The findings will guide development of policy and models of care aimed at improving the oral health of Aboriginal people living in Victoria.
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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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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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Gentile, Victoria, Adrian Carter, and Laura Jobson. "Examining the Associations Between Experiences of Perceived Racism and Drug and Alcohol Use in Aboriginal Australians." Journal of the Australian Indigenous HealthInfoNet 3, no. 1 (2022): 1–18. http://dx.doi.org/10.14221/aihjournal.v3n1.3.
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Objective This study aimed to explore the relationships between experiences of perceived racism, mental health and drug and alcohol use among Aboriginal Australians. Method Sixty-two Aboriginal Australians, ranging in age from 19-64 years (Mage = 33.71, SD = 12.47) and residing in Victoria completed an online questionnaire containing measures of perceived racism, alcohol use, substance use and mental health. Results First, 66% of the sample reported experiencing interpersonal racism, with the highest proportion of reported experiences occurring in health settings, educational/academic settings and by staff of government agencies. Second, perceived racism was significantly associated with poorer mental health and well-being. Finally, while perceived racism was not significantly associated with substance use, there was an indirect pathway from perceived racism to substance use through mental health concerns. Conclusions The current research indicates that racism is still frequently experienced by Aboriginal Australians and is directly associated with poorer mental health, and indirectly with substance use through poorer mental health. The findings demonstrate a clear need for further research in this area.
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Loakes, Debbie, and Adele Gregory. "Voice quality in Australian English." JASA Express Letters 2, no. 8 (August 2022): 085201. http://dx.doi.org/10.1121/10.0012994.
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This study is an acoustic investigation of voice quality in Australian English. The speech of 33 Indigenous Australians (Aboriginal English speakers) is compared to that of 28 Anglo Australians [Mainstream Australian English (MAE) speakers] from two rural locations in Victoria. Analysis of F0 and H1*-H2* reveals that pitch and voice quality differ significantly for male speakers according to dialect and for female speakers according to location. This study highlights previously undescribed phonetic and sociophonetic variability in voice quality in Australian English.
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Shahid, Shaouli, Lizzie Finn, Dawn Bessarab, and Sandra C. Thompson. "'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment." Australian Health Review 35, no. 2 (2011): 235. http://dx.doi.org/10.1071/ah09835.
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Background. Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. Design, setting and participants. Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. Results. The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. Conclusion. To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services. What is known about the topic? Cancer is a major cause of death among Indigenous Australians who are generally diagnosed later with their disease, have poorer continuity of care and lower uptake and completion of cancer treatment. For cancer diagnosis at an equivalent stage of cancer, Aboriginal people have poorer outcomes. What does this paper add? This study documents Aboriginal perspectives on basic infrastructure and logistical problems which impede their accessing hospital-based cancer treatments: transport, accommodation, preparation for the experience of hospital and cancer treatment, service affordability and the certainty of support services. What are the implications for practitioners? There are difficulties for practitioners in addressing the geographic, socioeconomic and cultural differences that Aboriginal people face in accessing cancer treatment. System level changes to ensure cultural safety, social support and better coordination with primary healthcare are essential to improve outcomes of Aboriginal people with cancer.
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Bailey, Benjamin, and Joanne Arciuli. "Indigenous Australians with autism: A scoping review." Autism 24, no. 5 (January 13, 2020): 1031–46. http://dx.doi.org/10.1177/1362361319894829.
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Aboriginal and Torres Strait Islander people with autism spectrum disorder, used interchangeably with the term autism, are among the most marginalised people in Australian society. This review maps out existing and emerging themes in the research involving Indigenous Australians with autism based on a search of the peer-reviewed and grey literature. Our search identified 1457 potentially relevant publications. Of these, 19 publications met our inclusion criteria and focused on autism spectrum disorder diagnosis and prevalence, as well as carer and service provider perspectives on autism, and autism support services for Indigenous Australians. We were able to access 17 publications: 12 journal articles, 3 conference presentations, 1 resource booklet and 1 dissertation. Findings suggest similar prevalence rates for autism among Indigenous and non-Indigenous Australians, although some Aboriginal and Torres Strait Islander people with autism may not receive a diagnosis or may be misdiagnosed. Research on the perspectives of Aboriginal and Torres Strait Islander carers and Indigenous and non-Indigenous service providers is discussed in relation to Indigenous perspectives on autism, as well as barriers and strategies to improve access to diagnosis and support services. Although not the focus of our review, we briefly mention studies of Indigenous people with autism in countries other than Australia. Lay Abstract Aboriginal and Torres Strait Islander people with developmental disabilities such as autism are among the most marginalised people in Australian society. We reviewed research involving Indigenous Australians with autism based on a search of the peer-reviewed and grey literature. Our search identified 1457 potentially relevant publications. Of these, 19 publications were in line with our main areas of inquiry: autism spectrum disorder diagnosis and prevalence, carer and service provider perspectives on autism, and autism support services. These included 12 journal publications, 3 conference presentations, 1 resource booklet and 1 thesis dissertation. Findings suggest similar prevalence rates for autism among Indigenous and non-Indigenous Australians, although some Aboriginal and Torres Strait Islander people with autism may not receive a diagnosis or may be misdiagnosed. We also discuss research on the perspectives of Aboriginal and Torres Strait Islander carers and Indigenous and non-Indigenous service providers, as well as barriers and strategies for improving access to diagnosis and support services.
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Phillips, Christine B., Mahomed S. Patel, and Yolanda Cabaron. "Utilisation of health services by Aboriginal Australians with diabetes." Diabetes Research and Clinical Practice 20, no. 3 (June 1993): 231–39. http://dx.doi.org/10.1016/0168-8227(93)90083-h.
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Wettasinghe, Pamela Ming, Wendy Allan, Gail Garvey, Alison Timbery, Sue Hoskins, Madeleine Veinovic, Gail Daylight, et al. "Older Aboriginal Australians’ Health Concerns and Preferences for Healthy Ageing Programs." International Journal of Environmental Research and Public Health 17, no. 20 (October 10, 2020): 7390. http://dx.doi.org/10.3390/ijerph17207390.
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While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians’ perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants’ health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.
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DiGiacomo, Michelle L., Sandra C. Thompson, Julie S. Smith, Kate P. Taylor, Lynette A. Dimer, Mohammed A. Ali, Marianne M. Wood, Timothy G. Leahy, and Patricia M. Davidson. "'I don't know why they don't come': barriers to participation in cardiac rehabilitation." Australian Health Review 34, no. 4 (2010): 452. http://dx.doi.org/10.1071/ah09803.
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Objectives. To describe health professionals’ perceptions of Aboriginal people’s access to cardiac rehabilitation (CR) services and the role of institutional barriers in implementing the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples. Design. Qualitative study. Setting. Metropolitan and rural tertiary and community-based public CR services and Aboriginal health services in WA. Participants. Thirty-eight health professionals working in the CR setting. Method. Semistructured interviews were undertaken with 28 health professionals at public CR services and 10 health professionals from Aboriginal Medical Services in WA. The participants represented 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services. Results. Emergent themes included (1) a lack of awareness of Aboriginal CR patients’ needs; (2) needs related to cultural awareness training for health professionals; and (3) Aboriginal health staff facilitate access for Aboriginal patients. Conclusions. Understanding the institutional barriers to Aboriginal participation in CR is necessary to recommend viable solutions. Promoting cultural awareness training, recruiting Aboriginal health workers and monitoring participation rates are important in improving health outcomes. What is already known about this subject? Significant health and social inequity exists for Aboriginal Australians. Despite the persisting high rates of morbidity and mortality related to cardiovascular disease in Aboriginal Australians, participation rates in cardiac rehabilitation remain low. What does this paper add? Despite widespread dissemination of NHMRC guidelines, there remains a disconnect between CR health professionals’ understandings and practices and the needs of Aboriginal people in WA. Increasing the volume and quality of cultural awareness training as well as access to Aboriginal health professionals are crucial in addressing this disparity. What are the implications for practitioners? Increasing the number and support of Aboriginal people trained as health professionals will assist the system to respond better to the needs of communities. Collaborative partnership models where Aboriginal and non-Aboriginal health professionals work together to increase mutual understanding are warranted.
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Soldatic, Karen, Kelly Somers, Kim Spurway, and Georgia van Toorn. "Emplacing Indigeneity and rurality in neoliberal disability welfare reform: The lived experience of Aboriginal people with disabilities in the West Kimberley, Australia." Environment and Planning A: Economy and Space 49, no. 10 (July 7, 2017): 2342–61. http://dx.doi.org/10.1177/0308518x17718374.
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This article maps the impact of neoliberal restructuring of disability services and income support measures on Aboriginal people with disabilities living in rural areas of the West Kimberley in Australia. The international literature has extensively documented disability and Indigenous neoliberal welfare retraction measures, though as discrete areas of research. We aim to emplace the intersectional experience of such reforms by exposing their unique and qualitatively different dynamics and processes of disablement and Indigenous dispossession in the lived experiences of Aboriginal Australians with disabilities in rural Australia. Interviews conducted with Aboriginal people with disabilities living in the West Kimberley revealed the impact of neoliberal policies of retracting disability supports and rationalising services. The effects were felt in terms of people’s mobility, autonomy and economic security, with chronic, and at times crisis, levels of socio-economic insecurity experienced. Neoliberal spatial structures have led to further peripheralisation of rural and remote populations and a resulting increase in levels of inequality, deprivation and marginalisation for Aboriginal Australians with disabilities, who endure and survive by navigating these disabling spaces.
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Beckmann, Elizabeth A. "Evaluating Visitors’ Reactions to Interpretation in Australian National Parks." Journal of Interpretation Research 4, no. 1 (April 1999): 5–19. http://dx.doi.org/10.1177/109258729900400102.
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Interpretive services are accepted elements of recreational experiences in natural areas. But what do we really know about the effectiveness of interpretation? By evaluating their services through well-planned visitor research, interpreters can better focus on enriching visitors’ experiences. This paper presents findings from three Australian studies into visitors’ reactions to interpretation. At Kakadu National Park, guided activities provided more immediate responses to visitors’ questions on Aboriginal art and culture than on-site signs, while a well-designed interpretive mural mitigated people's disappointment at visiting a wetland area when no birds were present. Two studies of guided activities in Victorian national parks showed that participants were neither the “converted” nor the “same old faces,” and that they valued the very elements that make guided interpretation so special. This paper also demonstrates how variety and innovation in evaluation techniques can enhance the quality of interpretation research.
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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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McCalman, Janet, Len Smith, Ian Anderson, Ruth Morley, and Gita Mishra. "Colonialism and the health transition: Aboriginal Australians and poor whites compared, Victoria, 1850–1985." History of the Family 14, no. 3 (August 25, 2009): 253–65. http://dx.doi.org/10.1016/j.hisfam.2009.04.005.
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Wallace, Jack, Bev Hanley, Mary Belfrage, Sandra Gregson, Niall Quiery, and Jayne Lucke. "Delivering the hepatitis C cure to Aboriginal people: documenting the perspectives of one Aboriginal Health Service." Australian Journal of Primary Health 24, no. 6 (2018): 491. http://dx.doi.org/10.1071/py18024.
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Aboriginal and Torres Strait Islander peoples are disproportionately affected by hepatitis C, an infection that is curable with direct acting antivirals (DAAs). The Australian Government funded access to DAAs from March 2016 for all people with hepatitis C, with primary care physicians, along with clinical specialists, permitted to prescribe these treatments. The Victorian Aboriginal Health Service, in recognising the effect of liver disease from viral hepatitis within their community, and of the increased availability to DAAs, established a Liver Clinic to facilitate access to treatment for people attending the service. This study conducted semi-structured interviews to document the health service provider perspectives on the barriers and enablers to treatment; explored patients’ experiences of hepatitis C treatment and cure; and sought to identify possible health system-level changes to facilitate increased access and uptake of treatment by Aboriginal people. The study found the success of the clinic was supported by the multidisciplinary and accessible nature of the health service, and the relationships built over time between clinic staff and people with, or at risk of, hepatitis C. For those treated, the individual effect of the cure not only eliminated the hepatitis C virus, but reduced shame and increased broader social participation.
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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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Anderson, Ian, Harriet Young, Milica Markovic, and Lenore Manderson. "Koori Primary Health Care in Victoria: Developments in Service Planning." Australian Journal of Primary Health 6, no. 4 (2000): 24. http://dx.doi.org/10.1071/py00031.
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The Alma Ata 1978 Declaration on primary health care has conventionally been applied in developing countries, where medically trained personnel and other highly skilled health professionals and medical infrastructure are limited. Although such concepts have salience in relatively resource rich countries such as Australia, it is in Aboriginal and Torres Strait Islander health policy that they have become pivotal. A growing national focus on the development of Aboriginal primary health care capacity followed the release of the National Aboriginal Health Strategy (NAHS) in 1989 (Anderson, 1997). This focus consolidated further, following the evaluation of the National Aboriginal Health Strategy implementation in 1994 which preceded the transfer of administrative responsibility for the Commonwealth Aboriginal health program from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the Commonwealth Health portfolio (DHFS, 1994). Within the strategic framework provided by federal state agreements, the development of primary health care services is a priority. In the current national policy framework domains of policy and strategy development have been identified as key developmental themes.
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Manifold, Andreana, David Atkinson, Julia V. Marley, Lydia Scott, Gavin Cleland, Paula Edgill, and Sally Singleton. "Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: a barrier to implementation in primary health care." Australian Journal of Primary Health 25, no. 5 (2019): 501. http://dx.doi.org/10.1071/py19030.
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The aim of this study is to ascertain whether a simplified screening algorithm incorporating glycated haemoglobin (HbA1c) tests increases type 2 diabetes (T2D) screening in 10- to 14-year-old Aboriginal Australians presenting to primary healthcare (PHC) services. The study involved a 6-month pilot of a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town. A retrospective audit of electronic health records for the pilot period (27 June–26 December 2016) and a 6-month period before the screening algorithm was introduced (1 October 2015–31 March 2016) was conducted. Interviews were held with 30 PHC staff at participating PHC services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service. During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (28/130 (22%) v. 50/139 (36%), P = 0.011), but there was no change at the hospital (0.02% v. 0.02%, P = 0.615). Staff feedback suggested measures to improve screening; these include simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for young-onset diabetes in Aboriginal Australians is challenging, but practical measures can be taken to improve screening.
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Kerrigan, Vicki, Rarrtjiwuy Melanie Herdman, David P. Thomas, and Marita Hefler. "'I still remember your post about buying smokes': a case study of a remote Aboriginal community-controlled health service using Facebook for tobacco control." Australian Journal of Primary Health 25, no. 5 (2019): 443. http://dx.doi.org/10.1071/py19008.
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Many Aboriginal Community Controlled Health Services (ACCHS) embrace Facebook as an organisational tool to share positive stories, which counter the negative narrative surrounding Aboriginal issues. However, the Facebook algorithm prioritises posts on personal pages over organisations. To take advantage of the algorithm, this project paid three Yolŋu employees of a north-east Arnhem Land ACCHS to share quit smoking messages on their personal Facebook pages. Smoking prevalence among Aboriginal and Torres Strait Islander Australians is nearly three-fold higher than non-Indigenous Australians, and previous research has identified the need for culturally appropriate communication approaches to accelerate the decline in Indigenous smoking. This research found Yolŋu participants nurtured healthy behaviours through compassionate non-coercive communications, in contrast to fear-inducing health warnings prevalent in tobacco control. Cultural tailoring of tobacco control messages was achieved by having trusted local health staff sharing, and endorsing, messages regardless of whether the content was Indigenous specific. This research also revealed online Facebook activity does not reflect the reach of posts, which may extend beyond social media users to individuals who do not have a Facebook profile.
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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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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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Kennedy, Michelle, Tess Bright, Simon Graham, Christina Heris, Shannon K. Bennetts, Renee Fiolet, Elise Davis, et al. "“You Can’t Replace That Feeling of Connection to Culture and Country”: Aboriginal and Torres Strait Islander Parents’ Experiences of the COVID-19 Pandemic." International Journal of Environmental Research and Public Health 19, no. 24 (December 13, 2022): 16724. http://dx.doi.org/10.3390/ijerph192416724.
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This Aboriginal-led study explores Aboriginal and Torres Strait Islander parents’ experiences of COVID-19. 110 Aboriginal and Torres Strait Islander parents were interviewed between October 2020 and March 2022. Participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory, Australia. Participants were predominantly female (89%) and based in Victoria (47%) or South Australia (45%). Inductive thematic analysis identified three themes: (1) Changes to daily living; (2) Impact on social and emotional wellbeing; and (3) Disconnection from family, community, and culture. COVID-19 impacted Aboriginal and Torres Strait Islander families. Disruption to cultural practice, and disconnection from country, family, and community was detrimental to wellbeing. These impacts aggravated pre-existing inequalities and may continue to have greater impact on Aboriginal and Torres Strait Islander parents and communities due to intergenerational trauma, stemming from colonisation, violence and dispossession and ongoing systemic racism. We advocate for the development of a framework that ensures an equitable approach to future public health responses for Aboriginal and Torres Strait Islander people.
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Skoss, Rachel, Jane White, Mandy J. Stanley, Melanie Robinson, Sandra Thompson, Elizabeth Armstrong, and Judith M. Katzenellenbogen. "Study protocol for a prospective process evaluation of a culturally secure rehabilitation programme for Aboriginal Australians after brain injury: the Healing Right Way project." BMJ Open 11, no. 9 (September 2021): e046042. http://dx.doi.org/10.1136/bmjopen-2020-046042.
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IntroductionAboriginal and Torres Strait Islander (hereafter respectfully referred to as Aboriginal) people are Australia’s First Peoples, having the longest continuous culture in the world and deep spiritual connections with ancestral land. Improvements in their health and well-being is a major policy goal of Australian governments, as the legacy of colonisation and disruption of cultural practices contribute to major health challenges. Lack of culturally secure services impacts participation of Aboriginal people in health services. Aboriginal people with a brain injury typically experience poor access to rehabilitation and support following hospital discharge. ‘Healing Right Way’ (HRW) is a randomised control trial aiming to improve access to interdisciplinary and culturally secure rehabilitation services for Aboriginal people after brain injury in Western Australia, improve health outcomes and provide the first best practice model. This protocol is for the process evaluation of the HRW trial.Methods and analysisA prospective mixed methods process evaluation will use the Consolidated Framework for Implementation Research to evaluate implementation and intervention processes involved in HRW. Data collection includes qualitative and quantitative data from all sites during control and intervention phases, relating to three categories: (1) implementation of trial processes; (2) cultural security training; and (3) Aboriginal Brain Injury Coordinator role. Additional data elements collected from HRW will support the process evaluation regarding fidelity and intervention integrity. Iterative cross-sectional and longitudinal data synthesis will support the implementation of HRW, interpretation of findings and inform future development and implementation of culturally secure interventions for Aboriginal people.Ethics and disseminationThis process evaluation was reviewed by The University of Western Australia Human Research Ethics Committee (RA/4/20/4952). Evaluation findings will be disseminated via academic mechanisms, seminars at trial sites, regional Aboriginal health forums, peak bodies for Aboriginal health organisations and the Australian Indigenous HealthInfoNet (https://healthinfonet.ecu.edu.au/).Trial registration numberACTRN12618000139279.
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Chakraborty, Amal, Emma Walke, Roxanne Bainbridge, Ross Bailie, Veronica Matthews, Sarah Larkins, Paul Burgess, et al. "VOICE–Validating Outcomes by Including Consumer Experience: A Study Protocol to Develop a Patient Reported Experience Measure for Aboriginal and Torres Strait Islander Peoples Accessing Primary Health Care." International Journal of Environmental Research and Public Health 20, no. 1 (December 26, 2022): 357. http://dx.doi.org/10.3390/ijerph20010357.
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Aboriginal and Torres Strait Islander peoples’ (hereafter respectfully referred to as Indigenous Australians) experiences of health care are shaped by historical, social and cultural factors, with cultural security critical to effective care provision and engagement between services and community. Positive patient experiences are associated with better health outcomes. Consequently, it is an accreditation requirement that primary health care (PHC) services must formally gather and respond to patient feedback. However, currently available patient feedback tools were not developed with Indigenous Australians, and do not reflect their values and world views. Existing tools do not capture important experiences of care of Indigenous Australians in PHC settings, nor return information that assists services to improve care. Consistent with the principles of Indigenous Data Sovereignty, we will co-design and validate an Indigenous-specific Patient Reported Experience Measure (PREM) that produces data by and for community, suitable for use in quality improvement in comprehensive PHC services. This paper presents the protocol of the study, outlining the rationale, methodologies and associated activities that are being applied in developing the PREM. Briefly, guided by an Aboriginal and Torres Strait Islander Advisory Group, our team of Indigenous and non-Indigenous researchers, service providers and policy makers will use a combination of Indigenous methodologies, participatory, and traditional western techniques for scale development. We will engage PHC service staff and communities in eight selected sites across remote, regional, and metropolitan communities in Australia for iterative cycles of data collection and feedback throughout the research process. Yarning Circles with community members will identify core concepts to develop an “Experience of Care Framework”, which will be used to develop items for the PREM. Staff members will be interviewed regarding desirable characteristics and feasibility considerations for the PREM. The PREM will undergo cognitive and psychometric testing.
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Bovill, Michelle, Yael Bar-Zeev, Maree Gruppetta, Peter O'Mara, Brett Cowling, and Gillian S. Gould. "Collective and negotiated design for a clinical trial addressing smoking cessation supports for Aboriginal and Torres Strait Islander mothers in NSW, SA and Qld – developing a pilot study." Australian Journal of Primary Health 23, no. 6 (2017): 497. http://dx.doi.org/10.1071/py16140.
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Tobacco smoking leads to one in five deaths of Aboriginal Australians and accounts for 17% of the reversible health gap. One in two Aboriginal women are reported to smoke during pregnancy, with no effective strategies currently available for health practitioners to utilise for supporting Aboriginal women. Aboriginal community participation in primary health research is crucial to implementing ethical research, with a clear benefit to the people and communities involved. However, currently there is little evidence on how Aboriginal programs and interventions are being developed in partnership with Aboriginal people and communities. ‘Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy’ aims to address the prevalence of smoking during pregnancy by enhancing health providers’ training in offering evidence-based smoking cessation care to Aboriginal mothers during pregnancy. This paper outlines the participatory research approach adopted for the developmental phase of the ‘ICAN QUIT in Pregnancy’ project developed in partnership with two Aboriginal Community-Controlled Health Services in NSW, and negotiation processes undertaken to implement a pilot intervention across NSW, SA and Qld.
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Zengin, Ayse, Cat Shore-Lorenti, Marc Sim, Louise Maple-Brown, Sharon Lee Brennan-Olsen, Joshua R. Lewis, Jennifer Ockwell, Troy Walker, David Scott, and Peter Ebeling. "Why Aboriginal and Torres Strait Islander Australians fall and fracture: the codesigned Study of Indigenous Muscle and Bone Ageing (SIMBA) protocol." BMJ Open 12, no. 4 (April 2022): e056589. http://dx.doi.org/10.1136/bmjopen-2021-056589.
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ObjectivesAboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians.SettingAll clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments will be repeated at follow-up 1 and follow-up 2, with an interval of 12 months between each clinical visit.ParticipantsThis codesigned prospective observational study aims to recruit a total of 298 adults who identify as Aboriginal and Torres Strait Islander and reside within Victoria, Australia. Stratified sampling by age and sex will be used to ensure equitable distribution of men and women across four age-bands (35–44, 45–54, 55–64 and 65+ years).Primary and secondary outcome measuresThe primary outcome is within-individual yearly change in areal bone mineral density at the total hip, femoral neck and lumbar spine assessed by dual energy X-ray absorptiometry. Within-individual change in cortical and trabecular volumetric bone mineral density at the radius and tibia using high-resolution peripheral quantitative computed tomography will be determined. Secondary outcomes include yearly differences in physical performance and body composition.Ethical approvalEthics approval for this study has been granted by the Monash Health Human Research Ethics Committee (project number: RES-19–0000374A).Trial registration numberACTRN12620000161921.
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Zorzin, Nicolas. "Heritage Management and Aboriginal Australians: Relations in a Global, Neoliberal Economy—A Contemporary Case Study from Victoria." Archaeologies 10, no. 2 (August 2014): 132–67. http://dx.doi.org/10.1007/s11759-014-9253-8.
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Zander, Kerstin K., and Anna Straton. "An economic assessment of the value of tropical river ecosystem services: Heterogeneous preferences among Aboriginal and non-Aboriginal Australians." Ecological Economics 69, no. 12 (October 2010): 2417–26. http://dx.doi.org/10.1016/j.ecolecon.2010.07.010.
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Regnier, Tamika, Mark Shephard, Anne Shephard, Peter Graham, Rizzi DeLeon, and Samantha Shepherd. "Results From 16 Years of Quality Surveillance of Urine Albumin to Creatinine Ratio Testing for a National Indigenous Point-of-Care Testing Program." Archives of Pathology & Laboratory Medicine 144, no. 10 (October 1, 2020): 1199–203. http://dx.doi.org/10.5858/arpa.2020-0106-oa.
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Context.— The burden of chronic kidney disease in Indigenous Australians is 7.3 times higher than that of non–Indigenous Australians. If chronic kidney disease is detected early and managed, deterioration in kidney function can be reduced. Urine albumin to creatinine ratio is a key marker of early renal damage. Objective.— To report on 16 years of analytic quality of urine albumin to creatinine ratio testing on Siemens DCA devices enrolled in the national Quality Assurance for Aboriginal and Torres Strait Islander Medical Services point-of-care testing program. Design.— Quality Assurance for Aboriginal and Torres Strait Islander Medical Services participants are required to test 2 quality assurance samples each month across two 6-monthly testing cycles per year. Participants also test 2 quality control samples monthly. Results.— The percentage of urine albumin, creatinine, and albumin to creatinine ratio results for quality assurance point-of-care testing that were within assigned allowable limits of performance averaged 96.9%, 95.9%, and 97.5%, respectively. The percentage acceptable quality control results for urine albumin and creatinine averaged 93.5% and 86.8%. The median imprecision for urine albumin, creatinine, and albumin to creatinine ratio quality assurance testing averaged 5.5%, 4.1%, and 3.3%, respectively, and the median within-site imprecision for quality control testing averaged 5.4%, 4.3%, and 5.7%, respectively, for the low sample and 4.0%, 4.1%, and 4.5%, respectively, for the high sample. Conclusions.— For 16 years the DCA system has proven to be reliable and robust and operators at Aboriginal medical services have demonstrated they are able to conduct point-of-care testing for urine albumin to creatinine ratio that consistently meets analytic performance standards.
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Tynan, Michael, Fran Smullen, Petah Atkinson, and Kylie Stephens. "Aboriginal cultural competence for health services in regional Victoria: lessons for implementation." Australian and New Zealand Journal of Public Health 37, no. 4 (July 30, 2013): 392–93. http://dx.doi.org/10.1111/1753-6405.12091.
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Myers, Judith, Sharon Thorpe, Jennifer Browne, Kay Gibbons, and Stephanie Brown. "Early childhood nutrition concerns, resources and services for Aboriginal families in Victoria." Australian and New Zealand Journal of Public Health 38, no. 4 (June 24, 2014): 370–76. http://dx.doi.org/10.1111/1753-6405.12206.
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Gotis-Graham, Anna, Rona Macniven, Kelvin Kong, and Kylie Gwynne. "Effectiveness of ear, nose and throat outreach programmes for Aboriginal and Torres Strait Islander Australians: a systematic review." BMJ Open 10, no. 11 (November 2020): e038273. http://dx.doi.org/10.1136/bmjopen-2020-038273.
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ObjectiveTo examine the ability of ear, nose and throat (ENT) outreach programmes to improve health outcomes among Aboriginal and Torres Strait Islander people.MethodsWe conducted a systematic literature search of nine databases (Medline, CINAHLS, PsycINFO, Embase, Cochrane, Scopus, Global health, Informit Rural health database and Indigenous collection) and grey literature sources for primary studies evaluating ENT outreach services for Aboriginal and Torres Strait Islander people. This review included English language studies of all types, published between 2000 and 2018, that supplied ENT outreach services to Aboriginal and Torres Strait Islander Australians and provided data to evaluate their aims. Two authors independently evaluated the eligible articles and extracted relevant information. Risk of bias was assessed using the Mixed Methods Assessment Tool.ResultsOf the 506 studies identified, 15 were included in this review. These 15 studies evaluated eight different programs/activities. Studies were heterogeneous in design so a meta-analysis could not be conducted. Seven studies measured health-related outcomes in middle ear or hearing status; six reported overall positive changes one reported no clinically significant improvements. Five programmes/activities and their corresponding studies involved Aboriginal and Torres Strait Islander people and organisations in delivery and evaluation, but involvement in programme or study design was unclear.ConclusionWhile some studies demonstrated improved outcomes, the overall ability of ENT programmes to improve health outcomes for Aboriginal and Torres Strait Islander children is unclear. The impact of ENT outreach may be limited by a lack of quality evidence, service coordination and sustainability. Community codesign and supporting and resourcing local capacity must be a component of outreach programmes and ongoing evaluation is also recommended. Improvements in these areas would likely improve health outcomes.PROSPERO registration numberCRD42019134757.
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Govil, Dhruv, Ivan Lin, Tony Dodd, Rhonda Cox, Penny Moss, Sandra Thompson, and Andrew Maiorana. "Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical Service." Australian Journal of Primary Health 20, no. 3 (2014): 266. http://dx.doi.org/10.1071/py12117.
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Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n = 6) and staff (n = 6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P < 0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P < 0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet diverse community needs.
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Armstrong, Elizabeth, Juli Coffin, Deborah Hersh, Judith M. Katzenellenbogen, Sandra Thompson, Leon Flicker, Meaghan McAllister, et al. "Healing Right Way: study protocol for a stepped wedge cluster randomised controlled trial to enhance rehabilitation services and improve quality of life in Aboriginal Australians after brain injury." BMJ Open 11, no. 9 (September 2021): e045898. http://dx.doi.org/10.1136/bmjopen-2020-045898.
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IntroductionDespite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury.Methods and analysisDesign: Stepped wedge cluster randomised control trial design; intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals.Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury.Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants.Primary outcome: Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference.Secondary outcome measures: Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role.Evaluations: An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks.Ethics and disseminationThe study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers.Trial registration numberACTRN12618000139279.
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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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Browne, Jennifer, Karen Adams, Petah Atkinson, Deborah Gleeson, and Rick Hayes. "Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: an overview of systematic reviews." Australian Health Review 42, no. 6 (2018): 689. http://dx.doi.org/10.1071/ah17082.
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Objective To provide an overview of previous reviews of programs that aimed to improve nutritional status or diet-related health outcomes for Aboriginal and Torres Strait Islander peoples, in order to determine what programs are effective and why. Methods A systematic search of databases and relevant websites was undertaken to identify reviews of nutrition interventions for Aboriginal and Torres Strait Islander Australians. Pairs of reviewers undertook study selection and data extraction and performed quality assessment using a validated tool. Results Twelve papers reporting 11 reviews were identified. Two reviews were rated high quality, three were rated medium and six were rated low quality. The reviews demonstrated that a positive effect on nutrition and chronic disease indicators can be a result of: 1) incorporating nutrition and breastfeeding advice into maternal and child health care services; and 2) multifaceted community nutrition programs. The evidence suggests that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in (and, ideally, control of) program development and implementation. Conclusions Community-directed food and nutrition programs, especially those with multiple components that address the underlying causes of nutrition issues, can be effective in improving nutrition-related outcomes. What is known about the topic? More effective action is urgently required in order to reduce the unacceptable health inequalities between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Food insecurity and nutrition-related chronic conditions are responsible for a large proportion of the ill health experienced by Australia’s First Peoples. What does this paper add? This narrative overview of 11 reviews published between 2005 and 2015 provides a synthesis of the current evidence for improving Aboriginal and Torres Strait Islander nutrition across the lifespan. The findings suggest that community-based and community-controlled programs, especially those with multiple components that address the underlying causes of nutrition issues, have the greatest potential to improve nutrition-related health outcomes. What are the implications for practitioners? Food and nutrition programs that are initiated and designed by local Aboriginal and Torres Strait Islander people are most likely to be effective. Nutrition and breastfeeding education and advice should be consistently incorporated into maternal and child healthcare services. Nutrition issues should be addressed through multifaceted approaches that address improving individual knowledge and skills, as well as strategies that increase access to nutritious food and provide a healthy food environment.
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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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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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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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Healy, Sianan. "‘Years ago some lived here’: Aboriginal Australians and the production of popular culture, history and identity in 1930s Victoria." Australian Historical Studies 37, no. 128 (October 2006): 18–34. http://dx.doi.org/10.1080/10314610608601217.
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MacDonald, Catherine, Bill Genat, Sharon Thorpe, and Jennifer Browne. "Establishing health-promoting workplaces in Aboriginal community organisations: healthy eating policies." Australian Journal of Primary Health 22, no. 3 (2016): 239. http://dx.doi.org/10.1071/py14144.
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Aboriginal community controlled health organisations (ACCHOs) and cooperatives function at the centre of community life for local Aboriginal people across Victoria. Local Aboriginal people govern them, work within them as managers and service providers, access health and community services from them and form the constituents who determine their directions. Victorian ACCHOs reflect the unique characteristics of the local Aboriginal community. Thus, potentially, Victorian ACCHOs are key strategic sites for health promotion activities that seek to establish and nurture healthy community, family and peer norms. The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) partnered five metropolitan, regional and rural ACCHOs in a pilot project towards the establishment of healthy food policies and practices in their organisations. Project activities combined both ‘top-down’ policy-oriented and ‘bottom-up’ practice-oriented strategies. This paper, drawing upon both baseline and follow-up quantitative and qualitative data, describes initiatives leading to increases in healthy catering choices and related challenges for Aboriginal workplace health promotion practice.