Journal articles on the topic 'Indigenous Australians – Medical care – Research'
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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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Brazionis, Laima, Anthony Keech, Christopher Ryan, Alex Brown, David O'Neal, John Boffa, Sven-Erik Bursell, and Alicia Jenkins. "Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and Associated Medical Services Network study." BMJ Open Ophthalmology 6, no. 1 (July 2021): e000559. http://dx.doi.org/10.1136/bmjophth-2020-000559.
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ObjectiveTo identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia.Methods and analysisA cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images.ResultsAge (median (range)) was 48 (21–86) years, and known diabetes duration (median (range)) was 8.0 (0–24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively; p<0.001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively; p=0.007), severe macroalbuminuria (>300 mg/mmol) (20.6 vs 5.7%, respectively; p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively; p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women.ConclusionSTDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services.Trial registration numberAustralia and New Zealand Clinical Trials Register: ACTRN 12616000370404.
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Marquess, John, Wenbiao Hu, Graeme R. Nimmo, and Archie C. A. Clements. "Spatial Analysis of Community-OnsetStaphylococcus aureusBacteremia in Queensland, Australia." Infection Control & Hospital Epidemiology 34, no. 3 (March 2013): 291–98. http://dx.doi.org/10.1086/669522.
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Objectives.TO investigate and describe the relationship between indigenous Australian populations, residential aged care services, and community-onsetStaphylococcus aureusbacteremia (SAB) among patients admitted to public hospitals in Queensland, Australia.Design.Ecological study.Methods.We used administrative healthcare data linked to microbiology results from patients with SAB admitted to Queensland public hospitals from 2005 through 2010 to identify community-onset infections. Data about indigenous Australian population and residential aged care services at the local government area level were obtained from the Queensland Office of Economic and Statistical Research. Associations between community-onset SAB and indigenous Australian population and residential aged care services were calculated using Poisson regression models in a Bayesian framework. Choropleth maps were used to describe the spatial patterns of SAB risk.Results.We observed a 21% increase in relative risk (RR) of bacteremia with methicillin-susceptibleS. aureus(MSSA; RR, 1.21 [95% credible interval, 1.15–1.26]) and a 24% increase in RR with nonmultiresistant methicillin-resistantS. aureus(nmMRSA; RR, 1.24 [95% credible interval, 1.13–1.34]) with a 10% increase in the indigenous Australian population proportion. There was no significant association between RR of SAB and the number of residential aged care services. Areas with the highest RR for nmMRSA and MSSA bacteremia were identified in the northern and western regions of Queensland.Conclusions.The RR of community-onset SAB varied spatially across Queensland. There was increased RR of community-onset SAB with nmMRSA and MSSA in areas of Queensland with increased indigenous population proportions. Additional research should be undertaken to understand other factors that increase the risk of infection due to this organism.
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Medlin, Linda G., Anne B. Chang, Kwun Fong, Rebecca Jackson, Penny Bishop, Annette Dent, Deb C. Hill, Stephen Vincent, and Kerry-Ann F. O'Grady. "Indigenous Respiratory Outreach Care: the first 18 months of a specialist respiratory outreach service to rural and remote Indigenous communities in Queensland, Australia." Australian Health Review 38, no. 4 (2014): 447. http://dx.doi.org/10.1071/ah13136.
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Objective Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described. Methods The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered. Results IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43 000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols. Conclusion IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia. What is known about this topic? The high rates of respiratory illnesses in Australian Indigenous children have been poorly explored. There is a dearth of research quantifying and qualifying risk from birth and throughout early childhood, and there are virtually no evidence-based evaluations of interventions to prevent and manage disease. Despite data suggesting an excess burden of disease, there has been little attention paid to respiratory health in this population. The limited research that has been done highlights that a ‘one size fits all’ model will not be effective in all communities, and that health service must meet the needs of communities, be culturally appropriate and be accessible to Aboriginal people for it to be effective and sustainable. The ‘common theme’ is that although health services are improving, service delivery needs to adapt to meet the needs of communities; this is not happening quickly enough for many Aboriginal people. What does this paper add? This paper highlights the importance of working with communities in the development and delivery of a culturally appropriate and accessible specialist respiratory service. In addition, this paper acknowledges the importance of recruiting Indigenous staff in the implementation, engagement and delivery of the project. What are the implications for clinicians? This paper provides an outline on how best to deliver a culturally appropriate respiratory outreach service and the role of clinicians, communities and Indigenous staff. This model supports the view that Aboriginal people must be a part of service delivery that is aligned to the ‘holistic concept of health’ for Aboriginal people, thus providing a culturally appropriate service that meets their needs and addresses the health continuum from within culture and community.
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Haswell-Elkins, Melissa, Ernest Hunter, Tricia Nagel, Carolyn Thompson, Brenda Hall, Robert Mills, Rachael Wargent, Komla Tsey, Leanne Knowles, and Yvonne Wilkinson. "Reflections on integrating mental health into primary health care services in remote Indigenous communities in Far North Queensland and the Northern Territory." Australian Journal of Primary Health 11, no. 2 (2005): 62. http://dx.doi.org/10.1071/py05023.
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At present, there is a perceived and functional separation of mental health services from the general delivery of primary health care services in remote Indigenous communities in most places in the country. There are a range of issues underlying this separation; many are historical but continue to influence patterns of thinking about mental and physical health. With the increasing shift of focus of care at primary level from being largely reactive to presentations of acute illnesses towards proactive and strategically guided approaches to the management of chronic diseases, coupled with similar national strategic documents guiding mental health care into a primary health care format, the opportunity to integrate the provision of mental and physical health care has never been better. Accompanying this integration should be a reflection and improvement on models of care that address needs of Indigenous people in a more culturally and contextually appropriate manner, as is clearly defined in an increasing range of Indigenous health policy documents. This paper will begin with a summary of the link between mental and physical health supported by key references. It will then briefly reflect on the current organisation of mental and physical health services in remote Indigenous settings of Far North Queensland and the Northern Territory, identifying some of the major disadvantages being experienced. The paper will close with a description of the approach and some early outcomes to address these issues by the Indigenous Stream of the AIMhi project (Australian Integrated Mental Health Initiative), which is a major National Health & Medical Research Council (NH&MRC) Strategic Partnership initiative that began implementing a framework of research activities in mid-2003.
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McGrath, Pam, Mary Anne Patton, Hamish Holewa, and Robert Rayne. "The Importance of the 'Family Meeting' in Health Care Communication with Indigenous People: Findings from an Australian study." Australian Journal of Primary Health 12, no. 1 (2006): 56. http://dx.doi.org/10.1071/py06009.
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The following discussion presents findings from a National Health and Medical Research Council (NHMRC) study that documents the importance to Indigenous people of including the network of extended family and community in health care communication. In particular the discussion explores the data relating to the importance of communicating through family meetings with Aboriginal people during end-of-life care. The data was collected through a series of open-ended, qualitative interviews (n=72) conducted with a cross-section of members of the Aboriginal community and health professionals within the Northern Territory, Australia. Acknowledging Aboriginal peoples' relationship rules and communicating through family meetings are practices that demonstrate respect for Indigenous cultural processes of information sharing. Anger on the part of Aboriginal people about lack of information can be the outcome when such processes are ignored or not understood. Respecting the need to "share the story" broadly with appropriate people in the extended family and community network through family meetings is noted as vitally important in health care, especially during the dying trajectory. The discussion explores the practical issues associated with, the different reasons for, and the positive outcomes from, incorporating family meetings for Indigenous people along the illness trajectory.
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Khan, Azim, Hilary Laura Martin, Lisa Spalding, and Andrew David Redfern. "Is there any health and geographical disparity in indigenous and non-indigenous women of Western Australia (WA)? A retrospective review with respect to de novo metastasis." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 115. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.115.
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115 Background: Indigenous women with breast cancer have substantially higher mortality then non-Indigenous women. They are more likely to live in more remote communities with potential delays to presentation, investigation and diagnosis as well as slower access to cancer treatment facilities, potentially impacting survival. Here we explore by evaluating the diagnosis of de-novo metastasis and any association of remoteness, highlighting the geographic and possibly early access to treatment. Methods: A cohort of patients was retrospectively selected comprising age- and remoteness matched Indigenous and non-Indigenous women in a 1:1 ratio from the Western Australian Cancer Registry. Further data were collected from medical records and results systems. Remoteness was defined by the ARIA system. In addition, the distance from the nearest treatment center was calculated. The survival analysis was performed by Indigenous status and remoteness. Results: The final cohort comprised 250 Indigenous and 261 non–Indigenous women. Of the total, 7.6% (19/250) and 7.7% (20/261) were identified to have de-novo metastasis. At 10 years of follow up, most de-novo metastatic patients in both groups were from remote communities, distributed as 10.1, 9.1, 7.8, 8.7 and 5.0 % in metropolitan, inner regional, outer regional, remote and very remote areas respectively. In Indigenous group with de-novo metastasis the average distance of patient from treatment center was 1720km for vs 1018 km in Non-Indigenous patient with a p-value of 0.03. In non-metastasis cohort, Indigenous patient has 1065 km v 1241 km in non-indigenous group. Considering outcomes for those developing metastatic disease, median survivals after metastatic diagnosis were shorter for Indigenous patients, 21 v 33 months, p = 0.03. Conclusions: Indigenous women in WA with metastatic breast cancer have inferior survival outcomes from diagnosis of metastases relative to non-Indigenous peers. Most de-novo metastatic patients were from remote locations in both cohorts but no relation between remoteness and de-novo metastasis, identified to be impacting survival. Future studies are needed to better elucidate if any geographical, health care disparities and improve on treatment related outcomes. It is suggested to derive targeted policies to improve survival outcome of all Indigenous cancer patients, particularly those residing in remote areas.
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Schofield, Deborah, Michelle M. Cunich, and Lucio Naccarella. "An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature." Australian Health Review 38, no. 5 (2014): 495. http://dx.doi.org/10.1071/ah14018.
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Objective There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. Methods The National Health and Medical Research Council of Australia’s (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005–13. Various diabetes workforce models were examined, including ‘one-stop shops’, pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Results Of the14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. Conclusions More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. What is known about the topic? Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. What does this paper add? This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the ‘best’ level of evidence), based on the NHMRC’s (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. What are the implications for practitioners? Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.
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Gould (Judean), Gillian Sandra, Ratika Kumar, Nicole M. Ryan, Leah Stevenson, Christopher Oldmeadow, Gina La Hera Fuentes, Simon Deeming, et al. "Protocol for iSISTAQUIT: Implementation phase of the supporting indigenous smokers to assist quitting project." PLOS ONE 17, no. 11 (November 9, 2022): e0274139. http://dx.doi.org/10.1371/journal.pone.0274139.
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Introduction About 44% of Aboriginal and/or Torres Strait Islander women smoke during pregnancy compared to 12% of their general population counterparts. Evidence-based quit smoking advice received from health care professionals (HCPs) can increase smoking cessation rates. However, HCPs lack culturally appropriate smoking cessation training, which is a major barrier to provision of smoking cessation care for this population. Methods and analysis iSISTAQUIT is a multicentre, single arm study aiming to implement and evaluate the evidence-based, culturally competent iSISTAQUIT smoking cessation training among health practitioners who provide support and assistance to pregnant, Aboriginal and Torres Strait Islander women in Australia. This project will implement the iSISTAQUIT intervention in Aboriginal Medical Services and Mainstream Health Services. The proposed sample size is 10 of each of these services (total N = 20), however if the demand is higher, we will aim to accommodate up to 30 services for the training. Participating sites and their HCPs will have the option to choose one of the two iSISTAQUIT packages available: a) Evaluation- research package b) Training package (with or without continued professional development points). Training will be provided via an online eLearning platform that includes videos, text, interactive elements and a treatment manual. A social media campaign will be conducted from December 2021 to September 2022 to raise brand and issue awareness about smoking cessation for Aboriginal and Torres Strait Islander women in pregnancy. This national campaign will consist of systematic advertising and promotion of iSISTAQUIT and video messages through various social media platforms. Analysis We will use the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to plan, evaluate and report the intervention impact of iSISTAQUIT. Effectiveness of social media campaign will be assessed via social media metrics, cross-sectional surveys, and interviews. Discussion This innovative research, using a multi-component intervention, aims to practically apply and integrate a highly translatable smoking cessation intervention in real-world primary care settings in Aboriginal Medical Services and Mainstream services. The research benefits Aboriginal women, babies and their family and community members through improved support for smoking cessation during pregnancy. The intervention is based on accepted Australian and international smoking cessation guidelines, developed and delivered in a culturally appropriate approach for Aboriginal communities.
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Bar-Zeev, Yael, Billie Bonevski, Michelle Bovill, Maree Gruppetta, Chris Oldmeadow, Kerrin Palazzi, Lou Atkins, Jennifer Reath, and Gillian S. Gould. "The Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy Pilot Study protocol: a feasibility step-wedge cluster randomised trial to improve health providers' management of smoking during pregnancy." BMJ Open 7, no. 8 (August 2017): e016095. http://dx.doi.org/10.1136/bmjopen-2017-016095.
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IntroductionIndigenous women have the highest smoking prevalence during pregnancy (47%) in Australia. Health professionals report lack of knowledge, skills and confidence to effectively manage smoking among pregnant women in general. We developed a behaviour change intervention aimed to improve health professionals’ management of smoking in Indigenous pregnant women—the Indigenous Counselling And Nicotine (ICAN) QUIT in Pregnancy. This intervention includes webinar training for health professionals, an educational resources package for health professionals and pregnant women, free oral nicotine replacement therapy (NRT) for pregnant women, and audit and feedback on health professionals' performance.The aim of this study is to test the feasibility and acceptability of the ICAN QUIT in Pregnancy intervention to improve health professionals' provision of evidence-based culturally responsive smoking cessation care to Australian Indigenous pregnant smokers.Methods and analysisThis protocol describes the design of a step-wedge cluster randomised pilot study. Six Aboriginal Medical Services (AMSs) are randomised into three clusters. Clusters receive the intervention staggered by 1 month. Health professionals report on their knowledge and skills pretraining and post-training and at the end of the study. Pregnant women are recruited and followed up for 3 months. The primary outcome is the recruitment rate of pregnant women. Secondary outcomes include feasibility of recruitment and follow-up of participating women, and webinar training of health professionals, measured using a designated log; and measures of effectiveness outcomes, including quit rates and NRT prescription rates.Ethics and disseminationIn accordance with the Aboriginal Health and Medical Research Council guidelines, this study has been developed in collaboration with a Stakeholder and Consumer Aboriginal Advisory Panel (SCAAP). The SCAAP provides cultural consultation, advice and direction to ensure that implementation is acceptable and respectful to the Aboriginal communities involved. Results will be disseminated to AMSs, Aboriginal communities and national Aboriginal bodies.Registration detailsThis protocol (version 4, 14 October 2016) is registered with the Australian and New Zealand Clinical Trials Registry (Ref #: ACTRN 12616001603404).
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James, Rodney, Caroline Chen, Kirsty Buising, Karin Thursky, and Courtney Ierano. "From Little Things Big Things Grow: The Development of an Auditing Program to Assess the Quality of Antimicrobial Prescribing." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s237. http://dx.doi.org/10.1017/ice.2020.792.
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Background: An important aspect of antimicrobial stewardship is the qualitative assessment of antimicrobial prescribing. Owing to lack of standardized tools and resources required to design, conduct and analyze qualitative audits, these assessments are rarely performed. Objective: We designed an audit tool that was appropriate for all Australian hospital types, suited to local user requirements and including an assessment of the appropriateness of antimicrobial prescribing. Methods: In 2011, a pilot survey was conducted in 32 Australian hospitals to assess the usability and generalizability of a qualitative audit tool. The tool was revised to reflect the respondents’ feedback. A second study was performed in 2012 in 85 hospitals. In 2013, following further feedback and refinement, an online auditing tool, the Hospital National Antimicrobial Prescribing Survey (NAPS), was developed. Early audits demonstrated that surgical prophylaxis had the highest rates of inappropriate prescribing. In 2016, the Surgical NAPS was developed to further investigate reasons for this, and the NAPS program was further expanded to audit antimicrobial prescribing practices in Australian aged-care homes (ie, the Aged Care NAPS). Results: Between January 1, 2013, and November 12, 2019, 523 Australian public and private hospitals (53.8%) utilized the Hospital NAPS; 215 (22.1%) have utilized the Surgical NAPS; and 774 of Australian aged-care homes (29.0%) have utilized the Aged Care NAPS. National reporting has identified key target areas for quality improvement initiatives at both local and national levels. The following initiatives have been outlined in 14 public reports: improved documentation; prolonged antimicrobial prophylaxis; compliance with prescribing guidelines; appropriateness of prescribing; access to evidence-based guidelines; and improved microbiology sampling. Conclusions: By utilizing the Plan-Do-Study-Act cycle for healthcare improvement and by involving end users in the design and evaluation, we have created a practical and relevant auditing program to assess both quantitative and qualitative aspects of antimicrobial prescribing in a wide range of settings. This voluntary program is now endorsed by the National Strategy for Antimicrobial Resistance Surveillance, partners with the Antimicrobial Use and Resistance in Australian Surveillance System, and is utilized by facilities to meet mandatory national accreditation standard requirements. With the success of the NAPS program in Australia, it has now been implemented in New Zealand, Canada, Malaysia, Fiji, and Bhutan, with plans for other countries to implement the program soon. Current research is being conducted to expand the program to include audits for family physicians, veterinarians, and remote indigenous communities, and for antifungal use.Disclosures: NoneFunding: None
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Harrison, Kristie H., KS Kylie Lee, Timothy Dobbins, Scott Wilson, Noel Hayman, Rowena Ivers, Paul S. Haber, et al. "Supporting Aboriginal Community Controlled Health Services to deliver alcohol care: protocol for a cluster randomised controlled trial." BMJ Open 9, no. 11 (November 2019): e030909. http://dx.doi.org/10.1136/bmjopen-2019-030909.
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IntroductionIndigenous peoples who have experienced colonisation or oppression can have a higher prevalence of alcohol-related harms. In Australia, Aboriginal Community Controlled Health Services (ACCHSs) offer culturally accessible care to Aboriginal and Torres Strait Islander (Indigenous) peoples. However there are many competing health, socioeconomic and cultural client needs.Methods and analysisA randomised cluster wait-control trial will test the effectiveness of a model of tailored and collaborative support for ACCHSs in increasing use of alcohol screening (with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)) and of treatment provision (brief intervention, counselling or relapse prevention medicines).SettingTwenty-two ACCHSs across Australia.RandomisationServices will be stratified by remoteness, then randomised into two groups. Half receive support soon after the trial starts (intervention or ‘early support’); half receive support 2 years later (wait-control or ‘late support’).The supportCore support elements will be tailored to local needs and include: support to nominate two staff as champions for increasing alcohol care; a national training workshop and bimonthly teleconferences for service champions to share knowledge; onsite training, and bimonthly feedback on routinely collected data on screening and treatment provision.Outcomes and analysisPrimary outcome is use of screening using AUDIT-C as routinely recorded on practice software. Secondary outcomes are recording of brief intervention, counselling, relapse prevention medicines; and blood pressure, gamma glutamyltransferase and HbA1c. Multi-level logistic regression will be used to test the effectiveness of support.Ethics and disseminationEthical approval has been obtained from eight ethics committees: the Aboriginal Health and Medical Research Council of New South Wales (1217/16); Central Australian Human Research Ethics Committee (CA-17-2842); Northern Territory Department of Health and Menzies School of Health Research (2017-2737); Central Queensland Hospital and Health Service (17/QCQ/9); Far North Queensland (17/QCH/45-1143); Aboriginal Health Research Ethics Committee, South Australia (04-16-694); St Vincent’s Hospital (Melbourne) Human Research Ethics Committee (LRR 036/17); and Western Australian Aboriginal Health Ethics Committee (779).Trial registration numberACTRN12618001892202; Pre-results.
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Marschner, Simone, Edwina Wing-Lun, Clara Chow, Louise Maple-Brown, Sian Graham, Stephen J. Nicholls, Alex Brown, et al. "Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol." BMJ Open 12, no. 12 (December 2022): e062685. http://dx.doi.org/10.1136/bmjopen-2022-062685.
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IntroductionCardiovascular disease (CVD) is the leading cause of death in women around the world. Aboriginal and Torres Strait Islander women (Australian Indigenous women) have a high burden of CVD, occurring on average 10–20 years earlier than non-Indigenous women. Traditional risk prediction tools (eg, Framingham) underpredict CVD risk in women and Indigenous people and do not consider female-specific ‘risk-enhancers’ such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM) and premature menopause. A CT coronary artery calcium score (‘CT-calcium score’) can detect calcified atherosclerotic plaque well before the onset of symptoms, being the single best predictor for future cardiac events. A CT-calcium score may therefore help physicians intensify medical therapy in women with risk-enhancing factors.Methods and analysisThis multisite, single-blind randomised (1:1) controlled trial of 700 women will assess the effectiveness of a CT-calcium score-guided approach on cardiovascular risk factor control and healthy lifestyle adherence, compared with standard care. Women without CVD aged 40–65 (35–65 for Aboriginal and Torres Strait Islander women) at low-intermediate risk on standard risk calculators and with at least one risk-enhancing factor (eg, HDP, GDM, premature menopause) will be recruited. Aboriginal and Torres Strait Islander women will be actively recruited, aiming for ~10% of the sample size. The 6-month coprimary outcomes will be low-density lipoprotein cholesterol and systolic blood pressure. Barriers and enablers will be assessed, and a health economic analysis performed.Ethics and disseminationWestern Sydney Local Health District Research Ethics Committee (HREC 2021/ETH11250) provided ethics approval. Written informed consent will be obtained before randomisation. Consent will be sought for access to individual participant Medicare Benefits Schedule, Pharmaceutical Benefits Scheme claims usage through Medicare Australia and linked Admitted Patient Data Collection. Study results will be disseminated via peer-reviewed publications and presentations at national and international conferences.Trial registration numberACTRN12621001738819p.
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Sanjida, Saira, Gail Garvey, James Ward, Roxanne Bainbridge, Anthony Shakeshaft, Stephanie Hadikusumo, Carmel Nelson, Prabasha Thilakaratne, and Xiang-Yu Hou. "Indigenous Australians’ Experiences of Cancer Care: A Narrative Literature Review." International Journal of Environmental Research and Public Health 19, no. 24 (December 16, 2022): 16947. http://dx.doi.org/10.3390/ijerph192416947.
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To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples’ cancer care experiences in the Australian healthcare system from the patient’s point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.
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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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Cotter, Philippa R., John R. Condon, Tony Barnes, Ian P. S. Anderson, Leonard R. Smith, and Teresa Cunningham. "Do Indigenous Australians age prematurely? The implications of life expectancy and health conditions of older Indigenous people for health and aged care policy." Australian Health Review 36, no. 1 (2012): 68. http://dx.doi.org/10.1071/ah11996.
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Objective. To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. Methods. Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. Results. At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. Conclusion. The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people. What is known about the topic? The empirical basis for the Australian Government’s use of age 50 for Indigenous aged care planning, compared to age 70 for the non-indigenous population, is not well established. It is not clear whether Indigenous people’s poorer health outcomes and lower life expectancy are associated with premature ageing. What does this paper add? This paper compares Indigenous and non-indigenous life expectancy and prevalence of health conditions. Only some conditions associated with ageing appear to affect Indigenous people earlier than other Australians. The proposition of premature ageing based on this explanatory framework is uncertain. The estimated gap between Indigenous and non-indigenous life expectancy in later life is ~6 years. What are the implications for practitioners? The current rationale for using a lower Indigenous planning age is problematic; however, further research is required to assess the effectiveness of this policy measure. The much higher prevalence of preventable chronic conditions among Indigenous Australians in middle-age groups is clear. The ‘early ageing’ frame can imply irremediable disability and disease. The aged care sector may be filling gaps in other services. The community care services for this group require a more tailored approach than simply lowering the planning age for aged care services.
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Cheluvappa, Rajkumar, and Selwyn Selvendran. "Strengths-Based Nursing to Combat Common Infectious Diseases in Indigenous Australians." Nursing Reports 12, no. 1 (January 18, 2022): 22–28. http://dx.doi.org/10.3390/nursrep12010003.
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(1) Problem: The increasing incidence and prevalence of infectious diseases in Indigenous Australians (Aboriginal groups and Torres Strait Islanders) are concerning. Indigenous Australians experience the burden of infectious diseases disproportionately when compared to non-Indigenous Australians. (2) Aim: Our report aims to describe how to apply Strengths-Based Nursing (SBN) to ameliorate the impact of the most common infectious diseases in Indigenous Australians. Specifically, we aim to describe how nurses can use SBN to partner with Indigenous Australian communities to remediate, control, and mollify the impact of the most common infectious diseases encountered by them using their limited resources. (3) Methods: Meticulous PubMed, Google Scholar, and web searches were conducted pertaining to Strengths-Based Nursing and common infectious diseases in Indigenous Australians. (4) Findings: The two groups of infectious diseases considered are sexually transmitted infections (STIs) and infectious skin diseases (including parasitic infestations). The prevalence of these infectious diseases in Indigenous Australians is deliberated on, with data when possible, or known trends and impacts. Finally, existing, evidence-based, prudent, and possible SBN approaches are discussed towards tackling these infectious diseases judiciously with available local resources, in conjunction with the support of impacted people, their families, and their communities. (5) Discussion and Conclusion: The SBN approach is a relatively new perspective/approach to clinical and nursing care. In contradistinction to the commonly utilised medical model, SBN pits strengths against deficits, available resources against professional judgment, solutions against unavailable items, and collaborations against hierarchy. In light of the current situation/data, several SBN approaches to combat STIs and skin infections in Indigenous Australians were identified and discussed for the first time in the “Results” section of this paper.
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Meiklejohn, Judith A., Brian Arley, Ross Bailie, Jon Adams, Gail Garvey, Jennifer H. Martin, Euan T. Walpole, and Patricia C. Valery. "Community-identified recommendations to enhance cancer survivorship for Aboriginal and Torres Strait Islander people." Australian Journal of Primary Health 24, no. 3 (2018): 233. http://dx.doi.org/10.1071/py17127.
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Indigenous Australians diagnosed with cancer experience higher mortality and lower survival rates compared to non-Indigenous Australians. Reasons are multifaceted and complex. Knowledge about Indigenous cancer survivors’ perspectives of positive cancer survivorship is a gap in research evidence. The study explored cancer survivorship perspectives of Indigenous cancer survivors, their support people and healthcare workers with a view to developing recommendations for cancer survivorship. Indigenous Australians who completed cancer treatment in the previous 6 months to 5 years, their support people and primary healthcare workers were recruited from primary healthcare centres and a large tertiary Queensland hospital. Semi-structured interviews and focus groups were conducted with written and informed consent obtained prior. Participants emphasised key action areas and recommendations to enhance cancer survivorship, namely: establishing a community cancer advocate and peer support program, availability and use of a cancer-specific Indigenous primary healthcare worker and hospital-based Indigenous patient navigator, as well as adoption of question prompt lists and cancer survivorship care plans. Existing research suggests significant benefits from implementing the key recommendations identified in this study. Greater support and commitment across health sectors and funding bodies is needed to promote institutional change and health system development.
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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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Fitts, Michelle S., Katrina Bird, John Gilroy, Jennifer Fleming, Alan R. Clough, Adrian Esterman, Paul Maruff, Yaqoot Fatima, and India Bohanna. "A Qualitative Study on the Transition Support Needs of Indigenous Australians Following Traumatic Brain Injury." Brain Impairment 20, no. 2 (August 22, 2019): 137–59. http://dx.doi.org/10.1017/brimp.2019.24.
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AbstractObjective:A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced.Methods and Procedure:Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis.Results:Five major themes were identified within the data. These were labelled ‘hospital experiences’, ‘engaging with medical and community-based supports’, ‘health and wellbeing impacts from the injury’, ‘everyday living’ and ‘family adjustments post-injury’.Conclusions:While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an individualised, coordinated transition support, may reduce the risks for re-admission with further head injuries.
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Olsen, Anna, Jack Wallace, and Lisa Maher. "Responding to Australia's National Hepatitis B Strategy 2010–13: gaps in knowledge and practice in relation to Indigenous Australians." Australian Journal of Primary Health 20, no. 2 (2014): 134. http://dx.doi.org/10.1071/py12162.
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The Australian National Hepatitis B Strategy 2010–13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action; preventing HBV transmission; optimising diagnosis and screening; clinical management of people with chronic hepatitis B (CHB); and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001–May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible individuals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.
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Blignault, Ilse, Liz Norsa, Raylene Blackburn, George Bloomfield, Karen Beetson, Bin Jalaludin, and Nathan Jones. "“You Can’t Work with My People If You Don’t Know How to”: Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease." International Journal of Environmental Research and Public Health 18, no. 14 (July 6, 2021): 7233. http://dx.doi.org/10.3390/ijerph18147233.
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Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital–community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.
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Atkinson-Briggs, Sharon, Alicia Jenkins, Christopher Ryan, and Laima Brazionis. "Prevalence of Health-Risk Behaviours Among Indigenous Australians With Diabetes: A Review." Journal of the Australian Indigenous HealthInfoNet 3, no. 4 (2022): 1–30. http://dx.doi.org/10.14221/aihjournal.v3n4.6.
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Aboriginal and Torres Strait Islander Australians are at high risk of Type 2 diabetes and its complications. Optimal lifestyle choices can improve health outcomes. A thematic review of original research publications related to smoking, nutrition, alcohol intake, physical activity and emotional wellness in Aboriginal and Torres Strait Islander Australians with diabetes was performed. Overall, 7118 English-language publications were identified by search engines (PubMed, CINAHL, Scopus, Medline-Web of Science, and Google Scholar) with search terms Indigenous Australians OR Aboriginal and Torres Strait Islanders AND diabetes AND lifestyle OR smoking OR nutrition OR alcohol OR physical activity OR emotional wellbeing and their common synonyms. After review of abstracts and publication reference lists, 36 articles met inclusion criteria and were reviewed. In general, the self-reported health-related behaviours of Aboriginal and Torres Strait Islander Australian adults with diabetes, which is predominantly Type 2 diabetes, was suboptimal. An important clinical challenge in diabetes care is to sustainably reduce smoking, improve nutrition (including alcohol use), increase physical activity, reduce sedentary time, and improve emotional wellbeing, which should lead to reduced rates of diabetes complications. Regular assessments and multi-stakeholder input, including individuals, communities, clinical, health policy, societal and government inputs and partnerships, are desirable to facilitate closing the gap in health between Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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Ypinazar, Valmae A., Stephen A. Margolis, Melissa Haswell-Elkins, and Komla Tsey. "Indigenous Australians’ Understandings Regarding Mental Health and Disorders." Australian & New Zealand Journal of Psychiatry 41, no. 6 (June 2007): 467–78. http://dx.doi.org/10.1080/00048670701332953.
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The purpose of the present paper was to determine what is currently documented about Indigenous Australians’ understandings of mental health and mental disorders through a meta-synthesis of peer-reviewed qualitative empirical research. The following databases were electronically searched (1995–April 2006): AOA-FT and AIATSIS, Blackwell Synergy, CINAHL and Pre CINHAL, Health source: nursing/academic edition, Medline, Proquest health and medical complete, PsycInfo, Science Direct, Synergy and Health InfoNet. Eligible studies were those written in English and published in peer-reviewed journals, empirical studies that considered Indigenous people's understandings of mental health and provided details on methodology. Five articles from four qualitative studies met these criteria. Meta-ethnography was used to identify common themes emerging from the original studies. Reciprocal translation was used to synthesize the findings to provide new interpretations extending beyond those presented in the original studies. An overarching theme emerged from the synthesis: the dynamic interconnectedness between the multi-factorial components of life circumstances. Reciprocal translations and synthesis regarding Indigenous understandings of mental health and illness resulted in five themes: (i) culture and spirituality; (ii) family and community kinships; (iii) historical, social and economic factors; (iv) fear and education; and (v) loss. The application of a meta-synthesis to these qualitative studies provided a deeper insight into Indigenous people's understandings of mental health and illness. The importance of understanding Indigenous descriptions and perceptions of mental health issues is crucial to enable two-way understandings between Indigenous people's constructs of wellness and Western biomedical diagnostic labels and treatment pathways for mental disorders and mental health problems.
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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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Thackrah, Rosalie D., and Sandra C. Thompson. "Applying a Midwifery Lens to Indigenous Health Care Delivery: The Contribution of Campus Learning and Rural Placements to Effecting Systemic Change." Canadian Journal of Nursing Research 50, no. 4 (May 4, 2018): 179–88. http://dx.doi.org/10.1177/0844562118771829.
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Study background Increasing cultural safety in health settings is essential to address stark health disparities between Indigenous and non-Indigenous Australians. Respect for cultural knowledge, better communication, and recognition of racism as a determinant of health are required for improved service delivery. How this knowledge is acquired in health professional training and translated to clinical settings is poorly understood. Purpose Impacts of an innovative Indigenous health unit and remote clinical placements on knowledge acquisition and attitude change were explored among midwifery students to inform cultural competency initiatives in health professional training. Methods A multiphased, mixed methods research design used surveys, observations, and interviews. Qualitative analysis was strengthened through triangulation with quantitative data. Results A unit conceived with substantial Indigenous Australian input and which privileged these voices enhanced knowledge and shifted attitudes in a positive direction; however, immediate gains diminished over time. Remote placements had a profound effect on student learning. Exposure to Indigenous Australians in classrooms and communities, and the self-reflection generated, helped dispel stereotypes and challenge assumptions based on limited cultural knowledge and contact. Conclusion Optimization of receptivity to Indigenous Australian content and opportunities for remote placements contributed to students’ developing cultural capabilities with implications for all health professional training. Whether this heightened awareness is enough to address institutional racism identified in health service delivery remains unanswered. The focus must include those established health practitioners and administrators who influence organizational culture if real systemic change is to occur. Given appropriate on-going support, graduates can play a vital role in expediting this process.
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Woods, John A., Claire E. Johnson, Samuel F. Allingham, Hanh T. Ngo, Judith M. Katzenellenbogen, and Sandra C. Thompson. "Collaborative data familiarisation and quality assessment: Reflections from use of a national dataset to investigate palliative care for Indigenous Australians." Health Information Management Journal 50, no. 1-2 (March 27, 2020): 64–75. http://dx.doi.org/10.1177/1833358320908957.
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Background: Data quality is fundamental to the integrity of quantitative research. The role of external researchers in data quality assessment (DQA) remains ill-defined in the context of secondary use for research of large, centrally curated health datasets. In order to investigate equity of palliative care provided to Indigenous Australian patients, researchers accessed a now-historical version of a national palliative care dataset developed primarily for the purpose of continuous quality improvement. Objectives: (i) To apply a generic DQA framework to the dataset and (ii) to report the process and results of this assessment and examine the consequences for conducting the research. Method: The data were systematically examined for completeness, consistency and credibility. Data quality issues relevant to the Indigenous identifier and framing of research questions were of particular interest. Results: The dataset comprised 477,518 records of 144,951 patients (Indigenous N = 1515; missing Indigenous identifier N = 4998) collected from participating specialist palliative care services during a period (1 January 2010–30 June 2015) in which data-checking systems underwent substantial upgrades. Progressive improvement in completeness of data over the study period was evident. The data were error-free with respect to many credibility and consistency checks, with anomalies detected reported to data managers. As the proportion of missing values remained substantial for some clinical care variables, multiple imputation procedures were used in subsequent analyses. Conclusion and implications: In secondary use of large curated datasets, DQA by external researchers may both influence proposed analytical methods and contribute to improvement of data curation processes through feedback to data managers.
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Usher, Kim, Navjot Bhullar, David Sibbritt, Suruchi Sue Anubha Amarasena, Wenbo Peng, Joanne Durkin, Reakeeta Smallwood, et al. "Influence of COVID-19 on the preventive health behaviours of indigenous peoples of Australia residing in New South Wales: a mixed-method study protocol." BMJ Open 11, no. 9 (September 2021): e047404. http://dx.doi.org/10.1136/bmjopen-2020-047404.
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IntroductionChronic conditions impact indigenous peoples of Australia at a much higher rate than non-indigenous Australians. Attendance at the Medicare Benefits Scheme (MBS) supported indigenous health checks are crucial to improve prevention and management of chronic health conditions. However, in conjunction with lifestyle and environmental factors, attendance rates at primary healthcare services for screening and treatment have fallen in Australia during the COVID-19 pandemic. This study aims to explore the influence of the COVID-19 pandemic on preventive health behaviours of indigenous Australians and the associated barriers to, and enablers of, engagement with health services to formulate a targeted intervention strategy.Methods and analysisA concurrent mixed-methods study (comprising quantitative and qualitative data collection methods) will be employed. Descriptive analysis of MBS data about the characteristics of indigenous peoples of Australia claiming health assessment services will be performed. Generalised estimating equation regression models will be used to examine the use of health assessment services over time. Qualitative interviews informed by indigenous research methods will be conducted. Interviews will investigate barriers to, and enablers of, engagement with health services. Thematic approach guided by the principles of indigenist praxis, storytelling and collaborative research will be used to analyse the interview data. The project commenced in July 2020 and will be completed by July 2022.Ethics and disseminationThe project received ethics approval from the Aboriginal Health and Medical Research Council of New South Wales and the University of New England Human Research Ethics Committee. Findings will be disseminated via peer-reviewed journal articles, conferences, government and relevant stakeholder reports, and infographics.
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O'Grady, Kerry-Ann F., Amber Revell, Graeme P. Maguire, Renate Millonig, Michael A. Newman, David W. Reid, Deborah C. Hill, and Anne B. Chang. "Lung health care for Aboriginal and Torres Strait Islander Queenslanders: breathing easy is not so easy." Australian Health Review 35, no. 4 (2011): 512. http://dx.doi.org/10.1071/ah10973.
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Objectives. In Aboriginal and Torres Strait Islander peoples in Queensland, to (a) determine the disease burden of common chronic lung diseases and (b) identify areas of need with respect to lung health services. Methods. Literature reviews and analyses of hospitalisation and mortality data were used to describe disease epidemiology and available programs and services. Key stakeholder interviews and an online survey of health professionals were used to evaluate lung health services across the state and to identify services, needs and gaps. Results. Morbidity and mortality from respiratory diseases in the Indigenous population is substantially higher than the non-Indigenous population across all age groups and regions. There are inadequate clinical services and resources to address disease prevention, detection, intervention and management in an evidence-based and culturally acceptable fashion. There is a lack of culturally appropriate educational resources and management programs, insufficient access to appropriately engaged Indigenous health professionals, a lack of multi-disciplinary specialist outreach teams, fragmented information systems and inadequate coordination of care. Conclusions. Major initiatives are required at all levels of the healthcare system to adequately address service provision for Indigenous Queenslanders with lung diseases, including high quality research to investigate the causes for poor lung health, which are likely to be multifactorial. What is known about the topic? Chronic diseases, including lung disease contribute to, and influence outcomes of, the well-known health and socioeconomic disadvantage among Aboriginal and Torres Strait Islander Australians. Nationwide, the most common reason for hospitalisation of Indigenous Australians is for lung diseases (after renal dialysis). What does this paper add? There is currently no state- or nation-wide comprehensive review of chronic lung disease burden and the health services available to prevent, treat and manage lung disease. This review fills this gap in Queensland and has found that chronic lung disease burden is not homogenous. There are substantial gaps in, and barriers to, the provision of high quality, evidence based services and a paucity of well-designed research to inform policy and health service delivery. What are the implications for practitioners? Evidence-based strategies are needed at the primary, secondary and tertiary levels of the healthcare system. Fourteen recommendations relevant to practitioners and policy makers were formulated.
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Ashman, A. M., C. E. Collins, L. Weatherall, L. J. Brown, M. E. Rollo, D. Clausen, C. C. Blackwell, et al. "A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study." Journal of Developmental Origins of Health and Disease 7, no. 4 (April 15, 2016): 357–68. http://dx.doi.org/10.1017/s204017441600009x.
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Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child’s first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5–43.2, n=110), median birth weight was 3180 g (910–5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.
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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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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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Yashadhana, Aryati, Ted Fields, Godfrey Blitner, Ruby Stanley, and Anthony B. Zwi. "Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia." BMJ Global Health 5, no. 1 (January 2020): e001999. http://dx.doi.org/10.1136/bmjgh-2019-001999.
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IntroductionOur study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.MethodsIn collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11.ResultsMore than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care.DiscussionWe outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.
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de Crespigny, Charlotte, Inge Kowanko, Helen Murray, Carolyn Emden, and Scott Wilson. "Improving Indigenous health through better medication management: an overview." Australian Journal of Primary Health 11, no. 1 (2005): 17. http://dx.doi.org/10.1071/py05003.
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This paper provides an overview of a major South Australian research project with implications for the health of all Indigenous Australians. The researchers set out to explore the medication needs of Aboriginal people with mental health problems and found that most Aboriginal people have to deal with profound challenges to social and emotional wellbeing with significant medication implications. No previous research had investigated the problem of medication use by Aboriginal people in metropolitan, rural and remote locations to the depth and extent of this project. The research therefore is of widespread relevance and holds interest for many Indigenous and non-Indigenous individuals and groups, consumers, service providers and policy-makers. As a research team comprising Indigenous and non-Indigenous members, we were committed to implementing strategies in the course of the project with immediate benefit to project participants as well as longer-term impact on improved use of medications. The design of the project enabled these strategic interventions and we are pleased to promote this model to other researchers. Recommendations from the project concern services, coordination of care, carers and family members, workforce education, and community development. Readers are advised where the project report and other published papers can be accessed. The project was funded by the Commonwealth Department of Health and Ageing.
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Duke, Daniel L. M., Megan Prictor, Elif Ekinci, Mariam Hachem, and Luke J. Burchill. "Culturally Adaptive Governance—Building a New Framework for Equity in Aboriginal and Torres Strait Islander Health Research: Theoretical Basis, Ethics, Attributes and Evaluation." International Journal of Environmental Research and Public Health 18, no. 15 (July 27, 2021): 7943. http://dx.doi.org/10.3390/ijerph18157943.
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Indigenous health inequities persist in Australia due to a system of privilege and racism that has political, economic and social determinants, rather than simply genetic or behavioural causes. Research involving Aboriginal and Torres Strait Islander (‘Indigenous’) communities is routinely funded to understand and address these health inequities, yet current ethical and institutional conventions for Indigenous health research often fall short of community expectations. Typically, mainstream research projects are undertaken using traditional “top-down” approaches to governance that hold inherent tensions with other dominant governance styles and forms. This approach perpetuates long-held power imbalances between those leading the research and those being researched. As an alternative, Indigenous governance focuses on the importance of place, people, relationships and process for addressing power imbalances and achieving equitable outcomes. However, empowering principles of Indigenous governance in mainstream environments is a major challenge for research projects and teams working within organisations that are regulated by Western standards and conventions. This paper outlines the theoretical basis for a new Culturally Adaptive Governance Framework (CAGF) for empowering principles of Indigenous governance as a prerequisite for ethical conduct and practice in Indigenous health research. We suggest new orientations for mainstream research project governance, predicated on translating theoretical and practical attributes of real-world ethics, adaptive governance and critical allyship frameworks to Indigenous health research. The CAGF is being implemented in a national Indigenous multicenter trial evaluating the use of continuous blood glucose monitors as a new technology with the potential to improve diabetes care and treatment for Indigenous Australians—the FlashGM Study. The CAGF is a governance framework that identifies the realities of power, acknowledges the complexities of culture and emerging health technologies, and foregrounds the principle of equity for mainstream Indigenous health research.
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Jones, Rodney P. "A Model to Compare International Hospital Bed Numbers, including a Case Study on the Role of Indigenous People on Acute ‘Occupied’ Bed Demand in Australian States." International Journal of Environmental Research and Public Health 19, no. 18 (September 7, 2022): 11239. http://dx.doi.org/10.3390/ijerph191811239.
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Comparing international or regional hospital bed numbers is not an easy matter, and a pragmatic method has been proposed that plots the number of beds per 1000 deaths versus the log of deaths per 1000 population. This method relies on the fact that 55% of a person’s lifetime hospital bed utilization occurs in the last year of life—irrespective of the age at death. This is called the nearness to death effect. The slope and intercept of the logarithmic relationship between the two are highly correlated. This study demonstrates how lines of equivalent bed provision can be constructed based on the value of the intercept. Sweden looks to be the most bed-efficient country due to long-term investment in integrated care. The potential limitations of the method are illustrated using data from English Clinical Commissioning Groups. The main limitation is that maternity, paediatric, and mental health care do not conform to the nearness to death effect, and hence, the method mainly applies to adult acute care, especially medical and critical care bed numbers. It is also suggested that sensible comparison can only be made by comparing levels of occupied beds rather than available beds. Occupied beds measure the expressed bed demand (although often constrained by access to care issues), while available beds measure supply. The issue of bed supply is made complex by the role of hospital size on the average occupancy margin. Smaller hospitals are forced to operate at a lower average occupancy; hence, countries with many smaller hospitals such as Germany and the USA appear to have very high numbers of available beds. The so-called 85% occupancy rule is an “urban myth” and has no fundamental basis whatsoever. The very high number of “hospital” beds in Japan is simply an artefact arising from “nursing home” beds being counted as a “hospital” bed in this country. Finally, the new method is applied to the expressed demand for occupied acute beds in Australian states. Using data specific to acute care, i.e., excluding mental health and maternity, a long-standing deficit of beds was identified in Tasmania, while an unusually high level of occupied beds in the Northern Territory (NT) was revealed. The high level of demand for beds in the NT appears due to an exceptionally large population of indigenous people in this state, who are recognized to have elevated health care needs relative to non-indigenous Australians. In this respect, indigenous Australians use 3.5 times more occupied bed days per 1000 deaths (1509 versus 429 beds per 1000 deaths) and 6 times more occupied bed days per 1000 population (90 versus 15 beds per 1000 population) than their non-indigenous counterparts. The figure of 1509 beds per 1000 deaths (or 4.13 occupied beds per 1000 deaths) for indigenous Australians is indicative of a high level of “acute” nursing care in the last months of life, probably because nursing home care is not readily available due to remoteness. A lack of acute beds in the NT then results in an extremely high average bed occupancy rate with contingent efficiency and delayed access implications.
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Rankoana, Sejabaledi A. "Indigenous Plant-Derived Medical Applications for Primary Health Care." International Journal of Social Science Research and Review 5, no. 11 (November 5, 2022): 163–68. http://dx.doi.org/10.47814/ijssrr.v5i11.719.
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Traditional medicine is an important primary health care resource for many people and has been acknowledged as a necessary component of reaching universal health. The purpose of this research is to offer an overview of indigenous plant-derived medicinal applications administered to treat current human ailments. The data were collected via a mixed-methods research in four Bapedi communities in South Africa's Limpopo Province. The research documented six different techniques for administering indigenous plant-derived medications, including decoction, infusion, steam bath, incense, poultice, and powder. These uses are determined by the kind of plant material employed and the type of illness being treated. For instance, a leaf poultice is applied directly to wounds to promote healing, while decoctions and infusions of the root, bark, and bulb are used as purgatives and enemas to treat gastrointestinal diseases and as emetics to alleviate cough. Steam baths and incense inhalation increase sweat, which is beneficial in the treatment of fever and cough. The standard dose for decoctions and infusions is a teacup, but there are no accounts of particular dosages for poultices, steam, ash, burned root, or leaf sap. This research advises hastening the process of authenticating traditional medicine in order to assure optimal practices, such as accurate dosage uses for medications.
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Hinton, Rachael, and Tricia Nagel. "Evaluation of a Culturally Adapted Training in Indigenous Mental Health and Wellbeing for the Alcohol and Other Drug Workforce." ISRN Public Health 2012 (March 13, 2012): 1–6. http://dx.doi.org/10.5402/2012/380581.
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Indigenous Australians have high rates of mental illness comorbid with substance misuse. The complex needs of this client group create challenges for the alcohol and other drug (AOD) workforce. This paper describes the outcomes of an Indigenous-specific “Yarning about Mental Health” training for the AOD workforce to strengthen knowledge and skills in mental health approaches and in their engagement with Indigenous clients. The training provides culturally adapted strategies and tools for understanding mental health, promoting wellbeing, and delivering brief interventions in the substance misuse setting. A nonexperimental evaluation which incorporated pre-post questionnaires was conducted with workshop participants attending one of four trainings. The training was perceived to be highly appropriate and helpful in participants’ work with Indigenous AOD clients. There was significant improvement in confidence and knowledge related to Indigenous mental health and wellbeing and qualitative data supported these positive outcomes. This study supports the need to blend Indigenous concepts of health and wellbeing with non-Indigenous ways of understanding and treating illness in order to develop services which are appropriate to Indigenous peoples. It also suggests research is required to understand whether self-reported increases in knowledge and confidence can translate into behavioural changes in participants' teaching and practice of culturally competent care and to improved client outcomes.
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Lavrencic, Louise M., Holly A. Mack, Gail Daylight, Sharon Wall, Margaret Anderson, Sue Hoskins, Emily Hindman, Gerald A. Broe, and Kylie Radford. "Staying in touch with the community: understanding self-reported health and research priorities in older Aboriginal Australians." International Psychogeriatrics 32, no. 11 (November 21, 2019): 1303–15. http://dx.doi.org/10.1017/s1041610219001753.
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ABSTRACTObjectives:Aboriginal Australians experience higher rates of non-communicable chronic disease, injury, dementia, and mortality than non-Aboriginal Australians. Self-reported health is a holistic measure and may fit well with Aboriginal views of health and well-being. This study aimed to identify predictors of self-reported health in older Aboriginal Australians and determine acceptable research methodologies for future aging research.Design:Longitudinal, population-based study.Setting:Five communities across New South Wales, Australia (two urban and three regional sites).Participants:Aboriginal and Torres Strait Islander people (n = 227; 60–88 years, M = 66.06, SD = 5.85; 145 female).Measurements:Participants completed baseline (demographic, medical, cognitive, mental health, and social factors) and follow-up assessments (self-reported health quantified with 5-point scale; sharing thoughts on areas important for future research). Predictors of self-reported health were examined using logistic regression analyses.Results:Self-reported health was associated with sex, activities of daily living, social activity participation, resilience, alcohol use, kidney problems, arthritis, falls, and recent hospitalization. Arthritis, kidney problems, and resilience remained significant in multiple logistic regression models.Conclusions:Perceived resilience and the absence of certain chronic age-related conditions predict older Aboriginal peoples’ self-reported health. Understanding these factors could inform interventions to improve well-being. Findings on acceptable research methodologies suggest that many older Aboriginal people would embrace a range of methodologies within long-standing research partnerships, which is an important consideration for Indigenous population research internationally.
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Flicker, Leon, and Dina Logiudice. "What can we learn about dementia from research in Indigenous populations?" International Psychogeriatrics 27, no. 12 (October 29, 2015): 1957–58. http://dx.doi.org/10.1017/s1041610215001684.
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Indigenous peoples represent up to 5% of the world's population (almost 400 million people), representing thousands of individual cultures and language groups. The health status of older Indigenous peoples has been little researched, partly related to lower life expectancy and the consideration that Indigenous peoples do not live long enough to experience the common “geriatric syndromes” such as dementia, frailty, and falls. Statistics from Australia and Canada now report that Indigenous populations are undergoing rapid aging, with many examples of survivorship to old age (Arkleset al., 2010; Jacklinet al., 2012). The systematic review by Warrenet al. (2015) is a timely one, in that it reminds clinicians interested in old age that this “fourth” World population deserves further attention. Researchers that have worked with these groups to produce population estimates are relatively few. In their systematic review, Warrenet al.(2015) demonstrate wide variation in prevalence rates of dementia. They conclude that a major cause of this heterogeneity in prevalence is due to basic methodological differences. In particular, those studies that have utilized already acquired routine data may be biased. The type and direction of this bias can be complex. For example, Cotteret al.(2012) using routinely collected data, concluded that the prevalence of dementia in Aboriginal Australians in the Northern Territory was not higher than non-Aboriginal prevalence. Using similar methodologies some years later the conclusion was that the Aboriginal population had markedly higher rates (Liet al., 2014). In the intervening period, a dementia awareness campaign coupled with the development of a culturally appropriate screening tool probably resulted in greater detection in routine care.
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McGill, Katie, Amir Salem, Tanya L. Hanstock, Todd R. Heard, Leonie Garvey, Bernard Leckning, Ian Whyte, Andrew Page, and Greg Carter. "Indigeneity and Likelihood of Discharge to Psychiatric Hospital in an Australian Deliberate Self-Poisoning Hospital-Treated Cohort." International Journal of Environmental Research and Public Health 19, no. 19 (September 27, 2022): 12238. http://dx.doi.org/10.3390/ijerph191912238.
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Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003–2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge; Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40–0.87) at the univariate level, with little change after sequential adjustment; and AOR 0.34 (0.21–0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation.
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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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Lea, Toby, Michael Costello, Limin Mao, Garrett Prestage, Iryna Zablotska, James Ward, John Kaldor, John de Wit, and Martin Holt. "Elevated reporting of unprotected anal intercourse and injecting drug use but no difference in HIV prevalence among Indigenous Australian men who have sex with men compared with their Anglo-Australian peers." Sexual Health 10, no. 2 (2013): 146. http://dx.doi.org/10.1071/sh12097.
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Background Although half of the HIV notifications among Aboriginal and Torres Strait Islander people (‘Indigenous Australians’) are attributed to homosexual transmission, there has been little research examining sexual and drug use risk practices among Indigenous Australian men who have sex with men (MSM). Methods: Respondents were Indigenous Australian (n = 1278) and Anglo-Australian men (n = 24 002) participating in the routine cross-sectional Gay Community Periodic Surveys conducted in Australia from 2007 to 2011. Sociodemographic characteristics, sexual risk practices, drug use, HIV testing and HIV status of Indigenous and Anglo-Australian men were compared and evaluated to discover whether Indigenous status was independently associated with HIV risk practices. Results: Although an equivalent proportion of Indigenous and Anglo-Australian men reported being HIV-positive (9.6%), Indigenous MSM were more likely to report unprotected anal intercourse with casual partners in the previous 6 months (27.9% v. 21.5%; Adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.11–1.49). Indigenous men were more likely than Anglo-Australian men to report use of several specific drugs and twice as likely to report injecting drug use in the previous 6 months (8.8% v. 4.5%; AOR = 1.43, 95% CI: 1.11–1.86). Conclusions: Despite a higher proportion of Indigenous men reporting sexual and drug use practices that increase the risk of HIV transmission, there were no differences in the HIV status of Indigenous and Anglo-Australian men. However, the elevated rates of risk practices suggest that Indigenous MSM should remain a focus for HIV prevention, care and support.
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Jowsey, Tanisha, Laurann Yen, Robert Wells, and Stephen Leeder. "National Health and Hospital Reform Commission final report and patient-centred suggestions for reform." Australian Journal of Primary Health 17, no. 2 (2011): 162. http://dx.doi.org/10.1071/py10033.
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The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants’ recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination.
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Bailie, Ross, Veronica Matthews, Sarah Larkins, Sandra Thompson, Paul Burgess, Tarun Weeramanthri, Jodie Bailie, Frances Cunningham, Ru Kwedza, and Louise Clark. "Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study." BMJ Open 7, no. 10 (October 2017): e016626. http://dx.doi.org/10.1136/bmjopen-2017-016626.
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ObjectivesTo examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians.DesignMixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care.SettingIndigenous primary healthcare services across five states/territories of Australia.Participants175 Indigenous primary healthcare services.InterventionsA range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research.Primary and secondary outcome measures(i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines).ResultsProgressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities.ConclusionsHealth authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.
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Rashid, Marghalara, Julie Nguyen, Jessica L. Foulds, Liz Dennett, Nicole Cardinal, and Sarah E. Forgie. "A Scoping Review of Indigenous Health Curricular Content in Graduate Medical Education." Journal of Graduate Medical Education 15, no. 1 (February 1, 2023): 24–36. http://dx.doi.org/10.4300/jgme-d-22-00180.1.
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ABSTRACT Background Graduate medical education is refocusing on the reconciliation process with Indigenous peoples and integrating Indigenous healing practices, cultural humility training, and courses on Indigenous health issues in their curricula. Physicians and all health care workers must be able to recognize, respect, and address the distinct health needs of all Indigenous peoples. Objective The aim of this scoping review was to explore and describe what exists in the current literature on the impact and challenges associated with Indigenous curricula developed for resident physicians. Methods The search was conducted using 9 bibliographic databases from inception until April 19, 2021. Two reviewers independently screened for inclusion using Covidence. Three reviewers extracted data and all 3 checked for completeness and accuracy. Results Eleven reports were included. Our included reports consisted of qualitative research (n=2), commentaries (n=1), special articles (n=3), systematic reviews (n=1), innovation reports (n=1), published abstracts (n=1), and program evaluation papers (n=2). Findings are presented by 3 themes: (1) Misunderstandings and cultural bias toward Indigenous people; (2) Increasing community-driven Indigenous partnerships to create a safe environment; and (3) Challenges in implementing Indigenous health curricula. Conclusions Themes identified related to Indigenous involvement, culturally competent care, common misconceptions about Indigenous peoples, as well as challenges and barriers to implementing Indigenous curricula for residency programs. A collaborative approach involving stakeholders with training in the community is a viable path forward. But comprehensive program evaluation, a source of stable funding, and further research focusing on effective Indigenous curricula for residents are needed.
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Frenopoulo, Christian. "Underlying premises in medical mission trips for Madiha (Kulina) Indigenous people in the Brazilian Amazon." Aporia 13, no. 1 (January 21, 2021): 46–68. http://dx.doi.org/10.18192/aporia.v13i1.5284.
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This article proposes two premises that underlie biomedical health care delivery provided through medical missions to Madiha (Kulina) Indigenous Amazonian people living in forest villages. First, that health care is implemented through a set of detached transferable goods and services. Second, that health is a condition that requires the importation of knowledge and resources. The premises were induced through qualitative research on the Brazilian government’s medical missions that provide biomedical care to Madiha (Kulina) in the southwestern Amazon as part of the national health care system. Despite policy rhetoric, delivery practices disregard embedding health and health care in local infrastructure and cultural conditions. There is little or no collaboration with Indigenous healers, capacity building of the local (Indigenous) health care system, education of resident lay health monitors, or extensive and lasting infrastructural development. The article recommends reorientation of delivery to prioritize local health care infrastructure development.
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Woodward, Emma, and Patricia Marrfurra McTaggart. "Co-developing Indigenous seasonal calendars to support ‘healthy Country, healthy people’ outcomes." Global Health Promotion 26, no. 3_suppl (April 2019): 26–34. http://dx.doi.org/10.1177/1757975919832241.
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In caring for Country, Indigenous Australians draw on laws, knowledge and customs that have been inherited from ancestors and ancestral beings, to ensure the continued health of lands and seas with which they have a traditional attachment or relationship. This is a reciprocal relationship, whereby land is understood to become wild/sick if not managed by its people, and in turn individuals and communities suffer without a maintained connection to Country. It is well understood by Indigenous people that if you ‘look after country, country will look after you’. Indigenous knowledge systems that underpin the local care (including use and management) of Country are both unique and complex. These knowledge systems have been built through strong observational, practice-based methods that continue to be enacted and tested, and have sustained consecutive generations by adapting continually, if incrementally, to the local context over time. This paper describes a research partnership that involved the sharing and teaching of Ngan’gi Aboriginal ecological knowledge in order to reveal and promote the complex attachment of Ngan’gi language speakers of the Daly River, Australia, to water places. This engagement further led to the incremental co-development of an Indigenous seasonal calendar of aquatic resource use. The seasonal calendar emerged as an effective tool for supporting healthy Country, healthy people outcomes. It did this by facilitating the communication of resource management knowledge and connection with water-dependent ecosystems both inter-generationally within the Ngan’gi language group, as well as externally to non-Indigenous government water resource managers. The Indigenous seasonal calendar form has subsequently emerged as a tool Indigenous language groups are independently engaging with to document and communicate their own knowledge and understanding of Country, to build recognition and respect for their knowledge, and to make it accessible to future generations.
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Maritim, Charity, Leigh McClarty, Stella Leung, Sharon Bruce, Gayle Restall, Paula Migliardi, and Marissa Becker. "HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada." Official Journal of the Association of Medical Microbiology and Infectious Disease Canada 6, no. 2 (July 2021): 119–28. http://dx.doi.org/10.3138/jammi-2020-0042.
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Background: Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. Methods: Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. Results: By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants ( p < 0.05). Conclusions: The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.
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Willis, Eileen M., Judith Dwyer, Kei Owada, Leah Couzner, Debra King, and Jo Wainer. "Indigenous women's expectations of clinical care during treatment for a gynaecological cancer: rural and remote differences in expectations." Australian Health Review 35, no. 1 (2011): 99. http://dx.doi.org/10.1071/ah09800.
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Objectives. To report on differences in Indigenous women’s expectations of clinical care during treatment for a gynaecological cancer in rural and remote regions. Design. Qualitative interviews were conducted in New South Wales, Victoria, South Australia and the Northern Territory in 2008 with 37 clinicians working in gynaecological cancer and 24 women with a gynaecological cancer. Three of the participants were Indigenous women living in large rural towns (others were non-Indigenous), whereas six of the 37 clinicians interviewed worked closely with Indigenous women in remote settings. Indigenous women were contacted through an Indigenous researcher. Interviews were analysed for emerging themes, then compared with each other and with the research literature for similarities and differences. Results. There is considerable variation between clinician observations of the expectations of Indigenous women in remote regions, and the views of Aboriginal women in rural settings. Conclusion. Indigenous women in rural settings have specific views about quality medical care. These include expectations of timely and culturally appropriate care, and strong ties to family and kin, but do not accord with other research findings that suggest Aboriginal women must receive care from same sex clinicians or that care is often delayed. The paper alerts practitioners to the fact that culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations. What is known about this topic? Cross-cultural health care research recognises that health professionals need to be attuned to the cultural preferences and needs of Indigenous patients. What does this paper add? This study warns against assuming all Indigenous people are the same, or have the same expectations about quality health care. It notes that little guidance is offered to clinicians on how Indigenous responses to Western bio-medical care might differ across the country. The paper identifies some differences and proposes strategies for understanding local preferences. What are the implications for practitioners? This paper alerts practitioners to the fact that although Indigenous patients share many cultural similarities, clinicians should not make assumptions about what is appropriate culturally safe care. Culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations in terms of timely access, culturally appropriate care and educational materials, the role of family and Aboriginal Health Workers, and sex preferences.