Letteratura scientifica selezionata sul tema "Aboriginal and Torres Strait Islander community-based research"

Summary Delivering cancer control at scale for Aboriginal and Torres Strait Islander communities is a national priority that requires Aboriginal and Torres Strait Islander leadership and codesign, as well as significant involvement of the Aboriginal community‐controlled health sector. The unique genomic variation observed among Aboriginal and Torres Strait Islander peoples may have implications for standard and precision medicine. Yet, Aboriginal and Torres Strait Islander peoples are absent from, or under‐represented within, human reference genome resources, genomic studies, cancer studies, cancer cell lines, patient‐derived xenografts and cancer clinical trials. Genomics‐guided precision cancer medicine offers an opportunity to reduce cancer health disparities experienced by Aboriginal and Torres Strait Islander peoples through personalising prevention, diagnosis, treatment and long term management. Here, we describe what is required to ensure that Aboriginal and Torres Strait Islander peoples can receive the benefits of precision cancer medicine. Equity of access to care, an Aboriginal and Torres Strait Islander cancer workforce, and appropriate genome reference resources are important for safe and effective cancer medicine. Building Indigenous data sovereignty principles and Aboriginal and Torres Strait Islander governance into research is required to protect Aboriginal and Torres Strait Islander rights and collective interests. Aboriginal and Torres Strait Islander community engagement should be undertaken to develop an understanding of the unique cultural and ethical considerations for precision cancer research. Local and national genomic health research guidelines are needed to define a consensus best practice in genomics research with Aboriginal and Torres Strait Islander peoples.

IntroductionConducting ethical and high-quality health research is crucial for informing public health policy and service delivery to reduce the high and inequitable burden of disease experienced by Aboriginal and Torres Strait Islander people. Ethical guidelines and principles specifically for health research with Aboriginal and Torres Strait Islander people have been developed for use since 1987. However, there has been limited examination of how these are being applied to the conduct of research.Methods and analysisMurru Minyawill be a large-scale national study to examine the implementation of ethical processes in Aboriginal and Torres Strait Islander health research. A mixed-methods design will be used in fourbaarra(steps). The first threebaarrawill collect knowledge, experiences and wisdom from three key groups: Aboriginal and Torres Strait Islander communities, research academics, and Human Research Ethics Committees using online surveys, yarning, and semistructured interviews. This knowledge will inform the finalbaarraof developing a set of practical recommendations to support ethical conduct in Aboriginal and Torres Strait Islander health research into the future.Ethics and disseminationEthical approval for this research project has been granted by National, State and Territory Human Research Ethics Committees. This research has been developed in collaboration with Aboriginal and Torres Strait Islander researchers, Aboriginal Community Controlled Health Organisation representatives, Aboriginal community members, the National Health Leadership Forum, and Aboriginal and Torres Strait Islander research team. The knowledge translation plan will be integrated and revised throughout the project as partnerships and engagement with Aboriginal and Torres Strait Islander communities continue. All findings will be shared with peak Aboriginal research bodies and Aboriginal and Torres Strait Islander communities in ways that are meaningful to them.

Background Digital health offers a fresh avenue to address health disparities experienced by Aboriginal and Torres Strait Islanders. Despite the scant evidence about how Aboriginal and Torres Strait Islanders access and use health technology, the Australian government has prioritised research that uses technology to enable people to manage their health and promote better health outcomes. Older Aboriginal and Torres Strait Islander women are cultural leaders in their communities, enabling them to provide valuable insights about the safety and efficacy of health care messaging. However, no research has engaged older Aboriginal and Torres Strait Islander, women as partners in digital health research. Objective This paper provides a protocol for co-designed translational research that privileges older Aboriginal & Torres Strait Islander women’s cultural expertise to design and test a framework for accessible, culturally safe and feasible digital health technologies. Methods This mixed-methods research project will use the collective impact approach, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology. A series of yarning circles with three different communities will elucidate enablers and barriers to access health information; co-create a framework clarifying what works and does not work for digital health promotion in their communities; and test the framework by co-creating three digital health information programs. Conclusions Privileging the cultural expertise of older Aboriginal and Torres Strait Islander women will provide a novel perspective and vital guidance that end users and developers can trust and rely upon to create and evaluate culturally safe and efficacious digital health promotion programs.

IntroductionKnowledge translation (KT) involves bridging the gaps between research knowledge and research application or practice, by sharing this knowledge with knowledge-users. KT is increasingly being used in research with Indigenous peoples globally to address the top-down and inappropriate research approaches commonly used in Indigenous research. Employing KT in Indigenous research in Australia is an emergent field, despite Aboriginal and Torres Strait Islander peoples having conducted KT for generations.There is limited evidence which demonstrates how KT is applied in the Aboriginal/Torres Strait Islander context. Results will benefit researchers by demonstrating ways of appropriately translating research findings to knowledge-users, including Aboriginal and Torres Strait Islander communities, researchers and policy makers. The scoping review will also inform a KT definition, method and practices used in a large-scale, longitudinal cohort study of Aboriginal and Torres Strait Islander adults: the Mayi Kuwayu Study.Methods and analysisUnder guidance of an Aboriginal and Torres Strait Islander governance committee, we will conduct a scoping review on KT in Aboriginal/Torres Strait Islander research. We will follow the scoping review method outlined by the Joanna Briggs Institute. We will search the ANU SuperSearch, and grey and hard to find literature in June 2022. Abstracts and full-text articles will be screened by two independent reviewers. We will include studies that relate to KT in Aboriginal/Torres Strait Islander research, regardless of the research topic. Results will be used to inform the KT definition, method and practices that can be used in Aboriginal/Torres Strait Islander research contexts in Australia.Ethics and disseminationThe Mayi Kuwayu Study has ethics approvals from the Australian Institute of Aboriginal and Torres Strait Islander Studies, 12 Aboriginal/Torres Strait Islander organisations, and the Australian National University Human Research Ethics Committee. Results will be disseminated through peer-review publication and community workshops. Protocol registration is available online (10.17605/OSF.IO/JMFQ3).

Aboriginal and Torres Strait Islander people experience a greater range of health and social disadvantages compared to other Australians. Wellbeing is a culturally-bound construct, and to date, a national evidence base around the components of wellbeing for Aboriginal and Torres Strait Islander people is lacking. Understanding and measurement of wellbeing for this population is critical in achieving health equity. This paper aims to identify and describe the foundations of wellbeing for Aboriginal and Torres Strait Islander adults. This national qualitative study was underpinned by an Indigenist research approach which privileges the voices of Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander adults were purposively recruited from around Australia between September 2017 and September 2018 to participate in Yarning Circles, led by Aboriginal and Torres Strait Islander researchers. Yarning Circles were audio recorded, transcribed and analyzed. A Collaborative Yarning Methodology was used, which incorporated reflexive thematic analysis to identify and describe the foundations of wellbeing reported by participants. A total of 359 Aboriginal and Torres Strait Islander adults participated. Our analysis revealed five foundations of wellbeing: belonging and connection; holistic health; purpose and control; dignity and respect; and basic needs. These foundations were deeply interwoven by three interconnected aspects of Aboriginal and Torres Strait Islander life: family, community and culture. The findings of this study will substantially aid our efforts to develop a new wellbeing measure for Aboriginal and Torres Strait Islander adults. The iterative Indigenist methods used in this study provide a robust research methodology for conducting large-scale, nationally-relevant qualitative research with Aboriginal and Torres Strait Islander people. Policies and practices that are informed by our results have the potential to address outcomes that are meaningful for Aboriginal and Torres Strait Islander people.

If there is one thing that should be clear by now to anyone working in the area of Aboriginal and Torres Strait Islander health, it is that biomedical research carried out in isolation from the Aboriginal and Torres Strait Islander community will not significantly improve health outcomes for Australia?s Indigenous peoples.

IntroductionAboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Since settler colonisation, Aboriginal and Torres Strait Islander peoples have experienced disparities in health outcomes, including cancer, when compared with non-Indigenous Australians, including higher cancer incidence and mortality rates, and lower participation in cancer screening programmes. Data to monitor and improve outcomes are limited.Aims, method and analysisThe Kulay Kalingka Study will be a national cohort study aiming to understand Aboriginal and Torres Strait Islander people’s beliefs about cancer and experiences with cancer care and treatment, and to improve experiences and outcomes. It will be nested within the Mayi Kuwayu Study, a national community-controlled cohort study of Aboriginal and Torres Strait Islander people (n>11 000), with supplementary in-community recruitment.Mayi Kuwayu Study participants aged ≥18 years who consented to being recontacted, and a diversity of local community members will be invited to participate through completing a questionnaire relevant to their cancer status, aiming to recruit 2800 participants without prior doctor-diagnosed cancer and 700 with a cancer diagnosis.This community-driven data will enable monitoring and reporting of national trends over time and will guide national cancer control research, policy and clinical care, to improve outcomes for Aboriginal and Torres Strait Islander peoples.Ethics and disseminationThe Kulay Kalingka Study has ethics approval from Australian Institute of Aboriginal and Torres Strait Islander Studies (#EO324-20220414 and REC-0121) and the Australian National University (#2022/465). The Kulay Kalingka Study is being developed with Aboriginal and Torres Strait Islander communities, following the Maiam nayri Wingara Indigenous Data Sovereignty Collective principles. Meaningful, accessible and culturally adapted study findings will be disseminated to Aboriginal and Torres Strait Islander communities through activities including community workshops, reports and feedback sheets, and in other ways as determined by the community. We will also return data to participating communities.

AbstractThe Queensland Aboriginal and Islander Health Council (QAIHC) lead and govern the Centre for Clinical Research Excellence (CCRE), which has a focus on circulatory and associated conditions in urban Aboriginal and Torres Strait Islander communities. The CCRE is a partnership between QAIHC and Monash University, the Queensland University of Technology, the University of Queensland, James Cook University, the National Heart Foundation, and the University of Wollongong. The establishment of the CCRE under the community-controlled model of governance is unique and presents both opportunities and challenges for innovative partnerships between universities and Aboriginal and Torres Strait Islander community organisations. This paper outlines the processes and strategies used to establish a multi-institutional research centre that is governed by the Aboriginal and Torres Strait Islander community-controlled health sector.

High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008–2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.

The aim of this study was to examine the effects of an action research partnership between the Tweed Valley Health Service (TVHS) and the Aboriginal & Torres Strait Islander community for the development and delivery of Aboriginal & Torres Strait Islander Mental Health Services. This partnership was based upon Labonte's (1989) view of empowerment where it is suggested that to be empowered means to have increased capacity to define, analyse and act upon one's problems. It was proposed that the establishment of a 'partnership' based upon these principles would assist in operationalising Indigenous community participation in TVHS planning. To achieve this type of 'partnership', the health service had to be willing to enter the partnership and to give the authority to the Aboriginal & Torres Strait Islander Health Outcome Council to seek and trial solutions on Aboriginal & Torres Strait Islander Mental Health matters. Key outcomes were defined as the extent to which the re-organised services proved to be acceptable and utilised by the local Aboriginal & Torres Strait Islander population. Outcomes were operationalised through measures of service utilisation and consumer satisfaction with accessibility, process and outcomes. The study trialed participatory action research as a method for Indigenous participation in Mental Health Service planning and development and concludes that it is a valid model for cross cultural research and health service development in a complex medical setting.

This paper discusses women’s involvement in their children’s mathematics education. It does, where possible, focus Torres Strait Islander women who share the aspirations of Aborginal communities around Australia. That is, they are keen for their children to receive an education that provides them with opportunities for their present and future lives. They are also keen to have their cultures’ child learning practices recognised and respected within mainstream education. This recognition has some way to go with the language of instruction in schools written to English conventions, decontextualised and disconnected to the students’ culture, Community and home language.

Reduced driver licence participation among Aboriginal and Torres Strait Islander people has significant road safety implications and contributes to transport injury and an overrepresentation of Aboriginal people in prison. Further, reduced licensing contributes to transport disadvantage and may be presenting a barrier to well-being that derives from fulfilling cultural priorities; however, little is known about the relationship between licence participation, social inclusion and health in Aboriginal communities. Licensing support interventions have been implemented in Aboriginal communities, however few are formally evaluated and consequently there is a dearth of evidence that establishes best practice for responsive licensing support. Consequently, this research aims to explore the barriers, facilitators and impact of licence participation in Aboriginal communities in Australia. Underlying this program of research is the objective to develop recommendations that promote equity and ensure interventions build upon the strengths in Aboriginal communities. A mixed methods approach was employed, which was underpinned by a social ecology framework to explore social and environmental inequalities that underlie health disparities. Significant barriers to licensing are attributed to vulnerability and inequity within the licensing and justice system that is pervasively inhibiting access to licensing and subsequently transport for Aboriginal people. Licensing can be addressed by sustained implementation of community-based support programs that are culturally responsive; however this does not comprehensively address the inequity that underlies reduced licence participation. Reduced licensing is not simply a “transport” issue; there are far-reaching consequences and a complex interplay of issues that thwart driver licensing participation in Aboriginal communities. This research has asserted the need for a review of policies that are inadvertently inequitable and the need for an intersectoral approach to promote Aboriginal health and well-being by comprehensively working across policy sectors. Addressing reduced licence participation in Aboriginal communities has the potential to create generational change across multiple sectors including health, human services and justice.

Research Doctorate - Doctor of Philosophy (PhD)
This doctoral thesis by publication provides new knowledge in two important and related areas in Aboriginal and Torres Strait Islander health. Firstly, the thesis investigates opportunities in primary health care for reducing some of the major contributors to the health disparity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. It suggests that strategies are needed to better support patients and GPs in accurately identifying patients at risk and also support the need for a continued policy commitment towards these activities. Secondly, where evidence is lacking of effective primary health care interventions, the research aims to inform health and medical research policy to support research that will maximise health improvements for Aboriginal and Torres Strait Islander people. It aims to inform policy-makers, health practitioners, researchers and Aboriginal and Torres Strait Islander communities on opportunities for health gains that are evident in primary health care and through more targeted health and medical research. One of the key findings of this doctoral research is the lack of intervention research being conducted specifically in Aboriginal and Torres Strait Islander health. It identifies the lack of research outputs that can be used to inform clinical practice as well as health policy and programs. The findings offer strategies that may be able to be implemented into policy to address barriers to increasing the amount of high quality intervention research being conducted in Australia. Another key finding is that research funding disproportionally funds descriptive research rather than measurement and intervention research. The findings aim to inform future health and medical research funding allocation in a way that targets specific health topics, types of research, as well as disciplines that may result in health gains more quickly due to their ability to more rapidly translate findings into policy and practice. The implications of the research aim to be practical and achievable. In primary health care, improving screening according to evidence-based guidelines will greatly improve the health of Aboriginal and Torres Strait Islander people. Where the evidence is lacking on effective health care strategies specifically targeting Aboriginal and Torres Strait Islander people, strategic research is needed that will create evidence to address the major causes of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.

The concept of ‘artistic terra nullius’ refers to the violent erasure of First Nations peoples in colony Australia and highlights their absence – particularly Aboriginal Women – in the white-dominated arts world. This doctoral research by creative project and exegesis sets out to document and respond to the work of Aboriginal women in art and community. I have used practice-led inquiry as the main methodology, informed by my own roles as artist, writer, curator, community researcher and as a Wemba-Wemba & Gunditjmara, matriarchal and sovereign woman. Practising community ways of 'being, knowing and doing' to witness, participate and respond to Aboriginal women's art making and activism, I developed a new body of visual works and a series of essays, together with an exegesis relating to the project as a whole. The exhibition in December 2019 at Footscray Community Arts Centre held two bodies of work in two spaces. The ontological (or Being) space was a healing space of unconditional love, one of memory, timelessness, and respite. It has been created as 'daily acts of repair' in collaboration with other Aboriginal women and family members in a new process of bush dyeing fabrics, clothing and rags to become 'healing cloths”, dyed with gathered gum leaves, bush flowers, plants and Wemba-Wemba family bush medicine gifted to me from my Aunties. As a three-dimensional space, it makes visible trauma trails and stains and visualises what respite and healing could look and feel like. Under the 1961 flickering Super-8 image of my great-grandmother, this space also recreates ‘home’, particularly resonating with Aboriginal women’s curation of ‘home’ even in Mission housing. The second space, an epistemological (or Knowing) space, was an active studio of photographic based works drawn from matriarchal family stories, both past, present and future, and archival research. It included scholarly and other literature on Blak art and representation, in a recreation of my home studio and office. These bodies of work were made over a four-year project, drawing on concepts of de-colonising, Aboriginal feminist standpoint theory (Moreton- Robinson) and sovereignty. In emphasising making art as both research and artistic outcomes, I demonstrate art as a sovereign act, based in cultural practice and sovereign values. Both the exhibition spaces and the exegesis weave across past, present and future, across research in family, community and the Aboriginal women’s arts-work, across multiple creative media and stories – in the process here called ‘Ghost Weaving’. Responding to various modes of oppression, patriarchy and racism, Blak women’s art is not only a form of resistance to colonising, to violence, to academia and the white art world. It is also an ethical foregrounding of other forms of knowing and being. The exegesis is in two main parts: the written, thesis-element and a series of appendices which include a pictorial record of the exhibition, links and lists of related works, including relevant essays.

Indigenous people worldwide face complex historical, social and cultural circumstances that impair their ability to live in safety. In Australia, two in three Aboriginal and Torres Strait Islander women have experienced spousal violence, and Indigenous children are seven times more likely than non-Indigenous children to experience substantiated abuse or neglect. Indigenous community safety is a complex concept that should be based on the self-identified concerns of Indigenous people. Few studies thus far have enquired how Indigenous Australians in rural and remote areas visualise safety in their own neighbourhoods. This study investigates how Kunwinjku Aboriginal people and service providers understand and operationalise community safety in Gunbalanya, Northern Territory. It enquires about the values, behaviours, social norms and controls that influence participants’ perceptions and experiences of harm and safety. An intercultural and strengths-based approach is needed to understand these multifaceted issues beyond simply measuring crime and violence. The study uses social disorganisation and ecological systems theories to understand how community members and service providers manage harmful behaviours and leverage values, attitudes and beliefs which are perceived to enhance safety. This mixed methods research involves long-term fieldwork, undertaken from September 2015 to October 2017 where the majority of residents are Indigenous. Data collection includes 19 semi-structured interviews and 55 questionnaires involving 78 Indigenous and non-Indigenous participants. This intercultural concept of Indigenous community safety: 1) identifies neighbourhood problems which need to be addressed for the community to reduce harm and improve safety; 2) embraces the strengths-based elements of kinship, law and ceremonies; and 3) develops a practical approach to understand how services could better enable positive behaviour change in Gunbalanya. In Gunbalanya, harmful behaviours are multi-layered and intimately interlinked. This concept of community safety has three main dimensions: interpersonal and community harm and the strengths-based values of Aboriginal Law. At the interpersonal level, neighbourhood problems occur amongst close kin relationships where children and elderly persons are most vulnerable. Interpersonal neighbourhood problems include alcohol and substance misuse, interpersonal and family violence, gambling, mental health issues and dangerous driving. These reoccurring patterns of behaviour at the interpersonal level have flow-on effects across the community and articulate in broader social issues. At the community level, distal neighbourhood problems include youth delinquency and fractured parent-child relationships, collective trauma, and intergenerational transmission of violence. Findings from this research suggest that future strategies for addressing these challenges need to build on Kunwinjku values as the foundation for enabling healthy and respectful relationships. At the third level, the values and beliefs in Kunwinjku society promote positive relationships through mutual respect including listening, helping and sharing with each other. These values are practiced through Aboriginal dispute resolution strategies and have the potential for use in formal service delivery. However, ongoing patterns of harmful behaviours are fracturing respect and belief in Aboriginal Law as social norms and controls are less able to manage delinquent and other harmful behaviours. Strengths-based solutions are required to engage elders and young people in a process of transgenerational learning according to the practices of Aboriginal Law.

Australia’s coral reefs stretch far and wide, covering 50 000 square kilometres from the Indian Ocean in the West to the Pacific Ocean in the East. They have been viewed as a bedrock of coastal livelihoods, as uncharted and perilous nautical hazards, as valuable natural resources, and as unique, natural wonders with secrets waiting to be unlocked. Australia’s coral reefs have sustained a global interest as places to visit, and as objects of study, science, protection and conservation. Coral Reefs of Australia examines our evolving relationship with coral reefs, and explores their mystery and the fast pace at which they are now changing. Corals are feeling the dramatic impacts of global climate change, having undergone several devastating mass coral bleaching events, dramatic species range shifts and gradual ocean acidification. This comprehensive and engaging book brings together the diverse views of Indigenous Australians, coral reef scientists, managers and politicians to reveal how we interact with coral reefs, focussing on Indigenous culture, coastal livelihoods, exploration, discovery, scientific research and climate change. It will inform and inspire readers to learn more about these intriguing natural phenomena and how we can protect coral reefs for the future. Cultural sensitivity Readers are warned that there may be words, descriptions and terms used in this book that are culturally sensitive, and which might not normally be used in certain public or community contexts. While this information may not reflect current understanding, it is provided by the author in a historical context. This publication may also contain quotations, terms and annotations that reflect the historical attitude of the original author or that of the period in which the item was written, and may be considered inappropriate today. Aboriginal and Torres Strait Islander peoples are advised that this publication may contain the names and images of people who have passed away.

The health of babies, children and young people is fundamentally different from that of adults, so their healthcare must reflect their unique needs and engage their parents, family members and communities. Paediatric Nursing in Australia and New Zealand introduces nursing students to the care of infants, children, young people and their families in a range of clinical and community settings across Australasia. This third edition includes New Zealand content and an increased focus on families. New chapters cover health services available for Aboriginal, Torres Strait Islander and Māori children, the transition to parenthood for new families, children's sleep patterns and behaviour, and paediatric health in school settings. Case studies and reflective questions encourage students to develop critical thinking and problem-solving skills. Written by an expert team, Paediatric Nursing in Australia and New Zealand equips future nurses with the knowledge and skills to provide evidence-based care to babies, children and their families.

AbstractThis chapter introduces the larger context within which Australian craftspeople and designer makers, like their colleagues elsewhere across the Global North, operate. On the consumer side demand for the handmade or artisanal and increasing interest in making processes themselves, is, we argue, part of a wider pushback against the impositions of the digital into our everyday lives, that is an attempt at a correction or seeking out of balance now that we are a generation into the normalisation of digital communication and other technologies. The chapter introduces the research project the book’s findings are based on including the research design, methods and data that inform the discussions to come. It also briefly outlines the strength of contemporary Aboriginal and Torres Strait Islander craft and designer maker activity.

AbstractConnection with Country, community, and culture lies at the heart of Aboriginal and Torres Strait Islander peoples’ health and wellbeing. Although there is some evidence on the role of cultural identity on the mental health of Indigenous adults, this relationship is relatively unexplored in the context of Indigenous Australian children. Robust empirical evidence on the role of cultural identity for social and emotional wellbeing is necessary to design and develop effective interventions and approaches for improving the mental health outcomes for Indigenous Australian children. Drawing on data from the Longitudinal Study of Indigenous Children (LSIC), we explore social and emotional wellbeing in Indigenous Australian children and assesses whether cultural identity protects against social-emotional problems in Indigenous children. The results show that Indigenous children with strong cultural identity and knowledge are less likely to experience social and emotional problems than their counterparts. Our work provides further evidence to support the change from a deficit narrative to a strengths-based discourse for improved health and wellbeing of Indigenous Australian children.

This chapter examines the importance of culturally responsive relationships-focused pedagogical approaches in engaging Aboriginal students in their learning and the significance of this to improving their educational outcomes. Significantly, the themes and issues raised in this chapter reflect much of the international literature on Indigenous, minority and marginalised students. The following enablers are necessary when implementing culturally responsive relationships focused pedagogies: Engaging with Aboriginal families and community members; Harnessing Aboriginal students' backgrounds, lived experiences and interests as classroom resources; Implementing innovative place-based curriculum approaches, and Exploring holistic teacher professional learning opportunities. The combination of these factors creates quality learning environments as places of belonging and socio-cultural support underpinned by mobilising Aboriginal family and community social and cultural capital in the educational process. Once schools and teachers realise the potential of this approach, conditions are created to improve the academic, social and cultural outcomes of Aboriginal and Torres Strait Islander students.

Information Technology is the most versatile technology yet developed. By enabling the components to be altered using a language emulating the spoken tongue, we have a technology that can readily be adapted to new situations. This flexibility is exemplified by the resources provided by the open source community which covers a wide range of applications including communication protocols, file conversions and web services. However the designers of this technology are still located in a cultural milieu which may not accommodate the needs of all users. This chapter looks at how innovative technology and software can meet the needs of some of the most dispossessed people through supporting Indigenous knowledge sharing. In designing Appropriate Technology, engineers consider the technical, environmental, social and economic aspects affecting uptake, as well as cultural suitability. Using this approach, the author considers IT uptake in Aboriginal and Torres Strait Islander communities across Australia.

This article details the construction of a Grounded Theory to explain the concept of enhancing professional learning through mobile devices. The research data was delimited to the behaviours and beliefs of Aboriginal and Torres Strait Islander pre-service teachers enrolled in two community-based initial teacher education programs in very remote communities in Australia. Four educational uses of mobile devices were identified: accessing content, handling administration, collaborating for academic support and sharing personal encouragement. The use of mobile devices enabled adults to choose times of study, choose places of study, complete assessment relevant to their course and achieve a career goal. Three elements that impact the educational use of mobile devices were identified (i.e. context, precursors and catalyst). Seven categories underlie the concept of enhancing professional learning through mobile devices: fostering access, facilitating customisation, promoting collaboration, supporting relevance, completing the course, empowering agency and enabling networking.

This article details the construction of a Grounded Theory to explain the concept of enhancing professional learning through mobile devices. The research data was delimited to the behaviours and beliefs of Aboriginal and Torres Strait Islander pre-service teachers enrolled in two community-based initial teacher education programs in very remote communities in Australia. Four educational uses of mobile devices were identified: accessing content, handling administration, collaborating for academic support and sharing personal encouragement. The use of mobile devices enabled adults to choose times of study, choose places of study, complete assessment relevant to their course and achieve a career goal. Three elements that impact the educational use of mobile devices were identified (i.e. context, precursors and catalyst). Seven categories underlie the concept of enhancing professional learning through mobile devices: fostering access, facilitating customisation, promoting collaboration, supporting relevance, completing the course, empowering agency and enabling networking.

Abstract This chapter takes a fresh look at contemporary contact languages spoken by Aboriginal and Torres Strait Islander peoples. Contact languages are treated here in groupings which are based on broad typological criteria, historical and sociolinguistic data, as well distinctive core language features. There is a north-eastern grouping of English-lexified creole languages spoken in the Torres Strait and on northern Cape York, including Yumplatok, Cape York Creole, and Lockhart River Creole. The Queensland Settlement contact languages are included in a grouping which acknowledges the historical superdiversity of Indigenous residents’ language backgrounds. Mixed languages (Gurindji Kriol, Light Warlpiri, and the less researched Modern Tiwi), are distinguished on the grounds of considerable traditional Aboriginal language material. The periphery of the Kriol speaking area is a dynamic and extensive zone of language contact and diffusion. Each grouping of contact languages is illustrated via case studies.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.