Rozprawy doktorskie: „Indigenous health”

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Angell, Blake Joseph. "Health Economics and Indigenous Health: measuring value beyond health outcomes". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17287.

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Australia has decades of public policy experience attempting to overcome the disparities in health outcomes facing Aboriginal and Torres Strait Islander (Indigenous) Australians. Significant resources have accompanied these policy initiatives, however, Indigenous Australians continue to bear a heavier burden of death, disease, disability and economic hardship than other Australians. Despite the policy experience of Australia and widespread support for initiatives to overcome Indigenous disadvantage, there is little consensus on the best means to actually do so. Working to ensure that available resources are used in their most effective way possible is vital to improving the health of Australia’s Indigenous populations. At its broadest level, health economics is the study of the choices made in the allocation of scarce resources to improve the health status of populations and service delivery. Notwithstanding the political, moral and economic importance of the issue, there remains limited health economic research in the field of Indigenous health nor is there a developed evidence base to provide guidance to policy-makers looking to invest in cost-effective interventions. Further, health economic methods have been criticised as potentially inappropriate for the area of Indigenous health. Current methods for economic evaluation tend to adopt a reductionist approach based on a cost per health outcome paradigm and are potentially insensitive to the outcomes and processes that Indigenous people see to be of value to their health and health care on three broad and related levels. First, Indigenous conceptions of health have been shown to differ from the biomedical notions which tend to underlie the reductionist approach of health economic evaluations. Second, a central tenet of Indigenous health care is community ownership and control of healthcare services. As such there is value associated with how well services achieve engagement with communities which may also be missed through a reductionist health economic approach. Third, social determinants of health have also been demonstrated to be particularly important to the health outcomes of Indigenous Australians but again have tended to lie outside the domain of traditional economic evaluation methods. Potentially because of these and other difficulties, resource allocation decisions in the field of Indigenous health have been made without a strong economic evidence-base and have instead seemingly relied on rights-based arguments promoting investment based on the sizeable need that these communities face. While there is no denying the stark disadvantage facing Australia’s Indigenous populations, such rights-based arguments provide little guidance on how much to invest or on trade-offs between different policy options or individual service components. Further, the weight attributed to such arguments has tended to vary according to the prevailing political climate. Health economic approaches on the other hand, can provide evidence based on value that can transcend politics and lay the foundation for rational priority-setting that maximises the health of target populations. Ignoring the realities of resource scarcity in the sector will not allow policy interventions to maximise the health outcomes for Australia’s Indigenous communities. Health economic methods such as discrete choice experiments (DCEs) and contingent valuation studies have been used to value factors outside of traditional economic evaluations in other fields yet have been largely untested in Australian Indigenous populations. Such techniques potentially represent a direct means through which to incorporate Indigenous values and preferences into the evaluation and design of health programs and ultimately a mechanism for the sector to demonstrate the value and impact that properly designed services can have. There is limited empirical understanding of the role of culturally-specific healthcare providers in terms of the service use patterns of these communities and overcoming the barriers that face Indigenous Australians attempting to access health services. Examining these issues through an economic lens is likely to provide a level of guidance to policy-makers that is currently absent from Indigenous health policy in Australia. This thesis explores these issues through a mixed-methods approach investigating the application and merits of a variety of health economic methods in these populations. Chapter 1 introduces the major issues in the field and provides an overview of the published literature carried out to date. Chapter 2 presents a more detailed investigation of the economic evaluation literature with a systematic review of published economic evaluations investigating health interventions in Indigenous populations around the world. The review finds relatively limited economic evaluation of health care interventions for Indigenous populations in Australia or globally, however, what has been done has demonstrated the potential for cost-effective interventions in these populations. Almost no consideration of alternative conceptions of health or Indigenous-specific values were found through the review. Chapter 3 examines this issue further, investigating the use of health-related quality of life (HRQoL) instruments in these populations, one of the most direct method to incorporate Indigenous conceptions of health into evaluations of health programs, through a systematic review of the use of these instruments in Indigenous populations around the world. The review found that while HRQoL instruments have been used to elicit the quality of life of Indigenous populations their use was relatively limited, as was evidence of the validation of these instruments in these population groups. The evidence that does exist suggests that some Indigenous populations potentially conceptualise these issues fundamentally differently to populations in which these tools have been designed and validated. Chapter 4 discusses the findings of the reviews presented in Chapters 2 and 3 in light of the Australian policy context. The chapter argues that the policy environment has emphasised rights-based rather than economic arguments in resource allocation decisions that has left room for efficiency and equity improvements in the way that resource allocation decisions are made in the field of Indigenous health. Given this, the chapter calls for further work to investigate the service utilisation of Indigenous populations and the role of culturally-specific healthcare providers and incorporate Indigenous values to value programs to improve Indigenous health including through contingent valuation and discrete choice experiment methodologies. Chapter 5 takes up the first of these issues with an analysis of the healthcare expenditure of a cohort of Indigenous and non-Indigenous Australians at high-risk of cardiovascular disease to investigate the relative service utilisation of the two groups. The analysis finds that when individuals are engaged with care providers, culturally-specific providers were providing equivalent care to mainstream providers in non-remote areas and factors other than patient Aboriginality seem to be more important in determining the healthcare expenditure of these high-risk patients. The chapter also highlights problems with current data collections in the field that acts to obscure analysis of service utilisation patterns of Indigenous Australians, particularly in remote areas, and comparisons between the relative service use of Indigenous and non-Indigenous Australians. Chapter 6 further investigates the role of culturally-specific service providers through a DCE attempting to value the cultural component of a fall-prevention service. The chapter presents the findings of a DCE carried out in a cohort of older Aboriginal people receiving a culturally-specific fall-prevention intervention. The chapter demonstrates that DCEs provide a potential means to incorporate the preferences of Indigenous communities into the design and evaluation of health services. A value for the cultural component of the service was derived through the DCE and the relative importance of different barriers to care to the decision-making of the participants were investigated. Chapter 7 presents the findings of a contingent valuation study investigating the value that the Australian community places on holding a driver licence as an example of a social determinant that has been shown to be associated with positive health outcomes in Indigenous populations. The analysis finds contingent valuation techniques can provide a means to value social determinants of health that lie outside traditional health economic evaluations and to value broader policy interventions to improve living standards. Chapter 8 puts forward the main findings of this thesis arguing that the health economics field has an important role to play in improving the health of Australia’s Indigenous populations. Appropriate targeting of available resources is essential to close the gap in health outcomes between Indigenous and non-Indigenous Australians. Economic research is vital to build an evidence-base for policy makers looking to invest in cost-effective policy options and this needs to be based on factors that Indigenous communities consider important to their health and healthcare. Potential for economic evaluation of programs needs to be a key consideration in resource allocation decisions in the field. These need to be robust enough to incorporate the factors that are important to Indigenous Australians. The role of culturally-specific providers needs to be better understood as do the different components that make up such a service. Finally, incorporating social determinants of health into the health policy environment remains crucial in the field of Indigenous health. Given the political, moral and economic importance of overcoming the disparities faced by Australia’s Aboriginal and Torres Strait Islander communities, the relative lack of health economic research in the sector is a failing of the field in Australia. Building an economic evidence base will assist those working in the sector to demonstrate the value of appropriately designed, culturally acceptable healthcare services and decision-makers in the field to move beyond rights-based arguments for funding decisions. Collectively this will enable a system of rational priority-setting in the sector whereby the health impacts derived from scarce resources are maximised.

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Andrews, Sonia. "A study of health inequality between Indigenous and non-Indigenous Australians". Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/1418.

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The health disadvantage of Indigenous people in Australia has been recognised for a long time. The reasons for this poor health status are considered to be complex and multi-faceted. Socioeconomic status, socio-cultural factors, access to quality healthcare, environmental factors and risky behaviours are considered the major factors affecting Indigenous health. Despite this, very little progress has been made in reducing the health inequality between Indigenous and non-Indigenous Australians.This thesis examines the health inequality between Indigenous and non-Indigenous Australians. First, the thesis investigates the gap in subjective and objective health outcomes between the two populations. The health outcomes include self-assessed health, chronic diseases and injury. Second, it looks at the relative contribution of four factors to the low health status of Indigenous Australians, viz.: demographic, behavioural, socio-economic and cultural. Third, as the Indigenous population is not a homogenous group, the thesis analyses separately the health status of different groups relative to non-Indigenous people. Fourth, the extent of association of each of the four factors to the health outcomes is examined. In addition, similar analyses are undertaken for healthcare utilisation.The thesis finds that only a minor proportion of the gap in health outcomes can be explained by observable demographic, behavioural and socio-economic characteristics. The removal of Indigenous people from their natural families (especially that of relatives) as part of the ‘assimilation policy’ is a major contributing factor to the health status gap between Indigenous and non-Indigenous people. The better socio-economic and behavioural status enjoyed by Indigenous people who experienced removal from their natural families does not improve their health status compared to those who did not experience any removal. Policies to address the trauma and grief associated with past policies of removal are needed if the gap in health status between Indigenous and non-Indigenous Australians is to be closed.

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Paradies, Yin Carl. "Race, racism, stress and indigenous health /". Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002514.

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Mbuzi, Vainess Banda. "Understanding Indigenous people’s experiences of acute health care with a focus on heart health". Phd thesis, Australian Catholic University, 2020. https://acuresearchbank.acu.edu.au/download/40626310ee5a3fd6023840c44f246c2c91a0e6cda381bd74a9f0e71e00725fec/16415877/Mbuzi_2020_Indigenous_People%27s_Experiences_Focus_On_Heart_Health.pdf.

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Overview The program of research presented in this thesis was designed to increase understanding of the central issues related to Indigenous peoples’ hospitalisation experiences. Emphasis was given to Indigenous peoples’ cardiovascular health care. This area was chosen because cardiovascular disease has been described as one of the major contributors to the health disparity between Indigenous and non-indigenous peoples in Australia. This was of interest to me because the main study setting is a cardiothoracic hospital. This hospital is the largest referral centre for cardiac conditions in Queensland, surrounding states, and neighbouring countries, including Papua New Guinea. This program of research comprised four studies. The first study, a metasynthesis, was undertaken to gather a worldwide perspective of Indigenous peoples’ experiences of acute care. In the second study, a narrative inquiry was undertaken. It focused on Indigenous Australians’ experiences of acute cardiac care. The third study was a systematic review. It adopted a broader perspective to investigate the effectiveness of Australian Indigenous cardiovascular health programs. The final study, an autoethnography, utilised reflective inquiry to examine issues related to researching with Indigenous people. Background There are many explanations given to explicate sources of health disparities for Indigenous people. Most of the factors have their roots in past colonialism and its policies. Past practices by former Australian governments devalued the Indigenous culture, tortured individuals both physically and psychologically, and effectively marginalised the Indigenous population. Indigenous people still experience elements of tacit and overt discriminatory practices within the healthcare system. A range of cultural and Indigenous-specific factors also impact Indigenous health in a negative way. As a result, Australian Indigenous people encounter noteworthy health inequalities when compared to non-Indigenous Australians. In recognition and response to this disparity in health status, the Australian government launched a “Close the Gap” campaign in 2008. The campaign attempts to narrow the health differences and life expectancy, while also considering other factors that impact Indigenous health such as education and employment opportunities. Coming to hospital is a challenge for most Indigenous Australians. In Australia, Indigenous people are often geographically isolated in scattered settlements, and living in relatively small communities, leading to fragmented services and support for health and social programs. They are isolated both geographically and culturally when they come to hospital. In most cases, they have to relocate in order to access the services they need. This experience can be overwhelming due to the different culture of hospital practices and world views of healthcare professionals, who are mainly from westernised backgrounds. In most healthcare settings, Indigenous peoples’ culture and views of health have not been integrated into mainstream health. In a way, Indigenous people are forced to leave their way of life at home and adapt to western culture when hospitalised. This can cause discomfort for Indigenous people in many ways. As a result, some avoid accessing health services even when such services are needed and are available to them. A few aspects of Indigenous culture may be presented in hospital settings but usually at tokenistic or symbolic levels. This includes items such as flags at the front of the hospital and Indigenous paintings on display. Health professionals’ attitudes, as well as the hospital policies that guide their practice, do not usually accommodate Indigenous values into practice. Bedside manners and ward practices have remained the same for many years – fashioned and practiced in the ways of the dominant culture. In Australia, cardiovascular disease is known to constitute one of the major single causes of ill health and death for Indigenous peoples. As a result, it contributes significantly to life expectancy differentials between this population and other Australians. Indigenous Australians suffer major gaps in health status even when compared with other Indigenous peoples in other first-class nations. This includes Indigenous peoples from Canada, New Zealand and the United States of America. Health practitioners, therefore, need to be aware and proactively act on the underlying causes of poor health outcomes among Indigenous people. Methods Four studies were conducted over the period of this program of research using qualitative and quantitative research methods. The first study was a metasynthesis of qualitative research studies. Its aim was to investigate current evidence of Indigenous peoples’ hospital experiences in order to summarise current knowledge. Systematic procedures were employed to retrieve studies from the period between 2000 to 2016. The review process was conducted following Joanna Briggs Institute (2014) guidelines for conducting systematic review and synthesis of qualitative data. The second study utilised narrative inquiry, a qualitative methodology in which face to face interviews were used to enable participants to recount their experiences of hospitalisation. Narrative inquiry was selected specifically because it involves storytelling, which is culturally familiar to Indigenous people. The aim was to explore Indigenous peoples’ experiences of hospitalisation of acute cardiac care. To accomplish this, data were collected using a purposeful sample of Indigenous cardiac participants: all Indigenous patient participants had been hospitalised for acute cardiac care. The third study was a systematic review. Its aim was to investigate the effectiveness of cardiovascular health care programs designed for Indigenous Australians. Analysis of the strategies that were used to achieve successful outcomes was conducted. Studies that used experimental designs and reported interventions or programs explicitly aimed at improving Indigenous cardiovascular health were considered for inclusion. The search period was between 2008 to 2017. The fourth study was an autoethnography. This study involved use of personal diary-based data and reflective inquiry to present a researcher perspective of the experience of conducting research with Indigenous people. The aim was to share the experience to inform others of aspects for consideration when conducting research with Indigenous participants. The purpose was to offer a true picture of conducting research from my perspective. The study enabled examination of the interplay of my personal, social, professional life and how these impact on my clinical and research practice. Findings The metasynthesis revealed that overall, Indigenous peoples, worldwide, have remained in a disadvantaged position when it comes to their health and wellbeing. Several factors were identified that contribute to widespread inequality in Indigenous healthcare. It was increasingly clear that current healthcare systems are not effectively working well in addressing Indigenous peoples’ health needs. The findings of the narrative inquiry indicated that three themes characterised Indigenous peoples’ experiences of hospitalisation which were as follows: the impact of the past, reality of the present, and anticipating the future in Australia. Hospitalisation remains a challenge for Indigenous peoples. This is due to a sense of dislocation and lack of cultural and spiritual aspects to care, as well as the persisting poor relational interactions encountered. Quantitative research studies that implemented interventions targeted for management of cardiac conditions among Indigenous population within Australia were included in the systematic review. The results revealed that there were limited published studies targeted specifically towards Indigenous Australians’ cardiac health improvement. However, positive outcomes were reported in terms of achieving clinical targets. Physical aspects such as blood pressure reduction, exercise attendance, and enhancing cardiac health knowledge in biomedical interventions for the Indigenous communities were the main focus. The autoethnography revealed that with adequate preparation and involvement of Indigenous people the research process can be made easier. Again, because of past experiences which have led Indigenous people to be over researched with little feedback to them; researching this population group is challenging. Most researchers in the past have conducted research that has not effectively benefited the community. In some cases, research outcomes have misrepresented participants through use of methodologies that are not appropriate for Indigenous peoples. It is not unusual for Indigenous peoples to view the word “research” as a “dirty” word that brings uncomfortable feelings. In some instances, Indigenous participants have not seen its benefits of the research or understood the outcomes. Conclusions In summary, the program of research appraised current evidence. Further, it presented new knowledge that can inform and support practitioners in their quest to progress Indigenous peoples’ healthiness and welfare. Highlighting issues from Indigenous peoples ’perspectives can facilitate development of a better understanding of issues that impact their experiences with healthcare institutions. Such revelations can help in the identification of limitations faced by health professionals or constraints they encounter in the delivery of healthcare among Indigenous people. This could assist in revealing issues that are barriers to being effective in designing and implementing effective strategies to improve Indigenous health and wellbeing. Further research is warranted to follow up on the issues identified in this research.

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Rainie, Stephanie Carroll. "Promoting Family and Community Health through Indigenous Nation Sovereignty". Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/594540.

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BACKGROUND: Indigenous populations in the United States (US) experience worse health outcomes and higher disease prevalence compared to the US all race population. The World Health Organization (WHO), Canadian research on Indigenous-specific determinants, the Harvard Project on American Indian Economic Development, and the Native Nation's Institute have all identified governance as a determinant that impacts community health and development. This dissertation explored the active and potential role of Indigenous nations' governance, since the Native nation building era commenced in the 1970s, in protecting and promoting family and community health. OBJECTIVES: The dissertation aims were to: (1) describe the state of population data for US Indigenous nations and benefits of engaging with data, data sovereignty, and data governance for US Indigenous nations, (2) outline the history and current state of tribal public health relative to other US public health systems, and (3) elucidate the assumptions and applicability of the social determinants of health framework to Indigenous health contexts. METHODS: This mixed-methods study integrated retrospective quantitative and primary quantitative and qualitative data from case studies with six reservation-based American Indian tribes with qualitative data collected in a focus group and two consensus panels of public health practitioners and scholars. RESULTS: The results by aim were: (1) self-determination with regard to health and other population data offers Indigenous nations opportunities to create and access relevant and reliable data to inform policy and resource allocations, (2) the federal government and others have not invested in tribal public health authority infrastructures in ways similar to investments made in federal, state, and local public health authorities, resulting in tribal public health systems falling below other public health authorities in function and capacity, and (3) underlying Euro-Centric assumptions imbedded in the social determinants of health framework reduce its applicability in Indigenous health contexts. CONCLUSIONS: This study contributes to understanding the roles of Indigenous nation self-determination and sovereignty in defining health to align with Indigenous philosophies of wellness. Guided by Indigenous-specific determinants of health, tribes can set community-based, culture-informed methods and metrics for establishing, monitoring, and assessing public health policies and programs to support healthy communities and families. RECOMMENDATIONS: Indigenous nations, in partnership with researchers and other governments as appropriate, should develop framework(s) for tribal health that include broad, shared, and nation-specific definitions of health, healthy families and communities, and health determinants. Federal, state, and local governments should partner with Indigenous nations to improve tribal public health infrastructures and to support tribal data sovereignty and data governance through building tribal data capacity, aligning data with tribal self-conceptions, and forming data sharing agreements.

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Williams, Llewellyn Joy. "Indigenous Australia in media: A portrait of health". Thesis, Indigenous Heath Studies, 2001. http://hdl.handle.net/2123/5707.

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The television media is a powerful tool in forming and influencing the general public on various issues and opinions. It has the potential to change and create a positive or negative effect on the peoples view of the world and the environment they live in. When positively viewed media can create an environment conducive to change. However, negative views will have the far reached outcomes unprecedented in many cases and time. The negative view can be a problem when the media, in particular television starts to create a negative portrayal of a particular group. The purpose of this Thesis is to investigate whether television reporting of Indigenous issues and peoples have an effect on their quality of life and in particular health. The methodology used in this Thesis is of a qualitative nature, which consisted of a series of interviews and literature reviews. The findings indicate that media, and in particular television have a negative view of Indigenous issues and portray the Indigenous people negatively. Such negative portrayals have adverse effects on the quality of life, in particular health, of Indigenous people and their communities. It is recommended that necessary Code of Practice to be developed by the relevant government agencies in partnership with the Indigenous communities, to make sure that the programmes are free from misused information on disadvantaged groups and in particular Indigenous peoples. Furthermore an Affirmative Action for employment of the Indigenous workers in media will go a long way to improve the current portrayals of the Indigenous Australians.

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Coates, Anna R. "Health, reproduction and identity : indigenous women of Chiapas, Mexico". Thesis, London School of Economics and Political Science (University of London), 2006. http://etheses.lse.ac.uk/1861/.

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Women are central to Primary Health Care strategies because of their social reproductive roles as family health carers, the health implications of biological reproduction, and the focus on family planning within related services. Such factors ensure that women have a close relationship with health policy and institutions. This thesis analyses the negotiation of differing paradigms of health and reproduction by indigenous women in the community of Amatenango del Valle in the southern Mexican state of Chiapas in relation to their ethnic and gender identities and to the context of social, economic and political marginalisation. The analysis reflects upon the divergence and convergence between this negotiation and the formulation of policy and service provision. The conceptual framework of pluralism and subjectivity is applied both to understandings of "Western" and "traditional" health paradigms as fluid and intersecting, rather than fixed and oppositional, as well as to the multiple and unfixed nature of indigenous women's identities. Concepts of pluralistic health and hybridity drawn from post-colonial and postmodern feminist theories allow space for envisioning women's agency to negotiate different health services and reproductive decisions, albeit in ways strongly mediated by the context of poverty and marginalisation. The discussion of policy formulation and the case study data reveal how pluralism is often accommodated at the level of the individual, rather than being recognised in policy and provision of services. The findings also illustrate how the historical and contemporary marginalisation of indigenous peoples affects the health status of women and their families and their utilisation of services, including family planning services. The thesis concludes that learning from the ways in which women negotiate services, particularly those multiplistic services of traditional providers, could result in the formulation of policy and the implementation of programmes which more effectively meet health and reproductive needs and better respect cultural diversity.

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Parter, Carmen. "Decolonising public health policies: Rightfully giving effect to Aboriginal and Torres Strait Islander peoples’ knowledges and cultures of ways of being, knowing and doing in public health policies". Thesis, University of Sydney, 2021. https://hdl.handle.net/2123/24415.

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This thesis details how the current health system consistently fails to incorporate Indigenous ways of knowing, being and doing. Using the Intervention Level Framework and the 3Es (enact, embed, and enable), the thesis demonstrates the ongoing coloniality and systemic racism of Indigenous public health policymaking and health systems in Australia. The research cogently demonstrates the need for greater self-determination and control of Indigenous affairs by Indigenous people, the necessity of privileging Indigenous voices, and Indigenous control, direction, and co-design a public policy-making, and the requirement to disrupt, deconstruct and decolonise Western knowledges and cultures of ways of being knowing and doing in order to move beyond colonial imperialist traumatic approaches to Indigenous public health policy which continue to this day. The research provides identifiable and concrete leverage points in the system which can be used to transform those racialized rules and norms to achieve sustainable transformational systemic, organisational and individual change such as legislation, statutory bodies and government commitments underpinned by the need to overcome deep-seated resistance to changing status quo mindsets and beliefs in order to address Indigenous oppression and disadvantage and implement Indigenous culture once it has been incorporated into a public policy. The findings fundamentally call for a turning away from white possessive logics and willingness to deeply listen with an open heart and open mind in genuine partnership with Aboriginal and Torres Strait Islander people so as to decolonise and Indigenise health systems and policy-making, including non-Indigenous people and governments being held to account and relinquishing power and control over Indigenous affairs in favour of localised place-based community-led approaches based on relatedness, connectivity, respect, reciprocity, reverence and responsibility.

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Ojelade, Ifetayo Iyajoke. "Use of Indigenous African Healing Practices as a Mental Health Intervention". Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/cps_diss/36.

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The purpose of this qualitative study was to describe the ways in which Orìsà priests and their clients conceptualize issues and concerns described by Western based approaches as mental health problems. The two research questions guiding this inquiry included: (a) how do Orìsà priests and their clients conceptualize issues and concerns associated with mental health problems in Western psychology and (b) what methods and techniques do Orìsà priests and their clients use to address issues or concerns associated with mental health problems in Western psychology? This study was grounded in African-centered theory by providing a cultural lens to guide the research design, data collection, and analysis. Data were collected during semi-structured individual interviews with four Orisa priests in a three phase model, for a total of 12 interviews. The study also included three focus groups (six informants per group), who did not participate in the individual interviews. Each group met for two sessions, for a total of six focus groups. Bracketing of assumptions by research team members and use of a reflexive journal was used to ensure credibility and dependability of the data (Creswell, 1998). Data analysis consisted of a recursive process divided into multiple steps, to help strengthen methodological rigor and verification of study procedures. The three part process included codebook development, code application, and data analysis. Three major themes emerged from the data. The first theme, The Conceptualization of Mental Health Problems as Spiritual Matters included one subtheme, Transgenerational Transmission. The second theme, Origins of Mental Health Problems, included three subthemes (Western Socialization, Spiritual Forces, and Ifa as a Healing System). The final theme, Addressing Mental Health Problems, included three subthemes (The Divination Process, Referrals, and Western Therapy). Results of this study indicate that respondents primarily conceptualize mental health problems as spiritual matters and seek to address these problems with the help of an Orìsà priest. In addition, some respondents sought the services of a Western trained therapist for the same issue. Practice and research implications are discussed.

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Koyuncuoglu, Leyla Maria. "Understanding the Health Needs among Indigenous Mayan Communities of Lake Atitlan". Thesis, University of North Texas, 2020. https://digital.library.unt.edu/ark:/67531/metadc1707368/.

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Considering the changes the Lake Atitlan, Guatemala region has undergone in the last several years, ODIM (Organization for the Development of the Indigenous Maya) seeks to understand the needs of the San Juan La Laguna and San Pablo La Laguna communities, and to provide competent, culturally-aligned care that is affordable to the Indigenous Maya of this region. Using mixed-methods approaches that incorporate interviews, surveys, graphic anthropology, and evaluation methods, this study investigated (1) the formal and informal health care services (including those offered by ODIM) and how and why they are utilized by local Guatemalans, (2) Guatemalan perceptions and experiences of health, wellbeing, and illness to understand how they might influence health related behavior, and (3) community health care needs and how ODIM can fill those needs. These objectives served to inform key stakeholders of current gaps in healthcare services, provide feedback regarding the ODIM health services and programs, and provide insight into the current health needs in order to ameliorate the burden of disease and illness around Lake Atitlan, Guatemala. This study produced a comprehensive community health profile, and it discusses the current state of health care, explains the local perspectives of health care, and gives direct feedback and recommendations to ODIM's community health programs.

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Hester, Rebecca J. "Embodied politics : health promotion in indigenous Mexican migrant communities in California /". Diss., Digital Dissertations Database. Restricted to UC campuses, 2009. http://uclibs.org/PID/11984.

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Suggit, Daniel Richard. "A Clever People: Indigenous healing traditions and Australian mental health futures". Thesis, Canberra, ACT : The Australian National University, 2008. http://hdl.handle.net/1885/12051.

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Indigenous Australians are currently hospitalised for mental health disorders at significantly higher rates than members of the non-Indigenous population. In this context, the development of effective Indigenous mental health service delivery models in remote, rural and urban areas continues to be a national priority. Traditional forms of healing are fundamental to Indigenous societies across Australia. Anthropologists, linguists, psychiatrists, psychologists, psycho-analysists and Indigenous healers themselves have recorded and discussed many localised traditions of healing over the last 100 years. This paper presents an overview of this significant Australian heritage and proposes that the challenges which face mental health service delivery within many Indigenous communities may be addressed in part through the recognition of the intellectual, religious and therapeutic bases of Indigenous healing traditions.

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Cartwright, Elizabeth 1959. "Malignant emotions: Indigenous perceptions of environmental, social and bodily dangers in Mexico". Diss., The University of Arizona, 1998. http://hdl.handle.net/10150/282765.

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This dissertation is based on ethnographic fieldwork conducted in San Pedro Amuzgos, Oaxaca and on La Coasta Hermosillo, Sonora, Mexico. In it I trace the movements of migrant farmworkers who come from southern Mexico to work in the grape fields of Sonora. Within that context of movement and change, I focus on understanding how illnesses are perceived and how they are healed. First I explore this issue, in depth, in their homeplace in rural Oaxaca. I follow specific illness events among residents of Amuzgos and I allow individuals actions and their reflections on those actions act as a corrective to static notions of the "Latino Folk Illnesses" that exemplify the way in which residents of this small village conceptualize their bodily problems. Local understandings of illnesses are embedded in the village as a specific Place where the topography of the village is inhabited by dangerous spirits that cause health problems for the Amuzgos. To heal, is to heal the Place where negative things occurred as well as the bodies that manifest negative symptoms. Following the Amuzgos up to the fields of Sonora, I focus on how the changing environmental context influences their perceptions of the sources of illnesses and the ways in which they treat them. In particular, I focus on the ways in which they conceptualize the health problems that arise from exposures to the pesticides that are ubiquitous in the fields and camps where they live and work.

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Bentsi-Enchill, Adwoa. "The elimination of indigenous wild poliomyelitis in Canada: A methodology for documentation". Thesis, University of Ottawa (Canada), 1994. http://hdl.handle.net/10393/6636.

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This thesis was conducted to establish the background for a plan to document the elimination of indigenous wild polio in Canada. Three independent studies were conducted to address the adequacy of polio detection in Canada: (a) a critical review of the existing surveillance system for poliomyelitis in Canada; (b) a retrospective chart review of acute flaccid paralysis (AFP) cases presenting in the Ottawa-Carleton Regional Municipality during a 5-year period (1986-1991); and (c) a cross-sectional survey in Ottawa-Carleton of physicians' awareness about the presentation of poliomyelitis, and their investigative practices for AFP in general. The overall conclusions from the chart review and the physician survey are that among physicians in the study region (a) the index of suspicion for paralytic poliomyelitis is very low, and (b) overall knowledge about the presentation of polio, appropriate diagnostic tests, and requirements for notification are poor, or else not adequately applied. On the basis of the above findings, the conclusion is that Canada does not currently meet the PAHO requirements for certification of a polio-free status. In addition, there is insufficient evidence from the data obtained for the supposition of wild polio elimination in Canada. Recommendations are presented for improving polio surveillance and for establishing protocols for investigation and control of polio. (Abstract shortened by UMI.)

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Mcguire-Adams, Tricia. "Anishinaabeg Women's Wellbeing: Decolonization through Physical Activity". Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37366.

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Settler colonialism has detrimental effects on the health and wellbeing of Indigenous peoples, as seen, for example, in the disproportionately high rates of chronic diseases experienced among Indigenous peoples. Indigenous peoples in Canada experience higher levels of ill health related to obesity, diabetes, and other chronic conditions than non-Indigenous people. Indigenous women experience greater incidents of chronic disease than men and are thus particularly vulnerable to ill health. Current research has focussed on documenting the health disparities between Indigenous and non-Indigenous peoples. While insightful, health disparity research reproduces settler colonial discourses of erasure and provides no meaningful or lasting solutions for addressing these disparities, thus demonstrating the need for Indigenous-led thinking regarding potential solutions. Therefore, the guiding research question for my dissertation was, “Can physical activity that encompasses a decolonization approach be a catalyst for regenerative wellbeing for Anishinaabeg women?” Using Indigenous feminist theory that is informed by Anishinaabeg gikendaasowin, I looked to the dibaajimowinan of Anishinaabeg women, Elders, and urban Indigenous women, which occurred in three stages of research and culminated in five publishable papers. In the first stage of research, I interviewed seven Anishinaabekweg who are exemplars of decolonized physical activity. In the second stage of research, I held a sharing circle with eight Elders from Naicatchewenin in Treaty #3 territory. In the last stage of research, I implemented Wiisokotaatiwin with 12 urban Indigenous women with the Odawa Native Friendship Centre, my community partner. The results of my research revealed that wellbeing for Indigenous women can be improved through decolonized physical activity, remembering Anishinaabeg stories, and building community in urban spaces. More specifically, these activities are important resistance tools that can lead to meaningful ways of addressing embodied settler colonialism and can also make strong contributions to Indigenous health research. Overall, my research showcased how Anishinaabeg gikendaasowin can be used as a foundation to improve Indigenous women’s health and wellbeing.

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Mahumana, Narciso António. "Rethinking indigenous medicine : illness (mis)representation and political economy of health in Mozambique's public health field". Thesis, University of Sussex, 2015. http://sro.sussex.ac.uk/id/eprint/58511/.

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This dissertation was motivated by the misrepresentation of, and apparent lack of knowledge about, indigenous medicine in Mozambique. This consequently raised the need to reveal the epistemologies of health, illness and healing; rewrite the historiography; and develop the knowledge of and about this medicine. The dissertation analyses illness representation and the political economy of health. The thesis defended is that indigenous medicine is a form of medical knowledge and practice that represents its illness, therapy and efficacy according to specific epistemological foundations, rooted in the local society and culture yet it has been misrepresented by local discourses, agencies and practices that battle to control health resources, knowledge and power in Mozambique. Within this, biomedical health paradigms, bodies, and representations have been imposed onto an imagined Official National Health Service (ONHS) whilst people, on the other hand, represent, legitimise, and seek therapy simultaneously in different epistemologies and practices of medicine within the therapeutic landscape creating a Contextual National Health Service (CNHS). This political economy of health is contingent on historical, socio-economical, political and geopolitical productions and constructions of health and efficacy within Mozambique's public health field. Research and health development needs to rewrite the historiography of indigenous medicine based on ethnographically sensitive material and linguistic competence. The construction and justification of this argument is made in seven chapters. The study was carried out in Maputo City and Manhiça district and relied on participant observation. It also uses a mixture of other qualitative methods which encompassed formal and informal interviews, documenting of life histories, desk review, and participatory learning for action (PLA).

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Corporal, Stephen. "The influence of Identity, Roles and Expectations on Indigenous students studying at university which impacts on building the Indigenous health workforce". Thesis, Griffith University, 2020. http://hdl.handle.net/10072/399431.

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The health of Aboriginal and Torres Strait Islander peoples has been problematic since colonisation. At present, Indigenous health has been prioritised nationally in Australia through initiatives such as the Close the Gap policy and many related activities led by Government, non-government, and Indigenous community organisations. There is a strong move toward Indigenous community led responses to promoting better health and wellbeing for our people. A key part of such community led responses is generating a sustainable Indigenous health workforce. This workforce needs to carry not only the knowledge and skills associated with formal mainstream study and qualifications but also the identity, roles, and expectations of Indigenous people, families and communities themselves. Aboriginal and Torres Strait Islander people have been historically excluded from universities and there remain tensions. The attrition rates of Aboriginal and Torres Strait Islander students in health degrees at Australian universities have been problematic over the past decades. There are many aspects of students’ experiences that can affect their success including institutionalised racism and deficit thinking and the level of academic, cultural, and financial support. Yet, there are deeper aspects of Indigenous students’ cultural identities and associated roles and expectations – extended from both Indigenous and non-Indigenous people – that shape their success. In my role as an Indigenous social worker, student support worker, teacher researcher and student over the past 30 years I recognised the need to understand the ways that students’ cultural, community, and family identities intersect with the identities, roles, and expectations sometimes imposed upon them in universities. The purpose of this study was to explore the significance and effects of identity, roles, and expectations for Indigenous students undertaking health degrees. Indigenous health students navigate a complex range of identities, roles, and expectations that come from community, family members, university staff and teaching academics. In many cases, the identities, roles, and expectations of and upon Indigenous students in their community and family contexts contrast with those launched upon them in university systems. This adds additional pressures to Indigenous students who are seeking to enter the health workforce. Many teaching academics and university staff are completely unaware of – and hence unresponsive to – Indigenous identities and roles. My study explores the complex but often inspiring realities of the student experience in navigating their different worlds of community, family, and university. Using an Indigenous Research Methodology, I interviewed 17 Indigenous health students at different stages of their degrees across diverse disciplines including social work, nursing, medicine, psychology and exercise science in one urban university in Australia. I also interviewed 10 non-Indigenous teaching academics at the same university to develop a rounded perspective on the kinds of experiences Indigenous students might have in the health classroom. Staff interviewees were from health disciplines including social work, medicine, nursing, dietetics, and psychology. I undertook thematic analysis of the interview data to determine key themes relating to identity, roles, and expectations. This process focussed on the Indigenous student experience but also explored teaching academics’ own identities, roles, and expectations and how they may directly or indirectly affect Indigenous students. The sub-themes under identity related to place, kinship, race, colour, and teaching academics’ awareness of student cultural identities. The sub-themes identified under roles were connection to identity, family commitment, community role, transition between community to university, university role, leadership role and health professional role. The sub-themes for expectations included achieving goals, expectations linked to bettering one’s self; high expectations, student perceptions of how academics see them, how academics saw students, academic expectation the same as other students’, expectations lower for Indigenous students. These major themes have crossover which contributes to the complexity of the research of Indigenous people. The findings show that Indigenous students and teaching academics need to be aware of the significance of identity when studying at university. The study shows that identity, roles, and expectations are interlinked in shaping student experience, success, and their developing sense of self as both an Indigenous person and health professional. If an academic is unaware of a student’s identity it may lead to problems that affect the student’s sense of self and welcome at the university. Likewise, if a student is still developing their identity as an Indigenous person, being institutionally identified as an Aboriginal or Torres Strait Islander person at university and by academics and other students can add extra pressure and stigmatisation to the student’s experience of university. Academics, students, and other staff members hence all have a role to play in making a space for Indigenous students to feel welcome and to succeed at university. This includes being aware of the dual roles and universal responsibility. If Indigenous students can be supported to reconcile and build strength from their diverse identities and roles, and resist negative and false expectations, they are better placed to complete their studies and succeed as health professionals. If Indigenous students encounter low expectations of their abilities from teaching academics and other students, they may succumb to negative self-expectations and attrition. If universities, teaching academics, staff and other students can make space for Indigenous students to be stable and strong in their identities throughout their studies, we have a far stronger opportunity to build this workforce to also be stable and strong, connected to Country, and people, and contribute to better health in our communities. This thesis offers some key understandings that will help us and universities to facilitate such spaces for Indigenous health students.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Serv & Soc Wrk
Griffith Health
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Mahoney, Raymond P. "Is identifying as Indigenous good for your health? Investigating the relationship between Indigenous status identification and management of cardiovascular disease". Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/114077/1/Raymond_Mahoney_Thesis.pdf.

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Improving the patient journey for Indigenous people has become an important focus to reduce the rates of cardiovascular disease and address underlying factors contributing to the disparities of care between Indigenous and non-Indigenous people. This study has demonstrated that a culturally safe cardiac outreach service staffed by Indigenous and non-Indigenous people is capable of providing timely evidence based care to the standards of best practice. The findings of this study indicate that racism at an interpersonal, individual, organisational and societal level contribute, interact and conspire to influence the Indigenous patient journey within mainstream health services. Identifying as Indigenous is not good for your health because, significantly, the patient journey commences with the collection of Indigenous status, an act of defining race that reinforces the disparity between Indigenous and non-Indigenous people.

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Zunino, De Ward Leonor. "Innu Minuinniuin: Understanding Ways of Achieving Wellbeing Among the Labrador Innu". Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42594.

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The Labrador Innu lived for millennia in the Quebec-Labrador Peninsula as nomadic hunters. Commencing in the 1950s, successive policies imposed on the Innu by federal and provincial governments brought significant disruptions to their traditional way of life. Today, the Labrador Innu are settled in the communities of Sheshatshiu and Natuashish in the province of Newfoundland and Labrador, Canada. They have maintained their language and culture, anchored in their understanding of territory and their relationship with their ancestral land, and have increasingly asserted their self-determination, including in research. The Innu articulated a Healing Strategy in 2014 after extensive community consultations. The Strategy states that a contemporary return to culture would provide healing to individuals and communities. Healing is important due to the social suffering experienced through sudden forced settlement and schooling in a non-Innu system. These abrupt changes altered the social fabric that had sustained Innu society for millennia. As part of the Strategy, the Innu decided to undertake a study to articulate their concept of wellbeing (minuinniuin) and their process of healing. Wellbeing and healing are intrinsic concepts for Innu; however, these concepts need to be uncovered for health and service providers, and policy makers. Having lived in Labrador and worked for the Innu, I was invited to be part of this community-initiated research. The Grand Chief of the Innu Nation directed that the research involve Innu researchers and utilize Innu ways-of-knowing and knowledge as fully as possible. Innu knowledge, like all Indigenous knowledges, is specific to the place where Innu live and to their experiences. Indigenous concepts of health and wellbeing, connections to land, and cultural identity are wholistically connected and culture-specific. The main objective of this dissertation is to articulate the Labrador Innu understanding of wellbeing and their distinctive process of healing. This qualitative study involves interviews and focus groups with 39 participants older than 16 years of age. This is a dissertation by articles. It consists of a general introduction to Indigenous health inequities, a literature review, a description of the methods, and the results as three separate manuscripts. It concludes with a summary of findings and implications. The first manuscript focuses on the process of developing an Innu framework for health research involving a partnership between Innu and non-Innu researchers. An Innu community-based participatory research (CBPR) framework for health research is proposed where Innu knowledge is foundational to the study. The framework is based on the metaphor of Innu and non-Innu canoeing together in one canoe. Within the space that joins all researchers, Indigenous knowledges are uncovered. This CBPR framework is used in the following two manuscripts. The second manuscript describes the contemporary process of healing of the Labrador Innu. Healing practices have been developed to deal with the historical and contemporary effects of colonialism and Innu people consider them effective. Healing is grounded in self-determination, culture, and non-reliance on bio-medicine. Five stages of healing are described: being “under the blanket”; finding spiritual strength; extending hands out; finding strength and power; and helping others. The findings highlighted the enablement of healing through spiritualities, support from Elders, return to culture, and resistance to negative stereotypes. The third manuscript aims to understand Innu views of wellbeing, and the influence of the land on health and wellbeing. Findings highlight that the experience of being on the land with family and community, learning cultural knowledge, and enacting Innu identity play a major role in enhancing wellbeing. For the Innu, the land sustains wellbeing by emplacing knowledge systems and cultural identity. The work presented in this dissertation contributes to the literature on Labrador Innu population health by highlighting that access to and experience of land build up health and wellbeing by providing and facilitating togetherness, fostering a relationship to all living beings, and enacting culture and a positive Innu identity. The findings add new knowledge to Indigenous health studies literature, particularly Innu health studies – holding promise for reducing health inequities. Implications for research, practice, and policy are also addressed.

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Krwece, Akhona. "Exploring traditional African beliefs with regard to mental health, health-seeking behaviour, and treatment adherence: A systematic review". University of Western Cape, 2021. http://hdl.handle.net/11394/8359.

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Magister Artium (Psychology) - MA(Psych)
Previous research indicates that mental health conditions contribute to the global burden of disease. Despite these findings, issues surrounding mental health are still plagued with ignorance and stigma. In recent years’ mental health has taken priority and is increasingly being recognized as an important public health and development issue. Research has found that belief systems play a crucial role in the conceptualisation of mental health and health-seeking behaviour. The exploration of these belief systems gives valuable insight on issues related to health-seeking and treatment adherence behaviours. This study looks specifically at traditional African beliefs and perceptions of mental health. The motivation of this study is to explore how these beliefs and perceptions impact on health-seeking and treatment adherence behaviours. The study poses the following research question: What current literature exists on traditional African beliefs and perceptions about mental health? To achieve this, the study employs a systematic review methodology to assess the methodological rigour of literature on traditional African belief systems. A systematic search in eleven databases was conducted to find relevant literature published between the years 2008 and 2019 with only qualitative research studies.

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Blackman, Nicole. "Chronic Disease and Injury Prevention Programming for Canada's Indigenous Population". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5165.

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Local public health units in the province of Ontario, Canada, are often the primary source of health promotion and health education resources, but many do not provide programming specific to the Indigenous population. As of January 2018, modernization of the Ontario Public Health Standards requires public health units to work with the Indigenous population in providing culturally appropriate programs and services. The practice question guiding the capstone project was to determine what chronic disease and injury prevention programs exist that are culturally appropriate for the Indigenous population. The purpose of this project was to do an environmental scan and compile an inventory of existing health promotion programming that is culturally appropriate to the Indigenous population. In total, 72 Indigenous-specific programs were identified from the 26 organizations that were included in the environmental scan. Of the 26 organizations, 3 were public health units, 7 were Aboriginal health access centers, 7 were Indigenous friendship centers, 5 were Indigenous health organizations, and 4 were non-Indigenous organizations with an Indigenous component. Results from the capstone project will inform public health units of available, culturally appropriate programs that can be adapted to their local context, thereby addressing a significant gap in the current public health system. This doctoral project aligns with the design of a new model of care in the Ontario public health system and has the potential to address a gap in practice at both the local and provincial level by providing culturally appropriate guidance in the effective delivery of CDIP programming specific to the Indigenous population. This positive social change would impact the health status of this underserved population.

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Priego, Hernández Jacqueline. "Sexual and reproductive health among indigenous Mexican adolescents : a socio-representational perspective". Thesis, London School of Economics and Political Science (University of London), 2011. http://etheses.lse.ac.uk/364/.

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In this thesis I advance a socio–representational perspective on sexual and reproductive health as constructed by indigenous Mexican adolescents. The social and psychological literature on health among indigenous populations and on adolescent sexual health is reviewed. It is argued that a socio–psychological perspective is needed to understand the resources through which contemporary indigenous youth, a population overlooked by research, make sense of their sexual and reproductive health. In generating the theoretical tools to tackle this issue, I adopt a dialogical approach to social representations theory to sharpen Jovchelovitch’s (2007) model of knowledge encounters by proposing a typology of potential outcomes of these encounters. The empirical research involved female and male indigenous adolescents in two social contexts: rural and urban. In–depth individual interviews, focus group discussions and unstructured observations were employed for data elicitation. Results from the interpretative thematic analysis performed are presented through a ‘funnelling’ approach whereby the interdependent engagements of indigenous adolescents with their social context, their partners and specific health beliefs are discussed by highlighting nuanced differences in relation to social context and gender. Key findings are related to the understanding of romantic relationships in terms of stability and continuity, which impacts on the way that sex and contraception are perceived and experienced. Results also reveal that, in dialogue with others, adolescents come to identify alternative ways of positioning themselves with regards to customary discourses about sexual health. Focus group discussions are further examined through a dialogical analysis of interactions that aim to identify, in sociodialogue, the outcomes of knowledge encounters initially proposed. A further data–driven outcome is subsequently added to the typology and analytical categories are refined. Implications for health promotion in terms of the reflexion entailed in dialogue are offered in the conclusion chapter.

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Williams, Julie. "Intersections Between Violence and Health Promotion Among Indigenous Women Living in Canada". Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39152.

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Violence against Indigenous women is a major public health concern worldwide and Canada is no exception. Multiple forms of violence inform the broader context of violence against Indigenous women. Nurses are likely to encounter Indigenous women in a variety of settings, but evidence suggests that nurses may lack understandings of violence. This thesis explored the following question: How does extant qualitative research conducted in Canada, contribute to understanding the health and wellbeing of First Nations, Métis and Inuit (Indigenous) women who have experienced violence? During the development of this thesis, significant gaps were highlighted including underrepresentation of Inuit women in the literature, limited focus on health promotion, and lack of methodological approaches to systematic reviews that were participatory and inclusive of the community. Therefore, a secondary aim of this thesis was to privilege perspectives of Inuit women and their communities, by developing a study protocol for a collaborative and community centered approach to reviewing and assessing the extant literature. A configurative and inductive approach based on thematic synthesis was used to systematically search, retrieve, analyze and synthesize extant literature. Post-colonial feminist theory and intersectionality were used as theoretical lenses to emphasize intersections between multiple forms of violence and locate the problem within the broader context of colonization and oppression. Sixteen studies were included in this review, fifteen qualitative and one mixed methods study. Four themes with subthemes emerged based on analysis and synthesis of findings in the included studies: 1) ruptured connections between family and home, 2) that emptiness… my spirit being removed, 3) seeking help and feeling unheard, and 4) a core no one can touch. These themes represent interconnected pathways that influenced health among Indigenous women, and have implications for healthy public policy, clinical practice, and nursing education.

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Cárdenas, Cynthia Giovanna, María Amalia Pesantes i Alfredo Rodríguez. "Interculturality in health: reflections from an indigenous experience in the Peruvian Amazon". Pontificia Universidad Católica del Perú, 2017. http://repositorio.pucp.edu.pe/index/handle/123456789/112542.

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Este artículo presenta y analiza las principales características de la propuesta de interculturalidad desarrollada por una organización indígena amazónica del Perú en la formación de jóvenes indígenas como enfermeros técnicos en salud intercultural. A través de este programa de formación, mostramos cómo la Asociación Interétnica de Desarrollo de la Selva Peruana (Aidesep) se apropia del concepto de interculturalidad, lo resignifica y reconstruye en la práctica. A partir de documentos internos, publicaciones institucionales, testimonios de egresados, dirigentes y miembros del equipo técnico del Programa de Salud Indígena de Aidesep, analizamos la construcción e implementación del concepto de interculturalidad. Este artículo muestra la forma en que una organización indígena se vuelve un actor proponente de la interculturalidad, construyendo una respuesta indígena para la formación de profesionales técnicos, preparados para brindar atención en salud culturalmente apropiada a la población indígena. La propuesta de formación de enfermeros técnicos en salud intercultural demuestra que es posible que la interculturalidad crítica pase del discurso a la práctica cuando los pueblos indígenas construyen propuestas interculturales propias.
This article examines the main characteristics of the proposal on interculturality developed by an indigenous Amazonian organization of Peru for the training of indigenous youth as nurse technicians in intercultural health. It shows how the Interethnic Association for the Development of the Peruvian Jungle (Aidesep) appropriates the concept of interculturality, reconfigures and reconstructs it. Based on internal documents, institutional publications, testimonies of graduates of the intercultural health program, leaders and members of the technical team of the Indigenous Health Program of AIDESEP, we analyze the construction and implementation of the concept of interculturality. We also examin the way in which an indigenous organization becomes a proponent of interculturality, building an indigenous response for the training of health professionals prepared to provide culturally appropriate health services to the indigenous population. The proposal for the training of nurse technicians in intercultural health shows that it is possible for critical interculturality to move from discourse to practice when indigenous peoples develop their own intercultural proposals.

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Block, Corey, Kim Bulkeley i Michelle Lincoln. "Occupational Therapy with Australian Indigenous children and their families: A rural and remote perspective". Thesis, Discipline of Occupational Therapy, 2016. http://hdl.handle.net/2123/14325.

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Background/aim: Occupational therapy service delivery must be adapted when working with Indigenous communities, as there is a diversity of beliefs, values and customs. There are currently no evidence-based models of therapy service delivery to rural and remote Indigenous children and their families. This study aims to explore occupational therapy service delivery to rural and remote Indigenous children and their families. Methods: Semi-structured telephone interviews were conducted with seven occupational therapists with experience with Australian rural and remote Indigenous children and their families. A thematic analysis was conducted on each interview with constant comparison to refine themes across interviews. Results: A total of six service delivery themes emerged from the data gathered in the interviews; flexible and accessible services; tailored services; culturally sensitive therapist; culturally inclusive services; occupational therapy awareness; and collaboration. These results linked with the need for long-term solutions, as the limited access to occupational therapy within these communities is a social injustice. Conclusion: The findings demonstrate that each Indigenous community is unique. Therapists work in collaboration with the community and use their critical reasoning skills to adjust practice accordingly. Significance of the study: This study contributes to growing knowledge about occupational therapy service provision in rural and remote Indigenous communities with children and their families. The findings will assist therapist in these communities to provide culturally aligned services. They also advocate for these communities by emphasising the basic human right violations that Indigenous communities are experiencing by not having access to consistent and culturally appropriate occupational therapy services.

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McLennan, Vanette. "The role of family and community resilience in Indigenous wellbeing". University of Sydney, 2010. http://hdl.handle.net/2123/6237.

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Doctor of Philosophy (PhD)
The alarming rates of ill-health and social disadvantage amongst Australian Indigenous peoples has continued despite improved understanding of the determinants behind these conditions. There appears to be an urgent need to review and re-orientate health and social programs, from a deficit-focused to a strengths-based model, whereby a community’s capacity and resilience is enhanced utilising, and building on, existing strengths and resources. The current study set out to investigate the meaning and role of resilience in the wellbeing of Indigenous Australians. The aim of the study was to examine resilience within an Indigenous context, its potential role in strengthening the Indigenous response to adversity, and the prospective ways in which this may be used in initiatives aimed at boosting health and wellbeing in Indigenous communities. The study involved qualitative in-depth interviews and focus groups within the Indigenous Yaegl community of north-eastern New South Wales. This was achieved through extensive consultation with the community, and a strong commitment to upholding cultural sensitivities and ethical considerations. The data was analysed using a phenomenological framework, involving objective and in-depth thematic analysis, with specific focus on the relationships within the data and their associations with the research questions posed. The study indicates the resilience of the Yaegl community, involving individual, family and community level resilience, involves interdependent protective factors and support structures. The experience of hardship itself, and the ability to employ positive adaptational/coping skills and recruit a variety of protective resources are key to the development of resilience throughout the life continuum. The study demonstrates the importance of these mechanisms not only at the individual level, but also in the resilience of family units and the community. This appears particularly important within the Indigenous context where these levels of functioning are interdependently connected. The study has implications for health and social practitioners looking to broaden their understanding of the Indigenous experience, to one that acknowledges the many existing strengths and protective factors present in Indigenous communities. Practitioners and program developers would benefit from utilising this holistic model of resilience, in which individual, family and community based protective factors play important roles in the prevention of risk and the development of resilience. Programs incorporating this understanding are expected to be more effective in both service delivery and outcomes, because all levels of functioning would be viewed and addressed as interdependent elements in the development of resilience and response to adversity.

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McLennan, Vanette. "The role of family and community resilience in Indigenous wellbeing". Thesis, The University of Sydney, 2009. http://hdl.handle.net/2123/6237.

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The alarming rates of ill-health and social disadvantage amongst Australian Indigenous peoples has continued despite improved understanding of the determinants behind these conditions. There appears to be an urgent need to review and re-orientate health and social programs, from a deficit-focused to a strengths-based model, whereby a community’s capacity and resilience is enhanced utilising, and building on, existing strengths and resources. The current study set out to investigate the meaning and role of resilience in the wellbeing of Indigenous Australians. The aim of the study was to examine resilience within an Indigenous context, its potential role in strengthening the Indigenous response to adversity, and the prospective ways in which this may be used in initiatives aimed at boosting health and wellbeing in Indigenous communities. The study involved qualitative in-depth interviews and focus groups within the Indigenous Yaegl community of north-eastern New South Wales. This was achieved through extensive consultation with the community, and a strong commitment to upholding cultural sensitivities and ethical considerations. The data was analysed using a phenomenological framework, involving objective and in-depth thematic analysis, with specific focus on the relationships within the data and their associations with the research questions posed. The study indicates the resilience of the Yaegl community, involving individual, family and community level resilience, involves interdependent protective factors and support structures. The experience of hardship itself, and the ability to employ positive adaptational/coping skills and recruit a variety of protective resources are key to the development of resilience throughout the life continuum. The study demonstrates the importance of these mechanisms not only at the individual level, but also in the resilience of family units and the community. This appears particularly important within the Indigenous context where these levels of functioning are interdependently connected. The study has implications for health and social practitioners looking to broaden their understanding of the Indigenous experience, to one that acknowledges the many existing strengths and protective factors present in Indigenous communities. Practitioners and program developers would benefit from utilising this holistic model of resilience, in which individual, family and community based protective factors play important roles in the prevention of risk and the development of resilience. Programs incorporating this understanding are expected to be more effective in both service delivery and outcomes, because all levels of functioning would be viewed and addressed as interdependent elements in the development of resilience and response to adversity.

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Johnson, Kirstin Rachel. "Knowledge, health and progress amongst an Akamba population in Makueni District, Kenya". Thesis, London South Bank University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297929.

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Winroth, AnnCristin. "Boteberättelser : en etnologisk studie av boteprocesser och det omprövande patientskapet /". Umeå : Institutionen för kultur och medier, Umeå universitet, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-360.

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Winch, Marie Joan. "Marr Mooditj Foundation : three decades of aboriginal health education". Thesis, Curtin University, 2010. http://hdl.handle.net/20.500.11937/2541.

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This thesis presents a history of Marr Mooditj Foundation, the Aboriginal health worker training college that has for the past thirty years provided culturally appropriate education in primary health care and training for Indigenous staff involved in delivering and managing health care and community service programs. It traces the development of Marr Mooditj from its origins in the context of Indigenous health in the 1970s through to its current achievements and challenges.This auto-ethnographic study, which focuses on my central positioning as an advocate and leader of Marr Mooditj, documents the history of how Marr Mooditj emerged from a context of ‘dis-ease’, where government legislation and the introduction of strict and repressive policies and practices regarding Indigenous people determined an outcome that resulted in a disruption of lifestyle, separation of children from families, serious illness, and an on-going, poverty-stricken separation from the rest of the population. It explores the wide-ranging ramifications of the appalling state of Indigenous health in Western Australia, and the part played by all those involved in establishing and running Marr Mooditj and the Perth Aboriginal Medical Service in working at changing this for the better. The thesis argues that Marr Mooditj Foundation is now deeply embedded within Aboriginal culture, is responsible for delivering culturally safe programs, and can be proud of its contribution to closing the gap between Aboriginal and mainstream health care in Australia.

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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006". Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/3538.

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As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.

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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006". University of Sydney, 2007. http://hdl.handle.net/2123/3538.

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Streszczenie:

Master of Philosophy
As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.

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Jeffs, Lynda Caron, i n/a. "A culturally safe public health research framework". University of Otago. Christchurch School of Medicine & Health Sciences, 1999. http://adt.otago.ac.nz./public/adt-NZDU20070524.120343.

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The concept of cultural safety arose in Aotearoa me Te Waipounamu/New Zealand in the late 1980�s in response to the differential health experience and negative health outcomes of the first nation people of Aotearoa me Te Waipounamu/New Zealand, the New Zealand Maori. It was introduced and developed by Maori nurses initially, as they recognised the effect culture had on health and understood safety as a common nursing concept. The concept of cultural safety has developed into a disipline which is taught as part of all nursing and midwifery curricula in Aotearoa me Te Waipounamu/New Zealand. As cultural safety has developed the concept of culture has been extended to include people who differ from the nurse by reason of: age, migrant status, sexual preference, socioeconomic status, religious persuasion, gender, ethnicity, and in Aotearoa me Te Waipounamu/New Zealand, the Treaty of Waitangi status of the nurse and recipient/s of her/his care. Nationally and internationally, health experience and health outcomes are poorer for people of minority group status than for people who are part of the dominant group. Public-health research is therefore generally conducted on, or with, people with minority group status. Public-health researchers, by education, are members of the dominant culture and may be unaware that their own and their clients; responses may relate to one/other or both cultures being diminished do not always ensure the safety of their own culture or the culture being researched. This study�s objective was to develop a flexible, culturally safe public health research framework for researches to use when researching people who are culturally different from themselves. The study will argue that the use of such a framework will contribute significantly to improved health outcomes for people with minority status and will assist the movement towards emancipatory social change. The methods undertaken included: gaining permission from Irihapeti Ramsden, the architect of cultural safety to undertake the research, conducting a literature review, consideration of primary sources and their key concepts, consulting widely with people in the field of public health and cultural safety, self reflecting on the writers own personal and professional experience and finally designing the culturally safe public health research framework.

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Eades, Anne-Marie. "Understanding how individual, family and societal influences impact on Indigenous women’s health and wellbeing". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17774.

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Introduction This PhD study explores issues of stress, psychosocial health and chronic disease (CD) affecting Indigenous Australian women. It seeks to understand the impact of the roles and responsibilities Indigenous women have in their families and communities on their ability to manage their own health. Background In relation to the social determinants of health, Indigenous Australian women are the most socially and economically disadvantaged women in Australia. They face considerable disparity in relation to their health and wellbeing compared to other women in Australia. Indigenous Australian women are predominantly the sole care providers for close family members and are called upon to support family and community members through extended kinship networks. These women often experience limited educational and employment opportunities as a consequence. Women with such limited opportunities often face a lifelong trajectory of inadequate housing, reduced access to services and poverty. Under these circumstances, Indigenous Australian women suffer a heavy burden of CD and ill-health. Premature mortality due to diabetes, chronic kidney disease (CKD) and cardiovascular disease (CVD) contributes significantly to the gap in life expectancy (LE) for Indigenous women in Australia. Despite the reality of the lived experiences of Indigenous women, positive stories of resilience, strength and outstanding leadership exist throughout the country. These stories are not only remarkable success stories in their own right, they are even more remarkable given that these stories of success and resilience were achieved within a society that had at its structural core, seemingly insurmountable impediments, often present from birth. For example, such impediments saw the author taken home to a tent on the outskirts of town from the hospital following her birth; and until the age of three, she was not counted as a person or citizen of this country. Laws such as the various Aboriginal Protectionist Acts that were in force across Australia from 1838 to the 1970s, reinforced oppression and thwarted the aspirations of many Aboriginal people (Sherwood, 2013). This reality continues to impact on Indigenous people today. As recent as 1980, the author’s own aspirations to become a nurse were seriously eroded by career guidance officers who enthusiastically promoted early school departure and a career as a hospital domestic and cleaner instead of directing her towards further education or a professional career in health. A particularly important focus of this thesis is the research study involving interviews with 72 Australian Indigenous women from four Aboriginal health services in Australia about their roles and responsibilities to their family and community. The author listened to stories of strength, resilience and cohesiveness underpinned by pride and a strong sense of identity and belonging. These women shared how they juggled hectic workplace responsibilities, with having to provide care and support for extended family. This was both a strongly positive factor in their lives, yet the research will also explore the potential impact of their caring roles upon their own health and wellbeing. Methods This study reviewed the published evidence exploring the impact on Indigenous women of living with a CD, and reports on the burden of stress and psychosocial issues for Indigenous women. A systematic review examined intervention programs to address CD and mental health. This review was focused on issues as they affected Indigenous women and highlighted interventions occurring within Aboriginal Medical Services (AMS). Findings from two qualitative research projects are reported. In-depth interviews were undertaken with 21 Indigenous men and women and their healthcare providers as part of the process evaluation accompanying the Kanyini-GAP clinical trial, which aimed to improve health outcomes for people with high cardiovascular risk. In-depth qualitative interviews were also undertaken with 72 Indigenous women from four AMS around Australia to explore their experiences of living with CD and seeking to understand the factors that impacted on their ability to manage their own health. Research findings A review of the literature outlined the historical, social and economic factors that impact on Indigenous women’s health. These social determinants result in a greater incidence and prevalence of CD and premature death. The review also explored the heavy burden of psychosocial stress faced by Indigenous women. A systematic review explored evidence regarding programs addressing CD and mental health or social and emotional wellbeing (SEWB) for Indigenous people. We found a lack of high quality intervention studies, with poor delineation of key outcome measures and indicators of success, and a strong potential for bias in the reporting of results. We were unable to determine the efficacy, cost-effectiveness, or the potential for using programs beyond the original research setting. The in-depth interviews of women from four AMS explored the roles and responsibilities that Indigenous women have in their family and community, and if these roles and responsibilities impacted on the women managing their CD. Women took on significant roles and responsibilities within extended family networks. These responsibilities affected the study participants’ wellbeing and management of their CD was also affected by additional factors such as the incarceration of family members. The heavy burden of CD on the individual, family and wider community was highlighted. The impact of domestic violence is also highlighted, as was the grief related to repeated accounts of death and family members dying. Protective factors that promoted resilience included family support, cultural identity and belonging, education and health service access. The impact upon the author as an Aboriginal woman undertaking this research and the potential for Indigenous researchers to suffer vicarious trauma (VT) through conducting such research is discussed in Chapter 6. Implications of the research The findings presented in this thesis have implications for service delivery, resource allocation and policy development. For Indigenous women to be better able to manage their own health, to support earlier presentation with illness, health maintenance, improved self-management and enhanced quality of life, the extended family and community caring responsibilities of these women need to be taken into account. Better resources to support new mothers, culturally appropriate safe houses for women fleeing family and domestic violence, and flexible models of service delivery to more communities to better accommodate the competing demands placed upon Indigenous women are required to bring about improvements in health and wellbeing.

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Tibbo, Markos. "Productivity and health of indigenous sheep breeds and crossbreds in the central Ethiopian highlands /". Uppsala : Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, 2006. http://epsilon.slu.se/200651.pdf.

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Lavoie, JoseÌe Gabrielle. "Patches of equity : policy and financing of indigenous primary health care providers in Canada". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417833.

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Albert, S. M. "Medical pluralism among the indigenous peoples of Meghalaya, northeast India : implications for health policy". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2014. http://researchonline.lshtm.ac.uk/1856013/.

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Introduction: Meghalaya is a state in northeast India that has a predominantly indigenous population and an age-old system of tribal medicine. There are practitioners of this system in most villages, who use medicinal plants sourced from the state’s vast forest bio-resources. This project studied the tribal medicine of Meghalaya from three perspectives, the healer, the community and the policy maker. It locates tribal medicine within the government’s policy on medical pluralism and seeks to understand how tribal medicine of a local context fits into the national policy of the Government of India. Methods: A mixed methods study design was employed. Estimates of awareness and use of traditional medicine in the community were obtained from the analysis of a household survey. For the qualitative component tribal healers, policy makers, and influential members of the community were interviewed. A combination of in-depth interviews, observations and focus group discussions was employed in the field with healers, while in-depth interviews were the main source of data from policy actors. Qualitative data was analysed using a thematic content analysis approach that incorporated elements of the grounded theory approach. Results: The community - tribal medicine has wide acceptance across the state, 87% believed it to be efficacious and 46 % reported using it in the 3 months prior to the survey. In comparison only 31% had heard of any of the AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) systems that are being promoted by the state and only 10.5% had ever used it in their lifetime. Healers - tribal healers are a heterogeneous group who treat a wide variety of ailments. Their expertise is well regarded in the community for certain ailments such as musculoskeletal disorders, but often their services were sought when patients were dissatisfied with biomedicine. For physical ailments that are culturally understood their services are often the preferred option. Their expertise niches have evolved through their interactions with, and the perceived needs of the community. 16 Policy actors – although there were some appreciative voices, several biomedical doctors and policy makers in the government department of health derided tribal medicine’s unscientific nature. In comparison other systems like Ayurveda and homeopathy were assumed to have scientific merit mainly because of institutionalisation and government recognition of these systems. The comparison with homeopathy is pertinent as its scientific credentials are being increasingly questioned in scientific literature. In contrast those outside the health department, academics, biomedical doctors and other influential members of the community favoured tribal medicine because of its widely regarded efficacy and its cultural value. Neglect of tribal medicine while promoting the imported AYUSH systems was seen as illogical and disrespectful to their culture by the latter group. Conclusions: the current policy in Meghalaya of mainstreaming AYUSH medicine is not supported by locally relevant evidence. It has led to a disproportionate increase in AYUSH doctors in the public sector. It represents a top down approach to policy formulation that ignores local realities. This study demonstrates the importance of contextualising policy to cultural milieus. It emphasises the importance of research in health system development and questions the generalising of policy in a country as diverse as India. The study illustrates the complexities, but points to the potential benefits of supporting tribal medicine in Meghalaya.

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Rikhotso, Steppies R. "Indigenous Knowledge of Traditional Health Practitioners in the management of Rigoni : Grounded Theory Approach". Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/61794.

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Indigenous knowledge of Traditional Health Practitioners (THPs) in the Management of rigoni is of paramount importance for the indigenous practitioners by exploring, describing and documenting their practices. There was limited evidence of the indigenous knowledge of Traditional Health Practitioners in the management of rigoni. The indigenous knowledge healing of rigoni is not documented by the THPs and IKHs, as a result there is limited literature on illnesses that are managed by THPs and IKHs. The main aim of the study was to develop a substantive theory that explains and describes childhood illnesses that are categorised by THPs and IKHs and not documented, thus remain unknown in Vhembe District, Limpopo Province of South Africa. The study was conducted in three sections. The first section dealt with the understanding and meaning of rigoni, the second section focused on exploration and description of the indigenous knowledge of THPs and IKHs in the Management of rigoni and the third section dealt with analysis of the concept “indigenous knowledge (IK) healing of rigoni” with the purpose of developing a substantive grounded theory. Data collection and analysis were concurrently done, where individual, face-to-face interviews were conducted with THPs and IKHs. The findings obtained during the initial and focused coding did not bring out clearly the concepts, thus the concept analysis was sought to assist in the development of the theory. Concept analysis of the concept “Indigenous knowledge healing of rigoni” confirmed the healing practices of rigoni by THPs and IKHs. Traditional health practitioners and indigenous knowledge holders narrated the healing process of rigoni amongst infants and their mothers, though there was lack of written evidence on the indigenous practices, using tacit knowledge as their work is not documented, but shared orally from generation to generation. Due to the undocumented indigenous knowledge of THPs and IKHs, Western medical practitioners label illness such as rigoni as “unknown or ill-defined”, as their laboratory tests and autopsy fail to display the results. Traditional health practitioners and indigenous knowledge holders confirmed that they use various herbal and animal products to comprehensively heal rigoni. The findings also revealed that biomedical practice and indigenous practice does not collaborate for patient care, as the work of THPs and IKHs are considered unscientific by some biomedical health professionals. From the concept analysis, a theoretical definition of “Indigenous knowledge healing of rigoni” was formulated from the concepts which linked together, and ultimately developed a theory. Further studies need to be conducted to facilitate the laboratory testing of the tissue which THPs and IKHs excise from the maternal vaginal wall as a way of treating rigoni. The healing process of rigoni as performed by THPs and IKHs need to be documented. An Indigenous Knowledge System on the healing of illness need to be included in the training of health care professionals, and collaboration between the two health care settings to be fast tracked, as the practise of THPs and IKHs is regulated by Traditional Health Practitioners Act (Act no.22 of 2007). The developed grounded theory will be documented for utilisation in the healthcare institutions, nursing colleges and universities curriculum to assist during the teaching of health care professionals on the diverse care of patients from diverse cultures.
Thesis (PhD)-University of Pretoria, 2017.
University-Based Nursing Education (UNEDSA) University of Pretoria
National Research Foundation (NRF)
University of Pretoria
Nursing Science
PhD
Unestricted

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Bond, Nell G. "Understanding the Emergence of HIV-2 Group F, a Novel, Pathogenic HIV-2 Indigenous to Sierra Leone". Thesis, Tulane University, School of Public Health and Tropical Medicine, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3734417.

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Background: AIDS is caused by infection with pathogenic strains of HIV-1 or 2. HIV-2 is broken into 9 groups, A-I. Groups A and B are epidemic in West Africa while the remaining groups are individual cases and are not known to be pathogenic. HIV-2F is an exception being both pathogenic and found in 2 persons, suggesting transmissibility. HIV's origins have been widely studied, however, questions remain. The simian ancestry of HIV is well established yet exactly how SIV adapted to HIV in humans is still unknown. Several theories have been put forth to explain HIV emergence from SIV including the serial passage theory of HIV emergence. Here we conduct an HIV survey in northern Sierra Leone (SL) to assess the public health threat of HIV-2F and also model the serial passage theory of emergence both in vivo and in vitro to elucidate mechanisms of adaptation.

Materials and methods: For the human HIV study in northern SL, we enrolled persons presenting for a voluntarily HIV test following education and outreach activities and those referred for an HIV test. This is a targeted, higher risk population than the general population. Commercial HIV-1/2 rapid tests were used in the field. Proviral DNA was amplified with PCR methods and sequenced with Sanger methods. Parallel pigtailed (PTM) and rhesus macaque in vivo and in vitro models were used to test the serial passage theory of HIV emergence. Virus was detected with an HIV-2F specific qPCR and commercial SIV p27 Antigen ELISA. Illumina methods were used to deep sequence day 3 samples with peak virus loads. A SNP analysis was conducted to investigate virus variation over serial passage.

Results: To date we have found the prevalence of HIV in the targeted sample population to be 6.36%. HIV-2 rates in the targeted sample were 0.50%, HIV-1 was 4.81% and apparent co-infections were seen in 1.06% of those tested. Two HIV-1 samples have been sequenced and typed to CRF02_AG. Attempts to PCR amplify proviral DNA from HIV-2 antibody positives were negative, possibly due to low virus load. In vitro, over serial passage, peak virus load decreased to undetectable, the opposite of what was expected. In fact, the in vitro serial passage results exactly contradict what was observed in a parallel in vivo serial passage experiment. In vivo we saw an increase in PVL over serial passage in the PTMs and viral escape in passages 2 and 3. SNP analysis showed mutations over serial passage allowing the virus to adapt to a new host in vivo.

Conclusion: In this study we asked two main research questions. First, is HIV-2F a public health threat? This question remains unanswered due to our inability to sequence the HIV-2 samples collected in this study. However, the samples remain preserved for applying different techniques. We described HIV burden in a self-selected, at risk population in northern Sierra Leone providing the first HIV-2 data in 20 years. We also provided the first HIV-1 sequence data from Sierra Leoneans living in Sierra Leone, all previous data are from SL immigrants to Europe or the USA. The second question was, can the serial passage hypothesis of HIV emergence be modeled to elucidate the role of serial passage in HIV cross-species transmission, adaptation and diversity? We successfully showed that this can be done through the in vivo serial passage experiment in pigtailed macaques. Together the data from the field studies along with the in vivo and in vitro models presented in this thesis provide a better understanding of mechanisms of HIV emergence as well as much needed information about HIV distribution and genetic diversity in northern Sierra Leone.

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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery: towards better health outcomes for Aboriginal peoples". Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/609.

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The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.

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Lemos, Pablo Natanael. "Atenção à saúde bucal de povos do Parque Indígena do Xingu, Brasil, no período de 2004 a 2013". Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-26082016-144334/.

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Introdução - Desde a criação do Sistema Único de Saúde (SUS), muitas mudanças ocorreram nas políticas públicas voltadas aos povos indígenas. A intensa luta dos movimentos indígenas subsidiou a proposta da criação e organização do Subsistema de Atenção à Saúde Indígena em 1999, sendo a Fundação Nacional de Saúde (FUNASA) designada como gestora e executora das ações de saúde indígena no país, no período de 1999 a 2010. Após 2010, a responsabilidade pela saúde indígena foi atribuída a Secretaria Especial de Saúde Indígena (SESAI). Em 2011, a Política Nacional de Saúde Bucal definiu a reorganização do modelo de atenção em saúde bucal para os povos indígenas, propondo-se que seja planejada a partir de um diagnóstico das condições de saúde-doença e subsidiada pela epidemiologia e informações sobre o território indígena, além de acompanhar o impacto das ações por meio de indicadores adequados. Objetivo - Analisar componentes de saúde bucal da Política Nacional de Saúde Indígena com foco na atenção à saúde bucal das comunidades do Xingu, considerando as tendências da cárie dentária entre crianças e jovens e as ações implementadas no período de 2004 a 2013. Método - Pesquisa com abordagem qualiquantitativa, do tipo estudo de caso, com o uso de dados secundários do Distrito Sanitário Especial Indígena Xingu e do Projeto Xingu, da Universidade Federal de São Paulo, a partir dos quais foram gerados indicadores de avaliação. Foi analisada a evolução, nesse período, dos indicadores de cobertura de primeira consulta odontológica programática, tratamento odontológico básico concluído, proporção de exodontia em relação aos procedimentos, média da ação coletiva de escovação dental supervisionada do Baixo, Médio e Leste Xingu. Foram utilizados os índices de experiência de cárie dentária (CPO-D e ceo-d) para as idades de 5 e 12 anos e no grupo etário de 15 a 19 anos, a partir de inquéritos epidemiológicos, realizados em 2007 e 2013, utilizando a padronização preconizada pela Organização Mundial da Saúde (OMS). Para contextualizar os indicadores, foi realizada uma revisão da produção científica sobre saúde bucal dos povos indígenas no Brasil no período de 1999 a 2014, bem como a análise de propostas relacionadas à saúde bucal dos povos indígenas nas cinco Conferências Nacionais de Saúde Indígena (1986 a 2013), na 3ª Conferência Nacional de Saúde Bucal (2004) e nas 13ª e 14ª Conferências Nacionais de Saúde (2007 e 2011). Resultados - Observou-se uma cobertura de primeira consulta odontológica programática maior que 60 por cento em todos os anos analisados, exceto nos anos de 2009 e 2010 com uma cobertura de 44,68 por cento e 53,41 por cento , respectivamente. O indicador de tratamento odontológico básico concluído apresentou um aumento significativo entre os anos 2006 e 2008, de 44,89 para 79,93. A proporção de exodontia em relação aos procedimentos apontou queda de 24,26 em 2004 para 3,84 em 2011. A média da ação coletiva de escovação dental supervisionada foi o indicador com maior variabilidade (de 1,25 a 23,27) entre os anos. Os valores de ceo-d e CPO-D indicaram padrões diferentes de cárie dentária entre os grupos. Foram examinados 368 pacientes em 2007 e 423 em 2013. Aos 5 anos, apresentou-se uma média de ceo-d de 6,43 em 2007 e 5,85 em 2013. Aos 12 anos de idade, média de CPO-D de 2,54 em 2007 e 2,78 em 2013. No grupo etário de 15 a 19 anos, verificou-se uma média de 6,89 em 2007 e 4,65 em 2013, sendo o único grupo com diferença estatisticamente significante (p<0,05). O Índice de Cuidados Odontológicos diminui em todos os grupos entre 2007 e 2013, sendo que aos 5 anos houve uma diminuição de 21,74 por cento para 7,14 por cento , aos 12 anos de 44,09 por cento para 16,35 por cento e de 63,14 por cento para 41,14 por cento no grupo etário de 15 a 19 anos. Conclusão - Este estudo descreve avanços e dificuldades na implementação do programa de saúde bucal no Baixo, Médio e Leste Xingu, com implicações importantes para programas de saúde bucal em áreas indígenas e para a produção de indicadores válidos nos serviços de atenção à saúde indígena. As estratégias de intervenções e parcerias com instituições privadas e públicas identificadas para melhorar a organização dos serviços, a equidade e o acesso da população indígena à saúde bucal, buscaram diminuir os entraves burocráticos e as iniquidades de saúde. A busca da integralidade da atenção através de parcerias com a própria comunidade e com outros setores foi realizada através de estratégias sensíveis às especificidades locais. Os resultados refletem uma tendência de diminuição da cárie nos dentes permanentes, apresentando um declínio da média de CPO-D no grupo etário de 15 a 19 anos e de avanços do programa. A efetiva diferenciação proposta nas conferências nacionais e nas políticas direcionadas aos povos indígenas, não tem se concretizado integralmente. O direito e o acesso à saúde para os povos indígenas são grandes desafios, sendo ainda tratados de forma homogênea e não diferenciada. Sugere-se a incorporação efetiva da realização de levantamentos epidemiológicos de saúde bucal que sejam específicos para cada realidade e que os programas busquem tecnologias, determinantes e especificidades no cotidiano do trabalho, para buscar minimizar os impactos que a sociedade nacional envolvente vem produzindo na saúde indígena.
Introduction - Since the creation of the Unified Health System (SUS), many changes have taken place in public policies related to indigenous population in Brazil. The intense struggle of the indigenous movements supported the proposal of the creation and organization of the Subsystem of the Indigenous Healthcare in 1999. The National Health Foundation (FUNASA) has been designated as manager and executor of actions indigenous health in the country, from 1999 to 2010. After 2010, responsibility for indigenous health was awarded the Indigenous Health Special Secretariat (SESAI). In 2011, the National Oral Health Policy defined the reorganization of the oral health care model for indigenous population, proposing that it be planned from a diagnosis of the health-disease conditions and subsidized by the epidemiology and information on the indigenous territory, monitor the impact of actions through appropriate indicators. Objective Analyze oral health component of the National Indigenous Health Policy focused on attention of oral health of the Xingu Indigenous Park, considering the trends of tooth decay among children and youth and the actions from 2004 to 2013. Method - research with quali-quantitative approach, the case study type, using secondary data from the Xingu Indigenous Special Sanitary District and the Xingu Project at the Federal University of São Paulo, from which evaluation indicators were generated. It was analyzed the evolution of the first programmatic dental consultation coverage indicators, basic dental treatment finished, extraction of proportion in relation to the procedures, average collective action of supervised toothbrushing the Lower, Middle and East Xingu. The indices of dental caries experience (DMFT and dmft) were used for ages 5 and 12 years and those aged 15-19 years from epidemiological surveys conducted in 2007 and 2013, using the standardization recommended by the World Health Organization (WHO). To contextualize the indicators, a review of scientific literature on oral health of indigenous population in Brazil from 1999 to 2014 was carried out and an analysis of proposals related to the oral health of indigenous population in five National Conference of Indigenous Health (1986 to 2013), the 3rd National Conference on Oral Health (2004) and the 13th and 14th National Health Conferences (2007 and 2011). Results - It was observed a cover of first programmatic dental consultation greater than 60 per cent in all years studied, except in 2009 and 2010 with a cover of 44.68 per cent and 53.41 per cent , respectively. The basic dental treatment finished indicator showed a significant increase between 2006 and 2008, from 44.89 to 79.93. The proportion of extraction for procedures faced decrease of 24.26 in 2004 to 3.84 in 2011. The average of collective action of supervised toothbrushing was the indicator with the highest variability (1.25 to 23.27) among years. The values of dmft and DMFT showed different patterns of dental caries between groups. 368 patients were examined in 2007 and 423 in 2013. At 5 years old, performed an average of dmft of 6.43 in 2007 and 5.85 in 2013. At 12 years old, a DMFT average of 2.54 in 2007 and 2.78 in 2013. In the age group 15-19 years of 6.89 in 2007 and 4.65 in 2013, the only group with a statistically significant difference (p < 0.05). The Dental Care index decreased in all groups between 2007 and 2013, and to 5 years old there was a decrease of 21.74 per cent to 7.14 per cent , to 12 years old 44.09 per cent to 16.35 per cent and 63 14 per cent to 41.14 per cent in the age group 15-19 years. Conclusion - This study shows progress and difficulties in the implementation of oral health program in the Lower, Middle and East Xingu, with important implications for oral health programs in indigenous territories and to produce valid indicators in care services for indigenous health. The strategies of interventions and partnerships with private and public institutions identified to improve the organization of services, equity and access of the indigenous population to oral health, sought to reduce the bureaucratic barriers and health inequities. The pursuit of integrality care through partnerships with the community and other sectors was conducted through sensitive strategies to local conditions. The results reflect a trend of reduction in decay in permanent teeth, showing a decline in DMFT average in the age group 15-19 years and the progress of the program. The effective differentiation proposed in national conferences and targeted policies on indigenous population, has not fully realized. The right and access to health care for indigenous population are major challenges still being treated evenly and undifferentiated. It is suggested the effective incorporation to carry out epidemiological surveys of oral health that are specific to each reality and that programs seek technologies, and specific determinants in daily work, to seek to minimize the impacts that nacional society surrounding has produced in indigenous health.

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Dangala, Study Paul. "An investigation of the potential role of indigenous healers in life skills education in schools". Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=init_3187_1180443519.

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This thesis investigated the potential role of indigenous healers in life skills education in South African schools. The main focus of this study was to explore how indigenous knowledge of traditional healers can contribute to the development of life skills education in South African schools. The research also sought to strengthen Education Support Services in the South African education system, in order to address barriers to learning. These barriers to learning are linked to health challenges such as substance abuse, violence, malnutrition and HIV/AIDS and many other health-related issues in school-going age learners.

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Lardeau, Marie-Pierre. "Diet and infection as predictors of stunting, iron deficiency and anemia in indigenous Panamanian communities". Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86719.

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This cross sectional study evaluated if coffee, associated with reduced linear growth, anemia and immunomodulation could contribute to childhood stunting and iron deficiency (ID) and anemia in Indigenous Ngöbe Buglé children and mothers. Questionnaires on socio-economic status, health, diet, anthropometry, iron supplement use and coffee consumption and a sample of coffee, venous blood and stool were collected. Our best model suggests that coffee is an independent negative predictor of stunting in children along with having inflammation, higher Ascaris infection, lower meat consumption, being a male and having a shorter mother. Diet, iron supplements and chronic infections explained more than 50% of the variability in hemoglobin and serum ferritin concentrations of mothers and children, with coffee only negatively affecting mothers. This study will add to the limited knowledge of the impact of coffee consumption on child health, and determine other predictors of stunting, ID and anemia in this vulnerable population.
Cette étude transversale a évalué si le café, qui est associé a l'anémie ferriprive, la réduction de la croissance linéaire et l'immunomodulation pourrait contribuer aux retards de croissance chez les enfants, à l'anémie et aux carences en fer des enfants et de leurs mères du groupe autochtone Ngöbe Buglé. Des questionnaires sur niveau socio-économique, la santé, l'anthropométrie, le régime alimentaire, l'utilisation des suppléments de fer et la consommation du café ainsi que des échantillons fécaux, de café, de sang ont été recueillis. Cette étude transversale permettra d'accroître les connaissances sur l'impact de la consommation du café chez les enfants et permettra d'évaluer si cette habitude nuit aux bénéfices des interventions de santé publique mises en place dans la région.

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44

Young, Alannah Earl. "Indigenous elders' pedagogy for land-based health education programs : Gee-zhee-kan'dug Cedar pedagogical pathways". Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/52622.

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This qualitative research articulates and develops an Anishnabe-Nehiyaw Cree perspective of a tribal pedagogy. The author weaves elements of critical ethnographies, Indigenous oral histories and critical tribal and feminist theories throughout the dissertation. She describes five pedagogical pathways that were developed through an Indigenous conversation method (Kovach, 2010) in 8 research circles with 18 Indigenous Elders in central, rural Manitoba. The research utilizes Indigenous storywork methodologies to gather and interpret the research on Indigenous local land-based pedagogies. The specific Gee-zhee-kan’-dug Cedar pedagogy is described by the Indigenous Elders who teach at a 24 year long land-based health education program. The author outlines five pedagogical learning pathways as key findings, which are: 1) culture: facilitating access to the revitalization of tribal Indigenous knowledges; 2) land: developing local co-partnerships and genealogies connected to territories; 3) orality: using story, ceremony, songs, prayers, language, dreams, performance, and genealogy as the primary modes of teaching; 4) community: aligning educators with local self-determining initiatives such as food sovereignty and access to healthy water and plant medicines; and 5) ethics: interweaving practices with sustainable, health-enhancing and decolonizing agendas. From the example of this Cedar pedagogy, the researcher proposes a framework for educators who want to develop their own local, land-based pedagogies. This framework includes five elements: 1) research local Indigenous nation’s culture and stories, and partner with appropriate resource people; 2) prepare materials and information required for students to learn in the class and on the land, and make space for and provide access to Indigenous knowledge holders; 3) follow local protocol principles, including proper expression of the value principles, negotiate local relationships to land, and modify protocol principles for each context; 4) apply the pedagogy by taking people out on the land, encouraging the use of all of the senses, and engaging respectfully with local peoples and places; and 5) reflect on the experience by sharing local stories of transformation and reconnection to lands/plants. The research concludes with a discussion on how Indigenous knowledge systems can inform land-based pedagogies, and how these pedagogies can have a pivotal role in strengthening peoples’ wholistic health.
Education, Faculty of
Educational Studies (EDST), Department of
Graduate

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45

Oborne, Katherine An. "Partnerships or ships apart? : a dilemma in the development and delivery of indigenous health policy /". Title page, abstract and contents only, 2002. http://web4.library.adelaide.edu.au/theses/09AR/09aro129.pdf.

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46

Panzironi, Francesca. "Indigenous Peoples' Right to Self-determination and Development Policy". University of Sydney, 2007. http://hdl.handle.net/2123/1699.

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Doctor of Philosophy
This thesis analyses the concept of indigenous peoples’ right to self–determination within the international human rights system and explores viable avenues for the fulfilment of indigenous claims to self–determination through the design, implementation and evaluation of development policies. The thesis argues that development policy plays a crucial role in determining the level of enjoyment of self–determination for indigenous peoples. Development policy can offer an avenue to bypass nation states’ political unwillingness to recognize and promote indigenous peoples’ right to self–determination, when adequate principles and criteria are embedded in the whole policy process. The theoretical foundations of the thesis are drawn from two different areas of scholarship: indigenous human rights discourse and development economics. The indigenous human rights discourse provides the articulation of the debate concerning the concept of indigenous self–determination, whereas development economics is the field within which Amartya Sen’s capability approach is adopted as a theoretical framework of thought to explore the interface between indigenous rights and development policy. Foundational concepts of the capability approach will be adopted to construct a normative system and a practical methodological approach to interpret and implement indigenous peoples’ right to self–determination. In brief, the thesis brings together two bodies of knowledge and amalgamates foundational theoretical underpinnings of both to construct a normative and practical framework. At the normative level, the thesis offers a conceptual apparatus that allows us to identify an indigenous capability rights–based normative framework that encapsulates the essence of the principle of indigenous self–determination. At the practical level, the normative framework enables a methodological approach to indigenous development policies that serves as a vehicle for the fulfilment of indigenous aspirations for self–determination. This thesis analyses Australia’s health policy for Aboriginal and Torres Strait Islander peoples as an example to explore the application of the proposed normative and practical framework. The assessment of Australia’s health policy for Indigenous Australians against the proposed normative framework and methodological approach to development policy, allows us to identify a significant vacuum: the omission of Aboriginal traditional medicine in national health policy frameworks and, as a result, the devaluing and relative demise of Aboriginal traditional healing practices and traditional healers.

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Marsden, Dawn Marie. "Indigenous wholistic theory for health : enhancing traditional-based indigenous health services in Vancouver". Thesis, 2005. http://hdl.handle.net/2429/17209.

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How traditional healing can be enhanced in cities, has been the subject of discussion between myself and Indigenous Elders, and between many others, for over 15 years. This project was initiated and completed through the recommendations of Indigenous Elders, through prayer and dreaming, and through increasingly specific factors: 1. Two to four hundred years of unequal relations between colonizing and Indigenous peoples, resulting in 2. Significant and persistent inequalities in the health and educational status of Indigenous peoples, leading to 3. Indigenous calls for more culturally appropriate health services, as reflected in the Royal Commission on Aboriginal Peoples (RCAP), instigating 4. Canadian government strategies for implementing the RCAP recommendations, entitled Gathering Strengths, which prompted a 5. Vancouver/Richmond Health Board review of local Aboriginal health and services, entitled Healing Ways, which led to 6. A Strategic Plan to Develop an Aboriginal Healing Centre in Vancouver, in which traditional healing was emphasized This dissertation affirms and extends prior research, including the National Aboriginal Health Organization document "Traditional Medicine in Contemporary Contexts" by asking how the access and provision of traditional-based health services (traditional healing) can be enhanced, by and for Indigenous peoples in a specific location (Greater Vancouver Regional District; Indigenous pop: 77,500), and by designing, implementing and analyzing this research, using Indigenous wholistic theory, storywork, and talking circle methodologies, protocols, and processes of analysis (prayer, dreaming, reflection, dialogue). Collective storywork, confirms and extends prior research, by providing locally-specific and detailed strategies for societal, institutional and community enhancements, including the establishment of a cohesive governance framework, educational campaigns, establishment of integrated health teams, establishment of a traditional-based Indigenous practitioner's council, establishment of liaison positions, and the establishment of traditional-based Indigenous healing centres. In addition, the research process has resulted in an affirmation and extension of: Indigenous wholistic theory, storywork and talking circle methodologies, Indigenous protocols and processes, a model for Indigenous research entitled a Wampum Research Model, a discussion of the inextricability of health and education, a need to prioritize worldview in the non-medical determinants of health, and Graham Hingangaroa and Linda Tuhiwai Smith's criteria for Indigenous theorizing and Indigenous projects.
Education, Faculty of
Educational Studies (EDST), Department of
Graduate

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48

Muller, Lorraine. "Indigenous Australian social-health theory". Thesis, 2010. https://researchonline.jcu.edu.au/39333/1/39333-muller-2010-extended-abstract.pdf.

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Indigenous Australian Social-Health theory, this thesis, and my book based on it, A Theory for Indigenous Australian Health and Human Service Work, published by Allen and Unwin, began when we, me and fellow Indigenous students and workers, collaboratively identified the need to have our knowledge documented. The collaborative nature of this research project continued throughout, so that although this research and dissertation is my work, the information shared so generously throughout the process means it is collective knowledge. The format of this thesis uses a theme of knowledge, and draws on the knowledge shared with me for the purpose of documenting our theory. Research participants in this research are 'people who shared their knowledge', and data is 'the knowledge' that was shared. In this thesis, non-Indigenous people are named as the 'other'. Resistance to the euro-centric nature of academic literature is evident in this study, as it positions Indigenous voices at the foreground. This research project, has taken the established theoretical framework, the oral theory used by 'our' Social Health professionals, those for whom the social, emotional (including Spiritual), and physical, wellbeing of our people is central to their practice, and translated it into an academic theory format: Indigenous Australian Social-Health theory. Written in three parts, each with 3 chapters, the text uses a layered learning style, circular learning, with topics introduced earlier being returned to later with additional learning adding depth to the knowledge gained in each subsequent iteration. The first part of this thesis sets the context of the research, with an introduction chapter, a chapter discussing colonisation, leading into a chapter on decolonisation as the framework of this study. In the second part, the chapters discuss the knowledge of others; the values and principles informing the research methodology; and the responsibility of being entrusted with knowledge. Lastly, the third part sets out the new knowledge gained and the specific knowledge that was identified as needing documentation. In this last part, chapters discuss the knowledge shared specifically for this text covering topics such as spirituality, racism, equality, respect, as well as knowledge on the practical application of this knowledge. Decolonisation is the theoretical framework in which this research is situated. To set the stage for a discussion on decolonisation an exploration of the process, ideologies, and history, of colonisation is incorporated. Knowledge of the history of colonisation, and a critical understanding of its implications are significant aspects of the practice theory of Social-Health and necessary for decolonisation. Beginning with Laenui's (2000) five stages of decolonisation, adapted to an Australian context, a sixth stage of decolonisation emerged early in this study. These six stages of decolonisation formed the framework used in this research. Also evident is that decolonisation is a useful and relevant framework for use in research and practice, for Indigenous and non-Indigenous peoples. Aboriginal Grounded Research is the uniquely Australian consensus-based research methodology used in this research project. The tools of creating knowledge, research, and the methods that prescribe and describe the process, are also resolutely linked to the worldview that decides what rules, principles and narratives are acceptable in the research (Overton & Ennis, 2006). The values and principles that inform the researcher’s worldview, are discussed in part two of this thesis. Central to this methodology is an expert panel who ensured the accuracy, cultural integrity, and appropriateness of the knowledge shared in this project. Honouring that our knowledge is a collective asset, it is noteworthy that this is not a 'panel of experts'; it is the collective group of knowledge holders who formed the 'expert panel'. Demonstrated in this research is that Indigenous Australian Social-Health theory is a significant body of knowledge that runs parallel to Western knowledge. This knowledge operates independent of, but selectively informed by, Western academic knowledge. Major themes identified in my research discussions were Aboriginal spirituality, philosophy, and respect, which form the basis of the theory, or more accurately the meta-theory, documented in this study. In addition to meta-theory, knowledge shared in this thesis includes how this relates to practice. Racism was identified as a pervasive backdrop for the environment where Social-Health practitioners work. This thesis covers the framework theory of decolonisation, the metatheory that informs research and our ways of doing, as well as connecting Indigenous knowledge to practice. This research is a story of Healing and Reclaiming Wellbeing.

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Lock, Mark John. "The participation of Indigenous people in national Indigenous health policy processes". 2008. http://repository.unimelb.edu.au/10187/6934.

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It is acknowledged that part of the failure to improve Indigenous health is due to the lack of participation of Indigenous people in national policy and decision making processes. In this three part study I investigated the nature of Indigenous people’s participation in national Indigenous health policy processes. I combined quantitative and qualitative methods through the perspective of policy networks.
The first part of the study was directed at the prominence of informal networks in the evolution of Indigenous affairs policy. I aimed to determine and describe the structural location of Indigenous people in an informal network of influential people. I administered a network survey questionnaire during the period 2003/04. In a snowball nomination process influential people nominated a total of 227 influential people. Of these, 173 people received surveys of which 44 people returned surveys, a return rate of 25 per cent. I analysed the data to detect the existence of network groups; measure the degree of group interconnectivity; measure the characteristics of bonds between influential people; and I used demographic information to characterise the network and its groups. I found a stable pattern of relationships in the three features of the informal network: the whole network was diverse, and the Indigenous people were integrated and embedded in the network. It would not have existed without Indigenous people due to a combination of their greater number, their distribution throughout the network groups, and the interconnections between the groups. I argued that the findings showed that Indigenous people were fundamental in this informal network of influential people.
The second part of the study was directed at the role of national health committees in engaging with advice about Indigenous health. I aimed to describe the structural location of Indigenous people in national health committees. Using internet sites I identified 121 national health committees at the end of 2003, and obtained information from 77 committees or 64 per cent of all committees. I calculated the proportion of members who were Indigenous within each committee; the proportion of committees which were Indigenous health committees; and constructed a visual representation of the formal reporting relationship between all the committees and Cabinet. I then determined the importance of each committee in terms of a committee network using eigenvector centrality scores. Finally, I identified the linking people between the informal network and the national health committees. I found that in a traditional hierarchical view that Indigenous people and Indigenous health committees were small in number and distant from Cabinet. In contrast a network view assumes that the importance of a committee depends on the combination of the number of interlocks, comembership, and betweenness with other committees. In this network view, Indigenous health committees were similarly located to other committees. A small number of elite knowledge brokers linked the informal networks and the national health committees. I argued that the findings showed a formal systemic deficiency in the strategic location of Indigenous people.
The third part of the study was directed at the significance of inter-personal bonds between influential people in influencing policy processes. I aimed to describe the interpersonal relationships between influential people through a semi-structured interview. The interview questions were designed to elicit responses in the broad context of knowledge and influence in national Indigenous health policy processes. From a list of 47 potential interviewees I obtained 34 interviews (a response rate of 72 per cent), transcribed 32 interviews and coded them thematically. I found that underlying the episodic meetings of national health committees was the constant activities of informal networking. The influential non-Indigenous people had to pass some rules of entry in order to engage in and utilise informal processes. The interviewees demonstrated a value of connectedness in interpersonal relationships through agreement with principles such as social models of health. However, advice about Indigenous health issues may need to be continually rediscovered as it remains anchored to local contexts in a macro context where advice faces pathways that are confusing and convoluted. I argued that the findings indicated a meta-level vacuum in conceptualising the relationship between the concepts of participation and advice in national Indigenous health policy processes.
The findings from the three parts indicated three characteristics of an ongoing meta-process (informal network), absence of a meta-perspective (national health committees), and a meta-concept of participation (interviews). I suggest that they form a meta-frame of participation. In this frame the energy dispersed in the many efforts at improving Indigenous peoples‟ participation are unfocussed because of multiple and uncoordinated policy origins. Therefore I concluded that the nature of participation of Indigenous people in national Indigenous health policy processes is one of unfocussed energy.

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Stewart, Suzanne L. "Indigenous mental health: Canadian Native counsellors' narratives". Thesis, 2007. http://hdl.handle.net/1828/1835.

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A small yet growing body of literature recognizes the importance of a cultural perspective to mental health services for Canadian Indigenous clients. Although the role of culture has not been studied extensively in counselling psychology, a few investigators have attempted a systemic examination of the area. Using a narrative methodology, five Indigenous counsellors described their perceptions, beliefs and experiences regarding mental health and healing from an Indigenous perspective. A narrative analysis of the data employed story maps to yield within and across participant themes. Overall results included the metathemes of community, cultural identity, holistic approach, and interdependence as integral to mental health and healing for Native clients, with an illustration for counselling that contains specific elements for incorporating this conception into practice. The results are used to inform literature on an Indigenous paradigm of mental health, counsellor training programmes aimed at meeting Indigenous health needs, government policy, and to generate further direction for health research into the Indigenous paradigm in Canada and beyond.

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