Дисертації з теми "Torres Strait Islander health"
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Adams, Michael John. "Sexual and reproductive health problems among Aboriginal and Torres Strait Islander males." Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/16599/1/Michael_John_Adams_Thesis.pdf.
Повний текст джерелаAdams, Michael John. "Sexual and reproductive health problems among Aboriginal and Torres Strait Islander males." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16599/.
Повний текст джерелаGrootjans, John, of Western Sydney Hawkesbury University, and of Health Humanities and Social Ecology Faculty. "Both ways and beyond : in Aboriginal and Torres Strait Islander health worker education." THESIS_FHHSE_SEL_Grootjans_J.xml, 1999. http://handle.uws.edu.au:8081/1959.7/445.
Повний текст джерелаDoctor of Philosophy (PhD)
Grootjans, John. "Both ways and beyond : in Aboriginal and Torres Strait Islander health worker education /." View thesis, 1999. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030725.103057/index.html.
Повний текст джерелаShepherd, Carrington C. J. "The socioeconomic pattern of health and developmental outcomes among Aboriginal and Torres Strait Islander children." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/712.
Повний текст джерелаWhatman, Susan Leigh. "'Wis Wei Youpla Health?' A case study of the nature and extent of community participation in health education decision-making for Torres Strait Islander girls at Bluewater High." Thesis, Queensland University of Technology, 2004. https://eprints.qut.edu.au/15863/1/Susan_Whatman_Thesis.pdf.
Повний текст джерелаWhatman, Susan Leigh. "'Wis Wei Youpla Health?' A case study of the nature and extent of community participation in health education decision-making for Torres Strait Islander girls at Bluewater High." Queensland University of Technology, 2004. http://eprints.qut.edu.au/15863/.
Повний текст джерелаAldrich, Rosemary Public Health & Community Medicine Faculty of Medicine UNSW. "Flesh-coloured bandaids: politics, discourse, policy and the health of Aboriginal and Torres Strait Islander Peoples 1972-2001." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/27276.
Повний текст джерелаKirkwood, Sandra Jane. "Frameworks of culturally engaged community music practice in rural Ipswich." Thesis, Griffith University, 2009. https://eprints.qut.edu.au/132103/2/132103.pdf.
Повний текст джерелаMahoney, 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.
Повний текст джерелаButten, Kaley Verlaine. "Oral health in an urban, Aboriginal and Torres Strait Islander community in Queensland, Australia and the development of a culturally specific health-related quality of life measurement tool." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/204193/1/Kaley_Butten_Thesis.pdf.
Повний текст джерелаSiripol, Samantha. "Health service delivery and health outcomes of at-risk populations." Master's thesis, Canberra, ACT : The Australian National University, 2018. http://hdl.handle.net/1885/154723.
Повний текст джерелаMills, Kyly M. "'Work it out': Evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people with or at risk of cardiovascular disease." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/90737/1/Kyly_Mills_Thesis.pdf.
Повний текст джерелаRheault, Haunnah. "Examining the chronic disease health literacy of First Nations Australians: A mixed methods study." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/228618/8/Haunnah%20Rheault%20Thesis.pdf.
Повний текст джерелаMcPhail-Bell, Karen. ""We don't tell people what to do": An ethnography of health promotion with Indigenous Australians in South East Queensland." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/91587/1/Karen%20McPhail-Bell%20Thesis.pdf.
Повний текст джерелаHodes, Jeremy. "Torres Strait Islander migration to Cairns before World War II." [S.l. : s.n.], 1998. http://catalog.hathitrust.org/api/volumes/oclc/44839600.html.
Повний текст джерела"A dissertation submitted in partial fulfilment of the requirements for the Degree of Letters in History. Central Queensland University." Cover title.
Ewing, Bronwyn. "Recognising Torres Strait Islander Women’s Knowledges in their Children’s Mathematics Education." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-79697.
Повний текст джерелаHall, Kerry K. "Acute respiratory illness in urban Aboriginal and Torres Strait Islander children." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/110528/1/Kerry_Hall_Thesis.pdf.
Повний текст джерелаMcLeod, Abby. "Towards an understanding of musical variation in Torres Strait : an analysis of songs performed by two Torres Strait Islander singers /." Title page, contents and conclusion only, 1996. http://web4.library.adelaide.edu.au/theses/09MUB/09mubm165.pdf.
Повний текст джерелаA loose leaved appendix of Transcriptions in back pocket (31 leaves). Includes bibliographical references (leaves 69-71).
McMaster, John. "Yumi pedagogy: pedagogy with cultural integrity in the Torres Strait." University of Southern Queensland, Faculty of Education, 2006. http://eprints.usq.edu.au/archive/00006230/.
Повний текст джерелаHogarth, Melitta Dorn. "A critical analysis of the Aboriginal and Torres Strait Islander Education Action Plan." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/89754/1/Melitta_Hogarth_Thesis.pdf.
Повний текст джерелаSimone, Nicole R. "Teachers perspectives of embedding Aboriginal and Torres Strait Islander peoples' histories and cultures in mathematics." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/227459/1/Nicole_Simone_Thesis.pdf.
Повний текст джерелаMiller, Melinda G. "Action for change? Embedding Aboriginal and Torres Strait Islander perspectives in early childhood education curricula." Thesis, Queensland University of Technology, 2013. https://eprints.qut.edu.au/60905/5/60905.pdf.
Повний текст джерелаFairfoot, Glen. "Torres strait islander students' experiences transitioning from various locations to Brisbane to undertake university studies." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/197684/1/Glen_Fairfoot_Thesis.pdf.
Повний текст джерелаCarman, Rebecca Anne. "The impact of immunisation service delivery in general practice on Aboriginal children living in the Perth metropolitan area: An opportunity to reduce the gap?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2019. https://ro.ecu.edu.au/theses/2176.
Повний текст джерелаPeacock, Janice, and n/a. "Inner Weavings: Cultural Appropriateness for a Torres Strait Island Woman Artist of Today." Griffith University. Queensland College of Art, 2006. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20070327.140720.
Повний текст джерелаMiller, Gregory P., and n/a. "Teacher education programs, at James Cook University of North Queensland, for Aboriginal and Torres Strait Islander students." University of Canberra. Education, 1988. http://erl.canberra.edu.au./public/adt-AUC20061110.103136.
Повний текст джерелаHughes, Bridget Y. "Collective impact: Closing the gap in educational outcomes for Aboriginal and Torres Strait Islander peoples in Queensland." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/230011/1/Bridget_Hughes_Thesis.pdf.
Повний текст джерелаBackhaus, Vincent Stuart. "Situating the countried existence of critical indigenous pedagogies & Aborginal and Torres Strait Islander student's ways of learning." Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/288428.
Повний текст джерелаHill, Braden. "Transformation at the cultural interface: Exploring the experiences of Aboriginal and Torres Strait Islander students undertaking university studies." Thesis, Hill, Braden (2020) Transformation at the cultural interface: Exploring the experiences of Aboriginal and Torres Strait Islander students undertaking university studies. Masters by Research thesis, Murdoch University, 2020. https://researchrepository.murdoch.edu.au/id/eprint/59416/.
Повний текст джерелаAh-Wong, Wayne, and w. ah-wong@cqu edu au. "Living between cultures: Reflections of three Mackay Elders: Aboriginal, Torres Strait Island and South Sea Island residents in Mackay from the 1930s to 2000." Central Queensland University. Nulloo Yumbah, 2007. http://library-resources.cqu.edu.au./thesis/adt-QCQU/public/adt-QCQU20081005.163730.
Повний текст джерелаJoliffe, Edward Keith, and n/a. "Developing a multiple discourse model of analysis through an evaluation of the National Aboriginal and Torres Strait Islander Education Policy." University of Canberra. Education, 1995. http://erl.canberra.edu.au./public/adt-AUC20060802.170810.
Повний текст джерелаArnold, Anna-Lena. "Applied Epidemiology in Aboriginal and Torres Strait Islander Health." Master's thesis, 2016. http://hdl.handle.net/1885/110475.
Повний текст джерелаRiley, Tamara. "Partnerships in Aboriginal and Torres Strait Islander health research." Master's thesis, 2020. http://hdl.handle.net/1885/201637.
Повний текст джерелаJones, Roxanne. "The epidemiology of Aboriginal and Torres Strait Islander culture, health and wellbeing." Master's thesis, 2019. http://hdl.handle.net/1885/156448.
Повний текст джерелаWest, Matthew. "“Footprints for Life” foot health of Aboriginal and Torres Strait Islander Peoples." Thesis, 2021. http://hdl.handle.net/1959.13/1445698.
Повний текст джерелаThe limited available data shows Aboriginal and Torres Strait Islander Peoples have disproportionately high rates of diabetes-related foot disease, and experience amputation up to 38 times more frequently than non-Indigenous Australians. The high rate of diabetes-related foot disease in this population results in reduced quality of life, elevated hospitalisation rates and associated expenditure, and significantly contributes to preventable deaths. The reasons for higher rates of diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples are complex, with a lack of available culturally safe care, low socioeconomic status and poor engagement with Western health services significantly contributing to the current catastrophic outcomes. To effectively address diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples, a better understanding of the extent of the problem is required, and, there needs to be improved access to culturally safe foot care through better service provision and a more culturally capable health workforce. This thesis had the overarching aims of establishing the foot health of Aboriginal and Torres Strait Islander Peoples in the local Central Coast community, and developing methods to improve access to, and delivery of, culturally safe foot care. This thesis investigated, via systematic review, the current state of diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples and the availability and effectiveness of foot care services to reduce diabetes-related foot complications in this population. The reviews demonstrated there is a lack of nationwide data relating to diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples, and, that most data focuses on amputation rates, with little information available regarding specific types of diabetes-related foot complications. Nevertheless we found Aboriginal and Torres Strait Islander Peoples had between a 3 to 6 fold increased likelihood of both foot ulcer and minor or major amputation, and, that these occurred at a younger age. Furthermore, we found no evidence of state- or nation-wide foot health programs for prevention of diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples. Existing services were localised and there was little evaluation of the acceptability of these programs, levels of community engagement or impact on foot disease. Subsequently through an extensive community consultation process we used an effective co-design approach to develop a foot care service embedded in an undergraduate podiatry program. Key design elements included; integrating ongoing community consultation; involvement of Aboriginal health workers and practitioners connected to their local community; recognising the role of community in cultural capability training of health students; and, creating a flexible and accessible care model that is aligned with the community foot care priorities. To conduct a comprehensive evaluation of the foot care service model, we used culturally appropriate methods to determine the Aboriginal and Torres Strait Islander perspective of program success through research yarns and customised surveys, as well as service utilisation data. These data demonstrated that service elements including yarning circles and group appointments, as well as student placements, increased participant engagement with, and ownership of the clinic. Increasing accessibility to the clinic was flagged as a mechanism to further increase engagement. In addition, student placement in a culturally safe clinic significantly improved students’ understanding of multiple aspects of cultural capability (e.g. understanding of culture, history, and their interrelationship with health and health care delivery), and level of confidence with providing culturally appropriate and safe foot care. In summary this research highlights the devastating impact of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and the importance of a co-designed approach to delivery of culturally safe foot health care, as well as the central role of immersive experiences for developing a culturally safe future podiatry workforce.
Strobel, Natalie. "Improving the health and wellbeing of Aboriginal and Torres Strait Islander children in Australia." Master's thesis, 2019. http://hdl.handle.net/1885/155692.
Повний текст джерелаStewart, Jessica. "Aboriginal and Torres Strait Islander health: identifying opportunities for health gain through primary health care and targeted research." Thesis, 2015. http://hdl.handle.net/1959.13/1310570.
Повний текст джерелаThis doctoral thesis by publication provides new knowledge in two important and related areas in Aboriginal and Torres Strait Islander health. Firstly, the thesis investigates opportunities in primary health care for reducing some of the major contributors to the health disparity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. It suggests that strategies are needed to better support patients and GPs in accurately identifying patients at risk and also support the need for a continued policy commitment towards these activities. Secondly, where evidence is lacking of effective primary health care interventions, the research aims to inform health and medical research policy to support research that will maximise health improvements for Aboriginal and Torres Strait Islander people. It aims to inform policy-makers, health practitioners, researchers and Aboriginal and Torres Strait Islander communities on opportunities for health gains that are evident in primary health care and through more targeted health and medical research. One of the key findings of this doctoral research is the lack of intervention research being conducted specifically in Aboriginal and Torres Strait Islander health. It identifies the lack of research outputs that can be used to inform clinical practice as well as health policy and programs. The findings offer strategies that may be able to be implemented into policy to address barriers to increasing the amount of high quality intervention research being conducted in Australia. Another key finding is that research funding disproportionally funds descriptive research rather than measurement and intervention research. The findings aim to inform future health and medical research funding allocation in a way that targets specific health topics, types of research, as well as disciplines that may result in health gains more quickly due to their ability to more rapidly translate findings into policy and practice. The implications of the research aim to be practical and achievable. In primary health care, improving screening according to evidence-based guidelines will greatly improve the health of Aboriginal and Torres Strait Islander people. Where the evidence is lacking on effective health care strategies specifically targeting Aboriginal and Torres Strait Islander people, strategic research is needed that will create evidence to address the major causes of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
Kilcullen, Meegan Lesley. "Explorations of understandings of mental health in an urban Aboriginal and Torres Strait Islander sample." Thesis, 2011. https://researchonline.jcu.edu.au/29143/1/29143_Kilcullen_2011_thesis.pdf.
Повний текст джерелаMcBain-Rigg, Kristin Emma. "Who cares?: Aboriginal and Torres Strait Islander health care choices and access barriers in Mount Isa." Thesis, 2011. https://researchonline.jcu.edu.au/31287/1/31287_McBainRigg_2011_thesis.pdf.
Повний текст джерелаBovill, Michelle. "Culturally responsive approaches for the empowerment of Aboriginal and Torres Strait Islander women in smoking cessation care." Thesis, 2019. http://hdl.handle.net/1959.13/1402953.
Повний текст джерелаThis thesis by publication is a body of work containing an introduction, six papers and a closing chapter with conclusions and recommendations for future practice, policy and research. All papers explore the area of concern being smoking during pregnancy among Aboriginal and Torres Strait Islander women, with a focus on how expectant mothers can be empowered to quit smoking. At the time of submission of this thesis, three of the six papers have been published or accepted for publication in peer-reviewed journals and the other three are under review.
(9797171), Bronwyn Fredericks. "Us speaking about women's health: Aboriginal women's perceptions and experiences of health, well-being, identity, body and health services." Thesis, 2003. https://figshare.com/articles/thesis/Us_speaking_about_women_s_health_Aboriginal_women_s_perceptions_and_experiences_of_health_well-being_identity_body_and_health_services/13464563.
Повний текст джерелаHarfield, Stephen. "The health and wellbeing of Aboriginal and Torres Strait Islander adolescents and young people: opportunities for applied epidemiology." Master's thesis, 2020. http://hdl.handle.net/1885/202461.
Повний текст джерелаWright, Alyson. "Whose risk? Whose responsibility? The Epidemiology of intervening in health risk behaviours for Aboriginal and Torres Strait Islander people." Master's thesis, 2017. http://hdl.handle.net/1885/140479.
Повний текст джерелаJayakody, Amanda A. "Reducing high rates of unplanned hospital readmissions among Aboriginal and Torres Strait Islander people with chronic disease." Thesis, 2020. http://hdl.handle.net/1959.13/1439011.
Повний текст джерелаAboriginal and Torres Strait Islander people, hereinafter respectfully referred to as Aboriginal people, a have a rich heritage and diverse cultures. They have a strong connection to their community and country. However, Aboriginal people have suffered long-lasting effects from colonisation, dispossession of land and racism with devasting impacts, particularly for health outcomes. In Australia, Aboriginal people have up to three-fold higher rates of chronic disease compared to non-Aboriginal people. Given the high risk of frequent avoidable admissions and unplanned hospital readmissions for people with chronic diseases, it is not surprising that Aboriginal people also have higher rates of these types of hospitalisations compared to non-Aboriginal people. High rates of avoidable admissions and unplanned readmissions reflect sub-optimal community healthcare and poor hospital care. However, little research has explored these types of potentially unnecessary hospitalisations for Aboriginal people with chronic disease in Australia’s most populous state of New South Wales (NSW). This thesis explores frequent avoidable admissions and unplanned readmissions among Aboriginal people by focusing on three key aims. The first was to examine the prevalence and trends of frequent avoidable admissions and unplanned readmissions of Aboriginal and non-Aboriginal people residing in NSW, utilising linked hospital administrative data. International research examining the factors associated with unplanned readmissions in general populations indicate the importance of factors such as chronic disease management, a regular general practitioner, good health literacy and medication adherence. Therefore, the second aim of this thesis was to identify perceptions of Aboriginal people regarding potential contributors to chronic-disease-related unplanned readmissions. In-depth interviews were conducted with a sample of Aboriginal people who had been readmitted to hospital. Telephone follow-up has been used alongside other intervention components, such as tailored discharge planning and patient education, with the aim of reducing unplanned readmissions in surgical and general medicine patients. The final aim of this thesis was to examine the potential impact of telephone follow-up in reducing unplanned readmissions rates for patients with chronic disease. This involved a systematic review of the research literature on the impact of telephone follow-up, and an evaluation of a program utilising telephone follow-up for Aboriginal people. The implications of the findings of this work are discussed in relation to hospital and community health service practices and state-wide data monitoring. Further explorative research and a community-led multicomponent telephone follow-up enhancement intervention are proposed.
Maher, Bobby. "Decolonising Public Health: Applying epidemiology and Indigenous worldview to how health and well-being is considered by Aboriginal and Torres Strait Islander people." Master's thesis, 2019. http://hdl.handle.net/1885/160863.
Повний текст джерелаBrinckley, Makayla-May. "Assessing the Reliability and Validity of the Kessler Psychological Distress Scale in the Aboriginal and Torres Strait Islander Population." Thesis, 2019. http://hdl.handle.net/1885/224438.
Повний текст джерела(13965105), Fiona J. Tulip. "Assessing the impact of a recall system on hospitalisations for patients with diabetes in the Torres Strait, 1998-2000: A retrospective re-evaluation study of a randomised control trial using a different data source." Thesis, 2003. https://figshare.com/articles/thesis/Assessing_the_impact_of_a_recall_system_on_hospitalisations_for_patients_with_diabetes_in_the_Torres_Strait_1998-2000_A_retrospective_re-evaluation_study_of_a_randomised_control_trial_using_a_different_data_source/21342918.
Повний текст джерелаBackground: A randomised control trial (RCT) was conducted in the Torres Strait and Northern Peninsula Area (NPA) Health Service District (HSD) during the period 1998-2000. The main intervention strategy for this trial was the introduction of a simple recall/patient reminder system in Primary Health Care Centres (PHCCs) in an attempt to improve the organisation and management of diabetes care. After a twelve-month period, there was a significant reduction (40 per cent) in the number of patients admitted in the intervention sites between baseline and followup. However, as hospitalisation data was derived from the PHC clinic records, it has been suggested that this methodology may have underestimated both the number of patients and hospital episodes captured in the RCT study population.
Aim: To conduct a retrospective re-evaluation study of the hospitalisation component of the original RCT in an attempt to better assess the impact of the clinic recall system for patients with diabetes in the Torres Strait and NPA, 1998-2000. All patients from the RCT were to be tracked manually through three local public hospitals for hospitalisation episodes in a bid to validate the total number of admissions for these Torres Strait Islanders (TSIs) with diabetes.
Methods and Subjects: Subjects included all those patients suffering with diabetes living in the Tones Strait and NPA whose PHC records had been audited during the original RCT. Instead of using PHC clinic patient files, hospital -based patient information systems were used (as a different data source) in order to validate the number of admissions for each individual from the trial. Analysis of the data used the same methodology as the RCT (that is, communities were clustered into intervention and control sites) in order to interpret results in terms of whether or not the implementation of a recall system in the intervention sites had any impact on the hospitalisation rates of patients with diabetes in the Torres Strait.
Results: In comparison with the RCT, the new hospitalisation study found some degree of underestimation in the number of patients identified as having hospitalisations and secondly, considerable underestimation in terms of the number of hospital episodes found. At baseline, the hospital -checking methodologyidentified one extra person and 102 additional episodes of care. At followup, this new methodology found an extra 30 persons and an additional 119 episodes of care. In comparison to the RCT, the new study showed an overall 6.7 per cent increase in the number of individual patients detected having had an admission in the study period. However, there was a large 47.1 per cent increase in extra hospital episodes detected across both audit timeframes.
Discussion: This study supports the main findings of the original RCT. That is, the new study also found a reduction in the proportion of patients hospitalised for any kind of `diabetes -related condition' in the intervention sites between baseline and followup. This reduction was slightly less at 29 per cent in the intervention sites (compared to 40 per cent in RCT across intervention sites) for 'total diabetes -related conditions,' however this new study finding was not statistically significant. The re-evaluation study also found that at followup, those in the intervention sites were 19 per cent significantly less likely to be hospitalised for a diabetes -related condition than those in the control sites (compared with a significant 40 per cent in the RCT). Therefore, admissions for diabetes -related conditions can be reduced or avoided through better organisation and a systematic approach to the management of PHCCs. Although hospital -based information systems may have been more sensitive in detecting patients with hospitalisation episodes and additional episodes for known patients, the tracking of individuals through the public hospital system (without a unique identifier) was problematic and time consuming.
Conclusion: The main aim of the RCT was to improve the organisation and management of PHC in the Tones Strait, in terms of clinical management for the large number of diabetic clients that are served. The original RCT findings suggested that improvements in diabetes care in the intervention sites such as the introduction of a patient recall system was successful in reducing the numbers of patients subsequently admitted to hospital. The re-evaluation study of hospitalisations using a different methodology has also been successful in recording a reduction in the number of people with diabetes being hospitalised from the intervention sites despite a 47 per cent increase in the number of hospital episodes being detected overall.
Bar-Zeev, Yael. "Improving health providers’ management of smoking in Australian Indigenous pregnant women." Thesis, 2019. http://hdl.handle.net/1959.13/1402480.
Повний текст джерелаGlobally, tobacco use is the leading cause of morbidity and mortality, causing an annual death rate of seven million people. In Australia, tobacco use is responsible for 9% of the total burden of disease. Smoking during pregnancy remains a significant public health problem for specific population groups, causing miscarriage, stillbirth, low birth weight and more. Psychosocial interventions such as behavioural counselling have been shown to be effective. Clinical guidelines in Australia recommend using the 5As approach: Ask about smoking status, Advise briefly to quit, Assess nicotine dependence and motivation to quit, Assist as needed (including behavioural counselling and nicotine replacement therapy [NRT] if required), and Arrange follow-up and referral to smoking cessation support services. NRT is recommended if the woman is unable to quit using only behavioural counselling, with oral NRT considered as first line. Aboriginal and Torres Strait Islander pregnant women have the highest smoking rates in Australia at 43%, facing multiple barriers to quitting smoking, including lack of adequate support from health providers. Health providers also face many barriers to support pregnant women to quit smoking, on an individual and systematic organisational level. To date, very few interventions have tried to improve health providers’ management of smoking with Aboriginal and Torres Strait Islander pregnant women. Those that have either did not use rigorous research methods or suffered from multiple implementation challenges. The aim of this thesis was to explore health providers’ practices regarding smoking cessation care during pregnancy, barriers to the provision of smoking cessation care and methods for improving health providers’ care, and to test an evidence-based behaviour change intervention to improve health providers’ provision of smoking cessation care to pregnant Aboriginal and Torres Strait Islander women. Papers one to five explore health providers’ provision of smoking cessation care during pregnancy in general. Some data for Aboriginal and Torres Strait Islander pregnant women who smoke is also presented. The results of the first five studies were used to refine the development of a multi-component pilot intervention: the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy intervention for implementation in Aboriginal medical services. Papers six to eight explore the development of the intervention resources, the intervention protocol and the effect of this intervention on health providers’ smoking cessation care. Three related theoretical frameworks were drawn on throughout the research: the Theoretical Domains Framework (TDF), Behaviour Change Wheel (BCW) and the COM-B (Capability, Opportunity, Motivation–Behaviour) model for behaviour change. Paper one, “Opportunities Missed: A Cross-Sectional Survey of the Provision of Smoking Cessation Care to Pregnant Women by Australian General Practitioners and Obstetricians”, presents the results of a national cross-sectional survey of 378 general practitioners (GPs) and obstetricians about their knowledge, attitudes and practices providing smoking cessation care to pregnant women. Data from this survey revealed low levels of provision of several smoking cessation care components (“Assess”, “Assist” and “Arrange”), with only 15.6% of GPs and obstetricians reporting “often and/or always” performing all of the recommended 5As. Specifically, GPs and obstetricians reported that they lacked time, resources and confidence in their ability to prescribe NRT during pregnancy, and lacked optimism that their intervention would be effective. Paper two, “Clinician Factors Associated with Prescribing Nicotine Replacement Therapy in Pregnancy: A Cross-Sectional Survey of Australian Obstetricians and General Practitioners”, reports the results from the same cross-sectional survey mentioned in paper one, exploring GPs’ and obstetricians’ NRT prescribing rates and factors that might influence this. Overall, 25% of GPs and obstetricians reported “never” prescribing NRT, with nearly 50% reporting they would “never” prescribe combination NRT (NRT patch plus an oral NRT). GPs had higher odds of prescribing NRT compared to obstetricians. Other factors that significantly increased the odds of NRT prescription were reading the Royal Australian College of General Practitioners (RACGP) guidelines, confidence in their ability to prescribe NRT and viewing NRT as safe, effective and with good patient adherence. Paper three, “Overcoming Challenges to Treating Smoking during Pregnancy – A Qualitative Analysis of Australian General Practitioners’ Barriers and Facilitators”, reports on semi-structured qualitative interviews that were conducted with 19 GPs, aiming to explore their management of smoking during pregnancy in greater depth and what would enable them to improve their smoking cessation support to pregnant women. GPs were recruited from the cross-sectional survey participants and from those attending a national GP conference. Participants reported they lacked communication skills to provide pregnant patients adequate support for quitting, focusing on providing information on smoking harms and discussing treatment options only with patients who reported an interest in quitting. Lack of time, NRT cost, previous negative experiences with NRT and safety concerns, being unfamiliar with the Quitline process and uncertainty over its suitability (specifically for Aboriginal and Torres Strait Islander peoples) were all perceived as additional challenges. Participants reported needing clear detailed guidelines, with visual resources they could use to discuss treatment options with patients. Paper four, “Nicotine Replacement Therapy for Smoking Cessation in Pregnancy – A Narrative Review”, provides an overview of the current guidelines regarding NRT use in pregnancy, while considering the existing evidence base on NRT safety, efficacy and effectiveness during pregnancy. Animal models show that nicotine is harmful to the foetus, especially for brain and lung development, but human studies have not found any harmful effects on foetal and pregnancy outcomes. Previous studies have used NRT doses that might have been too low and not have adequately accounted for the higher nicotine metabolism during pregnancy, and thus not sufficiently treating withdrawal symptoms. Nonetheless, studies of efficacy and effectiveness in the real world suggest that NRT use during pregnancy increases smoking cessation rates. Current national clinical guidelines from Australia, the United Kingdom, New Zealand and Canada recommend that if women are unable to quit smoking with behavioural interventions alone, they should be offered NRT in addition to behavioural counselling. The guidelines also impose many restrictions on NRT prescription during pregnancy and do not provide practical detailed guidance on when to initiate NRT and how to titrate the dosage. Pragmatic suggestions for clinical practice are made, including an approach for initiating and titrating NRT dosage during pregnancy and for discussing the risks versus benefits of using NRT in pregnancy with the pregnant patient and her partner. Paper five, “Improving Health Providers’ Smoking Cessation Care in Pregnancy: A Systematic Review and Meta-Analysis”, reviews the data from all published interventions aimed to improve health providers’ smoking cessation care during pregnancy. To be included, the intervention studies needed to collect data on the health providers’ performance. Overall, 16 studies describing 14 interventions were included – 10 used a quasi-experimental design (pre–post), with only six studies using a randomised controlled trial (RCT) design. Using the Cochrane Effective Practice of Care (EPOC) taxonomy of intervention components, the review found that the median number of intervention components reported by studies was two (range 1–6). The most common intervention components used were training (93%, n=13), educational resources (64%, n=9) and reminders (57%, n=8). Studies used a variety of outcome measures, with different data collection methods (such as self-report through survey, women’s report on the health providers’ care, audit of medical records or recordings of medical consultations), affecting the ability to synthesise the data. Specifically, the “Assist” or “Provide smoking cessation support” component of care was ill defined with vast variability between studies. Meta-analysis of the different smoking cessation care components (according to the 5As) showed a small significant increase in the provision of all smoking cessation care components. The review suggests that use of a behaviour change theory to guide intervention development, and inclusion of audit and feedback, increases the likelihood of intervention effectiveness in improving health providers’ provision of certain smoking cessation care components. Paper six, “Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women”, describes a multi-centre community-based participatory research study. This study aimed to assess a collaboratively developed educational resource package to aid health providers’ smoking cessation care in pregnant Aboriginal and Torres Strait Islander women. A panel of eight experts with complementary expertise provided input and suggestions to aid simplicity and usefulness of the resources. Staff members from three Aboriginal medical services in New South Wales (NSW), Queensland (Qld) and South Australia (SA) scored each of the patients’ resources using the “Suitability of Material” scoring method, finding that all received adequate or superior scoring. Average readability was grade 6.4 for patient resources (range 5.1–7.2; equivalent to ages 10–13 years) and 9.8 for health provider resources (range 8.5–10.6; equivalent to ages 13–16 years). Content analysis from focus groups with health providers from the three Aboriginal medical services revealed four themes including “Getting the message right”, “Engaging with family”, “Needing visual aids” and “Requiring practicality under a tight timeframe”. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel (SCAAP), and resources were adjusted accordingly for inclusion in the ICAN QUIT in Pregnancy multi-component intervention. Paper seven, “The Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy Pilot Study Protocol: A Feasibility Step-Wedge Cluster Randomized Trial to Improve Health Providers’ Management of Smoking during Pregnancy”, describes the protocol of a step-wedge cluster randomised pilot study: the ICAN QUIT in Pregnancy intervention. This protocol described an intervention aiming to improve health providers’ provision of evidence-based, culturally responsive smoking cessation care to pregnant Aboriginal and Torres Strait Islander smokers. Six Aboriginal medical services were randomised into three clusters for implementation. Clusters received the intervention staggered by one month. The intervention included a three-hour training webinar for health providers, educational resource packages for health providers and pregnant women, free oral NRT for pregnant women and audit and feedback on health providers’ performance. Health providers would complete a cross-sectional survey pre training and post training. Health providers’ outcomes would include changes in self-reported knowledge, attitudes and practices after receiving the intervention. Paper eight, “Improving Smoking Cessation Care in Pregnancy at Aboriginal Medical Services: ICAN QUIT in Pregnancy Step-Wedge Cluster Randomized Pilot Study”, presents the pilot study outcomes of changes in health providers’ knowledge, attitudes and practices. Of 93 eligible health providers, 50 consented to the trial (54%), 45 completed the pre-intervention survey (90%) and 20 completed the post-intervention survey (40%). About 42% (n=39) of health providers participated in the webinar training. Health providers’ knowledge was measured using two composite scores – one calculated using all 24 true/false statements and the other derived from 12 NRT-specific statements. Mean knowledge composite scores improved significantly from pre to post (78% vs 84% correct, p=0.011). The mean NRT-specific knowledge composite score also improved significantly (68% vs 79% correct, p=0.004). Self-assessment of 24 attitudes to providing smoking cessation care was measured using a 5-point Likert scale (Strongly Disagree to Strongly Agree). Two composite mean scores were calculated –one for 15 general smoking cessation care attitudes and the other for seven NRT-specific attitudes. The mean attitude composite score improved significantly (3.65 [SD 0.4] to 3.87 [SD 0.4]; p=0.017). The mean NRT-specific attitudes composite score also improved significantly (3.37 [SD 0.6] to 3.64 [SD 0.7]; p=0.005). Self-reported provision of smoking cessation care components was measured on a 5-point Likert scale (Never to Always); none of the practices improved significantly, including the prescribing of NRT. In summary, increasing health providers’ provision of smoking cessation care to pregnant Aboriginal and Torres Strait Islander women is a significant priority in Australia. This body of work highlights that currently, health providers are lacking in their provision of smoking cessation care, specifically in their support for pregnant Aboriginal and Torres Strait Islander women to quit smoking. Particularly, the provision of the “Assist” smoking cessation component was low, including the prescription of NRT. Multiple barriers exist and include lack of knowledge, skills (especially communication skills), time, resources and lack of optimism. Guidelines do not provide clear guidance, including the optimal timing for initiating NRT and titrating the dosage. The pilot intervention tested within this thesis showed promising initial results, with health providers significantly improving their knowledge and attitudes, although this did not translate into improved practices. Several strategies might enhance the effectiveness of the intervention and should be tested in a larger and adequately powered trial. The complex nature of tobacco smoking, and considering its historical and social context in Aboriginal communities, suggests that wider and more intensive interventions are needed.
Noble, Natasha. "Health risk factors in Aboriginal community controlled health services: an exploration of prevalence, clustering, screening options and intervention preferences." Thesis, 2017. http://hdl.handle.net/1959.13/1353444.
Повний текст джерелаAboriginal and Torres Strait Islander Australians have a substantially lower life expectancy and greater burden of chronic disease than their non-Indigenous Australian counterparts. The current health status of Indigenous Australians can be linked to a history of colonization and dispossession, as well as to past and ongoing racism and discrimination. While acknowledging the need to address such broader social determinants of health, there is also significant potential to improve the health of Aboriginal and Torres Strait Islander Australians through reducing the disproportionate prevalence of key health risk behaviours among this population, such as smoking, poor diet, excess alcohol and physical inactivity. Primary care is an important setting for the delivery of preventive health care, and Aboriginal Community Controlled Health Services (ACCHSs) are well placed to provide primary care for Aboriginal communities. A range of preventive care interventions have shown success in modifying health risk behaviours in non-Indigenous healthcare settings. However, such strategies are not well tested in Aboriginal health. Therefore this thesis aimed to explore the acceptability of strategies including point-of-care screening, and the provision of patient feedback, in the ACCHS setting. The need for primary care to address ‘lifestyles’ or patterns of interrelated health risks is also being increasingly recognized. In order to inform the provision of more holistic preventive care, this thesis also explored the clustering patterns of key health risk behaviours among ACCHS clients. Patient preferences for addressing their health risks, including whether health risks should be addressed individually, sequentially or simultaneously, and the types of support that would be most helpful, were examined. Implications of the results of these studies for the delivery of appropriate and effective primary care for Aboriginal and Torres Strait Islander Australians are discussed. Based on these findings and drawing on the existing literature, a multi-component, community-based intervention aimed at reducing multiple health risk behaviours is also proposed.