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Implementing Optimal Care Pathways for Aboriginal and Torres Strait Islander People With Cancer: A Survey of Rural Health Professionals’ Self-Rated Learning Needs. Int J Integr Care 2022; 22:27. [PMID: 35431703 PMCID: PMC8973837 DOI: 10.5334/ijic.6028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: Methods: Results: Conclusion:
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Dudgeon P, Derry KL, Mascall C, Ryder A. Understanding Aboriginal Models of Selfhood: The National Empowerment Project's Cultural, Social, and Emotional Wellbeing Program in Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4078. [PMID: 35409761 PMCID: PMC8997958 DOI: 10.3390/ijerph19074078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
Culturally safe and responsive interventions that acknowledge Aboriginal models of selfhood are needed. Such interventions empower Aboriginal peoples and communities by increasing self-determination over individual and community social and emotional wellbeing (SEWB). In response to this need, the National Empowerment Project developed the Cultural, Social, and Emotional Wellbeing Program (CSEWB). The CSEWB aims to strengthen SEWB and cultural identity and subsequently reduce psychological distress in Aboriginal peoples. An Aboriginal Participatory Action Research approach ensured community ownership and engagement. Seven research questions and a culturally modified adaption of the Most Significant Change technique informed a thematic analysis of the evaluation content. Aboriginal adults (n = 49; 53% ≥50 years, 66% female, 34% male) from three Western Australian urban communities participated in the program evaluation workshops. Participants reported the benefits of enhanced SEWB and reduced psychological distress. This research reaffirms the need for culturally safe programs that acknowledge social determinants of health and are guided by the SEWB framework. Long-term commitment from the government is needed to support such programs.
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Affiliation(s)
- Pat Dudgeon
- Poche Centre for Indigenous Health, School of Indigenous Studies, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Kate L. Derry
- Poche Centre for Indigenous Health, School of Indigenous Studies, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Carolyn Mascall
- Relationships Australia WA, West Leederville, WA 6007, Australia; Langford Aboriginal Association, Langford, WA 6147, Australia; (C.M.); (A.R.)
| | - Angela Ryder
- Relationships Australia WA, West Leederville, WA 6007, Australia; Langford Aboriginal Association, Langford, WA 6147, Australia; (C.M.); (A.R.)
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E. Stearne A, Lee KSK, Allsop S, Shakeshaft A, Wright M. First Nations Australians' self-determination in health and alcohol policy development: a Delphi study. Health Res Policy Syst 2022; 20:12. [PMID: 35062976 PMCID: PMC8777453 DOI: 10.1186/s12961-022-00813-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Recognition of the role of structural, cultural, political and social determinants of health is increasing. A key principle of each of these is self-determination, and according to the United Nations (2007), this is a right of Indigenous Peoples. For First Nations Australians, opportunities to exercise this right appear to be limited. This paper explores First Nations Australian communities' responses to reducing alcohol-related harms and improving the health and well-being of their communities, with a focus on understanding perceptions and experiences of their self-determination. It is noted that while including First Nations Australians in policies is not in and of itself self-determination, recognition of this right in the processes of developing health and alcohol policies is a critical element. This study aims to identify expert opinion on what is needed for First Nations Australians' self-determination in the development of health- and alcohol-related policy. METHODS This study used the Delphi technique to translate an expert panel's opinions into group consensus. Perspectives were sought from First Nations Australians (n = 9) and non-Indigenous Peoples (n = 11) with experience in developing, evaluating and/or advocating for alcohol interventions led by First Nations Australians. Using a web-based survey, this study employed three survey rounds to identify and then gain consensus regarding the elements required for First Nations Australians' self-determination in policy development. RESULTS Twenty panellists (n = 9 First Nations Australian) participated in at least one of the three surveys. Following the qualitative round 1 survey, six main themes, 60 subthemes and six examples of policy were identified for ranking in round 2. In round 2, consensus was reached with 67% of elements (n = 40/60). Elements that did not reach consensus were repeated in round 3, with additional elements (n = 5). Overall, consensus was reached on two thirds of elements (66%, n = 43/65). CONCLUSIONS Self-determination is complex, with different meaning in each context. Despite some evidence of self-determination, systemic change in many areas is needed, including in government. This study has identified a starting point, with the identification of elements and structural changes necessary to facilitate First Nations Australian community-led policy development approaches, which are vital to ensuring self-determination.
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Affiliation(s)
- Annalee E. Stearne
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, Western Australia Australia
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia Australia
| | - K. S. Kylie Lee
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, Western Australia Australia
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia Australia
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, New South Wales Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales Australia
- Burnet Institute, Melbourne, Victoria Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria Australia
| | - Steve Allsop
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, Western Australia Australia
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales Australia
| | - Michael Wright
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Western Australia Australia
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Yashadhana A, Howie A, Veber M, Cullen P, Withall A, Lewis E, McCausland R, Macniven R, Andersen M. Experiences and perceptions of ageing among older First Nations Australians: A rapid review. Australas J Ageing 2021; 41:8-19. [PMID: 34905642 DOI: 10.1111/ajag.13031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify and describe articles reporting the experiences and perceptions of ageing among older First Nations Australians. METHODS Following rapid review and PRISMA guidelines, we searched five databases for peer-reviewed articles published prior to October 2019 that reported qualitative accounts of ageing among older (≥ 45 years) First Nations Australians. Data were extracted and synthesised thematically. RESULTS Twenty-one articles were included in the final synthesis. Priorities in ageing highlighted the role of Elders, family, community, culture and connection to ancestral lands. Experiences and perceptions of ageing reflected cultural marginalisation in aged and health care services, and highlighted the importance of cultural identity, resilience and survival as key to ageing well. CONCLUSIONS Our review suggests that mainstream ageing frameworks do not fully reflect the priorities of older First Nations Australians. This has important implications for ageing policy and the design and delivery of culturally safe aged and health care services.
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Affiliation(s)
- Aryati Yashadhana
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Health Equity Training Research & Evaluation (CHETRE), University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Adam Howie
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Madelene Veber
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia Cullen
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Ngarruwan Ngadju, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Adrienne Withall
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ebony Lewis
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth McCausland
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Institute for Global Development, University of New South Wales, Sydney, New South Wales, Australia
| | - Rona Macniven
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Andersen
- University of New South Wales Ageing Futures Institute, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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Gibson M, Stuart J, Leske S, Ward R, Vidyattama Y. Does community cultural connectedness reduce the influence of area disadvantage on Aboriginal & Torres Strait Islander young peoples' suicide? Aust N Z J Public Health 2021; 45:643-650. [PMID: 34761851 DOI: 10.1111/1753-6405.13164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The study aimed to examine associations of community cultural connectedness with Aboriginal and Torres Strait Islander young peoples' suicide rates in areas with elevated risk factors. METHODS Age-specific suicide rates (ASSRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander young people (aged 15-24 years) in Queensland from 2001-2015. Rate Ratios (RRs) compared young peoples' suicide rates in areas with high and low levels of cultural connectedness indicators (cultural social capital and Indigenous language use) within areas with elevated risk factors (high rates of discrimination, low socioeconomic resources, and remoteness). RESULTS Within low socioeconomically resourced areas and where Aboriginal and Torres Strait Islander people experienced more discrimination, greater engagement and involvement with cultural events, ceremonies and organisations was associated with 36% and 47% lower young peoples' suicide rates respectively (RR=1.57, 95%CI=1.13-2.21, p=<0.01; RR=1.88, 95%CI=1.25-2.89, p=<0.01). Within remote and regional areas, higher levels of community language use was associated with 26% lower suicide rates (RR=1.35, 95%CI=1-1.93, p=0.04), and in communities experiencing more discrimination, language use was associated with 34% lower rates (RR=1.53, 95%CI=1.01-2.37, p=0.04). CONCLUSION Cultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples' suicide rates in communities experiencing the most disadvantage. Implications for public health: This provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.
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Affiliation(s)
- Mandy Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland
- School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Jaimee Stuart
- School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland
- School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Raelene Ward
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland
- College for Indigenous Studies Education and Research, University of Southern Queensland, Toowomba, Queensland
| | - Yogi Vidyattama
- National Centre For Social And Economic Modelling (NATSEM), The Institute for Governance and Policy Analysis, University of Canberra, Australian Capital Territory
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Cox T, Hoang H, Mond J, Cross M. 'It all comes back to community!': A qualitative study of Aboriginal Elders promoting cultural well-being. Aust J Rural Health 2021; 29:909-917. [PMID: 34757629 DOI: 10.1111/ajr.12791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine Australian Aboriginal Elders' (Elders) views on their contributions to and their potential to contribute to the well-being of their community. DESIGN Participatory action research methodology was employed. Data collection methods included yarning interviews and group circle discussions. Data were thematically analysed. SETTING The project was undertaken in collaboration with Elders from a discrete Aboriginal community in rural/remote Tasmania, an island state in southern Australia. PARTICIPANTS Twelve Aboriginal community Elders. INTERVENTION N/A. MAIN OUTCOME MEASURES N/A. RESULTS Elders were promoting cultural well-being through interconnected themes of mentoring, cultural healing and seeking balance between health services and the community's cultural foundation. Cultural values, identity, community cohesion and connections to country were further embedded in these themes. CONCLUSION The study findings draw attention to the age-old wisdom of Aboriginal Elders, who actively promote cultural well-being as a main determinant of community health.
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Affiliation(s)
- Terrance Cox
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Ha Hoang
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Jonathon Mond
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Merylin Cross
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Assessment tools measuring health-related empowerment in psychosocially vulnerable populations: a systematic review. Int J Equity Health 2021; 20:246. [PMID: 34789249 PMCID: PMC8596931 DOI: 10.1186/s12939-021-01585-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many programs are undertaken to facilitate the empowerment of vulnerable populations across the world. However, an overview of appropriate empowerment measurements to evaluate such initiatives remains incomplete to date. This systematic review aims to describe and summarise psychometric properties, feasibility and clinical utility of the available tools for measuring empowerment in psychosocially vulnerable populations. METHODS A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. A descriptive approach was used for data analysis. Papers were eligible if they explored the development, validation, cross-cultural translation or the utility of an empowerment measurement tool in the context of psychosocially vulnerable populations. RESULTS Twenty-six included articles described twenty-six separate studies in which 16 empowerment measurement tools were developed, validated/translated, or used. There was heterogeneity in empowerment constructs, samples targeted, and psychometric properties measured. The measurement of reliability of the included instruments was satisfactory in most cases. However, the validity, responsiveness, interpretability, feasibility and clinical utility of the identified measurement tools were often not adequately described or measured. CONCLUSION This systematic review provides a useful snapshot of the strengths as well as limitations of existing health related empowerment measurement tools used with psychosocially vulnerable populations in terms of their measurement properties, and constructs captured. It highlights significant gaps in empowerment tool measurement, development and evaluation processes. In particular, the results suggest that in addition to systematic assessments of psychometric properties, the inclusion of feasibility and clinical utility as outcome measures are important to assess relevance to clinical practice.
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Oliveira MVG, Abreu ÂMM, Welch JR, Coimbra CEA. Coping with Hypertension among Indigenous Peoples in Brazil and the Role of the Primary Care Nurse: A Critical Review from a Transcultural Perspective. NURSING REPORTS 2021; 11:942-954. [PMID: 34968280 PMCID: PMC8715468 DOI: 10.3390/nursrep11040086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
Our objective is to critically review the literature addressing the strategic role of nurses in the daily primary care of arterial hypertension in Indigenous communities in Brazil. We selected studies based on an initial keyword search of major bibliographic indexing databases for the years 2000 to 2020 and manual search. Further selection was based on topical, methodological, and thematic relevance, as well as evaluation of scholarship quality and pertinence to our chosen narrative. The literature demonstrates Indigenous peoples do not receive health services that measure up to national standards in large part due to a marked lack of academic and employer preparation for nurses operating in transcultural settings. Inequities were apparent in recurrent reports of victim-blaming, deficient clinical communication with patients, clinical malpractice, devaluation of hypertension as a problem for Indigenous peoples, insufficient intercultural training for nurses, and discrimination against Indigenous students in nursing education programs. This systemic problem needs to be addressed by universities and the Indigenous Health Care Subsystem in Brazil.
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Affiliation(s)
| | - Ângela Maria Mendes Abreu
- Escola de Enfermagem Anna Nery, Universidade Federal de Rio de Janeiro, Rio de Janeiro 20211-130, Brazil;
| | - James R. Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21041-210, Brazil; (J.R.W.); (C.E.A.C.J.)
| | - Carlos E. A. Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21041-210, Brazil; (J.R.W.); (C.E.A.C.J.)
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Christidis R, Lock M, Walker T, Egan M, Browne J. Concerns and priorities of Aboriginal and Torres Strait Islander peoples regarding food and nutrition: a systematic review of qualitative evidence. Int J Equity Health 2021; 20:220. [PMID: 34620180 PMCID: PMC8499519 DOI: 10.1186/s12939-021-01551-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/11/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians experience persistent health and social inequities. Chronic conditions, many of which are diet-related, are leading contributors to the burden of disease and health inequity in Australia. First Nations Peoples have the right to be involved in all policy decisions affecting them. This review aimed to synthesise Aboriginal and Torres Strait Islander Peoples' concerns and priorities about food and nutrition in order to inform policies to improve health equity. METHODS MEDLINE, CINAHL, Informit and Google Scholar were systematically searched to identify qualitative studies-published from January 2008-that included data from Aboriginal and/or Torres Strait Islander Peoples about their concerns and priorities related to food and nutrition. Data were extracted from included studies using a pre-determined template and study quality was assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Qualitative findings were synthesised using inductive thematic analysis and categorised based on an ecological model of health. RESULTS Twenty-one studies were included. Key factors influencing food and nutrition were identified across all levels of the ecological framework. These included interpersonal and institutional racism, junk food availability and marketing, food accessibility and affordability, housing conditions, food knowledge and cooking skills, and connection to family and culture. CONCLUSIONS Documenting Aboriginal and Torres Strait Islander Peoples' lived experiences of the colonised food system is one step necessary for informing policy to tackle food and nutrition inequities. Based on existing qualitative research, food and nutrition policymakers should prioritise building a supportive food environment by focusing on self-determination; ensuring access to healthy, affordable food and safe housing; and by eliminating systemic racism.
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Affiliation(s)
- Rebecca Christidis
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
| | - Mark Lock
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
| | - Troy Walker
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, 17-23 Sackville St, Collingwood, Victoria Australia
| | - Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
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Gall A, Diaz A, Garvey G, Anderson K, Lindsay D, Howard K. An exploration of the sociodemographic and health conditions associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults. BMC Res Notes 2021; 14:386. [PMID: 34600592 PMCID: PMC8487334 DOI: 10.1186/s13104-021-05794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/20/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify sociodemographic factors and health conditions associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults. Participants were recruited via investigator networks and an online panel provider with an established nationwide panel of Aboriginal and Torres Strait Islander adults. Those interested were invited to complete a survey that included an assessment of wellbeing using a visual analogue scale. Data was collected from October-November 2019 and August-September 2020. Exploratory analyses were conducted to ascertain factors associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults. RESULTS Having more than enough money to last until next pay day, full-time employment, completion of grade 12, having a partner, and living with others were significantly associated with higher wellbeing among Aboriginal and Torres Strait Islander adults. A self-reported history of depression, anxiety, other mental health conditions, heart disease, or disability were associated with lower self-rated wellbeing scores. Our findings indicate a need for further investigation among these socioeconomic and patient groups to identify how to improve and support the wellbeing of Aboriginal and Torres Strait Islander adults.
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Affiliation(s)
- A Gall
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
| | - A Diaz
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - G Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
- School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, 2006, Australia
- School of Public Health, University of Queensland, Brisbane, Australia
| | - K Anderson
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - D Lindsay
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - K Howard
- School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, 2006, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
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Butten K, Jones L, Newcombe PA, Chang AB, Sheffield JK, O'Grady KAF, Johnson NW, Bell AM, Ross G, Toombs M. Development and validation of a parent-proxy health-related quality of life survey for Australian First Nations children. BMJ Open 2021; 11:e046007. [PMID: 34400446 PMCID: PMC8370500 DOI: 10.1136/bmjopen-2020-046007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/23/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Within Australia, Aboriginal and Torres Strait Islander (First Nations) populations perceive health and well-being differently to non-Indigenous Australians. Existing health-related quality of life (HR-QoL) measurement tools do not account for these differences. The objective of this study was to develop and validate a culturally specific parent-proxy HR-QoL measurement tool for First Nations children. DESIGN Scale development was informed by parents/carers of children with a chronic illness and an expert panel. The preliminary 39-item survey was reviewed (n=12) and tested (n=163) with parents/carers of First Nations children aged 0-12 years at baseline with comparative scales: the Kessler Psychological Distress Scale, generic HR-QoL (Paediatric QoL Inventory 4.0, PedsQL4.0) and Spence Children's Anxiety Scale, and repeated (n=46) 4 weeks later. Exploratory Factor Analysis was used for scale reduction. Reliability and validity were assessed by internal consistency, test-retest, and correlations with comparison scales. RESULTS Items within our First Nations-Child Quality of Life (FirstNations-CQoL) were internally consistent with Cronbach's alpha coefficients of ≥0.7 (quality of life, 0.808; patient experience, 0.880; patient support, 0.768) and overall test-retest reliability was good (r=0.75; 95% CI 0.593 to 0.856). Convergent validity was observed with the PedsQL4.0 with Pearson's coefficients of r=0.681 (ages 2-4 years); r=0.651 (ages 5-12 years) and with the Kessler Psychological Distress scale (r=-0.513). Divergent validity against the Spence Anxiety Scale was not demonstrated. CONCLUSIONS The FirstNations-CQoL scale was accepted by the participants, reliable and demonstrated convergent validity with comparison measures. This tool requires further evaluation to determine responsiveness, its minimal important difference and clinical utility.
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Affiliation(s)
- Kaley Butten
- Institute of Health & Biomedical Innovation, Queensland University of Technology - QUT, Brisbane, Queensland, Australia
| | - Lee Jones
- Institute of Health & Biomedical Innovation, Queensland University of Technology - QUT, Brisbane, Queensland, Australia
| | - Peter A Newcombe
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Darwin, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeanie K Sheffield
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health & Biomedical Innovation, Queensland University of Technology - QUT, Brisbane, Queensland, Australia
| | - Newell W Johnson
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Gold Coast Campus - Griffith University, Gold Coast, Queensland, Australia
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Anna Maria Bell
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Greggory Ross
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Maree Toombs
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Wright M, Getta AD, Green AO, Kickett UC, Kickett AH, McNamara AI, McNamara UA, Newman AM, Pell AC, Penny AM, Wilkes UP, Wilkes AS, Culbong T, Taylor K, Brown A, Dudgeon P, Pearson G, Allsop S, Lin A, Smith G, Farrant B, Mirabella L, O’Connell M. Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8555. [PMID: 34444319 PMCID: PMC8394671 DOI: 10.3390/ijerph18168555] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.
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Affiliation(s)
- Michael Wright
- School of Allied Health, Curtin University, Bentley, Perth 6102, Australia; (M.W.); (T.C.)
| | - Aunty Doris Getta
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Oriel Green
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Uncle Charles Kickett
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Helen Kickett
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Irene McNamara
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Uncle Albert McNamara
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Moya Newman
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Charmaine Pell
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Millie Penny
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Uncle Peter Wilkes
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Aunty Sandra Wilkes
- Elders Co-Researcher Group, Perth 6000, Australia; (A.D.G.); (A.O.G.); (U.C.K.); (A.H.K.); (A.I.M.); (U.A.M.); (A.M.N.); (A.C.P.); (A.M.P.); (U.P.W.); (A.S.W.)
| | - Tiana Culbong
- School of Allied Health, Curtin University, Bentley, Perth 6102, Australia; (M.W.); (T.C.)
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, University of South Australia, Adelaide 5001, Australia;
| | - Pat Dudgeon
- Poche Centre for Indigenous Health, University of Western Australia, Crawley 6009, Australia;
| | - Glenn Pearson
- Telethon Kids Institute, University of Western Australia, Nedlands 6009, Australia; (G.P.); (A.L.); (B.F.)
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Bentley, Perth 6102, Australia;
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Nedlands 6009, Australia; (G.P.); (A.L.); (B.F.)
| | - Geoff Smith
- Medical School, University of Western Australia, Crawley 6009, Australia;
| | - Brad Farrant
- Telethon Kids Institute, University of Western Australia, Nedlands 6009, Australia; (G.P.); (A.L.); (B.F.)
| | | | - Margaret O’Connell
- School of Allied Health, Curtin University, Bentley, Perth 6102, Australia; (M.W.); (T.C.)
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Welch JR. A'uwẽ (Xavante) Social Constructions of Well-Being in Central Brazil. Med Anthropol 2021; 40:799-814. [PMID: 34383573 PMCID: PMC7612006 DOI: 10.1080/01459740.2021.1961247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Well-being is a heterogeneous idea with inconsistent applicability to real-world circumstances. In this article, I explore A’uwẽ (Xavante) notions of social well-being from an ethnographic perspective. My data indicate many members of this Indigenous group understand wellness to involve not only health and harmony, but also certain modes of strife and inequality that are also viewed as desirable. A’uwẽ understandings of social wellness, including linkages to the environment, suggest that a broader and more locally contingent concept of social well-being than is evident in mainstream literature would benefit transcultural health efforts and policy involving Indigenous and other culturally distinct communities.
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Affiliation(s)
- James R Welch
- Associate Researcher, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz
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Lavrencic LM, Donovan T, Moffatt L, Keiller T, Allan W, Delbaere K, Radford K. Ngarraanga Giinganay ('thinking peacefully'): Co-design and pilot study of a culturally-grounded mindfulness-based stress reduction program with older First Nations Australians. EVALUATION AND PROGRAM PLANNING 2021; 87:101929. [PMID: 33711689 DOI: 10.1016/j.evalprogplan.2021.101929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/08/2020] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
First Nations 'survivors' are ageing in increasing numbers. Life-course stress and depression are of concern for older First Nations Australians, yet there are limited psychosocial interventions. This study aimed to co-design a culturally-grounded mindfulness-based program ('Ngarraanga Giinganay') and evaluate acceptability/feasibility with an Aboriginal community on Gumbaynggirr Country. An expert Working Group guided program development, with Aboriginal and non-Aboriginal clinicians/consultants. A workshop, collaborative yarning group with older Aboriginal people (n = 9), and further consultation contributed to the design/refinement of the 8-session group-based program, ensuring content aligned with therapeutic principles of mindfulness and cultural understandings of the Gumbaynggirr community. A single-group pilot study was conducted (n = 7, 62-81 years), co-facilitated by an Aboriginal clinician and Elder. Outcomes were qualitative (understandings of mindfulness, program acceptability, benefits to health/wellbeing). Pilot results demonstrated feasibility, acceptability and preliminary effectiveness. The program enhanced understandings of mindfulness and participants highlighted benefits such as helping anxiety, relaxation, focusing on the moment and connection to Country/land. Trends were seen for reducing depression, anxiety and stress symptoms, and blood pressure. This study provides insight into partnering with underrepresented populations through ageing research, highlighting the effectiveness of this co-design approach. Ngarraanga Giinganay has considerable potential for supporting health and wellbeing of First Nations peoples.
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Affiliation(s)
- Louise M Lavrencic
- Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia.
| | | | - Lindy Moffatt
- Neuroscience Research Australia, Sydney, NSW, Australia
| | | | - Wendy Allan
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia
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65
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Kingsley J, Munro-Harrison E, Jenkins A, Thorpe A. Developing a framework identifying the outcomes, principles and enablers of 'gathering places': Perspectives from Aboriginal people in Victoria, Australia. Soc Sci Med 2021; 283:114217. [PMID: 34256253 DOI: 10.1016/j.socscimed.2021.114217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/14/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
Aboriginal 'gathering places' have been described as cultural hubs, healing centres, and social meeting places. This article explores a gap in the literature on the health and wellbeing outcomes of gathering places from the perspectives of Aboriginal people who attend them. The aim of this study was to develop a framework to articulate the enablers, principles, and outcomes of 'successful' Aboriginal gathering places. In this study, sixty-nine (n = 69) community members participated in qualitative interviews or focus group discussions across thirteen gathering place sites in Victoria (Australia). The research found that gathering places address social health disparities through the provision of a broad range of health and wellbeing programs that benefit Aboriginal community members accessing them. Gathering places were described by participants as providing connections to place, Aboriginal culture, and healing and mainstream health services that enhanced wellbeing. These findings contribute to a better understanding of how Aboriginal gathering places function and offer strategies for creating culturally safe and welcoming settings for Aboriginal peoples, with potential for consideration in international contexts. This research informed a best-practice framework and outlines different models for developing community empowering and culturally affirming gathering places for improving Aboriginal people's access to culturally appropriate health and support services, while simultaneously reducing health and social inequalities. Key elements of this framework that contribute to a successful gathering place include the people, place (location/facilities), programs and community themselves, whilst the principles that enable these places include elements like self-determination, respect of culture, sustainability and strong governance.
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Affiliation(s)
- Jonathan Kingsley
- School of Health Sciences, Swinburne University of Technology, 12 Wakefield Street (Swinburne Place West), Hawthorn, Victoria, 3122, Australia; Centre of Urban Transitions, Swinburne University of Technology, 12 Wakefield Street (Swinburne Place West), Hawthorn, Victoria, 3122, Australia.
| | - Emily Munro-Harrison
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3010, Australia; Intergenerational Health, Murdoch Children's Research Centre, Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Anne Jenkins
- Oonah Health & Community Services Aboriginal Corporation, 1A Badger Creek Road, Healesville, Victoria, 3777, Australia
| | - Alister Thorpe
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3010, Australia
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66
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Garvey G, Cunningham J, Mayer C, Letendre A, Shaw J, Anderson K, Kelly B. Psychosocial Aspects of Delivering Cancer Care to Indigenous People: An Overview. JCO Glob Oncol 2021; 6:148-154. [PMID: 32031444 PMCID: PMC6998016 DOI: 10.1200/jgo.19.00130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globally, a growing body of evidence has reported significant disparities in cancer outcomes between indigenous and nonindigenous people. Although some effort is being made to address these disparities, relatively little attention has been directed toward identifying and focusing on the psychosocial aspects of cancer care for indigenous patients, which are critical components in improving cancer care and outcomes. The purpose of this article is to describe the results of a scoping review of the psychosocial aspects of cancer care for indigenous people. We highlight considerations in undertaking research in this field with indigenous people and the implications for clinical practice.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Carole Mayer
- Health Sciences North Research Institute, Sudbury, Ontario, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angeline Letendre
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Edmonton, Alberta, Canada
| | - Joanne Shaw
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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67
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Ju X, Canfell K, Howard K, Garvey G, Hedges J, Smith M, Jamieson L. Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians. BMC Public Health 2021; 21:1455. [PMID: 34311730 PMCID: PMC8314643 DOI: 10.1186/s12889-021-11496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals' preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians. METHODS Development and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test. RESULTS Data from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91-0.92 in 'screened, cytology normal, HPV vaccination' and 'screened, HPV positive, endoscopy normal', to less than 0.90 (ranging from 0.87-0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75-0.79) in 'early stage throat cancer'. Higher utility scores were observed for 'screened, cytology normal and HPV vaccination' among younger participants (18-40 years), for 'early stage invasive throat cancer' among females, and for 'oral intraepithelial neoplasia' and 'early stage invasive throat cancer' among metropolitan-dwelling participants. CONCLUSION Among a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia.
| | - Karen Canfell
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Gail Garvey
- Menzies School of Health Research, Darwin, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia
| | - Megan Smith
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia
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Garvey G, Anderson K, Gall A, Butler TL, Whop LJ, Arley B, Cunningham J, Dickson M, Cass A, Ratcliffe J, Tong A, Howard K. The Fabric of Aboriginal and Torres Strait Islander Wellbeing: A Conceptual Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7745. [PMID: 34360037 PMCID: PMC8345714 DOI: 10.3390/ijerph18157745] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
Wellbeing is culturally bound and is shaped by many aspects of life, including experiences, beliefs and values. As such, in order to accurately measure wellbeing for a specific cultural group, it is necessary to understand the experiences, beliefs and values that influence the conception and experience of wellbeing of that group. This paper presents a conceptual model of wellbeing for Aboriginal and Torres Strait Islander people, which was developed from a large national qualitative study that explored the views of 359 Aboriginal and Torres Strait Islander adults. An Aboriginal- and Torres Strait Islander-led research team used an Indigenist research approach to iteratively develop this conceptual model, called the Fabric of Aboriginal and Torres Strait Islander Wellbeing model, which takes inspiration from Aboriginal and Torres Strait Islander weaving traditions whereby individual strands are twined to create fabrics that are both beautiful and strong. This reflects our findings that the parts of life that are most important to wellbeing for many Aboriginal and Torres Strait Islander people are interwoven with their families, communities and culture.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- School of Public Health, University of Queensland, Brisbane 4000, Australia
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Alana Gall
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Tamara L. Butler
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
| | - Brian Arley
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide 5042, Australia;
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kirsten Howard
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney 2006, Australia
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69
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Smith K, Gilchrist L, Taylor K, Clinch C, Logiudice D, Edgill P, Ratcliffe J, Flicker L, Douglas H, Bradley K, Bessarab D. Good Spirit, Good Life: A Quality of Life Tool and Framework for Older Aboriginal Peoples. THE GERONTOLOGIST 2021; 61:e163-e172. [PMID: 32191314 DOI: 10.1093/geront/gnz185] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. RESEARCH DESIGN AND METHODS The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semistructured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. RESULTS The participants preferred the term "a good life" to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. DISCUSSION AND IMPLICATIONS Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide.
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Affiliation(s)
- Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth
| | - Lianne Gilchrist
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth
| | - Kevin Taylor
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth
| | - Christine Clinch
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth
| | - Dina Logiudice
- Department of Medicine, University of Melbourne, Victoria
- Department of Medicine and Aged Care, Melbourne Health, Victoria
| | - Paula Edgill
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, University of Western Australia, Perth
| | - Harry Douglas
- Department of Medicine, University of Melbourne, Victoria
- Department of Medicine and Aged Care, Melbourne Health, Victoria
| | - Kate Bradley
- Department of Medicine, University of Melbourne, Victoria
- Department of Medicine and Aged Care, Melbourne Health, Victoria
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth
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Garvey G, Anderson K, Gall A, Butler TL, Cunningham J, Whop LJ, Dickson M, Ratcliffe J, Cass A, Tong A, Arley B, Howard K. What Matters 2 Adults (WM2Adults): Understanding the Foundations of Aboriginal and Torres Strait Islander Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6193. [PMID: 34201090 PMCID: PMC8226989 DOI: 10.3390/ijerph18126193] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Aboriginal and Torres Strait Islander people experience a greater range of health and social disadvantages compared to other Australians. Wellbeing is a culturally-bound construct, and to date, a national evidence base around the components of wellbeing for Aboriginal and Torres Strait Islander people is lacking. Understanding and measurement of wellbeing for this population is critical in achieving health equity. This paper aims to identify and describe the foundations of wellbeing for Aboriginal and Torres Strait Islander adults. This national qualitative study was underpinned by an Indigenist research approach which privileges the voices of Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander adults were purposively recruited from around Australia between September 2017 and September 2018 to participate in Yarning Circles, led by Aboriginal and Torres Strait Islander researchers. Yarning Circles were audio recorded, transcribed and analyzed. A Collaborative Yarning Methodology was used, which incorporated reflexive thematic analysis to identify and describe the foundations of wellbeing reported by participants. A total of 359 Aboriginal and Torres Strait Islander adults participated. Our analysis revealed five foundations of wellbeing: belonging and connection; holistic health; purpose and control; dignity and respect; and basic needs. These foundations were deeply interwoven by three interconnected aspects of Aboriginal and Torres Strait Islander life: family, community and culture. The findings of this study will substantially aid our efforts to develop a new wellbeing measure for Aboriginal and Torres Strait Islander adults. The iterative Indigenist methods used in this study provide a robust research methodology for conducting large-scale, nationally-relevant qualitative research with Aboriginal and Torres Strait Islander people. Policies and practices that are informed by our results have the potential to address outcomes that are meaningful for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
- School of Public Health, University of Queensland, Brisbane 4000, Australia
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
| | - Alana Gall
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
| | - Tamara L. Butler
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide 5042, Australia;
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Brian Arley
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
| | - Kirsten Howard
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (J.C.); (L.J.W.); (A.C.); (B.A.); (K.H.)
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney 2006, Australia
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Esgin T, Hersh D, Rowley KG, Macniven R, Glenister K, Crouch A, Newton RU. Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5969. [PMID: 34199675 PMCID: PMC8199758 DOI: 10.3390/ijerph18115969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022]
Abstract
Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18-25, 26-44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.
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Affiliation(s)
- Tuguy Esgin
- Discipline of Exercise, Health and Performance, The University of Sydney, Sydney, NSW 2006, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (D.H.); (R.U.N.)
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (D.H.); (R.U.N.)
| | - Kevin G. Rowley
- Onemda VicHealth Koori Health Unit, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Rona Macniven
- School of Population Health, University of New South Wales, Kensington, NSW 2052, Australia;
- Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Faculty of Health, Medicine and Human Sciences, Macquarie University, North Ryde, NSW 2109, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Shepparton, VIC 3630, Australia; (K.G.); (A.C.)
| | - Alan Crouch
- Department of Rural Health, University of Melbourne, Shepparton, VIC 3630, Australia; (K.G.); (A.C.)
| | - Robert U. Newton
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (D.H.); (R.U.N.)
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia
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Lovett RW, Brinckley MM. Community level cultural connectedness and suicide by young Aboriginal and Torres Strait Islander people. Med J Aust 2021; 214:511-512. [PMID: 34018202 DOI: 10.5694/mja2.51092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Raymond W Lovett
- National Centre for Epidemiology and Population Health, the Australian National University, Canberra, ACT
- Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra, ACT
| | - Makayla-May Brinckley
- National Centre for Epidemiology and Population Health, the Australian National University, Canberra, ACT
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Gall A, Anderson K, Howard K, Diaz A, King A, Willing E, Connolly M, Lindsay D, Garvey G. Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115832. [PMID: 34071636 PMCID: PMC8198891 DOI: 10.3390/ijerph18115832] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples' concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. We aim to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States. We searched CINAHL, Embase, PsycINFO and PubMed databases for papers that included key Indigenous and wellbeing search terms from database inception to April 2020. Papers that included a focus on Indigenous adults residing in Canada, Aotearoa and the United States, and that included empirical qualitative data that described at least one aspect of wellbeing were eligible. Data were analysed using the stages of thematic development recommended by Thomas and Harden for thematic synthesis of qualitative research. Our search resulted in 2669 papers being screened for eligibility. Following full-text screening, 100 papers were deemed eligible for inclusion (Aotearoa (New Zealand) n = 16, Canada n = 43, United States n = 41). Themes varied across countries; however, identity, connection, balance and self-determination were common aspects of wellbeing. Having this broader understanding of wellbeing across these cultures can inform decisions made about public health actions and resources.
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Affiliation(s)
- Alana Gall
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
- Correspondence:
| | - Kate Anderson
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Abbey Diaz
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
| | - Alexandra King
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada;
| | - Esther Willing
- Kōhatu–Centre for Hauora Māori, University of Otago, Dunedin 9054, New Zealand;
| | - Michele Connolly
- International Group for Indigenous Health Measurement, Columbia, MD 21045, USA;
| | - Daniel Lindsay
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
| | - Gail Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
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"The Land Nurtures Our Spirit": Understanding the Role of the Land in Labrador Innu Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105102. [PMID: 34065830 PMCID: PMC8151664 DOI: 10.3390/ijerph18105102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
We examined Indigenous views of wellbeing, aiming to understand how the Labrador Innu view influence of land on their health. The Innu live in two First Nation communities (Sheshatshiu and Natuashish) in the subarctic portion of the province of Newfoundland and Labrador, Canada. Their views on land and wellbeing are context specific and have not been studied; our research addresses this significant gap in literature. Findings highlight that the experience of being on the land with family and community, learning cultural knowledge, and gaining a sense of identity play a major role in enhancing wellbeing. Externally imposed policies and programs conceiving Indigenous land as a physical place only fail to understand that land sustains wellbeing by emplacing knowledge systems and cultural identity.
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Backholer K, Baum F, Finlay SM, Friel S, Giles-Corti B, Jones A, Patrick R, Shill J, Townsend B, Armstrong F, Baker P, Bowen K, Browne J, Büsst C, Butt A, Canuto K, Canuto K, Capon A, Corben K, Daube M, Goldfeld S, Grenfell R, Gunn L, Harris P, Horton K, Keane L, Lacy-Nichols J, Lo SN, Lovett RW, Lowe M, Martin JE, Neal N, Peeters A, Pettman T, Thoms A, Thow AMT, Timperio A, Williams C, Wright A, Zapata-Diomedi B, Demaio S. Australia in 2030: what is our path to health for all? Med J Aust 2021; 214 Suppl 8:S5-S40. [PMID: 33934362 DOI: 10.5694/mja2.51020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.
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A process of healing for the Labrador Innu: Improving health and wellbeing in the context of historical and contemporary colonialism. Soc Sci Med 2021; 279:113973. [PMID: 33991790 DOI: 10.1016/j.socscimed.2021.113973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
In light of the negative effects of historical and contemporary colonialism on the Labrador Innu, healing initiatives grounded in self-determination, renewal of cultural practices, and non-reliance on Western bio-medicine, are known, taught and widely practiced among the Innu. The value of Indigenous healing practices in the treatment of Indigenous people is well-recognized in Indigenous wellness literature, yet non-Indigenous health practitioners know little about healing processes. Moreover, to our knowledge, no studies have examined any contemporary Labrador Innu healing process. The main aim of this paper is to describe the process of healing among the Innu. Although there may be multiple processes of healing, we shed light on a major process that emerged from interviews and focus groups with 39 participants. Five stages of healing were described: being "under the blanket"; finding spiritual strength; extending hands out; finding strength and power; and helping others. Findings highlighted enablement of healing through spiritualities, support from Elders, return to culture, and resistance to negative stereotypes. We provide health professionals with valuable information for considering Innu healing as a model that expands their views for the benefit of Innu seeking mental health services. Implications for non-Innu health and social service providers are about broadening their understanding of the significant role of self-determination among Innu, learning Innu ways-of-knowing and being, recognizing one's own biases, and acknowledging the power imbalances between themselves and Innu people.
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Dingwall KM, Sweet M, Cass A, Hughes JT, Kavanagh D, Howard K, Barzi F, Brown S, Sajiv C, Majoni SW, Nagel T. Effectiveness of Wellbeing Intervention for Chronic Kidney Disease (WICKD): results of a randomised controlled trial. BMC Nephrol 2021; 22:136. [PMID: 33866968 PMCID: PMC8054368 DOI: 10.1186/s12882-021-02344-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. Few studies have investigated the efficacy of psychosocial interventions for people with ESKD and none exist for Indigenous people, a population in which the ESKD burden is especially high. Methods This three-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App in improving psychological distress (Kessler distress scale; K10), depressive symptoms (adapted Patient Health Questionnaire; PHQ-9), quality of life (EuroQoL; EQ. 5D) and dialysis adherence among Indigenous Australians undergoing haemodialysis in central and northern Australia (Alice Springs and Darwin), with follow up over two 3-month periods. Effects of immediate AIMhi Stay Strong App treatment were compared with those from a contact control app (The Hep B Story) and treatment as usual (TAU). Control conditions received the Stay Strong intervention after 3 months. Results Primary analyses of the full sample (N = 156) showed statistically significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong app or TAU. Restricting the sample to those with moderate to severe symptoms of distress or depression (K10 > =25 or PHQ-9 > =10) showed significant decreases in K10 and PHQ-9 scores for both Stay Strong and Hep B Story. No significant differences were observed for the EQ-5D or dialysis attendance. Conclusions Findings suggest that talking to people about their wellbeing and providing information relevant to kidney health using culturally adapted, locally relevant apps improve the wellbeing of people on dialysis. Further research is required to replicate these findings and identify active intervention components. Trial registration ACTRN12617000249358; 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
| | - David Kavanagh
- Centre for Children's Health Research and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
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Green M, Cunningham J, Anderson K, Griffiths K, Garvey G. Measuring health care experiences that matter to Indigenous people in Australia with cancer: identifying critical gaps in existing tools. Int J Equity Health 2021; 20:100. [PMID: 33845852 PMCID: PMC8042987 DOI: 10.1186/s12939-021-01433-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measurement of patients' healthcare experiences is increasingly used as an indicator of quality of care, but there are concerns that existing measures omit information that is meaningful to patients and that results may not be used systematically to inform service improvement. Further, current approaches may be inadequate for some population groups, such as Indigenous people in Australia, whose healthcare experience is impacted by the context of colonisation and discordance between Indigenous understandings of health and the Western biomedical health system. This study aimed to assess the extent to which existing patient experience measures used in Australia collect information about critical aspects of cancer care, as previously identified by Indigenous people affected by cancer and their health care providers. METHODS A two-stage process was used to examine the adequacy of existing patient experience measures for Indigenous people in Australia: (1) relevant tools and measures were identified and assessed, and four measures selected as suitable comparators; (2) comparators were examined in detail and mapped against topics identified in earlier research as important to Indigenous people with cancer. Gaps in topic coverage in comparators were identified. RESULTS No comparators completely captured the critical aspects of cancer care identified by Indigenous people affected by cancer and their health care providers. The number of topics 'partially' captured by the four comparators ranged from 4 to 7 out of 9. While most topics were partially covered, the lack of questions around culture and cultural safety was notable. CONCLUSIONS Existing tools are likely to miss key aspects of Indigenous peoples' experiences of cancer care in Australia. Failure to adequately assess care experiences related to cultural safety may compromise efforts to improve health outcomes. Addressing gaps requires development of experience measures that are strengths-based, reflect an Indigenous worldview and measure aspects of experience relevant to Indigenous people.
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Affiliation(s)
- Monica Green
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia.
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Kalinda Griffiths
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
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Evidence that loneliness can be reduced by a whole-of-community intervention to increase neighbourhood identification. Soc Sci Med 2021; 277:113909. [PMID: 33866082 DOI: 10.1016/j.socscimed.2021.113909] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
RATIONALE Social identification with the people in one's neighbourhood has a wide variety of benefits for individual and community health and wellbeing. In particular, previous research shows that residents' social identification with their neighbourhood is protective of mental health. However, researchers are only just beginning to design and evaluate interventions that directly target social identification on health grounds. OBJECTIVE This longitudinal study evaluated a whole-of-community intervention at scale (Neighbour Day, 2019), in which Australian residents were encouraged to build social connections in their local community. Neighbour Day is a campaign that seeks to raise public awareness of the importance of connecting with neighbours and had a reach of approximately 300,000 people in 2019. METHODS Participants were 437 hosts of neighbourhood events held across 276 diverse suburbs across Australia. Participants were surveyed at three-time points; before and after Neighbour Day, as well as at six-month follow up. RESULTS Hosting a Neighbour Day event led to a significant increase in neighbourhood social identification, which was sustained six months later. This increase in social identification predicted increased social cohesion, reduced loneliness and improved wellbeing. CONCLUSIONS This study provides evidence that neighbourhood identification is an effective target mechanism to curb loneliness and social fragmentation in the community. Implications are discussed with a focus on how social identity-building interventions can be effectively implemented in community settings to benefit public health.
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Ribeiro Santiago PH, Haag D, Macedo DM, Garvey G, Smith M, Canfell K, Hedges J, Jamieson L. Psychometric properties of the EQ-5D-5L for aboriginal Australians: a multi-method study. Health Qual Life Outcomes 2021; 19:81. [PMID: 33691744 PMCID: PMC7945337 DOI: 10.1186/s12955-021-01718-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/23/2021] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION In Australia, health-related quality of life (HRQoL) instruments have been adopted in national population surveys to inform policy decisions that affect the health of Aboriginal and Torres Strait Islanders. However, Western-developed HRQoL instruments should not be assumed to capture Indigenous conceptualization of health and well-being. In our study, following recommendations for cultural adaptation, an Indigenous Reference Group indicated the EQ-5D-5L as a potentially valid instrument to measure aspects of HRQoL and endorsed further psychometric evaluation. Thus, this study aimed to investigate the construct validity and reliability of the EQ-5D-5L in an Aboriginal Australian population. METHODS The EQ-5D-5L was applied in a sample of 1012 Aboriginal adults. Dimensionality was evaluated using Exploratory Graph Analysis. The Partial Credit Model was employed to evaluate item performance and adequacy of response categories. Area under the receiver operating characteristic curve (AUROC) was used to investigate discriminant validity regarding chronic pain, general health and experiences of discrimination. RESULTS The EQ-5D-5L comprised two dimensions, Physiological and Psychological, and reliability was adequate. Performance at an item level was excellent and the EQ-5D-5L individual items displayed good discriminant validity. CONCLUSIONS The EQ-5D-5L is a suitable instrument to measure five specific aspects (Mobility, Self-Care, Usual activities, Pain/Discomfort, Anxiety/Depression) of Aboriginal and Torres Strait Islander HRQoL. A future research agenda comprises the investigation of other domains of Aboriginal and Torres Strait Islander HRQoL and potential expansions to the instrument.
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Affiliation(s)
- Pedro Henrique Ribeiro Santiago
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
- School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Dandara Haag
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | | | - Gail Garvey
- Menzies School of Health Research, Darwin, Australia
| | - Megan Smith
- Cancer Council of NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Karen Canfell
- Cancer Council of NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joanne Hedges
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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Ju X, Hedges J, Garvey G, Smith M, Canfell K, Jamieson L. Poor self-rated oral health associated with poorer general health among Indigenous Australians. BMC Public Health 2021; 21:424. [PMID: 33648472 PMCID: PMC7919297 DOI: 10.1186/s12889-021-10426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Background Oral diseases negatively impact general health, affecting physical, psychological, social and emotional wellbeing, and ability to give back to community. The relationship between poor oral health, and general health and wellbeing among Indigenous Australians has not been documented. Working in partnership with seven Indigenous communities in South Australia, this study aimed to: 1) quantify self-rated oral health and health-related quality of life and; 2) investigate associations between poor self-rated oral health and general health among Indigenous Australian adults. Methods Data was collected from a large convenience sample of Indigenous Australians aged 18+ years from Feb 2018 to Jan 2019. General health-related quality of life, as the main outcome variable, was measured by calculating disutility scores with the five individual EQ-5D dimensions (EuroQol instrument: EQ-5D-5L), then classified as ‘no problem’ and ‘at least one problem’. Self-reported oral health, as the main explanatory, was dichotomised into ‘fair or poor’ and ‘excellent, very good or good’. Multivariable log-Poisson regression models were used to estimate associations between poor self-rated oral health and general health by calculating mean rate ratios (MRR) for disutility scores and prevalence ratios (PR) for individual dimensions, after adjusting for social-demographic characteristics and health-related behaviours. Results Data were available for 1011 Indigenous South Australian adults. The prevalence of ‘fair or poor’ self-rated oral health was 33.5%. The mean utility score was 0.82 (95% CI: 0.81–0.83). Compared with those rating their oral health as ‘excellent or very good or good’, those who rated their oral health as ‘fair or poor’ had a mean disutility score that was 1.6 (95% CI: 1.1–2.2) times higher, and the prevalence of at least one problem ranged from 90 to 160% higher for individual EQ-5D dimensions. Conclusions Fair or poor self-rated oral health among Indigenous persons in South Australia was associated with poor general health as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility, self-care and anxiety/depression. The findings emphasise the importance of oral health as predictors of general health among Indigenous Australians. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10426-3.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia.
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia
| | - Gail Garvey
- Menzies School of Health Research, Darwin, Australia
| | - Megan Smith
- Cancer Council of NSW, Woolloomooloo, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Karen Canfell
- Cancer Council of NSW, Woolloomooloo, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia
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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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Bennett-Levy J, Roxburgh N, Hibner L, Bala S, Edwards S, Lucre K, Cohen G, O'Connor D, Keogh S, Gilbert P. Arts-Based Compassion Skills Training (ABCST): Channelling Compassion Focused Therapy Through Visual Arts for Australia's Indigenous Peoples. Front Psychol 2021; 11:568561. [PMID: 33391084 PMCID: PMC7772135 DOI: 10.3389/fpsyg.2020.568561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/11/2020] [Indexed: 01/27/2023] Open
Abstract
The last 20 years have seen the development of a new form of therapy, compassion focused therapy (CFT). Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training (ABCST) group, in which usual CFT group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training” (ABCST). This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists (1 Indigenous, 1 non-Indigenous) and two artists (1 Indigenous, 1 non-Indigenous). There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants (2 clients, 4 health professionals) were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities.
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Affiliation(s)
- James Bennett-Levy
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Natalie Roxburgh
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Lia Hibner
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | | | - Stacey Edwards
- Department of Psychology, Charles Sturt University, Bathurst, NSW, Australia
| | - Kate Lucre
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Paul Gilbert
- Centre for Compassion Research and Training, University of Derby, Derby, United Kingdom
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Howard K, Anderson K, Cunningham J, Cass A, Ratcliffe J, Whop LJ, Dickson M, Viney R, Mulhern B, Tong A, Garvey G. What Matters 2 Adults: a study protocol to develop a new preference-based wellbeing measure with Aboriginal and Torres Strait Islander adults (WM2Adults). BMC Public Health 2020; 20:1739. [PMID: 33203391 PMCID: PMC7672853 DOI: 10.1186/s12889-020-09821-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Understandings of health and wellbeing are culturally bound. Many Aboriginal and Torres Strait Islander people perceive wellbeing and quality of life (QOL) differently from the Western biomedical models of health underpinning existing QOL instruments. Any instrument to measure the wellbeing of Aboriginal and Torres Strait Islander people should be culturally appropriate and safe, include relevant dimensions, and be informed by their own values and preferences. Existing QOL instruments do not meet these standards. This study will generate a new preference-based wellbeing measure, WM2Adults, for Aboriginal and Torres Strait Islander adults, underpinned by their values and preferences. METHODS A mixed methods approach will be used; we will employ decolonising methodologies, privilege Aboriginal and Torres Strait Islander voices and perspectives, and adopt a strengths-based approach rather than a deficit lens. Yarning Circles will be conducted with Aboriginal and Torres Strait Islander people across Australia. A candidate item pool will be developed from these data, on which psychometric analysis and validity testing will be undertaken to develop a descriptive system. Following finalisation of the descriptive system, wellbeing states will be valued using a quantitative preference-based approach (best-worst scaling) with a diverse sample of Aboriginal and Torres Strait Islander adults (n = 1000). A multinomial (conditional) logit framework will be used to analyse responses and generate a scoring algorithm for the new preference-based WM2Adults measure. DISCUSSION The new wellbeing measure will have wide applicability in assessing the effectiveness and cost-effectiveness of new programs and services for Aboriginal and Torres Strait Islander people. Results will be disseminated through journals, conferences and policy forums, and will be shared with Aboriginal and Torres Strait Islander communities, organisations and research participants.
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Affiliation(s)
- Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Michelle Dickson
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Sydney, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Sydney, Australia
| | - Allison Tong
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Evaluation of the ECOHIS and the CARIES-QC among an Australian "Aboriginal" population. Qual Life Res 2020; 30:531-542. [PMID: 32974881 DOI: 10.1007/s11136-020-02646-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE An evaluation of the reliability and validity of two child oral health-related quality of life (COHRQoL) measures among Australian Aboriginal children who participated in a randomised trial was undertaken. METHODS Study participants completed the Early Childhood Oral Health Impact Scale (ECOHIS) and the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The questionnaires were completed a second time to test the scales' test-retest reliability. Internal consistency, convergent and discriminant validity were evaluated through Cronbach's alpha, correlation of the scale scores with the global oral health evaluation, and comparison of scale scores among children with varying levels of caries experience, respectively. RESULTS Worse COHRQoL was reported by parents who rated their child's oral health as poor and by children who rated their teeth as being a lot of problem. Cronbach's alpha for the child impact section (CIS), family impact section (FIS), total ECOHIS score and the total CARIES-QC scale were 0.88, 0.81, 0.91 and 0.84, respectively. Spearman's correlations between scale scores and global oral health ratings of the CIS, FIS, total ECOHIS and the CARIES-QC were 0.42, 0.34, 0.45 and 0.70, respectively, p < 0.001. The Kruskal-Wallis test of scale scores with grouped caries experience was statistically significant, p < 0.005. Test-retest reliabilities for the ECOHIS were CIS ICC = 0.91, FIS ICC = 0.89, total ECOHIS ICC = 0.93 and for the CARIES-QC, ICC = 0.61. CONCLUSIONS Both the ECOHIS and the CARIES-QC were reliable and valid scales for use among an Australian Aboriginal population for assessing COHRQoL of preschool children. TRIAL REGISTRATION ACTRN12616001537448, date of registration-08 November 2016.
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Butler TL, Anderson K, Condon JR, Garvey G, Brotherton JML, Cunningham J, Tong A, Moore SP, Maher CM, Mein JK, Warren EF, Whop LJ. Indigenous Australian women's experiences of participation in cervical screening. PLoS One 2020; 15:e0234536. [PMID: 32542004 PMCID: PMC7295213 DOI: 10.1371/journal.pone.0234536] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Aboriginal and Torres Strait Islander (collectively, Indigenous Australian) women experience a higher burden of cervical cancer than other women. The National Cervical Screening Program (NCSP) is failing to meet the needs of Indigenous Australian women, resulting in many women not regularly participating in cervical screening. However, one third of Indigenous Australian women do participate in cervical screening. The reasons that some women in this population commence and continue to screen remain unheard but could provide insights to support women who currently do not participate. We aimed to describe Indigenous Australian women's experiences and views of participation in cervical screening by yarning (a culturally-appropriate interview technique) with 50 Indigenous Australian women aged 25-70 years who had completed cervical screening in the past five years, recruited via Primary Health Care Centres (PHCCs) from three jurisdictions. Aboriginal or Torres Strait Islander women researchers conducted the interviews. Thematic analysis identified six themes: screening as a means of staying strong and in control; overcoming fears, shame, and negative experiences of screening; needing to talk openly about screening; the value of trusting relationships with screening providers; logistical barriers; and overcoming privacy concerns for women employed at PHCCs. Despite describing screening as shameful, invasive, and uncomfortable, women perceived it as a way of staying healthy and exerting control over their health. This ultimately supported their participation and a sense of empowerment. Women valued open discussion about screening and strong relationships with health providers. We identified logistical barriers and specific barriers faced by women employed at PHCCs. This study is strengthened by a research approach that centred Indigenous Australian women's voices. Understanding the experiences of Indigenous Australian women who participate in screening will help screening providers support women to start and continue to screen regularly. Recommendations for practice are provided.
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Affiliation(s)
- Tamara L. Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - John R. Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne P. Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Clare M. Maher
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Queensland, Australia
| | | | - Eloise F. Warren
- Yerin Eleanor Duncan Aboriginal Health Centre, Wyong, New South Wales, Australia
| | - Lisa J. Whop
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Davison B, Liddle R, Fitz J, Singh GR. Computerised emotional well-being and substance use questionnaires in young Indigenous and non-Indigenous Australian adults. SAGE Open Med 2020; 8:2050312120906042. [PMID: 32095239 PMCID: PMC7011318 DOI: 10.1177/2050312120906042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/27/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Mental health disorders rank among the most substantial causes of morbidity
and mortality worldwide. Almost half of Australian adults experience mental
illness at some point in their lifetime, with Indigenous Australians
disproportionally affected. Thus, it is imperative that effective,
acceptable screening tools are used, which are tailored to the target
population. Objectives: This research investigates the methodology of computerised questionnaires in
assessing the emotional well-being and substance use in Indigenous and
non-Indigenous young adults. Methods: Cross-sectional data from young adults (21–28 years) in the Life Course
Program, Northern Territory, Australia, are presented. Through an extensive
consultation process, validated questionnaires were adapted to a
computerised format suitable for both remote and urban residing Indigenous
and non-Indigenous adults. Results: Of the 576 participants (459 Indigenous, 117 non-Indigenous) available for
assessment, high consent rates were seen, with completion rates >86%. One
in three young adults in this cohort were highlighted as ‘at risk’ of
psychological distress, and one in five as ‘at risk’ of suicidal ideation or
self-harm. Conclusion: The target population of this study were at a critical age with high levels
of psychological distress and suicidal ideation reported, particularly in
Indigenous young adults. This simple, user-friendly, pictorial programme
allowed assessment of a sensitive topic anonymously, while simultaneously
collating data and identifying those at high risk, irrespective of literacy
level or cultural background.
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Affiliation(s)
- Belinda Davison
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Robyn Liddle
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joseph Fitz
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gurmeet R Singh
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
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My experiences with kidney care: A qualitative study of adults in the Northern Territory of Australia living with chronic kidney disease, dialysis and transplantation. PLoS One 2019; 14:e0225722. [PMID: 31856215 PMCID: PMC6922340 DOI: 10.1371/journal.pone.0225722] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/10/2019] [Indexed: 12/26/2022] Open
Abstract
Background Australian healthcare quality and safety accreditation standards recommend health services partner with health care users, to ensure the highest quality of care. Aboriginal Australians with chronic and end stage kidney disease have high health care access needs. Aim To describe the experiences of health care users of a large government kidney healthcare service provider. Methods Within a government renal health service in the Top-End of the Northern Territory, we undertook a qualitative study involving in-depth interviews with 26 adult clients from urban, regional and remote settings who were living with kidney health conditions. Results Client characteristics included a mean age of 55 years, 55% female and 81% identifying as Aboriginal. The kidney related conditions of client participants included CKD (11, 42.3%), haemodialysis (12, 46.2%), peritoneal dialysis (1, 3.9%), and transplant (2, 7.7%). Key themes emerging from patient interviews related to perceived gaps for clients and carers including: 1) knowledge gaps about the health condition, 2) the impact of relocation in order to access centrally-based renal care, 3) healthcare staff professionalism and qualities and 4) service environments. Overall, the experiences centred on a greater need for client-centred, respectful and culturally based healthcare support. Clients recommended the need for patient-led collective care, including sustaining an Indigenous Patient Reference Group to support ongoing healthcare service decision processes. Participants included in almost equal proportion, clients with CKD (without dialysis) and clients utilising renal replacement therapy, which adds significant weight to the client-identified recommendations for highest quality of kidney care across a wide spectrum of kidney function. Conclusion Four major themes identified by clients related to their experience with renal care provided by this major regional health care provider: knowledge gaps of their own condition, the lived impacts of relocating to access health care, service environments, and Health Care Provider Quality. An Indigenous Patient Reference Group was one mechanism recommended to support the co-design of preferred care models.
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Chamberlain C, Ralph N, Hokke S, Clark Y, Gee G, Stansfield C, Sutcliffe K, Brown SJ, Brennan S, for the Healing The Past By Nurturing The Future group. Healing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment. PLoS One 2019; 14:e0225441. [PMID: 31834894 PMCID: PMC6910698 DOI: 10.1371/journal.pone.0225441] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/05/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. METHODS A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. FINDINGS The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. CONCLUSIONS Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Ralph
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Stacey Hokke
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne Clark
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Stansfield
- Evidence for Policy and Practice Co-ordinating Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, United Kingdom
| | - Katy Sutcliffe
- Evidence for Policy and Practice Co-ordinating Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, United Kingdom
| | - Stephanie J. Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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