A scoping review of Aboriginal and Torres Strait Islander health promotion programs focused on modifying chronic disease risk factors

The effect of maternal prenatal tobacco smoking on offspring academic achievement: A systematic review and meta-analysis

BACKGROUND

Previous epidemiological studies examining the prospective association between maternal prenatal tobacco smoking and offspring academic achievement have reported conflicting results. Therefore, this systematic review and meta-analysis was conducted to examine the magnitude and consistency of association reported by those studies.

METHODS

This systematic review and meta-analysis was guided by the PRISMA protocol. Relevant epidemiological studies on the topic were extracted from four main databases (PubMed/Medline, Embase, PsycINFO, and Scopus). The Newcastle-Ottawa Scale (NOS) was used to appraise the methodological quality of the included studies. We conducted a narrative assessment of the studies that did not report effect estimates. Inverse variance-weighted random effect meta-analysis was used to combine studies reporting effect sizes to estimate pooled adjusted odds ratio with 95% confidence intervals (95% CI). The review was prospectively registered in PROSPERO (CRD42022350901).

RESULTS

Nineteen observational studies, published between 1973 and 2021 with a total of 1.25 million study participants were included in the final review. Of these, fifteen studies (79 %) reported reduced academic achievement in offspring exposed to maternal prenatal tobacco smoking. The eight primary studies (sample size = 723,877) included in the meta-analysis together suggested a 49 % higher risk of reduced academic achievement in offspring exposed to maternal prenatal tobacco smoking when compared to non-exposed offspring (Pooled odds ratio = 1.49, 95 % CI:1.17-1.91).

CONCLUSION

Our review found a positive association between maternal prenatal tobacco smoking and offspring reduced academic achievement. However, variation in the adjustment of potential confounders and significant heterogeneity across included studies limited more conclusive inference. Mechanistic studies to identify causal pathways and specific academic impacts are needed to inform targeted developmental programs to assist child learning and academic performance.

Sustaining an Aboriginal wellbeing program: Informing health promotion practice and policy

ISSUE ADDRESSED

Aboriginal and Torres Strait Islander Peoples' holistic concepts of wellbeing are inadequately represented in the health promotion discourse. The aim of this article was to explore what sustains an Aboriginal wellbeing program, to inform critical reflection and reorientation to empower Aboriginal wellbeing approaches in health promotion practice and policy.

METHODS

Aboriginal and non-Indigenous researchers collaboratively designed a critically framed, strengths-based research approach with Aboriginal Community Controlled Health Service staff and wellbeing program participants. Data from Individual Yarning (n = 15) with program participants and staff inspired co-researchers to co-develop interpretations over two half-day Collaborative Yarning sessions (n = 9).

RESULTS

Co-researchers depicted five lifeworld qualities that sustain an Aboriginal wellbeing program: love, connection, respect, culture and belonging. The lifeworld qualities are relational, communicative and involve the dynamics of identity, power and self-determination.

CONCLUSIONS

The five qualities support a lifeworld approach to an Aboriginal wellbeing program, opening communicative and relational opportunities to mediate culturally responsive interactions. The qualities mediated interactions between people in the lifeworld including program participants and coordinators, and systems representatives including health service providers. A lifeworld approach provides a way to empower Aboriginal self-determination and leadership through embedment of cultural determinants of health in wellbeing programs. SO WHAT?: Health service providers and policy makers can use lifeworld approaches to guide critical reflection and reorient practice and policy related to Aboriginal health. The lifeworld qualities that encompass this approach in wellbeing programs are communicative and relational, centred on local community voices and co-produced with community for Aboriginal identity, empowerment and self-determination.

Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis

Background

Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia.

Methods

We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status.

Results

After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates.

Conclusion

Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.

From Deficit to Strength-Based Aboriginal Health Research-Moving toward Flourishing

Aboriginal Australians have a fundamental human right to opportunities that lead to healthy and flourishing lives. While the impact of trauma on Aboriginal Australians is well-documented, a pervasive deficit narrative that focuses on problems and pathology persists in research and policy discourse. This narrative risks further exacerbating Aboriginal disadvantage through a focus on 'fixing what is wrong' with Aboriginal Australians and the internalising of these narratives by Aboriginal Australians. While a growing body of research adopts strength-based models, limited research has sought to explore Aboriginal flourishing. This conceptual paper seeks to contribute to a burgeoning paradigm shift in Aboriginal research, seeking to understand what can be learned from Aboriginal people who flourish, how we best determine this, and in what contexts this can be impactful. Within, we argue the case for a new approach to exploring Aboriginal wellbeing that integrates salutogenic, positive psychology concepts with complex systems theory to understand and promote Aboriginal wellbeing and flourishing. While deeper work may be required to establish the parameters of a strength-based, culturally aligned Aboriginal conceptualisation of positive psychology, we suggest the integration of Aboriginal and Western methodologies offers a unique and potent means of shifting the dial on seemingly intractable problems.

Assessing community readiness to reduce consumption of sugary drinks in remote Aboriginal and Torres Strait Islander communities: A useful tool for evaluation and co-design

ISSUE ADDRESSED

There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non-Indigenous practitioners culturally adapted and applied the Tri-Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness.

METHODS

Aboriginal community-controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12-month follow-up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks.

RESULTS

The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre-defined issue, time and resource-intensiveness of the process, and need to review appropriateness prior to implementation in other regions.

CONCLUSION

The adapted CRT was valuable for evaluating the project and co-designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. SO WHAT?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns.

Engaging with a rural Aboriginal community to identify strategies to improve oral health within their community: a qualitative study

BACKGROUND

Aboriginal and Torres Strait Islanders bear a higher burden of oral disease compared to non-Indigenous persons. Rural Aboriginal and Torres Strait Islander communities are further disadvantaged due to service access difficulties. This study, initiated by community concern for oral health identified through its Health Action Group, aimed to explore a rural Aboriginal community's strategies to resolve oral health problems.

CONCLUSION

Community members are aware of local barriers and potential facilitators for improving oral health within their community. Their identification of priority strategies can be used to inform the delivery of oral healthcareservices and to develop oral healthcare promotion programs for the community. Co-designing solutions with the community should be an integral part of solving complex problems such as oral health.

METHODS

A qualitative research study using a phenomenological research design with focus group discussions and in-depth interviews was completed in partnership with a rural community in Queensland, Australia, with a predominantly Aboriginal population. The research team included Aboriginal and non-Aboriginal personnel; community and external personnel; and dental and non-dental personnel. The collaborative approach included the development, implementation, analysis and interpretation of the research involving the community through its Health Action Group. Community engagement led to the recruitment of 27 participants from local health and community groups.

RESULTS

Themes emerging from the data included: reducing financial barriers to accessing oral health care; integrating oral health care with other health services; increasing oral healthcare promotion activities; and ensuring local input and cultural safety within local oral healthcare services.

Incorporating local health education priorities in HealthLAB: Learnings from very remote Australia

ISSUE ADDRESSED

It is well-established that health education and promotion programs work best when they have been tailored to meet local contextual needs. In this brief report we describe a health education program and how it identified and incorporated local priorities into its delivery in two remote Aboriginal communities in the "Top End" of the Northern Territory.

METHODS

During the first visit to each community team members met with local stakeholders and ran an inaugural HealthLAB session. Fieldnotes were taken during or directly after each interaction. At the end of each day team members debriefed regarding their fieldnotes. After both trips had been completed, priority areas were extracted from fieldnotes and synthesised.

RESULTS

Although some health priorities were congruent across all groups, Community Members and Childcare staff tended to identify practical solutions while School and Clinic staff were focused on the clinical outcome. Community Members were particularly focused on the wider social and systemic factors impacting health.

CONCLUSION

In response to the need for practical support, HealthLAB modified their health education packages to upskill mothers and sports coaches to provide brief health education sessions to local children and young people. SO WHAT?: It is recognised that many health promotion programs focus on individual behaviours without creating supportive environments. While it was out of scope for HealthLAB to address physical environmental factors, by building local capacity and knowledge to deliver health education, the program can contribute to a healthier and supportive social environment.

Community co-selection of measures to evaluate the health and wellbeing impact of Aboriginal and Torres Strait Islander community running groups

ISSUE ADDRESSED

Physical activity participation can improve the physical health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. The evaluation of physical activity programmes can elicit a clearer understanding of where these impacts occur and to what extent. We describe applying a collaborative approach to the selection of a set of measures that can be used to examine health and wellbeing impacts of Indigenous community running groups.

METHODS

Physical activity, health and wellbeing measurement tools previously used with Aboriginal and Torres Strait Islander peoples were collated. Participants in the collaborative process were nine female running group members aged 30+ years from a regional New South Wales (NSW) town. The Indigenous research method, Yarning, explored views of participating in the group on health and wellbeing and how these could be measured using those collated measurement tools.

RESULTS

Runners described participating for holistic physical, mental and social reasons and stated the importance of the group participating together and providing social support to each other. There was broad support for the identified physical activity, lifestyle, physical health, and social and emotional wellbeing measures, with social networks and sports injuries identified as additionally relevant.

CONCLUSIONS

Co-selecting measures to evaluate a physical activity programme for Aboriginal and Torres Strait Islander participants can better inform the development of relevant future healthy lifestyle programme evaluation, revealing factors that may be missed as relevant by researchers. SO WHAT?: This process presents an example of determining evaluation measures with Aboriginal and Torres Strait Islander participants that could be applied more broadly to evaluation design.

Strengthening health promotion development with Aboriginal and Torres Strait Islander males in remote Australia: A Northern Territory perspective

Aims

To elucidate key considerations for effective health promotion with Aboriginal and Torres Strait Islander males in remote Northern Territory.

Context

Despite the significant disparities in health outcomes amongst Aboriginal and Torres Strait Islander males, particularly in remote Northern Territory, investment in health promotion policy and practice has been inadequate. Progressing towards self‐determination with Aboriginal and Torres Strait Islander males, and to meet the unique health and well‐being needs of this marginalised demographic, consideration for staff retention and training, strengths‐based approaches, and implications of divergent masculinities must be considered when devising and delivering culturally responsive and appropriate health promotion interventions. Health promotion needs to be conducted in a collaborative manner, and in less conventional settings, to better engage Aboriginal and Torres Strait Islander males.

Approach

This commentary draws on the author's reflections about working in remote Aboriginal and Torres Strait Islander health policy, practice and research contexts in Northern Australia. It brings together diffuse strands of scholarship about Aboriginal and Torres Strait Islander male health; Aboriginal and Torres Strait Islander health promotion; and health promotion in rural and remote contexts. In doing so, we identify and discuss strategies that have potential to strengthen Aboriginal and Torres Strait Islander male health promotion in rural and remote Australia.

Conclusion

Health services and professionals in remote Northern Territory must leverage the inherent strengths of Aboriginal and Torres Strait Islander males to imbue service delivery with both meaning and capacity for self‐determination. In doing so, this might ultimately help to alleviate the marginalisation of this demographic.

The impact of sport and physical activity programs on the mental health and social and emotional wellbeing of young Aboriginal and Torres Strait Islander Australians: A systematic review

This review aimed to identify and assess existing evidence of the impact of sport and physical activity programs on mental health and social and emotional wellbeing outcomes within young Aboriginal and Torres Strait Islander people. The review also aimed to highlight limitations of current practice within the research area. A systematic search of literature was undertaken on three peer-reviewed databases (PsycINFO, MEDLINE and SPORTSDiscus) and grey literature from January to March 2021. Studies were included if they described a sport and physical activity program for young (10-24 years) Aboriginal and Torres Strait Islander people and reported mental health or social and emotional wellbeing outcomes. Seventeen studies were selected for this review. Within these studies, the most commonly reported outcomes were related to psychosocial development (N = 12) and a sense of connectedness (N = 12). Mental illness related outcomes (N = 1) were rarely reported, as were substance use (N = 2) and social and emotional literacy (N = 1). Promising outcomes included increased connection to culture, self-esteem and confidence. Nonetheless, due to indirectness and suboptimal study design the precise impact on these outcomes could not be determined. A relevant evidence base is emerging on the impact sport and physical activity programs have on the mental health and social and emotional wellbeing of young Aboriginal and Torres Strait Islander people. However, further research that utilises robust, culturally appropriate methodologies and tools needs to be undertaken before the effects of sport and physical activity programs can reliably be discerned.

Healthy Skin, Healthy Mepla: A skin health promotional event for children in the Torres Strait

ISSUE ADDRESSED

Skin infections such as impetigo and scabies are common in Aboriginal Australian and Torres Strait Islander children living in rural and remote settings. Effective health promotion is a key element when addressing health literacy aimed at reducing the burden of skin disease. Community-driven health promotion provides a potentially effective and sustainable model for improved health outcomes.

METHODS

A one-day community-driven skin health promotional event was conducted on Waiben [Thursday Island] with the aim of improving local Torres Strait Islander children's appreciation of the importance of skin health through art, music and creation of a video. Participants completed written pre- and post-questionnaires to determine their response.

RESULTS

Fifty-two children participated in the event; median (range) age was 11 (9-12) years and all identified as Torres Strait Islander. Overall, 34 of 50 children (68%) felt that participating in this workshop improved their skin health knowledge.

CONCLUSIONS

Skin health promotion can be successful achieved through a locally conceived, locally driven and locally owned approach. SO WHAT?: This skin health promotional event could be a model for other health promotion activities in the Torres Strait.

Development of a Maternal and Child mHealth Intervention with Aboriginal and Torres Strait Islander Mothers: A Co-Design Approach (Preprint)

Background

Objective

Methods

Results

Conclusions

Australia in 2030: what is our path to health for all?

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.

A mixed-methods evaluation of an urban Aboriginal diabetes lifestyle program

OBJECTIVE

The objective of this study was to evaluate an Aboriginal-led diabetes lifestyle program catering to urban Aboriginal people in an Aboriginal organisation.

METHODS

Mixed-methods study that employed routinely collected physiological data and audio-recorded focus group sessions. Physiological data were analysed using a multi-level model to account for participant clustering. Qualitative data were subject to thematic analysis.

RESULTS

Participants were overwhelmingly positive about the program. They lost weight and improved their diastolic blood pressure and glycaemic control; however, it was the feelings of belonging and optimism about their ability to improve their health that they most valued. Qualitative analysis revealed three main themes. These were: 'With the Mob', 'For the Mob' and 'Program Elements. The strengths of the program lay in its indigeneity, low-cost and easy-to-prepare diet, and cultural and communication skills of the director.

CONCLUSIONS

Recommendations for improvement included educating participants on the pathophysiology of diabetes, the refinement of online elements and the introduction of face-to-face group exercise. Implications for public health: Programs of this nature should be expanded and evaluated longitudinally with multiple cohorts.

"They Are Worth Their Weight in Gold": Families and Clinicians' Perspectives on the Role of First Nations Health Workers in Paediatric Burn Care in Australia

Burns affect Australia’s First Nations children more than other Australian children, they also experience longer lengths of stay in tertiary burns units and face barriers in accessing burn aftercare treatment. Data sets from two studies were combined whereby 19 families, 11 First Nations Health Worker (FNHW) and 56 multidisciplinary burn team members from across Australia described the actual or perceived role of FNHW in multidisciplinary burn care. Data highlighted similarities between the actual role of FNHW as described by families and as described by FNHW such as enabling cultural safety and advocacy. In contrast, a disconnect between the actual experience of First Nations families and health workers and that as perceived by multidisciplinary burn team members was evident. More work is needed to understand the impact of this disconnect and how to address it.

Chronic disease prevention programs offered by Aboriginal Community Controlled Health Services in New South Wales, Australia

OBJECTIVES

To identify and describe chronic disease prevention programs offered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia.

METHODS

ACCHSs were identified through the Aboriginal Health and Medical Research Council of NSW website. Chronic disease programs were identified from the Facebook page and website of each ACCHS. Characteristics, including regions, target population, condition, health behaviour, modality and program frequency were extracted and summarised.

RESULTS

We identified 128 chronic disease programs across 32 ACCHSs. Of these, 87 (68%) programs were broad in their scope, 20 (16%) targeted youth, three (2%) targeted Elders, 16 (12%) were for females only and five (4%) were for males only. Interventions included physical activity (77, 60%), diet and nutrition (74, 58%), smoking (70, 55%), and the Aboriginal and Torres Strait Islander Health Check (44, 34%), with 93 programs (73%) of ongoing duration.

CONCLUSIONS

Chronic disease prevention programs address chronic conditions by promoting physical activity, diet and nutrition, smoking cessation and health screening. Most target the general Aboriginal community, a few target specific groups based on gender and age, and more than one-quarter are time-limited. Implications for public health: Chronic disease programs that are co-produced with specific groups, based on age and gender, may be needed.

A scoping review of Aboriginal and Torres Strait Islander health promotion programs focused on modifying chronic disease risk factors

Issue addressed

Noncommunicable chronic disease underlies much of the life expectancy gap experienced by Aboriginal and Torres Strait Islander people. Modifying contributing risk factors; tobacco smoking, nutrition, alcohol consumption, physical activity, social and emotional wellbeing (SNAPS) could help close this disease gap. This scoping review identified and describes SNAPS health promotion programs implemented for Aboriginal and Torres Strait Islander people in Australia.

Methods

Databases PubMed, CINAHL, Informit (Health Collection and Indigenous Peoples Collection), Scopus, Trove and relevant websites and clearing houses were searched for eligible studies until June 2015. To meet the inclusion criteria the program had to focus on modifying one of the SNAPS risk factors and the majority of participants had to identify as being of Aboriginal and/or Torres Strait Islander heritage.

Results

The review identified 71 health promotion programs, described in 83 publications. Programs were implemented across a range of health and community settings and included all Australian states and territories, from major cities to remote communities. The SNAPS factor addressed most commonly was nutrition. Some programs included the whole community, or had multiple key audiences, whilst others focused solely on one subgroup of the population such as chronic disease patients, pregnant women or youth. Fourteen of the programs reported no outcome assessments.

Conclusions

Health promotion programs for Aboriginal and Torres Strait Islander people have not been adequately evaluated. The majority of programs focused on the development of individual skills and changing personal behaviours without addressing the other health promotion action areas, such as creating supportive environments or reorienting health care services.

So What?

This scoping review provides a summary of the health promotion programs that have been delivered in Australia for Aboriginal and Torres Strait Islander people to prevent or manage chronic disease. These programs, although many are limited in quality, should be used to inform future programs. To improve evidence‐based health promotion practice, health promotion initiatives need to be evaluated and the findings published publicly.