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Meharg DP, Dennis SM, McNab J, Gwynne KG, Jenkins CR, Maguire GP, Jan S, Shaw T, McKeough Z, Rambaldini B, Lee V, McCowen D, Newman J, Longbottom H, Eades S, Alison JA. A Qualitative Study of Aboriginal Peoples' Health Care Experiences With Chronic Obstructive Pulmonary Disease. QUALITATIVE HEALTH RESEARCH 2024:10497323241259891. [PMID: 39117016 DOI: 10.1177/10497323241259891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Aboriginal Australians experience a high prevalence of chronic obstructive pulmonary disease (COPD), with high rates of potentially preventable hospitalisations. However, little is known about Aboriginal peoples' experiences of living with COPD and how they navigate health care systems. This study used thematic analysis and Aboriginal methodology to explore Aboriginal peoples' lived experiences of COPD, their health care journey from receiving a diagnosis of COPD to the clinical management, and the impact of COPD on their daily lives. We conducted in-depth semi-structured interviews over a 6-month period with 18 Aboriginal adults diagnosed with COPD from four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. Reflexive thematic analysis was employed to ensure rigour. The findings revealed deeply personal and reflective stories shaped by historical, social, and cultural realities of Aboriginal peoples living with COPD. Four themes were identified characterising their experiences. Based on the findings, the following guidance is provided on future COPD care for Aboriginal peoples: Better alignment of existing COPD management with Aboriginal peoples' cultural contexts and perspectives to improve access to culturally safe care; Increased funding for ACCHS to enhance COPD management, such as early detection through case finding and access to ACCHS-led pulmonary rehabilitation; Engaging family members in COPD management and providing culturally centred COPD education that facilitates discussions and builds health literacy and self-management skills; Implementing health promotion initiatives to increase awareness and counteract fear and shame to improve early COPD detection.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Justin McNab
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- University of New South Wales, Sydney, Kensington, NSW, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, Australia
| | - Hayley Longbottom
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, NSW, Australia
| | - Sandra Eades
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Centre for Epidemiology and Biostatistics, The School of Population and Global Health, The University of Melbourne, Carlton South, VIC, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Sydney Local Health District, Camperdown, NSW, Australia
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McKivett A, Paul D. Recreating the future-Indigenous research paradigms in health professional education research. MEDICAL EDUCATION 2024; 58:149-156. [PMID: 37329219 DOI: 10.1111/medu.15154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Health and self-determination are recognised as universal human rights. Health professional education research and practice hold the capacity to prioritise values, worldviews and agendas that envisage sustainable and equitable futures for the entire community served. This paper explores the need for the co-location of Indigenous research paradigms in health professional education research and teaching. Indigenous communities have a long history of science, research and sustainable living and are holders of ways of knowing, being and doing that can shape actions and priorities in health research that value equity and sustainability. DISCUSSION Knowledge construction in health professional education research does not occur in isolation nor is it value neutral. A continued dominance of the biomedical approach to health creates a system of innovation that is unbalanced and unable to deliver health outcomes demanded by contemporary society. As power and hierarchies are embedded in health professional education research and praxis, transformative action is required to bring forth marginalised voices in research processes. Critical reflexivity regarding the ontological, epistemological, axiological and methodological positioning of researchers is an important step towards creating and sustaining research structures that effectively value and co-locate different perspectives in knowledge production and translation. CONCLUSION Working towards more equitable and sustainable futures for Indigenous and non-Indigenous communities requires health care systems to be informed and guided by different knowledge paradigms. This can work to avoid the ongoing reproduction of inefficient biomedical structures and purposefully disrupt the status quo of health inequities. Realising this requires the effective co-location of Indigenous research paradigms and ways of working into health professional education research that centre relationality, wholism, interconnectedness and self-determination. This calls for a raising of the critical consciousness of health professional education research academies.
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Affiliation(s)
- Andrea McKivett
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David Paul
- Fremantle Medical Program, National School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Hamsanathan P, Katzenellenbogen JM, Andrews D, Carapetis J, Richmond P, McKinnon E, Ramsay J. A Review of Cardiac Surgical Procedures and Their Outcomes for Paediatric Rheumatic Heart Disease in Western Australia. Heart Lung Circ 2023; 32:1398-1406. [PMID: 37852820 DOI: 10.1016/j.hlc.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Surgical intervention is an important treatment modality for advanced rheumatic heart disease (RHD). This study aimed to describe patient characteristics and outcomes from cardiac surgery for RHD in patients referred to the only tertiary paediatric hospital in Western Australia. METHODS An analysis of patient characteristics and cardiac surgery outcomes in patients with RHD was undertaken, using data from clinical cardiac databases, medical notes, and correspondence from rural outreach clinics. RESULTS 29 patients (59% female, 97% Aboriginal, Māori or Pacific Islander) underwent 41 valve interventions over 34 cardiac surgeries for RHD between 2000-2018. Median age at first surgery was 12.2 (range 4-16) years. Severe mitral regurgitation (MR) was the most common indication for primary surgery (62%), followed by mixed mitral regurgitation/aortic regurgitation (21%) and severe aortic regurgitation (17%). Mitral valve repair was the most common valve intervention (56%). Two patients had mitral valve replacement (MVR) at first operation, two patients had MVR at second operation and two had MVR at third operation. There was no early mortality. One patient required early (<30 days) reoperation for aortic valve repair failure. Two patients had late reoperations at 3.3 and 6.1 months after the first procedure for MR. Four (14%) patients experienced documented ARF recurrences. Late mortality occurred in 3 (10%) patients, all due to cardiac causes. On last follow-up echocardiogram 5 patients (17%) had moderate MR and none had severe MR. CONCLUSIONS This is the first study to describe characteristics and outcomes in WA paediatric patients having surgery for RHD. Outcomes are comparable to similar studies, with favourable long-term survival.
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Affiliation(s)
| | - Judith M Katzenellenbogen
- The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - David Andrews
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia
| | - Jonathan Carapetis
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia; Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Peter Richmond
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia; The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - Elizabeth McKinnon
- Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - James Ramsay
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia
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Egoroff N, Bloomfield H, Gondarra W, Yambalpal B, Guyula T, Forward D, Lyons G, O'Connor E, Sanderson L, Dowden M, Williams D, de Dassel J, Coffey P, Dhurrkay ER, Gondarra V, Holt DC, Krause VL, Currie BJ, Griffiths K, Dempsey K, Glynn-Robinson A. An outbreak of acute rheumatic fever in a remote Aboriginal community. Aust N Z J Public Health 2023; 47:100077. [PMID: 37625204 DOI: 10.1016/j.anzjph.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES We describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. METHODS In August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. RESULTS 12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. CONCLUSIONS This outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. IMPLICATIONS FOR PUBLIC HEALTH Outbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management.
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Affiliation(s)
- Natasha Egoroff
- National Centre for Epidemiology and Population Health, Australian National University, Australia; Miwatj Health Aboriginal Corporation, Australia; Centre for Disease Control, Northern Territory Health, Australia.
| | - Hilary Bloomfield
- Miwatj Health Aboriginal Corporation, Australia; Centre for Disease Control, Northern Territory Health, Australia.
| | | | | | - Terrence Guyula
- Centre for Disease Control, Northern Territory Health, Australia.
| | - Demi Forward
- Miwatj Health Aboriginal Corporation, Australia.
| | - Gemma Lyons
- Miwatj Health Aboriginal Corporation, Australia.
| | - Emer O'Connor
- Miwatj Health Aboriginal Corporation, Australia; Centre for Disease Control, Northern Territory Health, Australia; Rheumatic Heart Disease Australia, Australia.
| | | | | | - Desley Williams
- Centre for Disease Control, Northern Territory Health, Australia.
| | | | | | | | | | - Deborah C Holt
- Menzies School of Health Research, Charles Darwin University, Australia.
| | - Vicki L Krause
- Centre for Disease Control, Northern Territory Health, Australia.
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Australia; Rheumatic Heart Disease Australia, Australia.
| | - Kalinda Griffiths
- Menzies School of Health Research, Charles Darwin University, Australia; University of New South Wales, Australia; University of Melbourne, Australia.
| | | | - Anna Glynn-Robinson
- National Centre for Epidemiology and Population Health, Australian National University, Australia.
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McRae T, Leaversuch F, Sibosado S, Coffin J, Carapetis JR, Walker R, Bowen AC. Culturally supported health promotion to See, Treat, Prevent (SToP) skin infections in Aboriginal children living in the Kimberley region of Western Australia: a qualitative analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100757. [PMID: 37424680 PMCID: PMC10326714 DOI: 10.1016/j.lanwpc.2023.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 07/11/2023]
Abstract
Background While there are many skin infections, reducing the burden of scabies and impetigo for remote living Aboriginal people, particularly children remains challenging. Aboriginal children living in remote communities have experienced the highest reported rate of impetigo in the world and are 15 times more likely to be admitted to hospital with a skin infection compared to non-Aboriginal children. Untreated impetigo can develop into serious disease and may contribute to the development of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). As the largest organ protecting the body and visible to everyone, skin infections are often unsightly and very painful, therefore maintaining healthy skin and reducing the burden of skin infections is important for overall physical and cultural health and well-being. Biomedical treatments alone will not address these factors; therefore, a holistic, strengths-based approach that aligns with the Aboriginal world view of wellness is required to help reduce the prevalence of skin infections and their downstream consequences. Methods Culturally appropriate yarning sessions with community members were conducted between May 2019 and November 2020. Yarning sessions have been identified as a valid method for story sharing and collecting information. Semi-structured, face-to-face interviews and focus groups with school and clinic staff were conducted. When consent was provided, interviews were audio-recorded and saved as a digital recording in a de-identified format; for those yarning sessions not recorded, handwritten notes were scribed. Audio recordings and handwritten notes were uploaded into NVivo software prior to a thematic analysis being conducted. Findings Overall, there was a strong knowledge of recognition, treatment, and prevention of skin infections. However, this did not extend to the role skin infections play in causing ARF, RHD or kidney failure. Our study has confirmed three main findings: 1. The biomedical model of treatment of skin infections remained strong in interviews with staff living in the communities; 2. Community members have a reliance and belief in traditional remedies for skin infections; and 3. Ongoing education for skin infections using culturally appropriate health promotion resources. Interpretation While this study revealed ongoing challenges with service practices and protocols associated with treating and preventing skin infections in a remote setting, it also provides unique insights requiring further investigation. Bush medicines are not currently practiced in a clinic setting, however, using traditional medicines alongside biomedical treatment procedures facilitates cultural security for Aboriginal people. Further investigation, and advocacy to establish these into practice, procedures and protocols is warranted. Establishing protocols and practice procedures focused on improving collaborations between service providers and community members in remote communities is also recommended. Funding Funding was received from the National Health and Medical Research Council [NHMRC] (GNT1128950), Health Outcomes in the Tropical NORTH [HOT NORTH 113932] (Indigenous Capacity Building Grant), and WA Health Department and Healthway grants contributed to this research. A.C.B. receives a NHMRC investigator Award (GNT1175509). T.M. receives a PhD scholarship from the Australian Centre for Elimination of Neglected Tropical Diseases (ACE-NTD), an NHMRC centre of excellence (APP1153727).
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Affiliation(s)
- Tracy McRae
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
| | | | - Slade Sibosado
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
| | - Juli Coffin
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Ngangk Yira Institute for Change, Murdoch University, 90 South St, Murdoch, Western Australia 6150, Australia
| | - Jonathan R. Carapetis
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
- Perth Children's Hospital, 15 Hospital Road, Nedlands, Western Australia, 6009, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, 90 South St, Murdoch, Western Australia 6150, Australia
- School of Indigenous Studies, Poche Centre for Indigenous Health Research, University of Western Australia, 35 Stirling Highway, Perth, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Perth, Australia
| | - Asha C. Bowen
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
- Perth Children's Hospital, 15 Hospital Road, Nedlands, Western Australia, 6009, Australia
- Menzies School of Health Research, Rocklands Drive, Tiwi, Northern Territory 0810, Australia
- University of Notre Dame, 32 Mouat St, Fremantle, Western Australia 6160, Australia
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Pratt B, de Vries J. Where is knowledge from the global South? An account of epistemic justice for a global bioethics. JOURNAL OF MEDICAL ETHICS 2023; 49:325-334. [PMID: 36657964 PMCID: PMC10176400 DOI: 10.1136/jme-2022-108291] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/30/2022] [Indexed: 05/14/2023]
Abstract
The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change.
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Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- The Ethics Lab, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Noutsos T, Perry MA, Secombe PJ, Roxby DJ, Sinha R, Campbell LT. A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia. J Clin Med 2023; 12:1606. [PMID: 36836141 PMCID: PMC9964698 DOI: 10.3390/jcm12041606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015-2019). Of 4183 total patients, 50.9% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9% versus 2.3%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6%) versus 52 (72.2%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5% First Nations versus 1.1% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95% CI 1.05-6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95% CI 1.01-1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.
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Affiliation(s)
- Tina Noutsos
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
- Department of Haematology, Royal Darwin Hospital, Darwin, NT 0810, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Maree A. Perry
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Paul J. Secombe
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
- Intensive Care Department, Alice Springs Hospital, Alice Springs, NT 0870, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - David J. Roxby
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Romi Sinha
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Lewis T. Campbell
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
- Intensive Care Unit, Royal Darwin Hospital, Darwin, NT 0810, Australia
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Butler T, Gall A, Garvey G, Ngampromwongse K, Hector D, Turnbull S, Lucas K, Nehill C, Boltong A, Keefe D, Anderson K. A Comprehensive Review of Optimal Approaches to Co-Design in Health with First Nations Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316166. [PMID: 36498237 PMCID: PMC9735487 DOI: 10.3390/ijerph192316166] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Australia's social, structural, and political context, together with the continuing impact of colonisation, perpetuates health care and outcome disparities for First Nations Australians. A new approach led by First Nations Australians is required to address these disparities. Co-design is emerging as a valued method for First Nations Australian communities to drive change in health policy and practice to better meet their needs and priorities. However, it is critical that co-design processes and outcomes are culturally safe and effective. Aims: This project aimed to identify the current evidence around optimal approaches to co-design in health with First Nations Australians. METHODS First Nations Australian co-led team conducted a comprehensive review to identify peer-reviewed and grey literature reporting the application of co-design in health-related areas by and with First Nations Australians. A First Nations Co-Design Working Group (FNCDWG) was established to guide this work and team.A Collaborative Yarning Methodology (CYM) was used to conduct a thematic analysis of the included literature. RESULTS After full-text screening, 99 studies were included. Thematic analysis elicited the following six key themes, which included 28 practical sub-themes, relevant to co-design in health with First Nations Australians: First Nations Australians leadership; Culturally grounded approach; Respect; Benefit to First Nations communities; Inclusive partnerships; and Evidence-based decision making. CONCLUSION The findings of this review provide a valuable snapshot of the existing evidence to be used as a starting point to guide appropriate and effective applications of co-design in health with First Nations Australians.
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Affiliation(s)
- Tamara Butler
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Alana Gall
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore 2480, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | | | | | | | | | | | - Anna Boltong
- Cancer Australia, Sydney 2010, Australia
- Kirby Institute, UNSW Medicine, The University of New South Wales, Kensington 2052, Australia
| | | | - Kate Anderson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
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Gidgup MJR, Kickett M, Jacques A, Weselman T, Hill KD, Coombes J, Ivers R, Bowser N, Palacios V, Hill AM. Translating and Evaluating a Physical Activity Program for Aboriginal Elders on Noongar Boodjar (Country) — A Longitudinal Study. Front Public Health 2022; 10:904158. [PMID: 35937226 PMCID: PMC9355611 DOI: 10.3389/fpubh.2022.904158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The primary aim of the study was to translate and evaluate the impact of a Physical Activity (PA) program on the physical function of older Aboriginal Elders on Noongar Boodjar (Country). Methods A longitudinal design framed within an Indigenous methodology. Two groups, one metropolitan and one regional, of Aboriginal Elders, aged ≥45 years, participated in the Ironbark PA program. This comprised weekly strength and balance exercises followed by yarning circles. Physical function (primary outcome) and functional ability, cardiovascular risk factors (weight, waist circumference), falls efficacy and health-related quality of life were measured at baseline 6, 12 and 24 months. Data were analyzed using generalized linear mixed effects modeling. Results Fifty-two Elders initially enrolled and of those, n = 23 (44.2%) Elders participated regularly for 24 months. There was a 6-month gap in program delivery due to the COVID-19 pandemic. Participants made significant improvement in physical function at 12 months compared to baseline: [short physical performance battery (SPPB) at baseline, 8.85 points (95% CI 8.10, 9.61); 12 months 10.28 (95% CI 9.44, 11.13), p = 0.001: gait speed at baseline 0.81 ms−1 (95% CI 0.60, 0.93); 12 months 1.14 (95% CI 1.01, 1.27), p < 0.001]. Some sustained improvement compared to baseline was still evident at 24 months after the 6-month gap in attendance [SPPB 9.60 (8.59, 10.60) p = 0.14, gait speed 1.11 (0.95, 1.26) p < 0.001]. Cardiovascular risk factors showed a non-significant improvement at 12 and 24 months compared to baseline. All participants reported that they enjoyed the program, found it culturally appropriate and would recommend it to others. Conclusion Older Aboriginal people showed sustained improvements in physical function after engaging in a culturally appropriate PA program. Culturally appropriate PA programs provide safety, security and choice for older Aboriginal people to engage in evidence-based PA.
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Affiliation(s)
- Margaret J. R. Gidgup
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- *Correspondence: Margaret J. R. Gidgup
| | | | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Tammy Weselman
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Julieann Coombes
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Sydney, NSW, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicole Bowser
- South West Aboriginal Medical Service Aboriginal Corporation, Bunbury, WA, Australia
| | - Vilma Palacios
- North Metropolitan Public Health Unit, WA North Metropolitan Health Service, Perth, WA, Australia
| | - Anne-Marie Hill
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
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Haynes E, Katzenellenbogen JM, Noonan S, Stacey I, Mitchell AG, Wade V, Bessarab D. Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations. Aust N Z J Public Health 2022; 46:554-557. [DOI: 10.1111/1753-6405.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Emma Haynes
- School of Global and Population Health University of Western Australia Perth Western Australia
| | | | - Sara Noonan
- School of Global and Population Health University of Western Australia Perth Western Australia
- Menzies School of Health Research Northern Territory
| | - Ingrid Stacey
- School of Global and Population Health University of Western Australia Perth Western Australia
| | | | - Vicki Wade
- Rheumatic Heart Disease Australia Casuarina Northern Territory
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health University of Western Australia Crawley Western Australia
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11
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Mitchell A, Wade V, Haynes E, Katzenellenbogen J, Bessarab D. “The world is so white”: improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease. Aust N Z J Public Health 2022; 46:588-594. [DOI: 10.1111/1753-6405.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/01/2021] [Accepted: 01/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alice Mitchell
- School of Population & Global Health University of Western Australia
| | - Vicki Wade
- Menzies School of Health Research Charles Darwin University Northern Territory
| | - Emma Haynes
- School of Population & Global Health University of Western Australia
| | | | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health University of Western Australia
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12
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Haynes E, Marawili M, Marika MB, Mitchell A, Walker R, Katzenellenbogen JM, Bessarab D. Living with Rheumatic Heart Disease at the Intersection of Biomedical and Aboriginal Worldviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4650. [PMID: 35457520 PMCID: PMC9025526 DOI: 10.3390/ijerph19084650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
Rheumatic heart disease (RHD) significantly impacts the lives of First Nations Australians. Failure to eliminate RHD is in part attributed to healthcare strategies that fail to understand the lived experience of RHD. To rectify this, a PhD study was undertaken in the Northern Territory (NT) of Australia, combining Aboriginal ways of knowing, being and doing with interviews (24 participants from clinical and community settings) and participant observation to privilege Aboriginal voices, including the interpretations and experiences of Aboriginal co-researchers (described in the adjunct article). During analysis, Aboriginal co-researchers identified three interwoven themes: maintaining good feelings; creating clear understanding (from good information); and choosing a good djalkiri (path). These affirm a worldview that prioritises relationships, positive emotions and the wellbeing of family/community. The findings demonstrate the inter-connectedness of knowledge, choice and behaviour that become increasingly complex in stressful and traumatic health, socioeconomic, political, historical and cultural contexts. Not previously heard in the RHD domain, the findings reveal fundamental differences between Aboriginal and biomedical worldviews contributing to the failure of current approaches to communicating health messages. Mitigating this, Aboriginal co-researchers provided targeted recommendations for culturally responsive health encounters, including: communicating to create positive emotions; building trust; and providing family and community data and health messages (rather than individualistic).
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Affiliation(s)
- Emma Haynes
- School of Global and Population Health, University of Western Australia, Crawley, WA 6009, Australia; (R.W.); (J.M.K.)
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia;
| | - Minitja Marawili
- Menzies School of Health Research, Casuarina, NT 0810, Australia; (M.M.); (M.B.M.); (A.M.)
| | - Makungun B. Marika
- Menzies School of Health Research, Casuarina, NT 0810, Australia; (M.M.); (M.B.M.); (A.M.)
| | - Alice Mitchell
- Menzies School of Health Research, Casuarina, NT 0810, Australia; (M.M.); (M.B.M.); (A.M.)
| | - Roz Walker
- School of Global and Population Health, University of Western Australia, Crawley, WA 6009, Australia; (R.W.); (J.M.K.)
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA 6150, Australia
| | - Judith M. Katzenellenbogen
- School of Global and Population Health, University of Western Australia, Crawley, WA 6009, Australia; (R.W.); (J.M.K.)
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia;
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13
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Haynes E, Marawili M, Mitchell A, Walker R, Katzenellenbogen J, Bessarab D. "Weaving a Mat That We Can All Sit On": Qualitative Research Approaches for Productive Dialogue in the Intercultural Space. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3654. [PMID: 35329344 PMCID: PMC8952013 DOI: 10.3390/ijerph19063654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Abstract
Research remains a site of struggle for First Nations peoples globally. Biomedical research often reinforces existing power structures, perpetuating ongoing colonisation by dominating research priorities, resource allocation, policies, and services. Addressing systemic health inequities requires decolonising methodologies to facilitate new understandings and approaches. These methodologies promote a creative tension and productive intercultural dialogue between First Nations and Western epistemologies. Concurrently, the potential of critical theory, social science, and community participatory action research approaches to effectively prioritise First Nations peoples' lived experience within the biomedical worldview is increasingly recognised. This article describes learnings regarding research methods that enable a better understanding of the lived experience of rheumatic heart disease-an intractable, potent marker of health inequity for First Nations Australians, requiring long-term engagement in the troubled intersection between Indigenist and biomedical worldviews. Working with Yolŋu (Aboriginal) co-researchers from remote Northern Territory (Australia), the concept of ganma (turbulent co-mingling of salt and fresh water) was foundational for understanding and applying relationality (gurrutu), deep listening (nhina, nhäma ga ŋäma), and the use of metaphors-approaches that strengthen productive dialogue, described by Yolŋu co-researchers as weaving a 'mat we can all sit on'. The research results are reported in a subsequent article.
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Affiliation(s)
- Emma Haynes
- School of Global and Population Health, University of Western Australia, Crawley, WA 6009, Australia; (R.W.); (J.K.)
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia;
| | - Minitja Marawili
- Menzies School of Health Research, Casuarina, Darwin, NT 0810, Australia; (M.M.); (A.M.)
| | - Alice Mitchell
- Menzies School of Health Research, Casuarina, Darwin, NT 0810, Australia; (M.M.); (A.M.)
| | - Roz Walker
- School of Global and Population Health, University of Western Australia, Crawley, WA 6009, Australia; (R.W.); (J.K.)
| | - Judith Katzenellenbogen
- School of Global and Population Health, University of Western Australia, Crawley, WA 6009, Australia; (R.W.); (J.K.)
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia;
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14
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Chakanyuka C, Bacsu JDR, DesRoches A, Dame J, Carrier L, Symenuk P, O'Connell ME, Crowshoe L, Walker J, Bourque Bearskin L. Indigenous-specific cultural safety within health and dementia care: A scoping review of reviews. Soc Sci Med 2021; 293:114658. [PMID: 34942579 DOI: 10.1016/j.socscimed.2021.114658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
Globally, health inequities experienced by Indigenous communities are often described and documented in terms of deficits and disease. However, health disparities are complex and involve numerous underlying issues beyond the social determinants of health. Indigenous Peoples face unique barriers to accessing culturally safe and equitable healthcare, including racism, systemic injustice, and a historical legacy of colonialism. There is a paucity of knowledge on Indigenous-specific cultural safety interventions to support health and dementia care. The objective of this scoping review of reviews was to appraise the existing literature to identify key elements, conceptualizations, and interventions of cultural safety to improve health services and dementia care for Indigenous Peoples. Guided by Indigenous principles of relationality, we conducted a scoping review of reviews published between January 2010 to December 2020. We searched CINAHL, PubMed, Scopus, Web of Science, and Google Scholar. Given the limited literature focusing specifically on Indigenous people with dementia, our inclusion criteria focused broadly on Indigenous cultural safety in healthcare. A collaborative and relational rights-based approach co-led by Indigenous cisgender, Two-Spirit, and non-Indigenous cisgender health care providers was used to re-center Indigenous ways of knowing. A total of seventeen articles met our inclusion criteria. Our review identified a range of cultural safety themes from education initiatives to collaborative partnerships with Indigenous communities. Themes emerged at three levels: person-centered/individual level, health practitioner/student level, and healthcare organizational level. Few reviews described specific interventions, implementation strategies, evaluation methods, or the concept of sex and gender to improve cultural safety in healthcare delivery. Findings from this review can help to inform future research, inspire innovative collaborative methodologies, and enhance cultural safety interventions. In moving forward, there is an urgent need for anti-racism education, self-determination, and authentic partnerships to achieve Indigenous-specific cultural safety inclusive of sex and gender considerations in health and dementia care.
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Affiliation(s)
- Christina Chakanyuka
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8V 2Y2, Canada.
| | - Juanita-Dawne R Bacsu
- Department of Psychology, Rural Dementia Action Research (RaDAR) Team, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, SK, S7N 4N3, Canada.
| | - Andrea DesRoches
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Jessy Dame
- Independent Researcher/Community Partner, Vancouver, BC, Canada.
| | - Leah Carrier
- School of Nursing, Dalhousie University, Halifax, NS, B3H 3J5, Canada.
| | - Paisly Symenuk
- Independent Researcher/Community Partner, Edmonton, AB, Canada.
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Lynden Crowshoe
- Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary Alberta, T2N 1N4, Canada.
| | - Jennifer Walker
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, P3E 2C6, Canada.
| | - Lisa Bourque Bearskin
- School of Nursing, Thompson Rivers University, 840 College Way, 272A, Kamloops, V2C 0C8, British Columbia, Canada.
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15
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Stacey I, Hung J, Cannon J, Seth RJ, Remenyi B, Bond-Smith D, Griffiths K, Sanfilippo F, Carapetis J, Murray K, Katzenellenbogen JM. Long-term outcomes following rheumatic heart disease diagnosis in Australia. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab035. [PMID: 35919882 PMCID: PMC9242034 DOI: 10.1093/ehjopen/oeab035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/15/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
Aims Rheumatic heart disease (RHD) is a major contributor to cardiac morbidity and mortality globally. This study aims to estimate the probability and predictors of progressing to non-fatal cardiovascular complications and death in young Australians after their first RHD diagnosis. Methods and results This retrospective cohort study used linked RHD register, hospital, and death data from five Australian states and territories (covering 70% of the whole population and 86% of the Indigenous population). Progression from uncomplicated RHD to all-cause death and non-fatal cardiovascular complications (surgical intervention, heart failure, atrial fibrillation, infective endocarditis, and stroke) was estimated for people aged <35 years with first-ever RHD diagnosis between 2010 and 2018, identified from register and hospital data. The study cohort comprised 1718 initially uncomplicated RHD cases (84.6% Indigenous; 10.9% migrant; 63.2% women; 40.3% aged 5–14 years; 76.4% non-metropolitan). The composite outcome of death/cardiovascular complication was experienced by 23.3% (95% confidence interval: 19.5–26.9) within 8 years. Older age and metropolitan residence were independent positive predictors of the composite outcome; history of acute rheumatic fever was a negative predictor. Population group (Indigenous/migrant/other Australian) and sex were not predictive of outcome after multivariable adjustment. Conclusion This study provides the most definitive and contemporary estimates of progression to major cardiovascular complication or death in young Australians with RHD. Despite access to the publically funded universal Australian healthcare system, one-fifth of initially uncomplicated RHD cases will experience one of the major complications of RHD within 8 years supporting the need for programmes to eradicate RHD.
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Affiliation(s)
- Ingrid Stacey
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Joseph Hung
- Medical School, University of Western Australia, Perth, Australia
| | - Jeff Cannon
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca J Seth
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Bo Remenyi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Daniela Bond-Smith
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia.,University of Hawai'i Economic Research Organisation, University of Hawai'i, Honolulu, HI, USA
| | - Kalinda Griffiths
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Centre for Big Data Research, The University of New South Wales, Sydney, Australia.,Centre for Health Equity, University of Melbourne, Melbourne, Australia
| | - Frank Sanfilippo
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Perth Children's Hospital, Perth, Australia
| | - Kevin Murray
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
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16
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Laird P, Chang AB, Jacky J, Lane M, Schultz A, Walker R. Conducting decolonizing research and practice with Australian First Nations to close the health gap. Health Res Policy Syst 2021; 19:127. [PMID: 34551774 PMCID: PMC8456666 DOI: 10.1186/s12961-021-00773-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
The purpose of this paper is to highlight a perspective for decolonizing research with Australian First Nations and provide a framework for successful and sustained knowledge translation by drawing on the recent work conducted by a research group, in five remote communities in North-Western Australia. The perspective is discussed in light of national and international calls for meaningful and dedicated engagement with First Nations people in research, policy and practice, to help close the health gap between First Nations and other Australians.
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Affiliation(s)
- Pamela Laird
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia. .,Department of Physiotherapy, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia. .,The Child Health Division Menzies School of Health Research, Darwin, NT, Australia.
| | - Anne B Chang
- The Child Health Division Menzies School of Health Research, Darwin, NT, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,The Centre of Children's Health Research, Australian Centre for Health Services Innovation, Qld University of Technology, Brisbane, QLD, Australia
| | - John Jacky
- Kulunga, Telethon Kids Institute, Broome, WA, Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service, Broome, WA, Australia
| | - André Schultz
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Department of Paediatrics, School of Medicine, University of WA, Perth, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia
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