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Fraser J, Askew D, Mahoney R, Spurling G. The acceptability and utility of Indigenous youth health assessments: a narrative systematic review. Aust J Prim Health 2023; 29:296-305. [PMID: 36732288 DOI: 10.1071/py22128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Indigenous youth are navigating the transition from childhood to adulthood while contending with challenges of ongoing colonisation and everyday lived experiences of racism. A comprehensive assessment of Indigenous youth's health could enable early diagnosis and respond to health concerns. This narrative systematic review synthesises evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth. METHODS A systematic search strategy was conducted using 20 electronic databases. Studies were included if they reported on health assessments conducted in primary health care with youth aged 12-24years who were Indigenous to Australia, New Zealand, Canada, the USA, Taiwan, and the arctic regions of Scandinavia and Russia. A narrative synthesis was undertaken. RESULTS Of 3061 unique studies identified, seven met the eligibility criteria. Included studies showed that youth health assessments were useful for making new diagnoses, detecting social and emotional wellbeing concerns, and biomedical parameters. Co-created health assessments with Indigenous youth conducted by clinicians familiar to the community were well accepted. Digital health assessments administered using an electronic tablet provide advantages. No health outcomes were reported. Additionally, no health assessments addressed the impacts of colonisation and racism. CONCLUSION There is insufficient evidence to make firm conclusions about the benefits of health assessments; however, health assessments can be useful for detecting new diagnoses and concerns regarding social determinants of health, and social and emotional wellbeing. Future development of Indigenous youth health assessments needs to involve Indigenous youth's perspectives and interpretations of health.
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Affiliation(s)
- Jed Fraser
- The University of Queensland, Surgical Treatment and Rehabilitation Service (STARS), Herston, Qld 4029, Australia
| | - Deborah Askew
- The University of Queensland, General Practice Clinical Unit, RBWH, Herston, Qld 4029, Australia
| | - Ray Mahoney
- Australian eHealth Research Centre (AEHRC), CSIRO, Surgical Treatment and Rehabilitation Service (STARS), Herston, 4029 - Turrbal, Jagera Country, Qld, Australia; and College of Medicine & Public Health, Flinders University, Adelaide, Kaurna land, South Australia; and School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane - Turrbal, Jagera Country, Qld, Australia
| | - Geoffrey Spurling
- The University of Queensland, General Practice Clinical Unit, RBWH, Herston, Qld 4029, Australia
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Merone L, McDermott R, Mein J, Clarke P, McDonald M. Primary Prevention of Cardiovascular Disease in Minority Indigenous Populations: A Systematic Review. Heart Lung Circ 2020; 29:1278-1291. [PMID: 32303469 DOI: 10.1016/j.hlc.2019.06.720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/07/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the commonest cause of death across the globe; incidence and prevalence rates are increasing. Together, CVD and diabetes mellitus are responsible for a quarter of the health gap observed between Aboriginal Australians and Torres Strait Islanders, and non-Indigenous Australians. Numerous programs have been proposed and implemented to Close the Gap; ideally, these should be evidence-based. OBJECTIVE The aim of this review is to evaluate primary prevention measures and programs that aim to reduce CVD risk in minority Indigenous populations around the world. METHODS A search of PubMed, the Cochrane Library and the Elsevier Scopus Database was initially conducted using the terms "cardiovascular disease", "population groups", "primary prevention", "health services, indigenous", "indigenous health", "risk assessment" and "risk management". Results were then assessed per inclusion/exclusion criteria. A second reviewer independently evaluated the publications and review process to ensure agreement. RESULTS The initial search produced 37 publications; 19 met the inclusion criteria and were incorporated into a comparative table. Most were descriptive, mixed-methods, audit or intervention studies. Heterogeneity of study design prevented statistical analysis. CONCLUSION Addressing CVD risk in minority Indigenous populations is a multifactorial challenge; there is substantial room for improvement in routine risk assessment and management. Holistic approaches need to embrace local cultural perceptions of health and wellbeing. Validated risk reduction tools, individualised management plans, polypills and computer based decision support tools are promising to improve outcomes for those at risk.
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Affiliation(s)
- Lea Merone
- Centre for Chronic Disease Prevention, James Cook University, Brisbane, Qld, Australia; Apunipima Cape York Health Council, Bungalow, Qld, Australia.
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, James Cook University, Brisbane, Qld, Australia; Apunipima Cape York Health Council, Bungalow, Qld, Australia; School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Jacki Mein
- Wuchopperen Health Service, Cairns, Qld, Australia
| | - Philip Clarke
- School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - Malcolm McDonald
- Centre for Chronic Disease Prevention, James Cook University, Brisbane, Qld, Australia; Wuchopperen Health Service, Cairns, Qld, Australia
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Silver B, Kaldor JM, Rumbold A, Ward J, Smith K, Dyda A, Ryder N, Yip TW, Su JY, Guy RJ. Community and clinic-based screening for curable sexually transmissible infections in a high prevalence setting in Australia: a retrospective longitudinal analysis of clinical service data from 2006 to 2009. Sex Health 2018; 13:140-7. [PMID: 26678863 DOI: 10.1071/sh15077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background In response to the high prevalence of sexually transmissible infections (STIs) in many central Australian Aboriginal communities, a community-wide screening program was implemented to supplement routine primary health care (PHC) clinic testing. The uptake and outcomes of these two approaches were compared. METHODS Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) community and clinic screening data for Aboriginal people aged 15-34 years, 2006-2009, were used. Regression analyses assessed predictors of the first test occurring in the community screen, positivity and repeat testing. RESULTS A total of 2792 individuals had 9402 tests (median: four per person) over 4 years. Approximately half of the individuals (54%) were tested in the community and clinic approaches combined, 29% (n=806) in the community screen only and 18% (n=490) in the clinic only. Having the first test in a community screen was associated with being male and being aged 15-19 years. There was no difference between community and clinic approaches in CT or NG positivity at first test. More than half (55%) of individuals had a repeat test within 2-15 months and of these, 52% accessed different approaches at each test. The only independent predictor of repeat testing was being 15-19 years. CONCLUSIONS STI screening is an important PHC activity and the findings highlight the need for further support for clinics to reach young people. The community screen approach was shown to be a useful complementary approach; however, cost and sustainability need to be considered.
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Affiliation(s)
- Bronwyn Silver
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Alice Rumbold
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
| | - Kirsty Smith
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Amalie Dyda
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Nathan Ryder
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Teem-Wing Yip
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Jiunn-Yih Su
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
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Vujcich D, Thomas J, Crawford K, Ward J. Indigenous Youth Peer-Led Health Promotion in Canada, New Zealand, Australia, and the United States: A Systematic Review of the Approaches, Study Designs, and Effectiveness. Front Public Health 2018; 6:31. [PMID: 29497608 PMCID: PMC5818867 DOI: 10.3389/fpubh.2018.00031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Youth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. However, no systematic reviews focusing on Indigenous youth have been published. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness. Methods A systematic search of Medline, Embase, and ProQuest Social Sciences databases was conducted, supplemented by gray literature searches. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers. Results Twenty-four studies were identified for inclusion, based on 20 interventions (9 Australian, 4 Canadian, and 7 from the United States of America). Only one intervention was evaluated using a randomized controlled study design. The majority of evaluations took the form of pre–post studies. Methodological limitations were identified in a majority of studies. Study outcomes included improved knowledge, attitude, and behaviors. Conclusion Currently, there is limited high quality evidence for the effectiveness of peer-led health interventions with Indigenous young people, and the literature is dominated by Australian-based sexual health interventions. More systematic research investigating the effectiveness of peer-led inventions is required, specifically with Indigenous populations. To improve health outcomes for Indigenous youth, greater knowledge of the mechanisms and context under which peer-delivered health promotion is effective in comparison to other methods of health promotion is needed.
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Affiliation(s)
- Daniel Vujcich
- Aboriginal Health Council of Western Australia, Perth, WA, Australia.,University of Western Australia, Perth, WA, Australia.,University of Notre Dame, Fremantle, WA, Australia
| | - Jessica Thomas
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Flinders University, Adelaide, SA, Australia
| | - Katy Crawford
- Kimberley Aboriginal Medical Service, Broome, WA, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Flinders University, Adelaide, SA, Australia
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Treloar C, Hopwood M, Cama E, Saunders V, Jackson LC, Walker M, Ooi C, Ubrihien A, Ward J. Evaluation of the Deadly Liver Mob program: insights for roll-out and scale-up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care. Harm Reduct J 2018; 15:5. [PMID: 29391019 PMCID: PMC5796347 DOI: 10.1186/s12954-018-0209-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Deadly Liver Mob (DLM) is a peer-driven, incentivised health promotion program aimed at increasing understanding of hepatitis C, promoting harm reduction in relation to injecting drug use, and linking participants to screening for hepatitis C, other blood borne viruses and sexually transmissible infections among Aboriginal people in Western Sydney, NSW. This paper presents the evaluation of a pilot study examining the acceptability of the program as a first step of a scalability assessment. Methods Deadly Liver Mob operated in co-located needle and syringe programs and sexual health clinics in two sites: (Site 1: two and a half years for 2 days/week; Site 2: 1 year for 1 day per week). Comparisons were made of the proportion of Aboriginal clients (Site 1) and occasions of service provided to Aboriginal clients (Site 2) in the 12 months prior and post-introduction of DLM. Interviews were conducted with 13 staff involved in delivery of DLM and with 19 clients. Results A total of 655 and 55 Aboriginal clients, respectively, attended Site 1 and Site 2 for health education. The proportion of Aboriginal clients attending both sites was significantly higher during the DLM compared with prior to its implementation. Of those attending for health education, 79 and 73%, respectively, attended screening following education. DLM clients strongly endorsed the program. Some staff were concerned about workforce capacity to effectively engage Aboriginal clients with multiple and complex needs, managing the differing aims of the participating services involved, and about offering of incentives for attendance at health services. Conclusion While acceptability was high among staff and clients and preliminary results show high engagement with Aboriginal communities, this evaluation of a pilot program raises some issues to consider in scale up of DLM to other sites. The initiation of additional DLM sites should address issues of alignment with governing strategies and workforce capacity.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Veronica Saunders
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - L Clair Jackson
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Melinda Walker
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
| | - Ashley Ubrihien
- Western Sydney HIV and Related Programs Unit, Western Sydney Local Health District, Sydney, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
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Esler D, Raulli A, Pratt R, Fagan P. Hypertension: high prevalence and a positive association with obesity among Aboriginal and Torres Strait Islander youth in far north Queensland. Aust N Z J Public Health 2015; 40 Suppl 1:S65-9. [PMID: 26123525 DOI: 10.1111/1753-6405.12401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/01/2014] [Accepted: 02/01/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Hypertension and other chronic disease risks are common among Aboriginal and Torres Strait Islander adults but there is little evidence regarding the epidemiology of these risk factors during adolescence. This study examines the prevalence of pre-hypertension, hypertension and other cardiovascular risk factors in Aboriginal and Torres Strait Islander people aged 15-24 years living in remote Indigenous communities in north Queensland. In so doing, it aims to better inform the approach to cardiovascular disease in this population. METHODS This is a descriptive study that retrospectively examines health service data from a program of community screening, the Young Persons Check (YPC). Participants were 1,883 Aboriginal and Torres Strait Islander people aged 15-24 years who attended for a YPC in 11 remote communities in north Queensland between March 2009 and April 2011. RESULTS Overall, the prevalence of pre-hypertension was 34.0%; stage I hypertension was 17.7% and stage II hypertension was 3.3%. The prevalence of elevated waist circumference was 47.6%, overweight or obesity 45.9%, elevated triglycerides 18.3%, decreased HDL 54.8% and proteinuria 24.3%. The prevalence of hypertension (stage I or II) among Torres Strait Islander males was 34.1%, Aboriginal males 26.9%, Torres Strait Islander females 12.6% and Aboriginal females 13.0%. Hypertension was associated with sex (males) (OR= 4.37, p<0.000), overweight (OR=2.46, p<0.000), obesity (OR=4.59, p<0.000) and elevated triglycerides (OR=2.38, p<0.000). CONCLUSION Pre-hypertension, hypertension and other cardiovascular risk in this population is highly prevalent. Hypertension was particularly prevalent among male participants. The results reiterate the importance of early life experience in cardiovascular disease prevention.
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Affiliation(s)
- Danielle Esler
- College of Public Health Medical and Veterinary Sciences, James Cook University, Queensland
| | | | - Rohan Pratt
- Cairns and Hinterland Hospital and Health Service, Queensland Health
| | - Patricia Fagan
- Tropical Medicine and Rehabilitation Sciences, Public Health, James Cook University, Queensland
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Fagan PS, Robertson HK, Pedrana AE, Raulli A, Crouch AA. Successes in sexual health communications development, programmatic implementation and evaluation in the Torres Strait region 2006 to 2012. Aust N Z J Public Health 2015; 39:270-6. [DOI: 10.1111/1753-6405.12356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Patricia S. Fagan
- School of Public Health; Tropical Medicine and Rehabilitation Sciences, James Cook University; Queensland
| | | | | | | | - Alan A. Crouch
- Centre for Excellence in Rural Sexual Health; University of Melbourne; Victoria
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Bohanna I, Bird K, Copeland J, Roberts N, Clough A. A service-level action research intervention to improve identification and treatment of cannabis and related mental health issues in young Indigenous Australians: a study protocol. BMJ Open 2014; 4:e005689. [PMID: 25082422 PMCID: PMC4120335 DOI: 10.1136/bmjopen-2014-005689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Regular cannabis use is associated with negative mental health impacts including psychosis, depression and anxiety. Rates of cannabis use have increased in Aboriginal and Torres Strait Islander communities in northern Australia within the last two decades, presenting a significant increased risk to young people's mental health in these regions. Improved screening, early detection and treatment for cannabis-related mental health issues are urgently required. This paper describes a service-level action research intervention and evaluation protocol for use in the few services where it is possible to engage young Aboriginal and Torres Strait Islander Australians. METHODS/DESIGN The protocol is being developed in two services where youth mental health is core business: a primary healthcare centre and a youth service in the Cairns and hinterland region, far north Queensland. The protocol calls first for baseline data to be collected using staff and client surveys; network mapping; and analysis of screening, treatment and referral rates. The protocol's intervention phase is driven by service needs identified from baseline data. Intervention strategies focus on implementing/enhancing cannabis screening instruments and processes in line with current best practice; enhancing networks with external drug and mental health services; developing culturally acceptable training and resources; developing activities aiming to reduce cannabis use in young Aboriginal and Torres Strait Islander clients using the services. The protocol requires implementation of the multilevel intervention within each service for 1 year, with follow-up data then collected and compared to baseline. Process evaluation identifies the more effective intervention strategies and documents the challenges to be overcome for full implementation. ETHICS AND DISSEMINATION Ethics approval was provided by The James Cook University, Human Research Ethics Committee. Ethics Approval Number H5322. Peer-reviewed publications will also be used to disseminate the finding. Results will also be discussed with stakeholder organisations.
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Affiliation(s)
- India Bohanna
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Katrina Bird
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Jan Copeland
- Department of Medicine, University of NSW, Sydney, New South Wales, Australia
| | - Nicholas Roberts
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Alan Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
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Crouch A, Fagan P. Are insights from Indigenous health shaping a paradigm shift in health promotion praxis in Australia? Aust J Prim Health 2014; 20:323-6. [DOI: 10.1071/py14039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/18/2014] [Indexed: 11/23/2022]
Abstract
Health promotion really is at a cross-road. Traditionally guided by the Ottawa Charter, it has been thought of as principle-guided actions, processes and technique, as well as outcomes or results. Health promotion has been characterised by its products and some even call it theory. In Australia, public funding for health promotion has, for many years, shaped its practice into behaviour change interventions. However, governments around the country are reconsidering their investments, evidenced by ideologically motivated policy shifts and associated substantial funding cuts. Recently, themes of empowerment, community control and community agency have emerged as new directions for future health promotion praxis and reports of activism-based approaches that seek to mobilise community energies around sexual health inequity have started to appear in the literature. Noting parallel developments in the social determinants and social change discourses, this paper posits that cutting edge health promotion efforts by Indigenous communities in Australia are shaping a new approach with potentially global application.
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