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Wynne R, Rendell G, Sorrell J, McTier L. Health literacy of critical care patients in a remote area health service: A cross-sectional survey. Aust Crit Care 2022:S1036-7314(22)00116-3. [PMID: 36182541 DOI: 10.1016/j.aucc.2022.08.007] [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: 03/27/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Lower life expectancy, higher rates of chronic disease, and poorer uptake of health services are common in remote patient populations. Patients with poor health literacy (HL) are less likely to attend appointments, adhere to medications, and have higher rates of chronic illness. Evidence underpinning the relationship between HL and inequity in remote critical care populations is sparse. OBJECTIVES The primary study aim was to explore a multidimensional HL profile of patients requiring critical care in a remote area health service. Secondary aims were to explore HL in subgroups of the sample and to explore associations between HL and emergency department representation and discharge against medical advice. METHODS This was a cross-sectional study of consecutive eligible patients admitted to the Mount Isa Base Hospital intensive care unit. The Health Literacy Questionnaire was administered in a semistructured interview. RESULTS In a 5-month period, there were 141 patient admissions to the five-bed intensive care unit, 67 patients (47.5%) met inclusion criteria and were not discharged prior to recruitment, and 37 (26.2%) agreed to participate. Participants felt understood and supported by healthcare providers, had sufficient information to manage their health, proactively engaged with healthcare providers, and had strong social supports. More challenging was their capacity to advocate on their own behalf, to explore and appraise information and to navigate healthcare systems. Patients who represented to the emergency department (n = 8, 21.6%) felt more empowered to seek healthcare advice. Of the 11 patients that discharged against medical advice, only one participated in the study. CONCLUSION Trends in the data showed that Aboriginal and Torres Strait Islander participants were marginally less likely to be information explorers and to understand all written information. Findings provide guidance for the development of interventions to progress a reduction in health disparities experienced by this population.
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Affiliation(s)
- Rochelle Wynne
- The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3010, Australia; School of Nursing & Midwifery, Deakin University, Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Georgia Rendell
- School of Nursing & Midwifery, Deakin University, Gheringhap Street, Geelong, VIC, 3220, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Julie Sorrell
- North West Hospital & Health Service, Mt Isa, QLD, 4825, Australia
| | - Lauren McTier
- School of Nursing & Midwifery, Deakin University, Gheringhap Street, Geelong, VIC, 3220, Australia; Centre for Quality & Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
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The risk of common mental disorders in Indigenous Australians experiencing traumatic life events. BJPsych Open 2021. [PMCID: PMC8693901 DOI: 10.1192/bjo.2021.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Experiencing traumatic life events is associated with an increased risk of common mental disorders (CMDs), but studies investigating this association within Indigenous populations are limited. Aims The aim of this study was to investigate associations between trauma and CMDs after controlling for other exposures. Method Trauma exposures and CMD diagnoses were determined in a broadly representative sample of 544 Indigenous Australians, using a diagnostic clinical interview. Associations were determined by multivariate logistic regression. Results Trauma exposure independently predicted CMDs. After adjustment for potential confounders, trauma exposure was associated with a 4.01-fold increased risk of a diagnosis of a CMD in the past 12 months. The increased risks were 4.38-, 2.65- and 2.78-fold of having an anxiety disorder, mood disorder or a substance use disorder, respectively. Trauma exposure and comorbid post-traumatic stress disorder was associated with a 4.53-fold increased risk of a diagnosis of a mood disorder, 2.47-fold increased risk of a diagnosis of a substance use disorder, and 3.58-fold increased risk of any diagnosis of a CMD, in the past 12 months. Experiencing both sexual and physical violence was associated with a 4.98-fold increased risk of a diagnosis of an anxiety disorder in the past 12 months. Conclusions Indigenous Australians experience significantly increased exposure to potentially harmful trauma compared with non-Indigenous Australians. Preventing and healing trauma exposure is paramount to reduce the high burden of CMDs in this population.
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data. Age Ageing 2021; 50:1778-1784. [PMID: 33989395 DOI: 10.1093/ageing/afab073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD). METHODS We conducted a retrospective record-linkage cohort study of patients with diverse CVD in Queensland, Australia. We investigated the relationship between the risk of frailty, defined using the hospital frailty risk score (HFRS), and 30-day mortality, 30-day unplanned readmission, non-home discharge, length of hospital stay (LOS) at an emergency department and inpatient units and costs of hospitalisation. Descriptive analysis, bivariate logistic regression and generalised linear models were used to estimate the association between HFRS and CVD outcomes. Smear adjustment was applied to hospital costs and the LOS for each frailty risk groups. RESULTS The proportion of low, medium and high risk of frailty was 24.6%, 34.5% and 40.9%, respectively. The odds of frail patients dying or being readmitted within 30 days of discharge was 1.73 and 1.18, respectively. Frail patients also faced higher odds of LOS, and non-home discharge at 3.1 and 2.25, respectively. Frail patients incurred higher hospital costs (by 42.7-55.3%) and stayed in the hospital longer (by 49%). CONCLUSION Using the HFRS on a large CVD cohort, this study confirms that frailty was associated with worse health outcomes and higher healthcare costs. Administrative data should be more accessible to research such that the HFRS can be applied to healthcare planning and patient care.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, Griffith University, Level 1-2, N78, 170 Kessels Rd. Nathan QLD 4111, Australia
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Level 1-2, N78, 170 Kessels Rd. Nathan QLD 4111, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Level 8 G40, Griffith Health Centre, Gold Coast Campus, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Level 1-2, N78, 170 Kessels Rd. Nathan QLD 4111, Australia
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Nasir BF, Toombs MR, Kondalsamy-Chennakesavan S, Kisely S, Gill NS, Black E, Hayman N, Ranmuthugala G, Beccaria G, Ostini R, Nicholson GC. Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ Open 2018; 8:e020196. [PMID: 29961007 PMCID: PMC6042557 DOI: 10.1136/bmjopen-2017-020196] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/22/2018] [Accepted: 05/09/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses. DESIGN Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). SETTING Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. PARTICIPANTS Indigenous Australian adults. OUTCOME MEASURES Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. RESULTS Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively-6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found. CONCLUSIONS The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.
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Affiliation(s)
- Bushra F Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Maree R Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | | | - Steve Kisely
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Neeraj S Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Emma Black
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Noel Hayman
- Inala Indigenous Health Services, Inala, Queensland, Australia
| | - Geetha Ranmuthugala
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Gavin Beccaria
- Faculty of Psychology and Counselling, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Remo Ostini
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Geoffrey C Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
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Katz A, Gajjar D, Zwi AB, Hill PS. Great expectations: An analysis of researchers' and policy makers' perceptions of the potential value of the Australian indigenous burden of disease study for policy. Int J Health Plann Manage 2017; 33:e181-e193. [PMID: 28758235 DOI: 10.1002/hpm.2445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/06/2016] [Accepted: 06/30/2017] [Indexed: 11/07/2022] Open
Abstract
The "Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples" was commissioned by the Australian government as part of the Australian Burden of Disease study. This paper explores the extent to which key actors in the research and policy communities expected the Indigenous Burden of Disease study's findings to inform, influence, or drive federal decisions concerning Indigenous health in Australia. This qualitative research undertook interviews with 13 key informants with significant involvement in the Indigenous Burden of Disease study: six researchers, five policy makers, and two knowledge brokers. Interviews were recorded, transcribed, and analyzed, and the findings were triangulated with a review of the literature. Policy makers and researchers anticipated that the Indigenous Burden of Disease study would improve the available information for policy deliberations about Indigenous health. Beyond that, their expectations about its policy influence differed substantially, with researchers more confident of the study's capacity to guide health priorities, and policy makers situating findings in the context of other critical inputs. Expectations of policy influence are shaped by the disciplinary perspectives of actors, and their relationship to policy outcomes and cannot be examined without also considering the policy, political, and financing context of the study being analyzed.
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Affiliation(s)
- Aaron Katz
- Department of Global Health, University of Washington, USA
| | - Deepa Gajjar
- School of Public Health, The University of Queensland, Australia
| | - Anthony B Zwi
- Department of Global Health and Development, The University of New South Wales, Australia
| | - Peter S Hill
- School of Public Health, The University of Queensland, Australia
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Relationship between Life Expectancy as well as Social Intelligence and Adaptability to the Mediating Role of Resistance in High School Boys. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2017. [DOI: 10.5812/rijm.57473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Doyle K, Cleary M, Blanchard D, Hungerford C. The Yerin Dilly Bag Model of Indigenist Health Research. QUALITATIVE HEALTH RESEARCH 2017; 27:1288-1301. [PMID: 28682713 DOI: 10.1177/1049732317700125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we discuss indigenist approaches to health research, including indigenist knowledges, cultural proficiency, and core values. We also highlight the importance of conducting Indigenous research in ways that are congruent with the needs and interests of Indigenous peoples. The discussion includes consideration of how indigenist approaches can be utilized to generate new Indigenous knowledges, in culturally appropriate ways. We then introduce the Yerin Dilly Bag Model for indigenist health research, an approach that allows for indigenist knowledges to be employed and created by the research/er/ed within an Indigenous framework. Use of the Yerin Dilly Bag Model enables research/er/ed concordance, together with the privileging of Indigenous voices. This is achieved by guiding researchers to align their research with the core values of the researched, with the Yerin Dilly Bag a metaphor for the holder of these core values.
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Affiliation(s)
- Kerrie Doyle
- 1 Royal Melbourne Institute of Technology University, Melbourne, Australia
- 2 Australian National University, Canberra, Australia
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Vindigni D, Polus BI, Cleary S, Doyle AK. Chiropractors` experience and readiness to work in Indigenous Australian Communities: a preliminary cross-sectional survey to explore preparedness, perceived barriers and facilitators for chiropractors practising cross-culturally. Chiropr Man Therap 2017; 25:13. [PMID: 28469841 PMCID: PMC5414224 DOI: 10.1186/s12998-017-0144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 04/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background Indigenous people make up approximately 3% of the total Australian population and score poorer on all health indices, including back pain. Chiropractors are well placed to alleviate back pain, yet there is no research that considers chiropractors’ readiness to treat Indigenous patients. This study explores chiropractors` experience working with Indigenous Australians, describes perceived barriers and facilitators to chiropractors’ participation in Indigenous Healthcare and their willingness to engage in cultural competency training. Methods This study used a non-representative cross-sectional design and a convenience sample. Participants were recruited via email invitation to complete an online survey and encouraged to send the invitation on to colleagues. A 17-item online-survey measured demographic data, perceived barriers and facilitators related to caring for Indigenous Australians, participants` level of comfort when working in Indigenous health, and their willingness to participate in cultural competency programs to enhance their skills, knowledge and cultural capacity when engaging with Indigenous Australians. Analysis of the data included descriptive statistics as well as thematic analysis of qualitative free text. Results One hundred and twenty-five chiropractors participated in the survey. The majority of participants (86%, n = 108) were employed in private practice. 62% of respondents were members of the Chiropractors' Association of Australia, 41% were Chiropractic and Osteopathic College of Australasia members. 60% of chiropractors considered that they had, or do treat Indigenous patients yet only 4% of respondents asked their patients if they identified as Indigenous. A majority of participants expressed a high level of ‘comfort’ or confidence in working with Indigenous people while only 17% of respondents had undertaken some form of cultural proficiency training. A majority of respondents (62.7%, n = 74) expressed an interest in working with Indigenous Australians and a majority (91%, n = 104) were willing to participate in training to develop Indigenous cultural competency. Conclusions The study points to a need for chiropractors to have access to cultural proficiency training in order to develop the capability and confidence to engage respectfully with their Indigenous patients. This preliminary study has provided the researchers with valuable insights aiding the development and implementation of an Indigenous cultural proficiency program for chiropractors. Electronic supplementary material The online version of this article (doi:10.1186/s12998-017-0144-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dein Vindigni
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Plenty Road Bundoora, Victoria, 3083 Australia
| | - Barbara I Polus
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Plenty Road Bundoora, Victoria, 3083 Australia
| | - Sonja Cleary
- Discipline of Nursing, School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Plenty Road, Bundoora, 3083 Victoria Australia
| | - Aunty Kerrie Doyle
- Discipline of Nursing, School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Plenty Road, Bundoora, 3083 Victoria Australia
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Brennan-Olsen SL, Vogrin S, Leslie WD, Kinsella R, Toombs M, Duque G, Hosking SM, Holloway KL, Doolan BJ, Williams LJ, Page RS, Pasco JA, Quirk SE. Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology. Bone Rep 2017; 6:145-158. [PMID: 28560269 PMCID: PMC5437735 DOI: 10.1016/j.bonr.2017.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. METHODS On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. RESULTS Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. CONCLUSIONS The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.
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Affiliation(s)
- Sharon L Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Department of Medicine, University of Melbourne-Western Precinct, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia.,Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, VIC, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia
| | - William D Leslie
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg R2H 2A6, Canada
| | - Rita Kinsella
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia
| | - Maree Toombs
- Rural Clinical School, School of Medicine, University of Queensland, Toowoomba, 4350, QLD, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Department of Medicine, University of Melbourne-Western Precinct, 176 Furlong Road, St Albans, 3021, VIC, Australia
| | - Sarah M Hosking
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia
| | - Kara L Holloway
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia
| | | | - Lana J Williams
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia
| | - Richard S Page
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, St John of God Hospital, Ryrie Street, PO Box 281, Geelong, 3220, VIC, Australia
| | - Julie A Pasco
- Department of Medicine, University of Melbourne-Western Precinct, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia.,Department of Preventive Medicine and Epidemiology, Monash University, Alfred Centre, Commercial Road, Prahran, VIC, Australia
| | - Shae E Quirk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Wellington Road, Clayton, 3168, VIC, Australia
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Brennan-Olsen SL, Quirk SE, Leslie WD, Toombs M, Holloway KL, Hosking SM, Pasco JA, Doolan BJ, Page RS, Williams LJ. Comparison of fracture rates between indigenous and non-indigenous populations: a systematic review protocol. BMJ Open 2016; 6:e012124. [PMID: 27566641 PMCID: PMC5013364 DOI: 10.1136/bmjopen-2016-012124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Over recent years, there has been concerted effort to 'close the gap' in the disproportionately reduced life expectancy and increased morbidity experienced by indigenous compared to non-indigenous persons. Specific to musculoskeletal health, some data suggest that indigenous peoples have a higher risk of sustaining a fracture compared to non-indigenous peoples. This creates an imperative to identify factors that could explain differences in fracture rates. This protocol presents our aim to conduct a systematic review, first, to determine whether differences in fracture rates exist for indigenous versus non-indigenous persons and, second, to identify any risk factors that might explain these differences. METHODS AND ANALYSIS We will conduct a systematic search of PubMed, OVID, MEDLINE, CINAHL and EMBASE to identify articles that compare all-cause fracture rates at any skeletal site between indigenous and non-indigenous persons of any age. Eligibility of studies will be determined by 2 independent reviewers. Studies will be assessed for methodological quality using a previously published process. We will conduct a meta-analysis and use established statistical methods to identify and control for heterogeneity where appropriate. Should heterogeneity prevents numerical syntheses, we will undertake a best-evidence analysis to determine the level of evidence for differences in fracture between indigenous and non-indigenous persons. ETHICS AND DISSEMINATION This systematic review will use published data; thus, ethical permissions are not required. In addition to peer-reviewed publication, findings will be presented at (inter)national conferences, disseminated electronically and in print, and will be made available to key country-specific decision-makers with authority for indigenous health.
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Affiliation(s)
- Sharon L Brennan-Olsen
- Deakin University, Geelong, Victoria, Australia
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science, The University of Melbourne, St Albans, Victoria, Australia
| | | | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maree Toombs
- Rural Clinical School, School of Medicine, University of Queensland, Toowoomba, Queensland, Australia
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Spangaro J, Herring S, Koziol-Mclain J, Rutherford A, Frail MA, Zwi AB. 'They aren't really black fellas but they are easy to talk to': Factors which influence Australian Aboriginal women's decision to disclose intimate partner violence during pregnancy. Midwifery 2016; 41:79-88. [PMID: 27551857 DOI: 10.1016/j.midw.2016.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES intimate partner violence is a significant global health problem but remains largely hidden. Understanding decisions about whether or not to disclose violence in response to routine enquiry in health settings can inform safe and responsive systems. Elevated rates of violence and systematic disadvantage found among Indigenous women globally, can impact on their decisions to disclose violence. This study aimed to test, among Indigenous women, a model for decisions on whether to disclose intimate partner violence in the context of antenatal routine screening. DESIGN we employed Qualitative Configurative Analysis, a method developed for the social sciences to study complex phenomena with intermediate sample sizes. Data were drawn from single semi- structured interviews with Indigenous women 28+ weeks pregnant attending antenatal care. Interviews addressed decisions to disclose recent intimate partner violence in the context of routine enquiry during the antenatal care. Interview transcripts were binary coded for conditions identified a priori from the model being tested and also from themes identified within the current study and analysed using Qualitative Configurative Analysis to determine causal conditions for the outcome of disclosure or non-disclosure of violence experienced. SETTINGS five Aboriginal and Maternal Infant Health Services (two urban and three regional), and one mainstream hospital, in New South Wales, Australia. PARTICIPANTS indigenous women who had experienced partner violence in the previous year and who had been asked about this as part of an antenatal booking-in visit. Of the 12 participants six had elected to disclose their experience of violence to the midwife, and six had chosen not to do so. FINDINGS pathways to disclosure and non-disclosure were mapped using Qualitative Configurative Analysis. Conditions relevant to decisions to disclose were similar to the conditions for non-Aboriginal women found in our earlier study. Unique to Aboriginal women's decisions to disclose abuse was cultural safety. Cultural safety included elements we titled: Borrowed trust, Build the relationship first, Come at it slowly and People like me are here. The absence of cultural safety Its absence was also a factor in decisions not to disclose experiences of violence by this group of women. KEY CONCLUSIONS cultural safety was central to Indigenous women's decision to disclose violence and processes for creating safety are identified. Other forms of safety which influenced disclosure included: safety from detection by the abuser; safety from shame; and safety from institutional control. Disclosure was promoted by direct asking by the midwife and a perception of care. Non-disclosure was associated with a lack of care and a lack of all four types of safety. Experiences of institutional racism were associated with Indigenous women's perceived risk of control by others, particularly child protection services. IMPLICATIONS FOR PRACTICE policies to ask abuse questions at first visits and models where continuity of care is not maintained, are problematic for Aboriginal women, among whom relationship building is important as is ample warning about questions to be asked. Strategies are needed to build cultural safety to counter widespread racism and promote safe opportunities for Indigenous women to disclose intimate partner violence and receive support. Elements of cultural safety are necessary for vulnerable or marginalised populations to fully utilise available health services.
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Affiliation(s)
- Jo Spangaro
- School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Sigrid Herring
- NSW Education Centre Against Violence, Locked Bag 7118, Parramatta BC, NSW 2150, Australia.
| | - Jane Koziol-Mclain
- Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Alison Rutherford
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Mary-Anne Frail
- School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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Botfield JR, Zwi AB, Hill PS. Policy context and narrative leading to the commissioning of the Australian Indigenous Burden of Disease study. Health Res Policy Syst 2015; 13:17. [PMID: 25890380 PMCID: PMC4409780 DOI: 10.1186/s12961-015-0004-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 02/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burden of disease (BoD) studies have been conducted in numerous international settings since the early 1990's. Two national BoD studies have been undertaken in Australia, in 1998 and 2003, although neither study estimated the BoD specifically for Indigenous Australians. In 2005 the Australian Government Department of Health and Ageing Office for Aboriginal and Torres Strait Islander Health formally commissioned the University of Queensland to undertake, in parallel with the second national BoD study, the "Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples" study, drawing on available data up to 2003. This paper aims to explore the policy context and narrative in the lead up to commissioning the Indigenous BoD (IBoD) study, focusing on relevant contextual factors and insights regarding the perspectives of key stakeholders and their anticipated value of the study. It is part of a broader project that examines the uptake of evidence to policy, using the IBoD study as a case study. METHODS A systematic review of the literature was undertaken in late 2013 and early 2014, and the findings triangulated with 38 key informant interviews with Indigenous and non-Indigenous academics, researchers, statisticians, policy advisors, and policymakers, conducted between 2011 and 2013. FINDINGS Contextual features which led to commissioning the IBoD study included widespread recognition of longstanding Indigenous disadvantage, lower life expectancy than non-Indigenous Australians, and the lack of an adequate evidence base upon which to determine priorities for interventions. Several anticipated benefits and expectations of key stakeholders were identified. Most informants held at least one of the following expectations of the study: that it would inform the evidence base, contribute to priority setting, and/or inform policy. There were differing or entirely contrasting views to this however, with some sharing concerns about the study being undertaken at all. CONCLUSIONS The IBoD study, in concept, offered the potential to generate much desired 'answers', in the form of a quantified ranking of health risks and disease burden, and it was hoped by many that the results of the study would feed into determining priorities and informing Indigenous health policy.
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Affiliation(s)
- Jessica R Botfield
- Health, Rights and Development, School of Social Sciences, The University of New South Wales, Room G25, Morven Brown building, UNSW, Kensington, 2052, NSW, Australia.
| | - Anthony B Zwi
- Health, Rights and Development, School of Social Sciences, The University of New South Wales, Room G25, Morven Brown building, UNSW, Kensington, 2052, NSW, Australia.
| | - Peter S Hill
- School of Public Health, University of Queensland, Room 118, Public Health Building, Herston Rd, Herston QLD, 4006, Brisbane, Australia.
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Lens-Pechakova LS. Closing the East–West Life Expectancy Gap in the European Union: A New Strategy. Rejuvenation Res 2014; 17:239-42. [DOI: 10.1089/rej.2013.1482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Anjrini AA, Kruger E, Tennant M. A 10-year retrospective analysis of hospitalisation for oral cellulitis in Australia: the poor suffer at 30 times the rate of the wealthy. ACTA ACUST UNITED AC 2014. [DOI: 10.1308/204268514x13859766312430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the trends of hospitalisation for cellulitis in Western Australia. There was a strong association between socioeconomic status and rate of cellulitis, with the most disadvantaged quintile of the population (1.7% of residents) accounting for 34% of cellulites cases. Aboriginal and Torres Strait Islander people were almost seven times over-represented, compared with non-Indigenous Western Australians.
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Affiliation(s)
| | - Estie Kruger
- International Research Collaborative – Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia 35 Stirling Hwy Nedlands, 6009 Australia
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