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Skinner T, Brown A, Teixeira-Pinto A, Farnbach SF, Glozier N, Askew DA, Gee G, Cass A, Hackett ML. Sensitivity and specificity of Aboriginal-developed items to supplement the adapted PHQ-9 screening measure for depression: results from the Getting it Right study. Med J Aust 2024; 221:258-263. [PMID: 39140407 DOI: 10.5694/mja2.52406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/13/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To determine the psychometric properties of an Aboriginal and Torres Strait Islander-developed depressive symptom screening scale. DESIGN Prospective diagnostic accuracy study. SETTING Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples. PARTICIPANTS 500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016. MAIN OUTCOME MEASURE Criterion validity of seven Aboriginal and Torres Strait Islander-developed items, using the adapted Patient Health Questionnaire 9 (aPHQ-9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards. RESULTS The seven-item scale had good internal consistency (α = 0.83) and correlated highly with the aPHQ-9 (ρ = 0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ-9 when compared with the MINI-identified diagnosis of a current major depressive episode. CONCLUSION Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts.
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Affiliation(s)
- Timothy Skinner
- Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, VIC
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Alex Brown
- Aboriginal Health Research, South Australian Health and Medical Research Institute, Adelaide, SA
- University of South Australia, Adelaide, SA
| | - Armando Teixeira-Pinto
- University of Sydney, Sydney, NSW
- Centre for Kidney Research, Westmead Millennium Institute for Medical Research, Sydney, NSW
| | - Sara F Farnbach
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | | | | | - Graham Gee
- Victorian Aboriginal Health Service Cooperative, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
| | - Alan Cass
- Menzies School of Health Research, Darwin, NT
| | - Maree L Hackett
- George Institute for Global Health, Sydney, NSW
- University of Central Lancashire, Preston, UK
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Meldrum K, Wallace V, Webb T, Ridgway L, Quigley R, Strivens E, Russell S. Developing an appropriate depression and anxiety screening tool for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia: Protocol for a Delphi study. PLoS One 2023; 18:e0292162. [PMID: 38060486 PMCID: PMC10703283 DOI: 10.1371/journal.pone.0292162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023] Open
Abstract
Tools that screen for depression and anxiety developed using the Western biomedical paradigm are still used with First Nations peoples globally, despite calls for cross-cultural adaption. Recent work by the research team found that tools used to screen for depression and anxiety were not appropriate for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area (NPA). of Australia. Consequently, the objective of this Delphi study is to gain consensus from an expert mental health panel to inform the development of an appropriate depression and anxiety screening tool(s). A Delphi study with Australian expert panellists will be used to reach consensus about whether an existing screening tool should be used or whether adaption or new tool development should take place. Three sequential rounds of anonymous online surveys will be used to reach consensus. The first round will seek consensus about the tool(s). Subsequent rounds will seek consensus on the development of the tool(s) identified in round one. Panellists will be identified using a combination of authorship of related publications, established national clinical or research profile in First Nations mental health, and/or by peer referral. Consensus will be reached when 75% of the panel agree. When agreement is not reached suggestions will be taken to the next round. If agreement is not achieved by the third round, the Steering Committee will make any outstanding decisions. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Torres Strait Islander members of the research team.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Valda Wallace
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Lynne Ridgway
- North Coast Neuropsychology, East Ballina, New South Wales, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Hedges J, Poirier B, Soares G, Haag D, Sethi S, Santiago PR, Cachagee M, Jamieson L. Journeying towards decolonising Aboriginal and Torres Strait Islander oral health re-search. Community Dent Oral Epidemiol 2023; 51:1232-1240. [PMID: 37294001 DOI: 10.1111/cdoe.12881] [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: 01/04/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Arguably, the deficit narrative of oral health inequities, perpetuated by colonial re-search agendas, media and sociopolitical discourse, contributes to oral disease burden and fatalism among Aboriginal and Torres Strait Islander Peoples. There remains a need to evolve the way oral health is understood, in a manner that reflects the lived experiences of Aboriginal and Torres Strait Islander Peoples. METHODS This paper proposes decolonising methodologies as a strategy to ensure oral health re-search creates more equitable oral health outcomes and realities for Aboriginal and Torres Strait Islander Communities. Anchored by a critical reflection of the failure of dominant oral health inequity re-search practices to address Indigenous oral health, both in Australia and internationally, we propose five explicit pathways for decolonising Aboriginal and Torres Strait Islander oral health re-search. RESULTS We argue the need for (1) positionality statements in all re-search endeavours, (2) studies that honour reciprocal relationships through the development of proposals that ask questions and follow models based on Traditional Knowledges, (3) the development of culturally secure and strengths-based data capturing tools, (4) frameworks that address the intersection of multiple axes of oppression in creating inequitable conditions and (5) decolonising knowledge translation techniques. CONCLUSION Importantly, we recognize that re-search will never be entirely 'decolonised' due to the colonial foundations upheld by academic institutions and society more broadly; however, as oral health re-searchers, we ascertain that there is an ethical compulsion to drive decolonising re-search pursuits that produce equitable oral health outcomes for Aboriginal and Torres Strait Islander Communities.
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Affiliation(s)
- Joanne Hedges
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Brianna Poirier
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Gustavo Soares
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Dandara Haag
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Sneha Sethi
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Pedro Ribeiro Santiago
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Madison Cachagee
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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4
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Liddle J, Langton M, Rose J, Rice S. Apmerrke Areye-kenhe Utnenge Rlterrke-irrirtne-tyenhenge. Early Interv Psychiatry 2023; 17:1222-1226. [PMID: 37956669 DOI: 10.1111/eip.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
Arrurle-nge-ntyele researchers lhentere areye-le intelhe-ilepe-ileme apmerrke areye-akerte. Itne akaltye-arle-irreke apmerrke areye akwele urreme-urreme-irreme, utnenge alhwarrpe awelhemele. Kenhe alhentere nhenhe areye akaltye-irretyakenhe iwenhenge-arle apmerrke areye alakenhe anerlte-aneme. Itne itelaretyakenhe nthakenhe-arle arne ingkirreke urrperle-areye-kenhe-le apmerrke areye atnerre ilirtnemere. Researchers itne akaltye-irreke artwe apmerrke Central Australia-arenye-arle akwele health akurne anthurre-ulkere, Australia arenye-arrpenhe areye-nge. Arrpenheme apeke clinic-werne alheme, kenhe itne akenhe itelaretyakenhe iwenhe-arle alhentere ngangkere-le itneke ileme, health itnekenhe-akerte, medications-akerte-arlke. Artwe atningke apeke itelaretyakenhe iwenhenge-arle itne ilkelhetyakenhe uthene akangketyakenhe uthene. The kwenhe PhD project mpwarerle-aneme apmerrke anwerneke-akerte. Anwerne ahentye aneme apmerrke areye atyenpe-irrirtnetyeke, atnerre anemele. Project nhenhe arne atyeperre anwerne-kenhe areye-akerte, angkentye, anpernirrentye, nthakenhe angkentye anwernekenhe intelhetyeke, anyenhenge, apmere-kenhe arritnye ingkirreke, thipe-kenhe arritnye, arne-kenhe arritnye, atnunthe apmere-altye-arlke. Apmerrke areye kwenhe akaltye-irretyeke nthakenhe English angketyeke, read-eme-iletyeke, intelhetyeke-arlke. Apmerrke areye apeke akaltye-irretyeke Akngerrepate arrwekelenye areye-ke, arne mwerre areye itne-arle mpware-warretyarte, kele itne anteme itnenhe ingkentetyeke. Artwe akaperte altywere-areye role models anwernekenhe aneme. 1930's-nge-ntyele governments-le laws mpwareke arritnye Assimilation Policy. Yanhe-iperre, atningke areye uye-akaltye-irreke urrperle-kenhe arne areye-kenhe-ke. Alhentere areye-le anamelhe-ileke arrpenheme apmere itnekenhe-nge-ntyele bungalow-atheke, ayerrere-werne atheke, antekerre-arlke. Assimilation Policys-nge ularre, tyerrtye atningke angkentye-ke uye akaltye-irreke, apmere-akerte, apmere-ke-artweye-ke, kwertengwerle-ke, laws anwernekenhe-arlke. Lhentere arrpenheme ahentye-aneke akaltye-irretyeke Tywerrenge-ke. Arne arrpenheme-ke itne-arle akaltye-irreke artwe-kenhe-ante, kenhe arrpenhe akenhe ingkirreke-ke. Arne nhenhe areye museums-uthene-le organisations arrpenhe areye uthene-le akwete atnyeneme. Alhentere areye-le itnenhe akeme "archives." Itnekenge-ntyele anwerne apmerrke areye akaltye-le-anthetyeke, nthakenhe arrwekelenye anwernekenhe anirntyeke-arteke. Kele, the pipe nhenhe intelhe-ileke apmerrke itnenhe alpeme-iletyeke rlterrke-irrirtnetyeke.
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Affiliation(s)
- Joel Liddle
- Orygen, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Parkville, Australia
- Strehlow Research Centre, Alice Springs, Northern Territory, Australia
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Marcia Langton
- Indigenous Studies Unit, Centre for Health Equity, The University of Melbourne, Parkville, Victoria, Australia
| | - James Rose
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Parkville, Australia
| | - Simon Rice
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Gomez Cardona L, Yang M, Seon Q, Karia M, Velupillai G, Noel V, Linnaranta O. The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review. Glob Ment Health (Camb) 2023; 10:e83. [PMID: 38161748 PMCID: PMC10755398 DOI: 10.1017/gmh.2023.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.
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Affiliation(s)
- Liliana Gomez Cardona
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michelle Yang
- École interdisciplinaire des sciences de la santé/Interdisciplinary School of Health Sciences, Université d’Ottawa/University of Ottawa, Ottawa, ON, Canada
| | - Quinta Seon
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Maharshee Karia
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | | | - Valérie Noel
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Outi Linnaranta
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Erratum: Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100856. [PMID: 37693869 PMCID: PMC10485659 DOI: 10.1016/j.lanwpc.2023.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
[This corrects the article DOI: 10.1016/j.lanwpc.2023.100855.][This corrects the article DOI: 10.1016/j.lanwpc.2022.100532.].
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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Sethi S, Santiago PHR, Soares GH, Ju X, Antonsson A, Canfell K, Smith M, Garvey G, Hedges J, Jamieson L. Development and validation of an HPV infection knowledge assessment scale among Aboriginal and Torres Strait Islander Peoples. Vaccine X 2023; 14:100317. [PMID: 37288370 PMCID: PMC10241973 DOI: 10.1016/j.jvacx.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
Background An increased incidence of Human Papillomavirus (HPV) infection and its related cancers has been observed in recent years. Correct knowledge about HPV infection can lead to a significant decrease in transmission and a subsequent increase in vaccine uptake. Awareness and behavioural perception towards HPV infections are critical for improving HPV vaccination rates among Aboriginal and/or Torres Strait Islander Peoples. However, to the best of our knowledge, there has been no instrument designed to measure knowledge about HPV infection that is culturally appropriate and validated among Aboriginal and/or Torres Strait Islander People. Aim To address this research gap, this paper aims to examine the psychometric properties of the HPV Knowledge Tool (HPV-KT) in an Indigenous population sample from South Australia. Methodology Data from 747 Indigenous Australian Adults who participated in the 12-month follow-up of the HPV and Oropharyngeal Carcinoma in Indigenous Australians Study was utilised for this study. The psychometric properties examined included1) dimensionality and item redundancy; (2) network loadings; (3) model fit; (4) criterion validity; and (5) reliability. The network model was estimated using the Graphical Least Absolute Shrinkage and Selector Operator (GLASSO). Evaluation of the HPV-KT (10 items) dimensionality and item redundancy was conducted within the framework of Exploratory Graph Analysis (EGA). Reliability was evaluated with the McDonald's Omega (ω) coefficient. Results After the exclusion of two items, the HPV-KT exhibited good psychometric properties for Aboriginal and/or Torres Strait Islander Peoples. The two dimensions of "General HPV Knowledge" and "Commonness of HPV" were identified. The dimension of "Commonness of HPV" displayed poor reliability, so a sum score for this subscale is not recommended (i.e. the items can still be used individually) The network model of the 7-item HPV-KT was fitted in the validation sample and model fit was adequate (x2 (7) = 17.17, p < 0.016; CFI = 0.980; TLI = 0.94; RMSEA = 0.063, 90% CI = 0.025-0.010). Furthermore, the reliability of the "General HPV Knowledge" subscale (ω = 0.76, 95% CI: 0.72-0.79), while the reliability of the "Commonness of HPV" subscale (ω = 0.58, 95% CI0.58-0.88) was poor. Conclusion The HPV-KT was adapted for an Aboriginal and/or Torres Strait Islander population and is readily available for future use in Australia. The addition of items assessing specifications of HPV infection, natural history and behaviour will improve the reliability and usability to assess the level of accurate knowledge about HPV infection. Future studies should investigate the possibility of developing new items for the dimension 'Commonness of HPV'.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Pedro Henrique Ribeiro Santiago
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW
| | - Megan Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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Meldrum K, Andersson E, Webb T, Quigley R, Strivens E, Russell S. Screening depression and anxiety in Indigenous peoples: A global scoping review. Transcult Psychiatry 2023:13634615231187257. [PMID: 37490720 DOI: 10.1177/13634615231187257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Indigenous peoples' worldviews are intricately interconnected and interrelated with their communities and the environments in which they live. Their worldviews also manifest in a holistic view of health and well-being, which contrasts with those of the dominant western biomedical model. However, screening depression and/or anxiety in Indigenous peoples often occurs using standard western tools. Understandably, the cultural appropriateness of these tools has been questioned. The purpose of this scoping review was to map the literature that used any type of tool to screen depression or anxiety in Indigenous adults globally. A systematic scoping review method was used to search databases including, but not limited to, CINAHL, PubMed, Scopus and Google. Database-specific search terms associated with Indigenous peoples, depression and anxiety, and screening tools were used to identify literature. In addition, citation searches of related systematic reviews and relevant websites were conducted. The data set was limited to English language publications since database inception. Fifty-four publications met the review's inclusion criteria. Most studies were completed in community settings using standard western depression and anxiety screening tools. Thirty-three different tools were identified, with the Patient Health Questionnaire-9 being the most frequently used. The review's findings are concerning given repeated calls for culturally appropriate screening tools to be used with Indigenous peoples. Although there has been some work to cross-culturally adapt depression screening tools for specific Indigenous populations, clearly more clinicians and researchers need to be aware of, and use, culturally appropriate approaches to screening.
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Affiliation(s)
| | | | | | | | - Edward Strivens
- James Cook University
- Queensland Health, Cairns and Hinterland Hospital and Health Service
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Samuel V, Arora R, Virk P. Improving Reporting on Qualitative Methods Used in the Development and Validation of Patient-Reported Outcome Measures for Mental Health Concerns. J Psychosoc Nurs Ment Health Serv 2023; 61:40-44. [PMID: 36099482 DOI: 10.3928/02793695-20220902-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Qualitative methodologies are recommended in the development and evaluation of psychological instruments. However, reporting on qualitative methods in instrument development studies remains variable and often insufficient to support claims surrounding content validity. In the current article, we present a commentary discussing the critical role qualitative inquiry plays in the development of patient-reported outcome measures. We outline the current state of reporting in qualitative instrument development and evaluation studies with a focus on mental health literature and highlight the clinical relevance of this topic for health care professionals. Despite challenges, we express confidence in the potential value of substantively engaging with qualitative methods and comprehensive reporting and summarize recommendations to this effect based on the current literature. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 40-44.].
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Meldrum K, Andersson E, Sagigi B, Webb T, Wapau C, Quigley R, Strivens E, Russell S. How Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia describe and discuss social and emotional well-being: a qualitative study protocol. BMJ Open 2022; 12:e067052. [PMID: 36600438 PMCID: PMC9772669 DOI: 10.1136/bmjopen-2022-067052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Colonisation has, and continues to, negatively impact the mental well-being of Australia's First Nations peoples. However, the true magnitude of the impact is not known, partially because clinicians have low levels of confidence in using many existing screening tools with First Nations clients. In addition, many authors have critiqued the use of tools designed for Western populations with First Nations peoples, because their worldview of health and well-being is different. Therefore, the aim of the overarching study is to develop an appropriate mental well-being screening tool(s) for older adults (aged 45 and over) living in the Torres Strait that can be used across primary health and geriatric settings. This protocol describes the first phase designed to achieve the overarching aim-yarning about social and emotional well-being (inclusive of mental well-being) in First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia. METHOD AND ANALYSIS The study will be guided by decolonising and participatory action research methodologies. Yarning is an Australian First Nations relational method that relies on storytelling as a way of sharing knowledge. Yarning circles will be conducted with community members and health and aged care workers living on six different island communities of the Torres Strait. Participants will be recruited using purposive sampling. Thematic analysis of the data will be led by Torres Strait Islander members of the research team. ETHICS AND DISSEMINATION The Far North Queensland, Human Research Ethics Committee (HREC) (HREC/2021/QCH/73 638-1518) and James Cook University HREC (H8606) have approved this study. Dissemination of study findings will be led by Torres Strait members of the research team through conferences and peer-reviewed publications.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Ellaina Andersson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Betty Sagigi
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Torres and Cape Hospital and Health Service, Queensland Health, Thursday Island, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Chenoa Wapau
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Torres and Cape Hospital and Health Service, Queensland Health, Thursday Island, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Reilly R, Azzopardi PS, Brown A, Fisher J, Patton G, Rickwood DJ, Yong CS, Pearson O, Brown N. Strengthening assessment and response to mental health needs for Aboriginal and Torres Strait Islander children and adolescents in primary care settings: study protocol for the Ngalaiya Boorai Gabara Budbut implementation project. BMJ Open 2022; 12:e063154. [PMID: 36691207 PMCID: PMC9462123 DOI: 10.1136/bmjopen-2022-063154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Opportunities for improved mental health and wellbeing of Aboriginal and Torres Strait Islander children and young people lie in improving the capability of primary healthcare services to identify mental healthcare needs and respond in timely and appropriate ways. The development of culturally appropriate mental health assessment tools and clinical pathways have been identified as opportunities for strengthening workforce capacity in this area. The Ngalaiya Boorai Gabara Budbut implementation project seeks to pursue these opportunities by developing and validating a psychosocial assessment tool, understanding what services need to better care for your people and developing resources that address those needs. METHODS AND ANALYSIS The project will be governed by a research governance group comprising Aboriginal service providers, young people, and researchers. It will be implemented in an urban health service in Canberra, and regional services in Moree, Wollongong, and the Illawarra regions of New South Wales Australia. The validation study will follow an argument-based approach, assessing cultural appropriateness and ease of use; test-retest validity; internal consistency, construct validity and the quality of decisions made based on the assessment. Following piloting with a small group of young people and their caregivers (n=10), participants (n=200) will be young people and/or their caregivers, attending one of the partner services. The needs assessment will involve an in-depth exploration of service via an online survey (n=60) and in-depth interviews with service providers (n=16) and young people (n=16). These activities will run concurrently. Service providers, researchers and the governance group will codesign resources that respond to the needs identified and pilot them through the participating services. ETHICS AND DISSEMINATION The Aboriginal Health and Medical Research Council of NSW Human Research Ethics committee (#1769/21) has approved this project. Informed consent will be obtained from all participants and/or their caregivers (with assent from those aged <16 years) prior to participating in all aspects of the study. Research dissemination will occur through participating health services, academic journal articles and conference presentations.
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Affiliation(s)
- Rachel Reilly
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter S Azzopardi
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Global Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Indigenous Genomics, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Debra J Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Choong-Siew Yong
- Child and Youth Mental Health, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Odette Pearson
- School of Population Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ngiare Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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12
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100532. [PMID: 35833207 PMCID: PMC9272378 DOI: 10.1016/j.lanwpc.2022.100532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable. Methods Data from two adult community health checks (2015-2018) were analyzed to determine the prevalence of 11 modifiable dementia risk factors among the First Nations residents of the Torres Strait and Northern Peninsula Area of FNQ. Population attributable fractions (PAF%) for dementia were calculated using age-standardized prevalence estimates derived from these health checks and relative risks obtained from previous meta-analyses in other populations. PAF% estimates were weighted for communality to account for overlap of risk factors. Findings Half (52·1%) of the dementia burden in this population may be attributed to 11 potentially modifiable risk factors. Hypertension (9·4%), diabetes mellitus (9·0%), obesity (8·0%), and smoking (5·3%) were the highest contributing risk factors. The contribution of depression (2·0%) and alcohol (0·3%) was lower than other global and national estimates. While the adjusted PAF% for social isolation was low based on the adult community health check data (1·6%), it was higher (4·2%) when official census data were analyzed. Interpretation These results suggest that a substantial proportion of dementia in FNQ First Nations peoples could potentially be prevented. Government investment in preventative health now is essential to reduce the future burden of dementia. Funding National Health and Medical Research Council (NHMRC, GNT1107140, GNT1191144, GNT1106175, GNT0631947).
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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13
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Haregu T, Jorm AF, Paradies Y, Leckning B, Young JT, Armstrong G. Discrimination experienced by Aboriginal and Torres Strait Islander males in Australia: Associations with suicidal thoughts and depressive symptoms. Aust N Z J Psychiatry 2022; 56:657-666. [PMID: 34256631 DOI: 10.1177/00048674211031168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms. METHODS We used cross-sectional data on 13,697 males aged 18-55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms. RESULTS Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p < 0.001), suicidal ideation (21.8% vs 9.4%, p < 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p < 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination. CONCLUSION Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Tilahun Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | - Bernard Leckning
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Jesse T Young
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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14
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Gardiner F, Middleton J, Perera S, Gunner M, Churilov L, Coleman M, Poole L. Cohort study comparison of Mental Health and Wellbeing Services delivered by The Royal Flying Doctor Service, across Far North and Central West Queensland. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100385. [PMID: 35540562 PMCID: PMC9079348 DOI: 10.1016/j.lanwpc.2022.100385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Understanding cultural differences between geographical regions is essential in delivering culturally appropriate healthcare. We aimed to describe the characteristics and outcomes of diverse clients using the Far North Mental Health and Wellbeing Service (FNS) and the Central West Health and Wellbeing Service (CWS). Methods We conducted a cohort study within Queensland, Australia, on all clients who received a mental health therapy session at either the FNS or the CWS. Patient data was prospective data collected form July 2019 to December 2020. Findings There were1202 clients, with a median number of individual contacts per-client of 3.0 (IQR 2.0-6.0). There was 428 (35.6% 95% CI 32.90-38.39) males and 772 (64.2% 95% CI 61.44-66.94) females with a median age across the genders of 38.0 (IQR 28.0-51.0). There was 505 (42.0% 95% CI 39.20-44.86) identifying as Indigenous and 697 (58.0% 95% CI 55.14-60.80) as non-Indigenous Australians. The FNS had a significantly higher proportion of Indigenous clients (n=484; 54.8% 95% CI 51.46-58.13) as compared to the CWS (n=21; 6.6% 95% CI 4.12-9.89). Of the 1202 clients, 946 (78.7% 95% CI 76.28-80.99) had a socio-economic classification of ‘most disadvantaged’, consisting of 740 (83.8%) clients from the FNS and 206 (64.6%) clients from the CWS. The majority of presentations were for neurotic, stress-related and somatoform disorders (n=568; 47.3%), followed by mood affective disorders (n=310; 25.8%). The overall number of treatments strategies employed was 10798, equalling a median of 6.0 (IQR 4.0-9.0) strategies per-client, with the leading strategies being counselling/psychosocial (n=1394; 12.9%), reflective listening (n=1191; 11.0%), and strengths based reasoning (n=1116; 10.3%). There were 511 (42.5%) clients who completed the Kessler Psychological Distress Scale (K10/K5), with 493 (41.0%) clients not offered as deemed not culturally appropriate by the treating team. The mean initial K10/K5 score was 23.7 (SD 9.4) which significantly decreased (p<0.001) to 18.0 (SD 10.0) at final consultation. Interpretation This study highlighted client socioeconomic differences between two geographically remote mental health services. It is essential that services are regionally co-designed to ensure cultural appropriateness. Funding No funding to declare.
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15
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Liddle J, Langton M, Rose JWW, Rice S. New thinking about old ways: Cultural continuity for improved mental health of young Central Australian Aboriginal men. Early Interv Psychiatry 2022; 16:461-465. [PMID: 34169649 DOI: 10.1111/eip.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 05/17/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
Decades of reports and policy have drawn attention to the significant social and occupational impairment of many young Aboriginal men in Central Australia. However, the role of mental ill-health as a contributing factor to this impairment, and culturally appropriate intervention targets have received insufficient attention in the psychiatry literature. Despite having the worst health outcomes of any population in Australia, Aboriginal men chronically underuse primary health care services. It's proposed that interventions ensuring cultural continuity through Identity-strengthening with a particular focus on positive Aboriginal masculinities will address a critical mental health gap for young men. In Central Australian and broader Indigenous populations, tangible and measurable kinship, language, religious and economic (KLRE) activities are catalytic vehicles for restoring traditional knowledge that suffer ongoing pressures as a result of colonization and assimilationist Government policy. By transforming KLRE knowledge content from ethnographic archives, these culturally rich repositories may be utilized to create education and engagement materials that will support young Aboriginal men's efforts to obtain and maintain positive mental health. This proposal focuses on building resilience through the acquisition of KLRE knowledge which young Aboriginal men can utilize as resources for enhancing positive identity and mental health outcomes.
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Affiliation(s)
- Joel Liddle
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Marcia Langton
- Indigenous Studies Unit, Centre for Health Equity, The University of Melbourne, Parkville, Victoria, Australia
| | - James W W Rose
- Indigenous Studies Unit, Centre for Health Equity, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon Rice
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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16
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Atkinson-Briggs S, Jenkins A, Ryan C, Brazionis L. Health-risk behaviours among Indigenous Australians with diabetes: A study in the integrated Diabetes Education and Eye Screening (iDEES) project. J Adv Nurs 2022; 78:1305-1316. [PMID: 35037286 DOI: 10.1111/jan.15141] [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: 02/26/2021] [Revised: 11/09/2021] [Accepted: 12/09/2021] [Indexed: 11/27/2022]
Abstract
AIM To assess the prevalence of modifiable health-risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary-care clinic. DESIGN A cross-sectional observational single-site study. METHODS As part of a multi-study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health-related behavioural data in the nurse-led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes. RESULTS Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46-67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2-12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty-nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10 min at a time 4 days/week and sat for an average of 8 h on weekdays; 35 (40%) had minimal-mild, and 30 (34%) had moderate-severe depressive symptoms. CONCLUSION Suboptimal modifiable health-risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes. IMPACT Orderly assessment and reporting of health-risk behaviours using a single multi-component survey instrument (SNAPE tool) during a nurse-led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels.
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Affiliation(s)
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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17
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Pandeya NA, Schluter PJ, Spurling GK, Tyson C, Hayman NE, Askew DA. Factors Associated with Thoughts of Self-Harm or Suicide among Aboriginal and Torres Strait Islander People Presenting to Urban Primary Care: An Analysis of De-Identified Clinical Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:153. [PMID: 35010413 PMCID: PMC8750353 DOI: 10.3390/ijerph19010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres Strait Islander people attending an urban primary health care service and identify factors associated with these thoughts. Multilevel mixed-effects modified Poisson regression models were employed to analyse three years of data gathered during the annual Aboriginal and Torres Strait Islander health assessments. At their first health assessment, 11.5% (191/1664) of people reported thoughts of suicide or self-harm in the prior two weeks. Having children, participating in sport or community activities or being employed full-time decreased the risk of such thoughts. Conversely, factors relating to social exclusion including homelessness, drug use, unemployment and job insecurity increased the risk of thoughts of self-harm or suicide. Individual clinicians, health services, and policy-makers all have a role in suicide prevention. Clinicians need appropriate training to be able to respond to people expressing these thoughts. Aboriginal and Torres Strait Islander community organisations need sovereignty and self-determination over resources to provide programs that promote cultural connectivity and address social exclusion, thereby saving lives.
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Affiliation(s)
- Neha A Pandeya
- General Practice Clinical Unit, School of Clinical Medicine, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
| | - Philip J Schluter
- General Practice Clinical Unit, School of Clinical Medicine, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch 8140, New Zealand
| | - Geoffrey K Spurling
- General Practice Clinical Unit, School of Clinical Medicine, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, P.O. Box 52, Inala, QLD 4077, Australia
| | - Claudette Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, P.O. Box 52, Inala, QLD 4077, Australia
| | - Noel E Hayman
- General Practice Clinical Unit, School of Clinical Medicine, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, P.O. Box 52, Inala, QLD 4077, Australia
| | - Deborah A Askew
- General Practice Clinical Unit, School of Clinical Medicine, Royal Brisbane & Women's Hospital, The University of Queensland, Herston, QLD 4029, Australia
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18
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Molinaro M, Adams HR, Mwanza-Kabaghe S, Mbewe EG, Kabundula PP, Mweemba M, Birbeck GL, Bearden DR. Evaluating the Relationship Between Depression and Cognitive Function Among Children and Adolescents with HIV in Zambia. AIDS Behav 2021; 25:2669-2679. [PMID: 33630200 PMCID: PMC8456506 DOI: 10.1007/s10461-021-03193-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
Depression is common among people living with HIV. Multiple studies demonstrate a link between depression and cognitive dysfunction in adults with HIV, but the association has been minimally investigated in children and adolescents with HIV in Africa. We conducted a cross-sectional analysis as part of the HIV-associated Neurocognitive Disorders in Zambia study, a prospective cohort study in Lusaka, Zambia. We included 208 perinatally-infected children with HIV ages 8-17 taking antiretroviral therapy and 208 HIV-exposed uninfected (HEU) controls. Cognition was assessed with a comprehensive neuropsychological battery. Depressive symptoms were evaluated using self-report and parent-report versions of the NIH Toolbox Sadness module and the Patient Health Questionnaire-9 (PHQ-9). Risk factors for depression and associations between depressive symptoms and cognition were evaluated in bivariable and multivariable regression models. Participants with HIV demonstrated higher levels of depressive symptoms than controls (mean NIH Toolbox Sadness T-Score 50 vs. 44, p < 0.01; mean PHQ-9 score 2.0 vs. 1.5, p = 0.03), and were more likely to have cognitive impairment (30% vs. 13%, p < 0.001). Risk factors for depressed mood included self-reported poor health (OR 7.8, p < 0.001) and negative life events (OR 1.3, p = 0.004) Depressed mood was associated with cognitive impairment in participants with HIV (OR = 2.9, 95% CI 1.2-7.2, p = 0.02) but not in HEU participants (OR 1.7, 95% CI 0.18-15.7, p = 0.6). In conclusion, depressed mood is common among youth with HIV in Zambia, and is associated with cognitive impairment. Depression may be a result of HIV-related stress and stigma, or may be part of the spectrum of HIV-associated neurocognitive disorders. The causal relationship between depressed mood and cognitive impairment is unclear and should be evaluated in future longitudinal studies.
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Affiliation(s)
| | - Heather R Adams
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 631, Rochester, NY, 14642, USA
| | | | - Esau G Mbewe
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia
| | | | - Milimo Mweemba
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - Gretchen L Birbeck
- Division of Epilepsy, Department of Neurology, Rochester, NY, USA
- University of Zambia School of Medicine, Lusaka, Zambia
| | - David R Bearden
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 631, Rochester, NY, 14642, USA.
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia.
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Measuring Social and Emotional Wellbeing in Aboriginal Youth Using Strong Souls: A Rasch Measurement Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168425. [PMID: 34444174 PMCID: PMC8391716 DOI: 10.3390/ijerph18168425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/04/2022]
Abstract
Currently, there are few robustly evaluated social and emotional wellbeing (SEWB) measures available for use with Aboriginal youth in research, policy, and practice. As such, this study used a Rasch measurement approach to examine the psychometric properties of Strong Souls, a 25-item self-reported SEWB instrument, created for use with Aboriginal youth in the Northern Territory. Our sample (N = 154) included youth (15–25 years old) living on Whadjuk (metropolitan Western Australia; N = 91) and Kamilaroi countries (rural New South Wales; N = 63). Using Rasch modelling techniques, evidence for multidimensionality in the scale was observed, resulting in subsequent analyses conducted separately on two subscales: Psychological Distress and Resilience. The Resilience subscale did not meet the Rasch model assumptions, with poor person and item separation and reliability indexes suggesting the scale was not reliably differentiating between participants’ Resilience scores. The Psychological Distress subscale had mixed separation and reliability index results, with good construct validity implied but poorer ability to target the distress of participants. Our findings provide novel evidence demonstrating the functioning of Strong Souls in a contemporary sample of Aboriginal youth, suggesting further modifications of the instrument are required before it can be used with confidence as a reliable measure in this population group.
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Garvey G, Anderson K, Gall A, Butler TL, Whop LJ, Arley B, Cunningham J, Dickson M, Cass A, Ratcliffe J, Tong A, Howard K. The Fabric of Aboriginal and Torres Strait Islander Wellbeing: A Conceptual Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157745. [PMID: 34360037 PMCID: PMC8345714 DOI: 10.3390/ijerph18157745] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
Wellbeing is culturally bound and is shaped by many aspects of life, including experiences, beliefs and values. As such, in order to accurately measure wellbeing for a specific cultural group, it is necessary to understand the experiences, beliefs and values that influence the conception and experience of wellbeing of that group. This paper presents a conceptual model of wellbeing for Aboriginal and Torres Strait Islander people, which was developed from a large national qualitative study that explored the views of 359 Aboriginal and Torres Strait Islander adults. An Aboriginal- and Torres Strait Islander-led research team used an Indigenist research approach to iteratively develop this conceptual model, called the Fabric of Aboriginal and Torres Strait Islander Wellbeing model, which takes inspiration from Aboriginal and Torres Strait Islander weaving traditions whereby individual strands are twined to create fabrics that are both beautiful and strong. This reflects our findings that the parts of life that are most important to wellbeing for many Aboriginal and Torres Strait Islander people are interwoven with their families, communities and culture.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- School of Public Health, University of Queensland, Brisbane 4000, Australia
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- Correspondence:
| | - Alana Gall
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Tamara L. Butler
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
| | - Brian Arley
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide 5042, Australia;
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
| | - Kirsten Howard
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia; (G.G.); (A.G.); (T.L.B.); (L.J.W.); (B.A.); (J.C.); (A.C.); (K.H.)
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.D.); (A.T.)
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney 2006, Australia
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Brodie T, Pearson O, Cantley L, Cooper P, Westhead S, Brown A, Howard NJ. Strengthening approaches to respond to the social and emotional well-being needs of Aboriginal and Torres Strait Islander people: the Cultural Pathways Program. Prim Health Care Res Dev 2021; 22:e35. [PMID: 34184630 PMCID: PMC8278791 DOI: 10.1017/s1463423621000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022] Open
Abstract
Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently 'do what it takes' to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being.The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.
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Affiliation(s)
- Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Luke Cantley
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Social Work Innovation Research Living Space, College of Education, Psychology & Social Work, Flinders University, South Australia
| | - Peita Cooper
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Seth Westhead
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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22
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Dingwall KM, Sweet M, Cass A, Hughes JT, Kavanagh D, Howard K, Barzi F, Brown S, Sajiv C, Majoni SW, Nagel T. Effectiveness of Wellbeing Intervention for Chronic Kidney Disease (WICKD): results of a randomised controlled trial. BMC Nephrol 2021; 22:136. [PMID: 33866968 PMCID: PMC8054368 DOI: 10.1186/s12882-021-02344-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. Few studies have investigated the efficacy of psychosocial interventions for people with ESKD and none exist for Indigenous people, a population in which the ESKD burden is especially high. Methods This three-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App in improving psychological distress (Kessler distress scale; K10), depressive symptoms (adapted Patient Health Questionnaire; PHQ-9), quality of life (EuroQoL; EQ. 5D) and dialysis adherence among Indigenous Australians undergoing haemodialysis in central and northern Australia (Alice Springs and Darwin), with follow up over two 3-month periods. Effects of immediate AIMhi Stay Strong App treatment were compared with those from a contact control app (The Hep B Story) and treatment as usual (TAU). Control conditions received the Stay Strong intervention after 3 months. Results Primary analyses of the full sample (N = 156) showed statistically significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong app or TAU. Restricting the sample to those with moderate to severe symptoms of distress or depression (K10 > =25 or PHQ-9 > =10) showed significant decreases in K10 and PHQ-9 scores for both Stay Strong and Hep B Story. No significant differences were observed for the EQ-5D or dialysis attendance. Conclusions Findings suggest that talking to people about their wellbeing and providing information relevant to kidney health using culturally adapted, locally relevant apps improve the wellbeing of people on dialysis. Further research is required to replicate these findings and identify active intervention components. Trial registration ACTRN12617000249358; 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
| | - David Kavanagh
- Centre for Children's Health Research and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
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23
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Green M, Cunningham J, Anderson K, Griffiths K, Garvey G. Measuring health care experiences that matter to Indigenous people in Australia with cancer: identifying critical gaps in existing tools. Int J Equity Health 2021; 20:100. [PMID: 33845852 PMCID: PMC8042987 DOI: 10.1186/s12939-021-01433-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measurement of patients' healthcare experiences is increasingly used as an indicator of quality of care, but there are concerns that existing measures omit information that is meaningful to patients and that results may not be used systematically to inform service improvement. Further, current approaches may be inadequate for some population groups, such as Indigenous people in Australia, whose healthcare experience is impacted by the context of colonisation and discordance between Indigenous understandings of health and the Western biomedical health system. This study aimed to assess the extent to which existing patient experience measures used in Australia collect information about critical aspects of cancer care, as previously identified by Indigenous people affected by cancer and their health care providers. METHODS A two-stage process was used to examine the adequacy of existing patient experience measures for Indigenous people in Australia: (1) relevant tools and measures were identified and assessed, and four measures selected as suitable comparators; (2) comparators were examined in detail and mapped against topics identified in earlier research as important to Indigenous people with cancer. Gaps in topic coverage in comparators were identified. RESULTS No comparators completely captured the critical aspects of cancer care identified by Indigenous people affected by cancer and their health care providers. The number of topics 'partially' captured by the four comparators ranged from 4 to 7 out of 9. While most topics were partially covered, the lack of questions around culture and cultural safety was notable. CONCLUSIONS Existing tools are likely to miss key aspects of Indigenous peoples' experiences of cancer care in Australia. Failure to adequately assess care experiences related to cultural safety may compromise efforts to improve health outcomes. Addressing gaps requires development of experience measures that are strengths-based, reflect an Indigenous worldview and measure aspects of experience relevant to Indigenous people.
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Affiliation(s)
- Monica Green
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia.
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Kalinda Griffiths
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Level 10, East Tower, 410 Ann Street, Brisbane, QLD, 4000, Australia
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24
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Testing the Effects of Dietary Seafood Consumption on Depressive Symptoms. Methods Mol Biol 2021. [PMID: 32219752 DOI: 10.1007/978-1-0716-0471-7_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
This chapter presents a protocol for assessing the effects dietary seafood consumption on depressive symptoms. We designed a cross-sectional study of 206 participants recruited in two Torres Strait Island communities. Depressive symptoms were assessed using the adapted Patient Health Questionnaire-9 (aPHQ-9), diet was analyzed with a structured questionnaire, omega-3 and omega-6 fatty acid concentrations were measured via a capillary dried blood spot system, and plasma levels of triglycerides and cholesterol were measured by gas-phase chromatography. Finally, we tested the relationship between seafood consumption, blood lipid concentrations, and depression scores using independent samples t-tests and a logistic and quantile regression model.
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25
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Thompson F, Cysique LA, Harriss LR, Taylor S, Savage G, Maruff P, Mcdermott R. Acceptability and Usability of Computerized Cognitive Assessment Among Australian Indigenous Residents of the Torres Strait Islands. Arch Clin Neuropsychol 2020; 35:1288-1302. [PMID: 32647858 DOI: 10.1093/arclin/acaa037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This cross-sectional study aimed to investigate the acceptability and usability of the Cogstate Brief Battery (CBB) in a community-based sample of Australian Indigenous people from the Torres Strait region, based on a user experience framework of human-computer interaction. METHODS Two-hundred community participants completed the four subtests of the CBB on an iPad platform, during a free adult health check on two islands in the region, between October and December 2016. Acceptability was defined as completing the learning trial of a task and usability as continuing a task through to completion, determined by examiner acumen and internal Cogstate completion and integrity criteria. These were combined into a single dichotomous completion measure for logistic regression analyses. Performance-measured as reaction times and accuracy of responses-was analyzed using linear regression analyses. RESULTS CBB completion ranged from 82.0% to 91.5% across the four tasks and the odds of completing decreased with age. After adjusting for age, iPad/tablet familiarity increased the odds of completion for all tasks while level of education and employment increased the odds for some tasks only. These variables accounted for 18.0%-23.8% of the variance in reaction times on speeded tasks. Age and education had the most effect, although semipartial correlations were modest. CONCLUSIONS When administered in a health-screening context, the acceptability and usability of the CBB were greatest in young- to middle-aged participants with some education and iPad/tablet experience. Older and more vulnerable participants may have benefited from additional time and practice on the CBB prior to administration.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Lucette A Cysique
- Neurosciences Research Australia, Psychology Department, University of New South Wales, Sydney, New South Wales, Australia
| | - Linton R Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Greg Savage
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | | | - Robyn Mcdermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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26
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Black EB, Toombs MR, Kisely S. The Cultural Validity of Diagnostic Psychiatric Measures for Indigenous Australians. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emma B. Black
- School of Medicine, Rural Clinical School, The University of Queensland,
| | - Maree R. Toombs
- School of Medicine, Rural Clinical School, The University of Queensland,
| | - Steve Kisely
- School of Medicine, Rural Clinical School, The University of Queensland,
- School of Medicine, Southern Clinical School, The University of Queensland,
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Nagel T, Sweet M, Dingwall KM, Puszka S, Hughes JT, Kavanagh DJ, Cass A, Howard K, Majoni SW. Adapting wellbeing research tools for Aboriginal and Torres Strait Islander people with chronic kidney disease. BMC Nephrol 2020; 21:130. [PMID: 32293331 PMCID: PMC7161120 DOI: 10.1186/s12882-020-01776-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease is an increasingly common health problem for Aboriginal and Torres Strait Islander people. It is associated with multiple concurrent psychosocial stressors frequently resulting in negative impacts on emotional and social wellbeing. There is need for well-designed intervention studies to provide evidence of effective treatment for comorbid depression or other mental illness in this setting. Attention to early phase piloting and development work is recommended when testing complex interventions. This paper documents feasibility testing and adaptation of an existing culturally responsive brief wellbeing intervention, the Stay Strong App, and three commonly used wellbeing outcome measures, in preparation for a clinical trial testing effectiveness of the intervention. METHODS The Stay Strong App, which has not been used in the setting of Chronic Kidney Disease before, is reviewed and adapted for people with comorbid wellbeing concerns through expert consensus between research team and an Expert Panel. The outcome measures (Kessler 10, Patient Health Questionnaire 9, and EuroQoL) are valid, reliable, and commonly used tools to assess various aspects of wellbeing, which have also not been used in this context before. Feasibility and acceptability are examined and developed through 3 stages: Pilot testing in a purposive sample of five haemodialysis patients and carers; translation of outcome measures through collaboration between the Aboriginal Interpreter Service, Aboriginal and Torres Strait Islander research officers and the research team; and conversion of translated outcome measures to electronic format. RESULTS Research team and expert panel consensus led to adaptation of the Stay Strong App for renal patients through selective revision of words and images. Pilot testing identified challenges in delivery of the wellbeing measures leading to word changes and additional prompts, integration of audio translations in 11 local Indigenous languages within an interactive Outcome Measures App, and related research protocol changes. CONCLUSION Modelling the complex intervention prior to full-scale testing provided important information about the design of both the outcome measures and the intervention. These changes are likely to better support success in conduct of the clinical trial and future implementation of the intervention in clinical settings.
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Affiliation(s)
- Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Stefanie Puszka
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
- Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
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Wright M, Culbong T, Crisp N, Biedermann B, Lin A. "If you don't speak from the heart, the young mob aren't going to listen at all": An invitation for youth mental health services to engage in new ways of working. Early Interv Psychiatry 2019; 13:1506-1512. [PMID: 31286680 DOI: 10.1111/eip.12844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/05/2019] [Accepted: 06/09/2019] [Indexed: 11/30/2022]
Abstract
AIM Aboriginal and Torres Strait Islander young people are more likely to experience mental health issues or end their life by suicide than non-Aboriginal youth, but are less likely to access mental health services for support. Systemic change is required if mainstream youth mental health services are to be relevant and culturally secure for Aboriginal and Torres Strait Islander young people. METHODS Building Bridges (2017-2019) is a three-year participatory action research project being conducted in partnership with the Nyoongar community and three mainstream youth mental health services in Perth, Western Australia. The project involves Nyoongar Elders and Aboriginal and Torres Strait Islander young people working directly with senior management and key staff of youth mental health services to co-design, implement and evaluate a framework for systems change. The aim of the project is to increase Aboriginal and Torres Strait Islander young people's engagement with services and improve mental health outcomes for young people and their families. RESULTS This paper outlines the engagement process that underpinned the first phase of the project. Our research methods are premised by an investment in establishing safe spaces for the Elders, young people and service staff to engage in open, honest dialogue. We present two key activities that illustrate this process of building trust and deepening understanding, namely: spending time "On Country" and engaging in a "storying" process. CONCLUSIONS Building Bridges demonstrates the centrality of trusting relationships for systemic change and the way in which meaningful engagement is at the core of both the process and the outcome.
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Affiliation(s)
| | - Tiana Culbong
- Curtin University, Perth, Western Australia, Australia
| | - Nikayla Crisp
- Curtin University, Perth, Western Australia, Australia
| | | | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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Xu D, Jenkins A, Ryan C, Keech A, Brown A, Boffa J, O'Dea K, Bursell SE, Brazionis L. Health-related behaviours in a remote Indigenous population with Type 2 diabetes: a Central Australian primary care survey in the Telehealth Eye and Associated Medical Services Network [TEAMSnet] project. Diabet Med 2019; 36:1659-1670. [PMID: 31385331 DOI: 10.1111/dme.14099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2019] [Indexed: 12/01/2022]
Abstract
AIM There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. METHODS We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. RESULTS At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 - 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. CONCLUSIONS Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health.
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Affiliation(s)
- D Xu
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
| | - A Jenkins
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
| | - C Ryan
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - A Keech
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, SA
| | - J Boffa
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - K O'Dea
- The University of Melbourne, Melbourne, VIC
| | - S E Bursell
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
- Telehealth Research Institute, University of Hawaii, Hawaii, HI, USA
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30
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Farnbach S, Gee G, Eades AM, Evans JR, Fernando J, Hammond B, Simms M, DeMasi K, Glozier N, Brown A, Hackett ML. Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9. BMC Public Health 2019; 19:1270. [PMID: 31533670 PMCID: PMC6749631 DOI: 10.1186/s12889-019-7569-4] [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: 04/26/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022] Open
Abstract
Background The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Methods Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Results Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Conclusion Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Trial registration Australian New Zealand Clinical Trial Registry ANZCTR12614000705684, 03/07/2014.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, The University of New South Wales, PO Box M201, Missenden Road, Sydney, New South Wales, 2050, Australia. .,University of New South Wales, Sydney, New South Wales, 2052, Australia. .,University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Graham Gee
- Victorian Aboriginal Health Service, Melbourne, Victoria, 3065, Australia.,University of Melbourne, Melbourne, Victoria, 3000, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - Anne-Marie Eades
- The George Institute for Global Health, The University of New South Wales, PO Box M201, Missenden Road, Sydney, New South Wales, 2050, Australia.,University of New South Wales, Sydney, New South Wales, 2052, Australia.,University of Sydney, Sydney, New South Wales, 2006, Australia
| | - John Robert Evans
- The University of Technology, Sydney, New South Wales, 2006, Australia.,The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Jamie Fernando
- The Glen Centre (Ngampie), Chittaway Point, New South Wales, 2261, Australia.,The University of Newcastle, Newcastle, New South Wales, 2308, Australia
| | - Belinda Hammond
- Nunkuwarrin Yunti of South Australia, Adelaide, South Australia, 5000, Australia
| | - Matty Simms
- The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Karrina DeMasi
- Aboriginal Medical Services Alliance Northern Territory, Darwin, 0801, Australia
| | - Nick Glozier
- Brain and Mind Centre and Central Clinical School University of Sydney, Sydney, New South Wales, 2052, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Maree L Hackett
- The George Institute for Global Health, The University of New South Wales, PO Box M201, Missenden Road, Sydney, New South Wales, 2050, Australia.,University of New South Wales, Sydney, New South Wales, 2052, Australia.,University of Sydney, Sydney, New South Wales, 2006, Australia.,The University of Central Lancashire, Preston, PR1 2HE, UK
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Titov N, Schofield C, Staples L, Dear BF, Nielssen O. A comparison of Indigenous and non-Indigenous users of MindSpot: an Australian digital mental health service. Australas Psychiatry 2019; 27:352-357. [PMID: 30058351 DOI: 10.1177/1039856218789784] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report on Aboriginal and Torres Strait Islander (Indigenous) users of MindSpot, a national service for the remote assessment and treatment of anxiety and depression. METHODS The characteristics and treatment outcomes of Indigenous patients who registered with MindSpot between January 2015 and December 2016, were compared with non-Indigenous users. Changes in psychological distress, depression and anxiety were measured using the Kessler 10-Item (K-10), Patient Health Questionnaire 9-Item (PHQ-9), and Generalised Anxiety Disorder Scale 7-Item (GAD-7), respectively. RESULTS Of 23,235 people who completed a MindSpot assessment between 1 January 2015 and 31 December 2016, 780 (3.4%) identified as Indigenous Australian. They had higher symptom scores, were more likely to live in a remote location, and a third reported no previous contact with mental health services. Fewer Indigenous patients enrolled in a treatment course, but those who did had similar rates of completion and similar reductions in symptoms to non-Indigenous patients. CONCLUSIONS MindSpot treatments were effective in treating anxiety and depression in Indigenous Australians, and outcomes were similar to those of non-Indigenous patients. Services like MindSpot are a treatment option that can help overcome barriers to mental health care for Indigenous Australians.
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Affiliation(s)
- Nickolai Titov
- Professor, Department of Psychology Project Director, MindSpot Clinic, Macquarie University, Sydney, NSW, and; eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Carlie Schofield
- Aboriginal Mental Health Consultant, Illawarra Aboriginal Medical Service, Wollongong, NSW, Australia
| | - Lauren Staples
- Clinical Analyst, MindSpot Clinic, Macquarie University, Sydney, NSW, and; eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Blake F Dear
- NHMRC Career Development Fellow, Managing Co-Director, MindSpot Clinic, Macquarie University, Sydney, NSW, and; eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Olav Nielssen
- Clinical Professor of Psychiatry, MindSpot Clinic, Macquarie University, Sydney, NSW, and; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Hackett ML, Teixeira‐Pinto A, Farnbach S, Glozier N, Skinner T, Askew DA, Gee G, Cass A, Brown A. Getting it Right: validating a culturally specific screening tool for depression (
aPHQ
‐9) in Aboriginal and Torres Strait Islander Australians. Med J Aust 2019; 211:24-30. [DOI: 10.5694/mja2.50212] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/28/2019] [Indexed: 01/25/2023]
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Berger M, Taylor S, Harriss L, Campbell S, Thompson F, Jones S, Sushames A, Amminger GP, Sarnyai Z, McDermott R. Hair cortisol, allostatic load, and depressive symptoms in Australian Aboriginal and Torres Strait Islander people. Stress 2019; 22:312-320. [PMID: 30835590 DOI: 10.1080/10253890.2019.1572745] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Chronic stress and adversity are associated with poor mental health and are thought to contribute to the existing mental health gap between Aboriginal and Torres Strait Islander people and other Australians. Hair cortisol and allostatic load (AL) are indices of sustained stress and may be mediators of the effects of stress on health. The aim of this study was to examine the relationship between hair cortisol, AL, and depressive symptoms. This cross-sectional study comprised 329 Aboriginal and Torres Strait Islander adolescents and adults recruited at two health screening programs operating in three communities in north Queensland. We measured hair cortisol and calculated an AL index from 10 biomarkers. We assessed depressive symptoms with a version of the Patient Health Questionnaire-9 adapted for Aboriginal and Torres Strait Islander people (aPHQ-9). We found differences in cortisol and AL between the screening programs and communities, which were not explained by depressive symptoms. Overall aPHQ-9 scores were unrelated to hair cortisol (p = .25 and p = .94) and AL (p = .30 and p = .88) when age, gender and smoking were taken into account. However, anhedonia (p = .007) and insomnia (p = .006) sub-scores were each significantly associated with AL in one study site. Our present data did not demonstrate overall associations of stress biomarkers and multisystem dysregulation with depressive symptoms, which suggests that the relationship between cumulative stress and depression may be better explained by other factors in this population. The specific association between anhedonia and insomnia with AL indicates that chronic multisystem dysregulation plays a role in these features of depression in this population. Lay summary Our study investigated the relationship between symptoms of depression and two biological pathways thought to mediate depression risk - the stress hormone cortisol and allostatic load (AL) - in an Australian Aboriginal and Torres Strait Islander population. Overall, cortisol and AL were unrelated to depression. However, AL was selectively associated with anhedonia (lack of motivation or drive) and sleep disturbances. These results suggest that metabolic dysregulation measured as AL may be relevant to the depression risk in this population.
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Affiliation(s)
- Maximus Berger
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
- b College of Public Health, Medical and Veterinary Sciences, Laboratory of Psychiatric Neuroscience , Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Townsville , Australia
- c The National Centre of Excellence in Youth Mental Health, Orygen , Melbourne , Australia
| | - Sean Taylor
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
| | - Linton Harriss
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
| | - Sandra Campbell
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
| | - Fintan Thompson
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
| | - Samuel Jones
- d Torres and Cape Hospital and Health Service , Thursday Island , Australia
| | - Ashleigh Sushames
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
| | - G Paul Amminger
- c The National Centre of Excellence in Youth Mental Health, Orygen , Melbourne , Australia
| | - Zoltan Sarnyai
- b College of Public Health, Medical and Veterinary Sciences, Laboratory of Psychiatric Neuroscience , Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Townsville , Australia
| | - Robyn McDermott
- a College of Public Health, Medical and Veterinary Sciences , Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University , Cairns , Australia
- e School of Health Sciences , University of South Australia , Adelaide , Australia
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Shand F, Mackinnon A, O'Moore K, Ridani R, Reda B, Hoy M, Heard T, Duffy L, Shanahan M, Pulver LJ, Christensen H. The iBobbly Aboriginal and Torres Strait Islander app project: Study protocol for a randomised controlled trial. Trials 2019; 20:198. [PMID: 30953556 PMCID: PMC6451212 DOI: 10.1186/s13063-019-3262-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 02/27/2019] [Indexed: 11/24/2022] Open
Abstract
Background Suicide amongst Australian Aboriginal and Torres Strait Islander communities occurs at twice the rate of the general population and, with significant barriers to treatment, help-seeking prior to a suicide attempt is low. This trial aims to test the effectiveness of an app (iBobbly) designed with Aboriginal and Torres Strait Islander people for reducing suicidal ideation. Methods/design This is a two-arm randomised controlled trial that will compare iBobbly to a wait-list control condition. The trial aims to recruit Aboriginal and Torres Strait Islander participants aged 16 years and over to test iBobbly, which is a self-help app delivering content based on acceptance and commitment therapy. The primary outcome for the study is suicidal ideation, and secondary outcomes include depression, hopelessness, distress tolerance, perceived burdensomeness and thwarted belonging, and help-seeking intentions. Data will be collected for both groups at baseline, post-intervention (after 6 weeks of app use), and at 6 months post-baseline (with a final 12-month follow-up for the iBobbly group). Primary analysis will compare changes in suicidal ideation for the intervention condition relative to the wait-list control condition using mixed models. An examination of the cost-effectiveness of the intervention compared to the control condition will be conducted. Discussion If effective, iBobbly could overcome many barriers to help-seeking amongst a group of people who are at increased risk of suicide. It may provide a low-cost, accessible intervention that can reach more people. This trial will add to a sparse literature on indigenous suicide prevention and will increase our knowledge about the effectiveness of e-health interventions for suicide prevention. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000686606. Registered on 30 June 2014. Electronic supplementary material The online version of this article (10.1186/s13063-019-3262-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona Shand
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia.
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Kathleen O'Moore
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Rebecca Ridani
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Bill Reda
- Australian National University, Canberra, Australia
| | - Mel Hoy
- Alive & Kicking Goals!, Broome, Australia
| | - Todd Heard
- Hunter New England Local Health District, Wiyiliin ta CAMHS, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Luke Duffy
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | | | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
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Banham D, Karnon J, Lynch J. Health related quality of life (HRQoL) among Aboriginal South Australians: a perspective using survey-based health utility estimates. Health Qual Life Outcomes 2019; 17:39. [PMID: 30777065 PMCID: PMC6378737 DOI: 10.1186/s12955-019-1107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Australian health surveys occasionally include health utility measures in describing health related quality of life (HRQoL) across the general population. However, the HRQoL of specific population groups, such as Aboriginal and Torres Strait Islander (respectfully referred to as Aboriginal), are poorly understood. Our analysis describes HRQoL utility among Aboriginal South Australians by examining the characteristics of respondents completing HRQoL questioning, the relationship between HRQoL and respondent characteristics, then considers reported HRQoL utility in the wider population context. Methods Population weighted and self-reported HRQoL was measured using SF-6D, as derived from the SF-12 version 2, in the South Australian Aboriginal Health Survey’s face to face interviews with 399 respondents aged 15 or more in 2010/11. Results Mean HRQoL utility was 0.77 (95% CIs 0.76–0.79) with marked variations by gender (females 0.03, 95% CIs 0.00–0.06 lower than males), age (with ages 55 or more 0.08, 95% CIs 0.02–0.14 lower than 15–35 years) and number of chronic health conditions (3 or more conditions 0.14, 95% CIs 0.09–0.19 lower than those with 0 conditions). A pattern of response to HRQoL questions was also evident. Response was less likely among respondents speaking Aboriginal languages at home, living in non-urban settings, and experiencing multiple chronic health conditions. Conclusions The SF-6D provides useful information on the HRQoL of Aboriginal South Australians. However, non-completion was pronounced among respondents speaking traditional languages and experiencing more chronic health conditions. Improved participation of vulnerable and health compromised respondents through culturally safe and relevant self-reporting HRQoL utility instruments is needed.
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Affiliation(s)
- David Banham
- School of Public Health, University of Adelaide, North Terrace, Adelaide, South Australia, 5000. .,Wardliparingga Aboriginal Health Research, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000. .,Division of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000.
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, North Terrace, Adelaide, South Australia, 5000
| | - John Lynch
- School of Public Health, University of Adelaide, North Terrace, Adelaide, South Australia, 5000
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Mazzuca A, Nagarchi D, Ramanaik S, Raghavendra T, Javalkar P, Rotti S, Bhattacharjee P, Isac S, Cohen A, Beattie T. Developing a Mental Health Measurement Strategy to Capture Psychological Problems among Lower Caste Adolescent Girls in Rural, South India. Transcult Psychiatry 2019; 56:24-47. [PMID: 30113275 DOI: 10.1177/1363461518789540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescent girls vulnerable to early marriage and school dropout in rural India may be at elevated risk of psychosocial problems. However, few screening instruments have been culturally adapted and validated to measure this risk. This paper describes the process by which the Primary Health Questionnaire PHQ-9, a screening instrument for depression, was tested for cultural validity as part of the Samata evaluation - an intervention to support low caste adolescent girls in rural south India to attend and complete secondary school and to delay marriage until adulthood. Three focus groups discussions (FGDs) were held with 20 adolescent girls and six outreach workers of the Samata programme in rural north Karnataka, south India. The FGDs were used to explore local expressions of psychosocial problems and to understand the acceptability and appropriateness of PHQ-9 items. A thematic content analysis was conducted on the transcripts of the FGDs. Descriptions of local expressions of psychosocial problems generally matched the items on the PHQ-9. However, not all representations of psychological symptoms were captured by this tool. Persistent worry, loneliness and isolation, and externalised behaviours were also described by participants as common expressions of psychosocial distress. Based on the limitations of translation methods, local stakeholders must be involved in evaluating the cultural appropriateness of mental health screening tools. The current research demonstrates a strategy by which to assess the cultural validity of Western psychiatric instruments with key stakeholders in low- and middle-income settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alex Cohen
- London School of Hygiene and Tropical Medicine
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Screening for depression: Review of the Patient Health Questionnaire-9 for nurse practitioners. J Am Assoc Nurse Pract 2019; 30:406-411. [PMID: 29905589 DOI: 10.1097/jxx.0000000000000052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Depression is a major health concern encountered by nurse practitioners working in an array of health care settings. Many current guidelines and articles on this topic recommend using the Patient Health Questionnaire-9 (PHQ-9) as a screening tool. Nurse practitioners should have a sophisticated knowledge of this tool. METHODS Review of the criteria for diagnosing depression as well as depression screening tools. Database search of EMBASE, CINAHL, and MEDLINE for articles about the PHQ-9. Discussion of how the instrument is used in the clinical setting. CONCLUSIONS The PHQ-9 is a free tool that nurse practitioners can use to screen patients in the primary care environment. Screening will detect more instances of depression, which is often missed in this population of patients. IMPLICATIONS FOR PRACTICE Nurse practitioners can and should use the PHQ-9 when screening for depression. However, they should do so with full knowledge and awareness of its strengths and limitations.
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Dingwall KM, Nagel T, Hughes JT, Kavanagh DJ, Cass A, Howard K, Sweet M, Brown S, Sajiv C, Majoni SW. Wellbeing intervention for chronic kidney disease (WICKD): a randomised controlled trial study protocol. BMC Psychol 2019; 7:2. [PMID: 30621791 PMCID: PMC6325814 DOI: 10.1186/s40359-018-0264-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Incidence of end stage kidney disease (ESKD) for Indigenous Australians is especially high in remote and very remote areas of Australia (18 and 20 times the rate of comparable non-Indigenous people). Relocating away from family and country for treatment, adjusting to life with a chronic condition and time lost to dialysis cause grief and sadness which have immense impact on quality of life and challenges treatment adherence. We describe the first randomised controlled trial to address both chronic disease and mental health in Indigenous people with ESKD, which is the first to test the effectiveness of a culturally adapted e-mental health intervention in this population. It builds on an existing program of mental health research with demonstrated efficacy – the Aboriginal and Islander Mental Health Initiative (AIMhi) – to test the newly developed electronic motivational care planning (MCP) therapy – the AIMhi Stay Strong App. Methods This is a 3-arm, waitlist, single-blind randomised controlled trial testing the efficacy of the Stay Strong App in improving psychological distress, depressive symptoms, quality of life and treatment adherence among Indigenous clients undergoing haemodialysis for ESKD in Alice Springs and Darwin with follow up over two periods of 3 months (total of 6 months observation). The study compares the efficacy of MCP using the AIMhi Stay Strong App with two control groups (control app intervention and treatment as usual) on participant-reported psychological distress (the primary outcome) using the Kessler Distress Scale (K10); depressive symptoms using the adapted Patient Health Questionnaire (PHQ-9); quality of life using the EuroQoL instrument (EQ5D) and adherence to dialysis treatment planning through file audit. Participants are randomised to receive MCP either at baseline (early treatment) or after 3 months (delayed treatment). The study also examines the cost effectiveness of this therapy in this setting through examination of health care service utilisation across groups during the first 3 months. Discussion This project will contribute much needed evidence on the efficacy of an electronic wellbeing intervention for Indigenous people with ESKD – a group in which distress is likely to be unacceptably high, yet relatively untreated. Trial registration Australian New Zealand Clinical Trial Registry; ACTRN12617000249358; Date registered: 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia.
| | - Tricia Nagel
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Alan Cass
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Michelle Sweet
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia.,Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Flinders University, Adelaide, SA, 5042, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia.,Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
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The Transition from Hospital to Home: Protocol for a Longitudinal Study of Australian Aboriginal and Torres Strait Islander Traumatic Brain Injury (TBI). BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2018.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Traumatic brain injury (TBI) is a leading cause of disability in Australia. Evidence shows that multidisciplinary rehabilitation and support in the six months following TBI is important for successful independent living and social re-integration. Despite this, access to services and supports during this period is often limited by environmental, socio-economic, geographic and cultural factors. Australian studies on outcomes after brain injury have reported primarily on non-Indigenous people. This study will investigate key sentinel events during the transition from hospital to home after a TBI in the first longitudinal study with Indigenous Australians.Method: Indigenous Australians admitted to one of three major trauma hospitals in northern Australia with a TBI, and their care givers, will be recruited. Clinical and brain injury risk factor information, along with measures of cognitive function, transition events, mental health and community re-integration will be collected at three time points prior to hospital discharge, and at three and six months post-discharge. Qualitative interviews will also be conducted. Data will be analysed using regression methods for the quantitative component, and situational analysis for the qualitative component. Annual rates of brain injury will be calculated for patients admitted to tertiary hospital facilities in the study region with a diagnosis of TBI.Discussion: Understanding the experience and events which shape the transition period is critical to determining the services and supports that may enhance transition outcomes, and ensure that such services are culturally appropriate and endorsed by Indigenous families and communities.
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Canuto K, Wittert G, Harfield S, Brown A. "I feel more comfortable speaking to a male": Aboriginal and Torres Strait Islander men's discourse on utilizing primary health care services. Int J Equity Health 2018; 17:185. [PMID: 30558619 PMCID: PMC6297962 DOI: 10.1186/s12939-018-0902-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander men have the highest morbidity and mortality rates, and lowest rates of health service utilization in Australia. There is a current perception that Aboriginal and Torres Strait Islander men are disinterested in their health. This study aimed to identify the perceived motivators, barriers and enablers of Aboriginal and Torres Strait Islander men’s utilization of primary health care services, explore their experiences and obtain suggestions from them as to how services could be modified to improve utilization. Methods This study utilized the principles of Indigenist Research Methods. Semi-structured interviews with Aboriginal and Torres Strait Islander men (N = 19) took place in South Australia and far north Queensland. Participants were asked about their experiences with primary health care services, including what they could remember as a child. A thematic analysis of the qualitative data was completed without the use of computer software. Results Feelings of invincibility, shame, being uncomfortable, fearful, along with long waiting times, having a lack of knowledge, and culturally inappropriate staff/services were all found to be barriers to service utilization. Enabling factors included convenience, the perceived quality of the service, feeling culturally safe and/or a sense of belonging, and having a rapport with staff. Motivation for attending primary health care services included going when feeling sick/unwell, attending a particular service (dental or sexual health), visiting for check-ups and preventative health and family encouragement. This study also highlights strategies surrounding logistical factors, promotion of services and improved communications, having culturally appropriate services and providing gender specific services all of which were suggested by the participants to improve service utilization. Conclusion Contrary to common misperceptions, this study demonstrated that most of the Aboriginal and Torres Strait Islander men participants were motivated to engage with primary health care services for preventative health care. Even though there were men that fitted the stereo-type who avoid doctors, there were usually underlying reasons and barriers accounting for this reluctance. This study suggests that if primary health care services commit to better understanding the barriers, enablers and motivators their cohort of men face, then utilization could be greatly improved.
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Affiliation(s)
- Kootsy Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia. .,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia. .,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, Adelaide, Australia.
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia
| | - Stephen Harfield
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, Adelaide, Australia.,School of Public Health, the University of Adelaide, Adelaide, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, Adelaide, Australia.,School of Public Health, the University of Adelaide, Adelaide, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Canuto K, Brown A, Wittert G, Harfield S. Understanding the utilization of primary health care services by Indigenous men: a systematic review. BMC Public Health 2018; 18:1198. [PMID: 30352579 PMCID: PMC6199732 DOI: 10.1186/s12889-018-6093-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander men experience worse health outcomes and are the most marginalized and disadvantaged population group in Australia. Primary health care services are critical to providing both clinical and social and emotional support, however, remain underutilized by Aboriginal and Torres Strait Islander men. This review aims to better understand the utilization of primary health care services by Indigenous men and assess the effectiveness of strategies implemented to improve utilization. METHODS A four-step search strategy was employed across four databases to find peer-reviewed publications and grey literature from Australia, New Zealand, Canada and America. The search began in March 2015 and included the following databases PubMed, CINAHL, Informit (Indigenous collection) and Embase. Additional databases and websites were also searched for grey literature, reference lists of included publications were searched for additional studies and relevant experts were consulted. RESULTS The literature search found seven articles that met the inclusion criteria; four describing three research projects, plus three expert opinion pieces. The search was unable to find published research on strategies implemented to improve primary health care utilization by Indigenous men. There is limited published research focused on the utilization of primary health care by Indigenous men. From the identified papers Indigenous men described factors impacting utilization which were categorized into three primary organizing themes; those related to health services, the attitudes of Indigenous men and knowledge. It is evident from the identified papers that improvements in Indigenous health can only occur if future programs are developed in collaboration with health services and Indigenous men to address differing requirements. CONCLUSIONS Currently, health systems in Australia are limited in their ability to improve the health and wellbeing of Aboriginal and Torres Strait Islander males without such strategies. Future research should focus on evaluating the implementation of men specific utilization strategies. It is through evidence-based research that subsequent policies and programs can be made and implemented to improve Indigenous men's health.
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Affiliation(s)
- Kootsy Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia. .,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia. .,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, Adelaide, Australia.
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, Adelaide, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia
| | - Stephen Harfield
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), University of Adelaide, Adelaide, Australia
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Harriss LR, Kyle M, Connolly K, Murgha E, Bulmer M, Miller D, Munn P, Neal P, Pearson K, Walsh M, Campbell S, Berger M, McDermott R, McDonald M. Screening for depression in young Indigenous people: building on a unique community initiative. Aust J Prim Health 2018; 24:PY18006. [PMID: 30089528 DOI: 10.1071/py18006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/20/2018] [Indexed: 02/28/2024]
Abstract
Gurriny Yealamucka Health Service Aboriginal Corporation (GYHSAC) is an Indigenous community-controlled health organisation providing comprehensive primary care to the people of Yarrabah in far north Queensland, Australia. GYHSAC conducts an annual Young Person's Health Check (YPC) for people aged 15-25 years based on the Medical Benefits Schedule Item 715. However, the YPC is constantly evolving to meet the needs of the community, and in 2016, in response to concerns about psychological risk among Indigenous youth, GYHSAC teamed up with James Cook University to trial an adapted PHQ-9 depression screening tool (aPHQ-9) as part of the YPC. This study describes the 2016 YPC event, reports the prevalence of depressive symptoms, examines local issues related to the use of the screening tool and proposes recommendations for future health screening. Experienced health professionals conducted the aPHQ-9 assessment in a private area of the clinic. One-in-five young people were found to have moderate-severe symptoms or self-harm ideation in the previous 2 weeks; they were referred to the mental health service. The aPHQ-9 screening process was found to be straightforward and well accepted by staff and youth. Importantly, it provided valuable 'space' to facilitate communication on sensitive issues and was a conduit for speedy referral and follow up by trained staff. Based on our experience, we recommend dedicated depression screening in future routine community health checks for young people and adults.
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Berger M, Taylor S, Harriss L, Campbell S, Thompson F, Jones S, Makrides M, Gibson R, Paul Amminger G, Sarnyai Z, McDermott R. Cross-sectional association of seafood consumption, polyunsaturated fatty acids and depressive symptoms in two Torres Strait communities. Nutr Neurosci 2018; 23:353-362. [PMID: 30073906 DOI: 10.1080/1028415x.2018.1504429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Dietary intake of long-chain omega 3 (n-3) polyunsaturated fatty acids (LCPUFA) represents a putative modifiable risk factor for depression, and a high ratio of omega 6 (n-6) to n-3 LCPUFA is frequently observed in patients with major depressive disorder. Recent reports suggest that the availability of fish and seafood may be associated with lower depression rates. The aim of this study was to investigate associations of fish consumption and LCPUFA levels with depressive symptoms.Methods Participants for this cross-sectional study (n=206) were recruited at a community screening programme in two Torres Strait Islander communities (Mer and Waiben). Depressive symptoms were assessed with the adapted Patient Health Questionnaire-9 (aPHQ-9) and diet with a structured questionnaire. LCPUFA concentrations were measured with a capillary dried blood spot system (PUFAcoat). Logistic and quantile regression modelling was used to test the relationship between seafood consumption, membrane LCPUFAs and depression scores.Results A higher blood n-6/3 LCPUFA ratio was associated with moderate/severe depression scores across both study sites (OR=1.59 (95%CI 1.09-2.34), P = .017). Seafood consumption was higher and the proportion of participants with aPHQ-9 scores above the cut-off for depression was lower on Mer (n = 100) compared with Waiben (n = 106). Higher seafood consumption was associated with lower depression scores on Waiben (B = -0.57 (95%CI -0.98 - -0.16), P = .006) but not on Mer.Conclusions Our findings support an association of n-3 LCPUFA from natural sources with depressive symptoms. The availability of fresh seafood in the local diet may represent a protective factor for depression in this setting.
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Affiliation(s)
- Maximus Berger
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.,Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Sean Taylor
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Linton Harriss
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Sandra Campbell
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Fintan Thompson
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Samuel Jones
- Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Robert Gibson
- FOODplus Research Centre, School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - G Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Zoltan Sarnyai
- Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine (AITHM), College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia
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Dadfar M, Kalibatseva Z, Lester D. Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:144-151. [DOI: 10.1590/2237-6089-2017-0116] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022]
Abstract
Abstract Introduction: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. Methods: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Results: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, −0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. Conclusions: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.
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Taylor S, McDermott R, Thompson F, Usher K. Depression and diabetes in the remote Torres Strait Islands. Health Promot J Austr 2017; 28:59-66. [PMID: 27464880 DOI: 10.1071/he15118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 06/02/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Diabetes is associated with significant depression, which can result in poorer clinical outcomes, including increased mortality. Little is known about the prevalence of depression among Torres Strait Islander adults with diabetes. Methods Self-reported depression was measured using the Patient Health Questionnaire (PHQ)-9 translated into Torres Strait Creole, and associations with socioeconomic, behavioural and clinical indicators in Torres Strait Islander adults with diabetes in five remote Torres Strait Islands were examined. Results Seventy-three men and 115 women completed interviews. The median PHQ-9 score was 5.5 (IQR 0-7); 42% of respondents scored 0-4 (none-minimal), 46% scored 5-9 (mild) and 12% scored 10+ (moderate-severe). Mean HbA1c was 8.3% (67.4mmol). HbA1c was not related to PHQ-9 scores (β=0.20, P=0.323), however exercise in hours (β=-0.34, P<0.001) and screen time in hours (β=0.11, P<0.001) were significant predictors of depression after adjusting for other study variables. Conclusions This sample of remote living Torres Strait Islanders reported relatively low rates of depression compared with national samples, and depression was not related to glycaemic control. Exercise and screen time were the strongest predictors of depression based on PHQ-9 scores. This represents an opportunity for health promotion. So what? These findings provide an indication of the health impact of physical activity in rural and remote communities. Local health and education services, councils and sporting bodies should work collaboratively to promote sustainable physical activity programs.
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Affiliation(s)
- Sean Taylor
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, Veterinary Science, James Cook University, Smithfield, Qld 4870, Australia
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, Veterinary Science, James Cook University, Smithfield, Qld 4870, Australia
| | - Fintan Thompson
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, Veterinary Science, James Cook University, Smithfield, Qld 4870, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, NSW 2351, Australia
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Farnbach S, Evans J, Eades AM, Gee G, Fernando J, Hammond B, Simms M, DeMasi K, Hackett M. Process evaluation of a primary healthcare validation study of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people: study protocol. BMJ Open 2017; 7:e017612. [PMID: 29102990 PMCID: PMC5722089 DOI: 10.1136/bmjopen-2017-017612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Process evaluations are conducted alongside research projects to identify the context, impact and consequences of research, determine whether it was conducted per protocol and to understand how, why and for whom an intervention is effective. We present a process evaluation protocol for the Getting it Right research project, which aims to determine validity of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people. In this process evaluation, we aim to: (1) explore the context, impact and consequences of conducting Getting It Right, (2) explore primary healthcare staff and community representatives' experiences with the research project, (3) determine if it was conducted per protocol and (4) explore experiences with the depression screening tool, including perceptions about how it could be implemented into practice (if found to be valid). We also describe the partnerships established to conduct this process evaluation and how the national Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research is met. METHODS AND ANALYSIS Realist and grounded theory approaches are used. Qualitative data include semistructured interviews with primary healthcare staff and community representatives involved with Getting it Right. Iterative data collection and analysis will inform a coding framework. Interviews will continue until saturation of themes is reached, or all participants are considered. Data will be triangulated against administrative data and patient feedback. An Aboriginal and Torres Strait Islander Advisory Group guides this research. Researchers will be blinded from validation data outcomes for as long as is feasible. ETHICS AND DISSEMINATION The University of Sydney Human Research Ethics Committee, Aboriginal Health and Medical Research Council of New South Wales and six state ethics committees have approved this research. Findings will be submitted to academic journals and presented at conferences. TRIAL REGISTRATION NUMBER ACTRN12614000705684.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, Camperdown, New South Wales, Australia
- University of New South Wales, Sydney, New SouthWales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - John Evans
- The University of Technology and The University of Sydney, Sydney, New South Wales, Australia
| | - Anne-Marie Eades
- The George Institute for Global Health, Camperdown, New South Wales, Australia
- University of New South Wales, Sydney, New SouthWales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- Murdoch University, Western Australia, Australia
| | - Graham Gee
- Victorian Aboriginal Health Service, Victoria, Australia
| | | | - Belinda Hammond
- Nunkuwarrin Yunti of South Australia, South Australia, Australia
| | - Matty Simms
- The Glen Centre (Ngampie), New South Wales, Australia
| | - Karrina DeMasi
- Danila Dilba Health Service, Northern Territory, Australia
| | - Maree Hackett
- The George Institute for Global Health, Camperdown, New South Wales, Australia
- University of New South Wales, Sydney, New SouthWales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, Lancashire, UK
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Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Soc Sci Med 2017; 187:164-173. [PMID: 28689090 DOI: 10.1016/j.socscimed.2017.06.046] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 06/21/2017] [Accepted: 06/30/2017] [Indexed: 01/15/2023]
Abstract
RATIONALE There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. OBJECTIVE The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. METHOD The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. RESULTS Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. CONCLUSION It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings.
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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Hackett ML, Farnbach S, Glozier N, Skinner T, Teixeira-Pinto A, Askew D, Gee G, Cass A, Brown A. Getting it Right: study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people. BMJ Open 2016; 6:e015009. [PMID: 27927669 PMCID: PMC5168627 DOI: 10.1136/bmjopen-2016-015009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9). METHODS AND ANALYSIS Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid. ETHICS AND DISSEMINATION Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community. TRIAL REGISTRATION NUMBER ACTRN12614000705684.
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Affiliation(s)
- Maree L Hackett
- Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
- University of Central Lancashire, Preston, Lancashire, UK
| | - Sara Farnbach
- Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Glozier
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Skinner
- Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Queensland Health, Brisbane, Queensland, Australia
- Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia
| | - Graham Gee
- Victorian Aboriginal Health Service, Fitzroy, Victoria, Australia
| | - Alan Cass
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Askew DA, Togni SJ, Schluter PJ, Rogers L, Egert S, Potter N, Hayman NE, Cass A, Brown ADH. Investigating the feasibility, acceptability and appropriateness of outreach case management in an urban Aboriginal and Torres Strait Islander primary health care service: a mixed methods exploratory study. BMC Health Serv Res 2016; 16:178. [PMID: 27175475 PMCID: PMC4866273 DOI: 10.1186/s12913-016-1428-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The disparities in health and life expectancy of Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians are well documented. Chronic diseases are a leading contributor to these disparities. We aimed to determine the feasibility, acceptability and appropriateness of a case management approach to chronic disease care integrated within an urban Aboriginal and Torres Strait Islander primary health care service. METHODS The Home-based, Outreach case Management of chronic disease Exploratory (HOME) Study provided holistic, patient centred multidisciplinary care for Aboriginal and Torres Strait Islander people with chronic disease. A developmental evaluation approach supported the implementation and ongoing adaptations in the delivery of the model of care, and ensured its alignment with Aboriginal and Torres Strait Islander peoples' understandings of, and approaches to, health and wellbeing. In-depth, semi-structured interviews were conducted with nine patient participants (one interview also included a participant's spouse) and 15 health service staff and key themes were identified through an iterative reflective process. Quantitative data were collected directly from patient participants and from their medical records at baseline, 3 and 6 months. Patient participants' baseline characteristics were described using frequencies and percentages. Attrition and patterns of missing values over time were evaluated using binomial generalized estimating equation (GEE) models and mean differences in key clinical outcomes were determined using normal GEE models. RESULTS Forty-one patients were recruited and nine withdrew over the 6 month period. There was no evidence of differential attrition. All participants (patients and health service staff) were very positive about the model of care. Patient participants became more involved in their health care, depression rates significantly decreased (p = 0.03), and significant improvements in systolic blood pressure (p < 0.001) and diabetes control (p = 0.05) were achieved. CONCLUSIONS The exploratory nature of our study preclude any definitive statements about the effectiveness of our model of care. However, staff and patients' high levels of satisfaction and improvements in the health and wellbeing of patients are promising and suggest its feasibility, acceptability and appropriateness. Further research is required to determine its efficacy, effectiveness and cost-effectiveness in improving the quality of life and quality of care for Aboriginal and Torres Strait Islander peoples living with chronic disease.
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Affiliation(s)
- Deborah A Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Wirraway Pde, Inala Queensland, 4077, Australia. .,The University of Queensland, Discipline of General Practice, Brisbane, Australia.
| | - Samantha J Togni
- Baker IDI Heart and Diabetes Institute, Alice Springs, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Philip J Schluter
- University of Canterbury, School of Health Sciences, Christchurch, New Zealand.,The University of Queensland, School of Nursing, Midwifery and Social Work, Brisbane, Australia
| | - Lynne Rogers
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Wirraway Pde, Inala Queensland, 4077, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Wirraway Pde, Inala Queensland, 4077, Australia
| | - Nichola Potter
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Wirraway Pde, Inala Queensland, 4077, Australia
| | - Noel E Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Wirraway Pde, Inala Queensland, 4077, Australia
| | - Alan Cass
- Menzies School of Health Research, Darwin, Australia
| | - Alex D H Brown
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, Australia
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