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Everson G, Spring B, Middleton J, Richardson A, Gardiner FW. Culturally appropriate psychotherapy and its retention: An example from Far North Queensland (Australia). Acta Psychol (Amst) 2024; 242:104122. [PMID: 38145592 DOI: 10.1016/j.actpsy.2023.104122] [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: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Culturally appropriate mental health care is essential in remote Australia. However, while associated with the development of an effective therapeutic alliance, current literature insufficiently reports the retention and psychotherapy outcomes of Indigenous adults. We aimed to describe the characteristics and retention of clients attending the Far North Mental Health and Wellbeing Service (FNS). METHODS We conducted a retrospective cross-sectional study on clients who received one or more psychotherapy consultations between 1st July 2019 and 31st December 2020. Population, entrance, and treatment characteristics were described, with retention compared between the major cultural groups. Entrance characteristics comprised referral pathway and reason for presentation and were investigated as alternative predictors of client retention. FINDINGS There were 186 non-Indigenous (68.3 % female) and 174 Indigenous (62.6 % female) clients, with a median number of 3.0 consultations (IQR 2.0-5.3). Indigenous status did not significantly predict retention. Referral pathway significantly predicted the number of consultations (Wald X2(6) = 17.67, p = .0071) and immediate discontinuation (Wald X2(6) = 12.94, p = .044), with self-referred clients having the highest retention. Initial presentation reason significantly predicted the number of consultations (Wald X2(5) = 13.83, p = .017), with clients with potential health hazards related to socioeconomic and psychosocial circumstances having the lowest retention. Significantly more Indigenous clients presented for this reason (20.1 % vs 4.3 %). INTERPRETATION Comparable retention of Indigenous clients suggests cultural appropriateness of the psychotherapy being delivered by the FNS. Services might use the described therapeutic approach as a guide for culturally appropriate care.
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Affiliation(s)
- George Everson
- The ANU School of Medicine and Psychology, Australian National University, ACT, Canberra, Australia
| | - Breeanna Spring
- Royal Flying Doctor Service of Australia, 10-12 Brisbane Avenue, Barton, ACT, Australia; Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Jocelyn Middleton
- Royal Flying Doctor Service of Australia, 12 Casuarina Street, Brisbane Airport, QLD, Australia
| | - Alice Richardson
- The Statistical Support Network, Australian National University, ACT, Canberra, Australia
| | - Fergus W Gardiner
- The ANU School of Medicine and Psychology, Australian National University, ACT, Canberra, Australia; Royal Flying Doctor Service of Australia, 10-12 Brisbane Avenue, Barton, ACT, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, WA, Australia.
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Holland L, Reid N, Hewlett N, Toombs M, Elisara T, Thomson A, Humphrey T, Smirnov A. Alcohol use in Australia: countering harm with healing. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100774. [PMID: 37693874 PMCID: PMC10485668 DOI: 10.1016/j.lanwpc.2023.100774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 09/12/2023]
Abstract
Harmful use of alcohol consumption in Australia is a serious socio-political and public health issue that is exacerbated by exploitative marketing campaigns by the alcohol industry. In Indigenous populations harmful alcohol use is directly related to the legacy of colonisation that has led to complex social issues and adverse intergenerational trauma. To effectively address alcohol-related harm in Australia, it is necessary to critically apply the 'Three Pillars of Harm Minimisation', which are demand reduction, supply reduction, and harm reduction. This can be facilitated through approaches such as the 'Interplay Wellbeing Framework', which situates concepts of wellbeing and risky alcohol use within the context of systemic inequities across all social determinants of health. Culturally responsive approaches embody a holistic view of community, mutually respectful collaboration, culture, healing, and self-determined change. This is underpinned by Indigenous leadership that promotes existing resistance, resilience, interpersonal relationships, and strengths that instil healing to counter the harms associated with alcohol use.
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Affiliation(s)
- Lorelle Holland
- School of Nursing, Midwifery and Social Work, The Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland 4006, Australia
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Natasha Reid
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Nicole Hewlett
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Maree Toombs
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Fisher Road, Camperdown, New South Wales 2006, Australia
| | - Tylissa Elisara
- School of Nursing, Midwifery and Social Work, The Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland 4006, Australia
| | - Amy Thomson
- School of Education, Faculty of Humanities and Social Sciences, The University of Queensland, St Lucia, Queensland 4006, Australia
| | - Tracy Humphrey
- Faculty of Health and Behavioural Sciences, The University of South Australia, 101 Currie St, Adelaide 5000, Australia
| | - Andrew Smirnov
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland 4006, Australia
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3
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De Salis HF, Martin R, Mansoor Z, Newton-Howes G, Bell E. A realist review of residential treatment for adults with substance use disorder. Drug Alcohol Rev 2023; 42:827-842. [PMID: 36747370 DOI: 10.1111/dar.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023]
Abstract
ISSUES Completion of residential treatment for substance use disorder (SUD) relates to improvements in substance use and mental health. Findings from systematic reviews have been equivocal about which interventions work best for clients. There has been limited attention to the theories that explain the effectiveness of residential treatment. APPROACH We conducted a realist review of the literature to identify program theories that would explain successful and unsuccessful outcomes from residential treatment for SUD. The unit of analysis was context-mechanism-outcome (CMO). Inclusion criteria were studies of residential treatment of more than 30 days for adults with SUD. Pharmacological studies were excluded. KEY FINDINGS We identified 24 studies from 5748 screened. The studies were from settings comprising Indigenous programs, faith-based programs, psycho-social interventions and therapeutic communities and were conducted in North America, Scandinavia, Continental Europe and Australasia. We chose six CMO configurations as the best explanations for outcomes from residential treatment. Theories that best explained the mechanisms of change were the need to belong, meaning in life, and self-determination theory. IMPLICATIONS Previous research has noted similar outcomes from different residential treatment interventions, but has not been able to explain these similarities. In contrast, our findings suggest that the outcomes can be explained by causal mechanisms that apply across all programs, regardless of the philosophy of treatment. CONCLUSION We identified six CMO configurations whose mechanisms of change could be explained by three overarching theories-the need to belong, meaning in life and self-determination theory. The findings apply across ethnicities and genders.
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Affiliation(s)
- Henry F De Salis
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Rachelle Martin
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.,Burwood Academy Trust, Burwood Hospital, Christchurch, New Zealand
| | - Zara Mansoor
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.,Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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Vinzent A, Fredes-Torres M, Shakeshaft A, Doran CM, Settumba S, Clifford-Motopi A, Tran AD. Health utilities among Aboriginal people attending residential rehabilitation services in New South Wales, Australia: An observational follow-up study. Drug Alcohol Rev 2023; 42:248-257. [PMID: 36504471 DOI: 10.1111/dar.13586] [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: 05/08/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There have been no published studies reporting health utilities among Aboriginal people attending residential rehabilitation for substance use treatment. This study aims to examine health utilities for Aboriginal people in residential rehabilitation and investigate the association between health utilities and length of stay. METHODS EuroQol-5 Dimension 5-level (EQ-5D-5L) raw data collected from three residential rehabilitation services in New South Wales, Australia was transferred into a quality-adjusted health index using EQ-5D-5L Crosswalk Index Value Calculator. Clients were categorised into two groups based on their length of stay in treatment: ≤60 days or more than 60 days. Among people who stay longer than 60 days, we also examined health utilities by exit status (yes/no). Bootstrapping was used to examine the difference in improvement in health utilities from baseline to the latest assessment in both groups. RESULTS Our study included 91 clients (mean age 32 years old SD: 9). Mean health utility at baseline was 0.76 (SD 0.25) and at the latest assessment was 0.88 (SD 0.16). For clients staying 60 days, the incremental health utility was 0.13 (95% confidence interval [CI] 0.06-0.20; p < 0.01). For clients staying less than or equal to 60 days, the incremental health utility was 0.12 (95% CI 0.00-0.24; p = 0.06). For the total sample, the incremental health utility was 0.12 (95% CI 0.06-0.19; p < 0.01). DISCUSSION AND CONCLUSIONS There is a significant improvement in health utilities for people staying longer in residential rehabilitation. Strategies to improve treatment retention could potentially increase quality of life for Aboriginal people in residential rehabilitation.
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Affiliation(s)
- Annaëlle Vinzent
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Christopher M Doran
- Cluster for Resilience and Well-being, Central Queensland University, Brisbane, Australia
| | - Stella Settumba
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Anh D Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Haora P, Roe Y, Hickey S, Gao Y, Nelson C, Allen J, Briggs M, Worner F, Kruske S, Watego K, Maidment SJ, Hartz D, Sherwood J, Barclay L, Tracy S, Tracy M, Wilkes L, West R, Grant N, Kildea S. Developing and evaluating Birthing on Country services for First Nations Australians: the Building On Our Strengths (BOOSt) prospective mixed methods birth cohort study protocol. BMC Pregnancy Childbirth 2023; 23:77. [PMID: 36709265 PMCID: PMC9883816 DOI: 10.1186/s12884-022-05277-8] [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: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements. METHODS Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation. DISCUSSION Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up. TRIAL REGISTRATION Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020).
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Affiliation(s)
- Penny Haora
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Yvette Roe
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Darwin, Australia
| | - Sophie Hickey
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Yu Gao
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Carmel Nelson
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia ,grid.1003.20000 0000 9320 7537Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD Australia
| | - Jyai Allen
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Melanie Briggs
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Faye Worner
- Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Sue Kruske
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
| | - Kristie Watego
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia
| | - Sarah-Jade Maidment
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Donna Hartz
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Juanita Sherwood
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Lesley Barclay
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Sally Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Mark Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Liz Wilkes
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,My Midwives Brisbane, Windsor Road, Red Hill, QLD 4059 Australia
| | - Roianne West
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Congress of Aboriginal & Torres Strait Islander Nurses and Midwives, Lytton Road, Murarrie, QLD 4172 Australia
| | - Nerida Grant
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Sue Kildea
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
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Farnbach S, Fernando J, Coyte J, Simms M, Hackett ML. "I tried to get help about my addiction but he just gave me tablets:" male Aboriginal drug and alcohol rehabilitation clients' experiences and preferences speaking about substance use in primary care. BMC PRIMARY CARE 2023; 24:25. [PMID: 36681795 PMCID: PMC9863190 DOI: 10.1186/s12875-023-01983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Primary healthcare (PHC) services are crucial in supporting people who use substances. The aims of this study were to explore the experiences of Aboriginal males in NSW in treatment for substance use about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use. METHODS Semi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group. RESULTS Twenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) speaking up about substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. CONCLUSION This research highlights opportunities to improve access and to better support Aboriginal males who use substances in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre and The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | | | - Joe Coyte
- CEO, The Glen Centre (Ngaimpe), Chittaway Point, Australia
| | - Matthew Simms
- South Coast Medical Service Aboriginal Corporation, Nowra, Australia
| | - Maree L Hackett
- The George Institute for Global Health, UNSW, The University of Central Lancashire, Preston, UK
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Tamayo N, Lane A. Effective Nursing Recovery-Oriented Interventions for Individuals With Substance Use Disorder: A Literature Review. J Addict Nurs 2022; 33:233-246. [PMID: 37140411 DOI: 10.1097/jan.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT Nurses support the recovery of individuals with substance use disorder. How they support individuals, however, may impact the effectiveness of their work. For example, there are various paradigms of recovery that alter interventions. In addition, negative attitudes adopted by clinicians discourage individuals who use substances from accessing healthcare services, experiencing further health deterioration. Alternatively, nurses can enact interventions that promote positive experiences, further supporting the recovery of individuals. Hence, it is beneficial to increase nurses' awareness of effective interventions that promote recovery. The purpose of this literature review is to examine effective nursing interventions that promoted recovery of those with substance use disorders from the perspective of nurses and individuals who received nursing care. The review identified that effective interventions were based on three major themes: person-centered care, empowerment, and maintaining supports and capability enhancement. In addition, literature revealed that some interventions were perceived to be more effective; this depended on whose viewpoint was examined-nurses or individuals with substance use disorders. Finally, there are interventions based on spirituality, culture, advocacy, and self-disclosure that are often disregarded but may be effective. Nurses should utilize the more prominent interventions as they offer the most benefit and integrate interventions that are often overlooked.
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Kennedy M, Maddox R, Booth K, Maidment S, Chamberlain C, Bessarab D. Decolonising qualitative research with respectful, reciprocal, and responsible research practice: a narrative review of the application of Yarning method in qualitative Aboriginal and Torres Strait Islander health research. Int J Equity Health 2022; 21:134. [PMID: 36100899 PMCID: PMC9472448 DOI: 10.1186/s12939-022-01738-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Indigenous academics have advocated for the use and validity of Indigenous methodologies and methods to centre Indigenous ways of knowing, being and doing in research. Yarning is the most reported Indigenous method used in Aboriginal and Torres Strait Islander qualitative health research. Despite this, there has been no critical analysis of how Yarning methods are applied to research conduct and particularly how they privilege Indigenous peoples. OBJECTIVE To investigate how researchers are applying Yarning method to health research and examine the role of Aboriginal and Torres Strait Islander researchers in the Yarning process as reported in health publications. DESIGN Narrative review of qualitative studies. DATA SOURCES Lowitja Institute LitSearch January 2008 to December 2021 to access all literature reporting on Aboriginal and Torres Strait Islander health research in the PubMed database. A subset of extracted data was used for this review to focus on qualitative publications that reported using Yarning methods. METHODS Thematic analysis was conducted using hybrid of inductive and deductive coding. Initial analysis involved independent coding by two authors, with checking by a third member. Once codes were developed and agreed, the remaining publications were coded and checked by a third team member. RESULTS Forty-six publications were included for review. Yarning was considered a culturally safe data collection process that privileges Indigenous knowledge systems. Details of the Yarning processes and team positioning were vague. Some publications offered a more comprehensive description of the research team, positioning and demonstrated reflexive practice. Training and experience in both qualitative and Indigenous methods were often not reported. Only 11 publications reported being Aboriginal and/or Torres Strait Islander led. Half the publications reported Aboriginal and Torres Strait Islander involvement in data collection, and 24 reported involvement in analysis. Details regarding the role and involvement of study reference or advisory groups were limited. CONCLUSION Aboriginal and Torres Strait Islander people should be at the forefront of Indigenous research. While Yarning method has been identified as a legitimate research method to decolonising research practice, it must be followed and reported accurately. Researcher reflexivity and positioning, and Aboriginal and Torres Strait Islander ownership, stewardship and custodianship of data collected were significantly under detailed in the publications included in our review. Journals and other establishments should review their processes to ensure necessary details are reported in publications and engage Indigenous Editors and peer reviewers to uphold respectful, reciprocal, responsible and ethical research practice.
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Affiliation(s)
- Michelle Kennedy
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Raglan Maddox
- National Centre for Epidemiology and Public Health, The Australian National University, Canberra ACT, Australia
| | - Kade Booth
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sian Maidment
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Catherine Chamberlain
- School of Population and Global Health, Centre for Health Equity, University of Melbourne, Melbourne, VIC, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, WA, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, UWA Medical School, Crawley, WA, Australia
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Munro A, Shakeshaft A, Breen C, Jones M, Oldmeadow C, Allan J, Snijder M. The impact of Indigenous-led programs on alcohol-related criminal incidents: a multiple baseline design evaluation. Aust N Z J Public Health 2022; 46:581-587. [PMID: 36047847 DOI: 10.1111/1753-6405.13211] [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: 04/01/2021] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a multi-component, Aboriginal-led strategy to reduce alcohol-related criminal incidents for Aboriginal people in four rural/remote communities in New South Wales (NSW), Australia. METHODS A retrospective multiple baseline design (MBD), using interrupted time series analysis of routinely collected crime data. RESULTS A statistically significant reduction in alcohol-related criminal incidents was observed in one community for both victims of crime (parameter estimate -0.195; p≤0.01) and persons of interest (parameter estimate -0.282; p≤0.001). None of the analyses show level shifts, meaning there were no measurable changes immediately post the introduction of the Breaking the Cycle (BTC) programs. CONCLUSIONS It is not possible to conclude that the program was effective independently of any other community factors, because the statistically significant result was not observed across multiple communities. The statistically significant result in one community has clear practical benefits in that community: a sustained impact over two years would reduce Aboriginal victims of alcohol-related crime from an estimated 56 incidents per annum to 36, and reduce Aboriginal persons of interest in alcohol-related crime from an estimated 68 alcohol-related person of interest (POI) per annum to 40. IMPLICATIONS FOR PUBLIC HEALTH The statistically and practically meaningful result in Community 1 highlights the potential of multi-component, Aboriginal-led strategies to reduce alcohol-related criminal incidents. Earlier engagement with researchers, to identify best-evidence strategies to reduce alcohol harms and to facilitate the use of prospective evaluation designs, would help translate the positive outcome in one community across multiple communities.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, UNSW, New South Wales.,Western NSW Local Health District, New South Wales
| | | | - Courtney Breen
- National Drug and Alcohol Research Centre, UNSW, New South Wales
| | - Mark Jones
- Hunter Medical Research Institute, University of Newcastle, New South Wales
| | | | - Julaine Allan
- National Drug and Alcohol Research Centre, UNSW, New South Wales.,University of Wollongong, New South Wales
| | - Mieke Snijder
- National Drug and Alcohol Research Centre, UNSW, New South Wales.,Institute of Development Studies, UK
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Morin KA, Marsh TN, Eshakakogan C, Eibl JK, Spence M, Gauthier G, Walker JD, Sayers D, Ozawanimke A, Bissaillion B, Marsh DC. Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario. BMC Health Serv Res 2022; 22:1045. [PMID: 35974328 PMCID: PMC9381149 DOI: 10.1186/s12913-022-08406-3] [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: 02/28/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Our primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS. Methods We observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 – March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Abstract Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients’ health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40. Conclusions Our results indicate that IHSS positively influenced program completion but had no significant effect on health service use. Trial registration This study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08406-3.
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Affiliation(s)
- K A Morin
- Northern Ontario School of Medicine, ON, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Ontario, Canada.,ICES North, Sudbury, Ontario, Canada.,Canadian Addiction Treatment Centres, Toronto, Ontario, Canada
| | - T N Marsh
- Northern Ontario School of Medicine, ON, Sudbury, Canada
| | | | - J K Eibl
- Northern Ontario School of Medicine, ON, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - M Spence
- Northern Ontario School of Medicine, ON, Sudbury, Canada
| | - G Gauthier
- Northern Ontario School of Medicine, ON, Sudbury, Canada
| | - J D Walker
- McMaster University, Hamilton, Ontario, Canada
| | - Dean Sayers
- Batchewana First Nation, Sault Ste. Marie, Ontario, Canada
| | | | | | - D C Marsh
- Northern Ontario School of Medicine, ON, Sudbury, Canada. .,Health Sciences North Research Institute, Sudbury, Ontario, Canada. .,ICES North, Sudbury, Ontario, Canada. .,Canadian Addiction Treatment Centres, Toronto, Ontario, Canada.
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11
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Bryant J, Caluzzi G, Bruun A, Sundbery J, Ferry M, Gray RM, Skattebol J, Neale J, MacLean S. The problem of over-medicalisation: How AOD disease models perpetuate inequity for young people with multiple disadvantage. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103631. [PMID: 35276402 DOI: 10.1016/j.drugpo.2022.103631] [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: 11/17/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
Young people who experience multiple disadvantage have been identified as some of the most marginalised and under-serviced people in the alcohol and other drug (AOD) system. In this paper, we draw on a range of research evidence to argue that one of the challenges in responding appropriately to the needs of these young people are models of care which seek to ameliorate 'illness' rather than promote wellness. While disease approaches have some important benefits, overly-medicalised AOD treatment responses also have negative impacts. We argue that disease models rest on understandings of substance use as an individual enterprise and thereby pay insufficient attention to the material disadvantage that shape young people's substance use, creating feelings of shame, failure and a reluctance to return to care if they continue to use. Additionally we draw on literature that shows how disease models construe young people's substance use as compulsive, perpetuating deficit views of them as irrational and failing to account for the specific meanings that young people themselves give to their substance use. By focusing on clinical solutions rather than material and relational ones, medicalised treatment responses perpetuate inequity: they benefit young people whose resources and normative values align with the treatments offered by disease models, but are much less helpful to those who are under-resourced,. We suggest that alternative approaches can be found in First Nations models of care and youth programs that attend to social, cultural, and material wellbeing, making living well the focus of treatment rather than illness amelioration.
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Affiliation(s)
- J Bryant
- Centre for Social Research in Health, University of New South Wales, Sydney 2052, Australia.
| | - G Caluzzi
- Social Work and Social Policy & Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - A Bruun
- Youth Support and Advocacy Service, Fitzroy, Victoria 3065, Australia
| | - J Sundbery
- Youth Support and Advocacy Service, Fitzroy, Victoria 3065, Australia
| | - M Ferry
- Ted Noffs Foundation, Randwick, NSW 2031, Australia
| | - R M Gray
- Centre for Social Research in Health, University of New South Wales, Sydney 2052, Australia
| | - J Skattebol
- Social Policy Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - J Neale
- Addictions Department, King's College London, London, United Kingdom
| | - S MacLean
- Social Work and Social Policy & Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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12
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Mutschler C, Junaid S, Tellez C, Franco G, Gryspeerdt C, Bushe J. Community-based residential treatment for alcohol and substance use problems: A realist review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e287-e304. [PMID: 35122344 DOI: 10.1111/hsc.13511] [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: 09/16/2020] [Revised: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 06/14/2023]
Abstract
Research and reviews to date suggest that community-based residential treatments for substance use disorders (SUDs) have mixed effectiveness, with some studies finding positive outcomes while others finding no differences between intervention arms, including inpatient, outpatient, and control groups. In order to understand these mixed findings, reviews have underscored the importance of outlining the active treatment components of residential treatment, as well as treatment mechanisms and outcomes. Further, there is very little research on the underlying theories explaining how and for whom residential treatments are effective. The purpose of the present realist synthesis was to address this gap in the literature by exploring how, why, for whom, and in what circumstances, community-based residential treatments are effective. Following the RAMESES Publication Standards, a search was undertaken for articles examining community-based residential treatments in PsycINFO and PubMed from anytime to January 2020. The search generated 28 articles that met inclusion criteria and were extracted for relevant information. Results of the realist synthesis identified six Context-Mechanism-Outcome (CMO) configurations. Contextual factors that generated subsequent mechanisms and outcomes included substance-related problem severity, psychiatric comorbidities, diverse populations, pre-treatment relationships, lack of structure and lack of coping strategies. These CMO configurations provide important information for clinicians, treatment centres and policy makers, including the specific programme components that need to be offered in treatment to facilitate positive treatment outcomes.
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Affiliation(s)
| | - Sana Junaid
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Carmina Tellez
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Giselle Franco
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Julianne Bushe
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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13
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James DB, Lee KSK, Dronavalli M, Courtney RJ, Conigrave KM, Conigrave JH, Shakeshaft A. Predictors of length of treatment, discharge reason, and re-admission to Aboriginal alcohol and other drug residential rehabilitation services in New South Wales, Australia. Drug Alcohol Rev 2021; 41:603-615. [PMID: 34644427 DOI: 10.1111/dar.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aboriginal clients accessing Aboriginal community-controlled residential alcohol and other drug rehabilitation services in New South Wales, Australia believe they have better outcomes due to culturally appropriate care. However, there is a paucity of published treatment outcome data. This study aims to identify predictors of treatment outcomes based on client characteristics at intake. METHODS A cross-sectional, retrospective, observational study of 2326 admissions to six services between January 2011 and December 2016. The outcomes were: (i) leaving treatment early; (ii) self-discharge or house discharge (by staff); and (iii) re-admission within two years. The predictors examined were Aboriginal status, age, justice system referral and primary substance of concern. Competing risk and Poisson regression analyses were used to identify trends in the data. RESULTS The mean age of clients was 33 years, and the majority (56%) stayed at least 6 weeks. Aboriginal clients whose primary substance of concern was stimulants were almost eight times more likely to re-admitted within 2 years than other clients (risk ratio 7.91; P < 0.001). Aboriginal clients who were also referred from justice were more likely to self-discharge (risk ratio 1.87; P < 0.001). Furthermore, Aboriginal clients who were aged older than 30 were less likely to have a re-admission (risk ratio 0.32; P ≤ 0.001). DISCUSSION AND CONCLUSIONS This study showed client characteristics that are predictive of harmful outcomes include age under 30, justice client, primary substance of use and their interactions. Future research could build on these results to aid ongoing development of residential rehabilitation programs for Aboriginal peoples.
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Affiliation(s)
- Doug B James
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Mithilesh Dronavalli
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Ryan J Courtney
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,Burnet Institute, Melbourne, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - James H Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Anthony Shakeshaft
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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14
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Marsh TN, Eshakakogan C, Eibl JK, Spence M, Morin KA, Gauthier GJ, Marsh DC. A study protocol for a quasi-experimental community trial evaluating the integration of indigenous healing practices and a harm reduction approach with principles of seeking safety in an indigenous residential treatment program in Northern Ontario. Harm Reduct J 2021; 18:35. [PMID: 33731138 PMCID: PMC7967948 DOI: 10.1186/s12954-021-00483-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Indigenous communities in Canada face significant challenges with intergenerational trauma, which manifests in substance use disorders. There is consensus that connecting treatment approaches to culture, land, community, and spiritual practices is a pathway to healing trauma and substance use disorders for Indigenous peoples. Indigenous residential addiction treatment programs have been established as the primary intervention to provide healing for Indigenous peoples with substance use disorders and intergenerational trauma. However, there is limited evidence demonstrating the effectiveness of these programs. In collaboration with the Benbowopka Treatment Centre, this paper describes a study protocol which aims to evaluate the effectiveness of blending Indigenous Healing Practices and Seeking Safety for the treatment of Indigenous patients with intergenerational trauma and substance use disorders. Methods We will conduct a pre/post Quasi Experimental Community trial, to compare historical treatment outcomes for patients following the implementation of Indigenous Healing and Seeking Safety. We will conduct quantitative and qualitative analyses to understand the differences before and after the intervention is implemented. The pre- Indigenous Healing and Seeking Safety intervention study window will span from 2013 to 2016; n = 343, and the post-Indigenous Healing and Seeking Safety intervention study window from 2018 to 2020; n > 300. All participants will be enrolled in the Benbowopka residential treatment for the first time during the study periods. All data will be anonymized at the time of data entry. Propensity matching will be undertaken for patient characteristics, including sex/gender, age, and substance use type. Results and conclusions The study findings could be used to inform intergenerational trauma and substance use disorders residential treatment programming for Indigenous communities across Canada. Our work will contribute to the field of community-based intergenerational trauma and substance use disorders programming by addressing objectives that consider: (a) the patient perspective, (b) the program perspective, and (c) the community perspective. The study findings may validate an innovative approach for evaluating the effectiveness of residential addiction treatment and particularly the effective and appropriate care for Indigenous patients with intergenerational trauma and substance use disorders.
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Affiliation(s)
- T N Marsh
- Northern Ontario School of Medicine, Sudbury, Canada.
| | | | - J K Eibl
- Northern Ontario School of Medicine, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada.,ICES North, Sudbury, Canada
| | - M Spence
- Northern Ontario School of Medicine, Sudbury, Canada
| | - K A Morin
- Northern Ontario School of Medicine, Sudbury, Canada
| | - G J Gauthier
- Northern Ontario School of Medicine, Sudbury, Canada
| | - D C Marsh
- Northern Ontario School of Medicine, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada.,ICES North, Sudbury, Canada.,Canadian Addiction Treatment Centres, Markham, Canada
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15
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Jones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. Int J Equity Health 2020; 19:222. [PMID: 33317556 PMCID: PMC7734845 DOI: 10.1186/s12939-020-01334-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/26/2020] [Indexed: 11/11/2022] Open
Abstract
Background It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. Methods A systematic search strategy was developed and applied to six electronic databases between January 2000 and July 2019. Titles and abstracts were screened before applying the inclusion criteria to full text articles. A meta-narrative synthesis was undertaken. Results Fifty-four publications were identified from four research traditions; each with a unique conceptualisation of patient experience. Three themes emerged that demonstrate Aboriginal and Torres Strait Islander patient experiences are informed by 1) beliefs about wellbeing and healthcare provision, 2) their level of trust in the healthcare system, and 3) individual and community health system interactions. The findings highlight a range of aspects of patient experience that were important to participating Aboriginal and Torres Strait Islanders in the included studies but not captured currently in health system surveys. Conclusion This review highlights the influence of beliefs about health and wellbeing on the patient experience amongst Aboriginal and Torres Strait Islander populations in the Australian health system. Patient experiences were informed by past experience and their trust in the health system. The different factors influencing patient experience and the gravity of their influence must be considered in current approaches to capturing patient experience data collection methods. Trial registration PROSPERO (ID: CRD42019134765).
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Affiliation(s)
- Benjamin Jones
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - David Heslop
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia.
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16
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Gubhaju L, Williams R, Jones J, Hamer D, Shepherd C, McAullay D, Eades SJ, McNamara B. "Cultural Security Is an On-Going Journey…" Exploring Views from Staff Members on the Quality and Cultural Security of Services for Aboriginal Families in Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8480. [PMID: 33207696 PMCID: PMC7697803 DOI: 10.3390/ijerph17228480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
Cultural security is a key element of accessible services for Indigenous peoples globally, although few studies have examined this empirically. We explored the scope, reach, quality, and cultural security of health and social services available to Aboriginal and/or Torres Strait Islander families in Western Australia (WA), from the point of view of staff from the services. We recruited staff from health and social services for Aboriginal people in the Perth, Kalgoorlie, Great Southern, and South West regions of WA between December 2015 and September 2017 to complete online surveys. We examined the proportions of participants that responded saying the service was culturally secure, the reasons for the response, and perceived factors related to a high-quality service. Sixty participants from 21 services responded to the survey. Seventy-three percent stated the service was culturally secure; however, only 36% stated that the staff employed at the service had sufficient knowledge on cultural security. Participants suggested having Aboriginal staff and better cultural awareness training as methods to improve cultural security within the service. Participants highlighted that staffing, funding for resources, and patient financial difficulties in accessing care as key areas for quality improvement. Much greater effort is required in improving knowledge through on-going training of staff in the practice of culturally safe care. Organisations must also be required to meet specific standards in cultural safety.
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Affiliation(s)
- Lina Gubhaju
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Robyn Williams
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, 7 Parker Place, Technology Park, Bentley, WA 6102, Australia;
| | - David Hamer
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Carrington Shepherd
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia;
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, 90 South Street, Murdoch, WA 6150, Australia
| | - Dan McAullay
- Kurongkurl Katitjin, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia;
| | - Sandra J. Eades
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
- Curtin Medical School, Curtin University, 410 Koorliny Way, Bentley, WA 6102, Australia
| | - Bridgette McNamara
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
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17
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Ashdown JD, Treharne GJ, Neha T, Dixon B, Aitken C. Māori Men's Experiences of Rehabilitation in the Moana House Therapeutic Community in Aotearoa/New Zealand: A Qualitative Enquiry. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:734-751. [PMID: 30348033 DOI: 10.1177/0306624x18808675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In Aotearoa/New Zealand, culturally embedded rehabilitation programmes have been developed to reduce criminal offending among the indigenous Māori population. Currently, there is a lack of research investigating the experiences of these programmes from clients' perspectives. This study aimed to enhance understandings of the lived experiences of Māori men who were participating in a residential therapeutic community (TC) programme in Aotearoa/New Zealand. Semistructured interviews were conducted one-on-one by a psychology master's student who was a staff member at the TC and also of Māori descent. Seven Māori TC residents aged 22 to 48 were interviewed about life in a TC. Thematic analysis of the interview data yielded three themes: (a) "The importance of healing family relationships"; (b) "The relevance of Māori culture in rehabilitation"; (c) "Increased self-awareness." The findings highlight the significance of holistic approaches that emphasize culturally relevant approaches and the involvement of family members in the treatment of substance-use disorders and offending behaviour among indigenous populations.
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Affiliation(s)
- Jacob D Ashdown
- 1 University of Otago, Dunedin, New Zealand
- 2 Moana House, Dunedin, New Zealand
| | | | - Tia Neha
- 3 Victoria University of Wellington, New Zealand
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18
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Munro A, Shakeshaft A, Clifford A. The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach. HEALTH & JUSTICE 2017; 5:12. [PMID: 29204895 PMCID: PMC5714938 DOI: 10.1186/s40352-017-0056-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Given the well-established evidence of disproportionately high rates of substance-related morbidity and mortality after release from incarceration for Indigenous Australians, access to comprehensive, effective and culturally safe residential rehabilitation treatment will likely assist in reducing recidivism to both prison and substance dependence for this population. In the absence of methodologically rigorous evidence, the delivery of Indigenous drug and alcohol residential rehabilitation services vary widely, and divergent views exist regarding the appropriateness and efficacy of different potential treatment components. One way to increase the methodological quality of evaluations of Indigenous residential rehabilitation services is to develop partnerships with researchers to better align models of care with the client's, and the community's, needs. An emerging research paradigm to guide the development of high quality evidence through a number of sequential steps that equitably involves services, stakeholders and researchers is community-based participatory research (CBPR). The purpose of this study is to articulate an Indigenous drug and alcohol residential rehabilitation service model of care, developed in collaboration between clients, service providers and researchers using a CBPR approach. METHODS/DESIGN This research adopted a mixed methods CBPR approach to triangulate collected data to inform the development of a model of care for a remote Indigenous drug and alcohol residential rehabilitation service. RESULTS Four iterative CBPR steps of research activity were recorded during the 3-year research partnership. As a direct outcome of the CBPR framework, the service and researchers co-designed a Healing Model of Care that comprises six core treatment components, three core organisational components and is articulated in two program logics. The program logics were designed to specifically align each component and outcome with the mechanism of change for the client or organisation to improve data collection and program evaluation. CONCLUSION The description of the CBPR process and the Healing Model of Care provides one possible solution about how to provide better care for the large and growing population of Indigenous people with substance misuse issues. [corrected].
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Anton Clifford
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia
- University of Queensland, Brisbane, QLD, 4072, Australia
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