Lowitja Associated Research

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The Lowitja Institute’s pioneering research projects and scholarship initiatives have significantly influenced health research worldwide. This collection includes research outputs that either reference publications by the Lowitja Institute or utilise our research tools.
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Petrol sniffing in Aboriginal communities: a review of interventions.
(2002-08-21) MacLean S.J.; D'Abbs P.H.N.
Petrol sniffing (and other forms of inhalant misuse) occur within some Aboriginal communities across Australia. However, there is little documented information about the nature and combination of interventions that are most effective in addressing it. This article reviews published and unpublished literature relevant to petrol sniffing in Australian Aboriginal communities. A range of strategies which have been trialled previously are discussed under the categories of primary, secondary and tertiary intervention, We have adopted Zinberg's schema of 'drug', 'set' and 'setting' in theorizing the mix of interventions most likely to reduce petrol sniffing. We argue that interventions should address as many as possible of these factors. Further, while no strategy is likely to succeed without strong support from local community members, governments also have an important role in addressing petrol sniffing. Consistent funding for strategies directly addressing petrol sniffing and co-ordinated government responses to the broader needs of Aboriginal young people and their communities are critical.
Smoking behaviour among Indigenous secondary school students in north Queensland.
(2004-05-24) Lowe J.B.; Saeck L.; Brough M.; Carmont S.-A.; Clavarino A.; Stanton W.; Balanda K.; Shannon C.
This study investigated smoking behaviour among Indigenous youth. A sample of schools (n = 12) in north Queensland with large proportions of Indigenous students was selected. Details about the prevalence of smoking behaviour in both Indigenous and non-Indigenous students (n = 883) were gathered. Data were also collected on the cultural, social, and psychological factors associated with cigarette smoking for Indigenous and non-Indigenous students. This survey indicated smoking rates for Indigenous and non-Indigenous students were 24% and 30%, respectively. The study found similarities between both groups regarding where they obtained their cigarettes (friends) and their reasons for not smoking (their parents and health). Results of this survey challenge the belief that Indigenous youth are significantly different in their smoking patterns and behaviours compared to non-Indigenous secondary school students in rural regions. It indicated the potential importance of school communities in promoting non-smoking behaviours among Indigenous students even in the face of strong normative pressures from elsewhere in the community. This survey can be used to monitor smoking prevalence among Indigenous secondary students in north Queensland, help guide the development of culturally appropriate school curriculum resources and contribute to the overall evaluation of smoking prevention and smoking cessation programs which are developed for Indigenous secondary school students.
Other people, other drugs: the policy response to petrol sniffing among Indigenous Australians.
(2005-02-24) D'Abbs P.H.; Brady M.
This paper examines the policy response of Australian governments to petrol sniffing in Indigenous communities from the 1980s until the present. During this period, despite the formation of numerous inquiries, working parties and intergovernmental committees, there has been little accumulation of knowledge about the nature and causes of sniffing, or about the effectiveness of interventions. Policies are fragmentary; programmes are rarely evaluated, and most rely on short-term funding. The paper sets out to explain why this should be so. It draws upon a conceptual framework known as 'analytics of government' to examine the ways in which petrol sniffing comes to the attention of government agencies and is perceived as an issues the mechanisms deployed by governments to address petrol sniffing; ways in which knowledge about sniffing is generated; and the underlying assumptions about people that inform policy-making. Drawing upon case studies of policy responses, the paper argues that a number of structural factors combine to marginalize petrol sniffing as an issue, and to encourage reliance on short-term, one-off interventions in place of a sustained policy commitment. Four recommendations are advanced to help overcome these factors: (1) agreements should be reached within and between levels of government on steps to be taken to reduce risk factors before the eruption of petrol-sniffing crises; (2) the evidence base relevant to petrol sniffing (and other inhalants) should be improved by funding and directing one or more existing national drug research centres to collate data on inhalant-caused mortality and morbidity, and to conduct or commission research into prevalence patterns, effectiveness of interventions and other gaps in knowledge; (3) the current pattern of short-term, pilot and project funding should be replaced with longer-term, evidence-based interventions that address the multiple risk and protective factors present in communities; and (4) insistence by governments that communities must take 'ownership' of the problem should be replaced by a commitment to genuine partnerships involving governments, non-government and community sectors.
Social determinants of health, the 'control factor' and the family wellbeing empowerment program.
(2006-01-05) Tsey K.; Whiteside M.; Deemal A.; Gibson T.
Objective: To explore links between the social determinants of health, the 'control factor', and an Aboriginal empowerment program. Method(s): The evidence that rank or social status is one of the most important determinants of health is briefly presented. This is followed by a critique of the Australian policy and intervention framework for tackling and reducing social inequalities. The concept of 'control' as an important element in addressing social determinants of health is examined next and the Family Wellbeing empowerment program is analysed to illustrate how the concept of control might be operationalised at program or intervention level. Implications for health practitioners are identified. Result(s): By providing a safe group environment for participants to explore sets of critical questions about themselves, their families and communities, through the process of participatory action research, Family Wellbeing has demonstrated its potential to 'enable' Indigenous people to take greater control and responsibility for their situation. While program participants first address personal and immediate family issues, evidence is emerging of a ripple effect of increasing harmony and capacity to address issues within the wider community Conclusion(s): The social determinants of health are complex and multilayered and so addressing them needs to involve multilevel thinking and action. The control factor is only one element, albeit an important one, and Family Wellbeing is providing evidence that 'control' can be addressed in Indigenous settings. For empowerment programs to achieve their full potential, however, there is a need to ensure that such programs reach a critical mass of the target group. It is also imperative that policy-makers and practitioners take a longer-term approach, including properly resourced longitudinal studies to document and enhance the evidence base for such interventions. As health practitioners it is vital we consider our work within this broader context, creatively seek to enhance linkages between services and programs, and support processes for change or intervention at other levels.
Housing and health in Indigenous communities: key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities.
(2006-10-25) Bailie R.S.; Wayte K.J.
Indigenous people living in remote communities face some particular difficulties with regard to housing and its impact on their health. This paper reviews the contemporary international understanding of the relationship between housing and health, the history of settlement and housing conditions in remote Aboriginal and Torres Strait Islander communities, and some of the recent initiatives to improve housing in these communities. © 2006 The Authors; Journal Compilation © 2006 National Rural Health Alliance Inc.
Stopping petrol sniffing in remote Aboriginal Australia: key elements of the Mt Theo program.
(2007-11-08) Preuss K.; Brown J.N.
Petrol sniffing is a major form of substance misuse in Aboriginal communities across Australia. This practice has detrimental effects on the health and wellbeing of individual sniffers, their families, communities and wider society. There are few examples of programmes that have successfully stopped petrol sniffing. This paper looks at the Mt Theo Program, regularly cited as 'the success story in petrol sniffing interventions. The aim of this paper is to demonstrate key elements that have contributed towards Mt Theo Program's rare achievement: (1) initially, a multi-faceted approach including an outstation and youth programme, (2) community-initiated, operated, owned basis of the organisation, which incorporates (3) strong partnership between Indigenous and non-Indigenous team members and (4) an ability to operate beyond crisis intervention.
Evaluation of a community-driven preventive youth initiative in Arnhem Land, Northern Territory, Australia.
(2008-02-19) Lee K.S.K.; Conigrave K.M.; Clough A.R.; Wallace C.; Silins E.; Rawles J.
Introduction and Aims. We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. Design and Methods. Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. Results. Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. Discussion and Conclusions. Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use. [Lee KSK, Conigrave KM, Clough AR, Wallace C, Silins E, Rawles J. Evaluation of a community-driven preventive youth initiative in Arnhem Land, Northern Territory, Australia. Drug Alcohol Rev 2008;27:75-82].
Indigenous women and smoking during pregnancy: knowledge, cultural contexts and barriers to cessation.
(2008-05-23) Wood L.; France K.; Hunt K.; Eades S.; Slack-Smith L.
Despite active tobacco control efforts in Australia, smoking prevalence remains disproportionately high in pregnant Indigenous women. This study investigated the place of smoking in pregnancy and attitudes towards smoking within the broader context of Indigenous lives. Focus groups and in-depth interviews were used to collect data from 40 women, and ten Aboriginal Health Workers (AHWs) in Perth, Western Australia. The research process and interpretation was assisted by working with an Indigenous community reference group. Results demonstrated the impact of contextual factors in smoking maintenance, and showed that smoking cessation even in pregnancy was not a priority for most women, given the considerable social and economic pressures that they face in their lives. Overwhelmingly, smoking was believed to reduce stress and to provide opportunities for relaxation. Pregnancy did not necessarily influence attitudes to cessation, though women's understanding of the consequences of smoking during pregnancy was low. Reduction of cigarette intake during pregnancy was seen as an acceptable and positive behaviour change. The AHWs saw their role to be primarily one of support and were conscious of the importance of maintaining positive relationships. As a result, they were often uncomfortable with raising the issue of smoking cessation with pregnant women. The stories of Indigenous women and AHWs provided important insight into smoking during pregnancy and the context in which it occurs. © 2008 Elsevier Ltd. All rights reserved.
Identifying psychosocial mediators of health amongst Indigenous Australians for the heart health project.
(2008-09-15) Reilly R.E.; Doyle J.; Bretherton D.; Rowley K.G.; Harvey J.L.; Briggs P.; Charles S.; Calleja J.; Patten R.; Atkinson V.
Objective. The Heart Health Project is an ongoing community-directed health promotion programme encompassing the collection of health-related data and interventions promoting cardiovascular health. Following research which has emphasised the importance of psychological factors including mastery, or personal control, in mitigating cardiovascular health outcomes, this qualitative study explored whether such constructs were relevant from Indigenous perspectives, or whether there were other, more meaningful and relevant psychosocial factors identified by participants that should be incorporated into models of Indigenous health and which could be effective targets for change. Design. The study fits within the broader participatory action research design of the Heart Health Project. Data comprised 30 in-depth interviews with members of a rural Aboriginal community in south-eastern Australia to identify psychosocial factors relevant to their health. Interviews were semi-structured and carried out by two interviewers, one Aboriginal and one non-Aboriginal. Qualitative analysis using QN6 software resulted in a number of salient themes and sub-themes. These are summarised using extracts from the data. Results/Conclusions. Five major themes and 15 sub-themes emerged from data analysis. The findings indicated that while a sense of control may be one factor impacting on health and health behaviours, there were other factors that participants spoke about more readily that have specific relevance to the social and cultural context of Indigenous health. These included history, relationship with mainstream and connectedness. These may be worthy of further empirical investigation and are likely to assist in the design of community health promotion interventions for Aboriginal people. © 2008 Taylor & Francis.
Joining the dots: the links between education and health and implications for Indigenous children.
(2010-02-01) Johnston V.; Lea T.; Carapetis J.
This paper provides a general overview of the literature investigating the nexus between education and health; discussing the relationship between these domains at individual, family and community levels. We then briefly examine the programme and research implications of such a framework for interventions aimed at improving education and health, with specific reference to young Indigenous Australians. We find that while education and health are inextricably linked, throughout the life course and at different levels of influence, there is less empirical work exploring this relationship in an Indigenous context. Given the gravity of literacy and numeracy failure rates in school-based education and its potential impact on Indigenous health, we assert an urgent case for rigorous research into interventions that address the barriers to effectiveness in implementing quality educational experiences and opportunities for Indigenous children. © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Indigenous higher degree research students making a difference to the Indigenous health agenda.
(2011-09-01) Usher K.
While research has been seen to perpetuate rather than improve the ongoing health disadvantage of Indigenous Australians, more recently we have witnessed a transformation in the way research is undertaken with Indigenous people. A more collaborative and inclusive approach has made research more appropriate to the needs of Indigenous people and more Indigenous people undertaking higher degree research study. Insights about research with Indigenous people are provided by four Indigenous students undertaking research in health and nursing who discuss 'closing the gap', cultural care, and the current situation surrounding access to and experiences in the health service in Australia for Indigenous people.
Putting Indigenous cultural training into nursing practice.
(2011-09-01) Downing R.; Kowal E.
The provision of Indigenous cultural training for non-Indigenous health workers has been widely promoted as a method of improving health service provision to 'close the gap' in Indigenous health. However, in the absence of strong evidence, the power of Indigenous cultural training to meaningfully contribute to the health of Aboriginal and Torres Strait Islander peoples remains questionable. This research explored how six hospital-based nurses consider the role of Indigenous cultural training and the impact it has had on their practice through individual semi-structured interviews. Thematic analysis revealed the significance of individual professionals' attitudes in determining the impact of Indigenous cultural training, as well as the need for institutional support to assist in translating Indigenous cultural training into practice. Utilising post-colonial theory, two key findings emerge. First, the way in which Indigenous cultural training conceptualises 'identity' and 'culture' is critical to its ultimate outcomes. Second, deficits in institutional support limit the efficacy of Indigenous cultural training by placing the onus for institutional change on the shoulders of individual health workers.
Having a yarn about smoking: using action research to develop a 'no smoking' policy within an Aboriginal health organisation.
(2011-11-01) Fletcher G.; Fredericks B.; Adams K.; Finlay S.; Andy S.; Briggs L.; Hall R.
Objectives: This article reports on a culturally appropriate process of development of a smoke-free workplace policy within the peak Aboriginal Controlled Community Health Organisation in Victoria, Australia. Smoking is acknowledged as being responsible for at least 20% of all deaths in Aboriginal communities in Australia, and many Aboriginal health workers smoke. Method(s): The smoke-free workplace policy was developed using the iterative, discursive and experience-based methodology of Participatory Action Research, combined with the culturally embedded concept of 'having a yarn'. Result(s): Staff members initially identified smoking as a topic to be avoided within workplace discussions. This was due, in part, to grief (everyone had suffered a smoking-related bereavement). Further, there was anxiety that discussing smoking would result in culturally difficult conflict. The use of yarning opened up a safe space for discussion and debate, enabling development of a policy that was accepted across the organisation. Conclusion(s): Within Aboriginal organisations, it is not sufficient to focus on the outcomes of policy development. Rather, due attention must be paid to the process employed in development of policy, particularly when that policy is directly related to an emotionally and communally weighted topic such as smoking. © 2011 Elsevier Ireland Ltd.
Integrated care for chronic conditions: the contribution of the ICCC framework.
(2011-11-07) Nuno R.; Coleman K.; Bengoa R.; Sauto R.
Objective: The aim of this research is to highlight the current relevance of the Innovative Care for Chronic Conditions (ICCC) Framework, as a model for change in health systems towards better care for chronic conditions, as well as to assess its impact on health policy development and healthcare redesign to date. Method(s): The authors reviewed the literature to identify initiatives designed and implemented following the ICCC Framework. They also reviewed the evidence on the effectiveness, cost-effectiveness and feasibility of the ICCC and the earlier Chronic Care Model (CCM) that inspired it. Result(s): The ICCC Framework has inspired a wide range of types of intervention and has been applied in a number of countries with diverse healthcare systems and socioeconomic contexts. The available evidence supports the effectiveness of this framework's components, although no study explicitly assessing its comprehensive implementation at a health system level has been found. Conclusion(s): As awareness of the need to reorient health systems towards better care for chronic patients grows, there is great potential for the ICCC Framework to serve as a road map for transformation, with its special emphasis on integration, and on the role of the community and of a positive political environment. © 2011 Elsevier Ireland Ltd. All rights reserved.
Social gradients in the health of Indigenous Australians.
(2012-04-27) Shepherd C.C.; Li J.; Zubrick S.R.
The pattern of association between socioeconomic factors and health outcomes has primarily depicted better health for those who are higher in the social hierarchy. Although this is a ubiquitous finding in the health literature, little is known about the interplay between these factors among Indigenous populations. We begin to bridge this knowledge gap by assessing evidence on social gradients in Indigenous health in Australia. We reveal a less universal and less consistent socioeconomic status patterning in health among Indigenous Australians, and discuss the plausibility of unique historical circumstances and social and cultural characteristics in explaining these patterns. A more robust evidence base in this field is fundamental to processes that aim to reduce the pervasive disparities between Indigenous and non-Indigenous population health.
Mibbinbah and spirit healing: fostering safe, friendly spaces for Indigenous males in Australia.
(2012-08-09) Bulman J.; Hayes R.
This article seeks to share some of the insights that have been gained through a participatory action research program exploring the issue of safe spaces for Aboriginal and Torres Strait Islander males in Australia. The three-year program sought to build the capacity of the men, their organisations and their communities. It began out of the friendship of two men and expanded to include dozens of men and a number of key organisations through time. Thus, recounting some of the beginnings, progress and conclusion of the process offers some understanding of what might be possible in terms of improving the health of Indigenous males. The focus has been on a strengths-based, or salutogenic approach we call "Spirit Healing." This article seeks to provide insight into safe spaces for dealing with depression and anxiety and supporting community-based Indigenous male researchers. In the end, safe, well-facilitated spaces foster and further respect while they diminish lateral violence and its consequences. © 2011 by the Men's Studies Press, LLC. All rights reserved.
"Hiding the story": Indigenous consumer concerns about communication related to chronic disease in one remote region of Australia.
(2012-09-18) Lowell A.; Maypilama E.; Yikaniwuy S.; Rrapa E.; Williams R.; Dunn S.
This paper reports on a collaborative qualitative study which explored education and communication practice related to chronic disease from the perspectives of Aboriginal people in a remote region of the Northern Territory, Australia, where the prevalence of chronic disease is extremely high. Most Yolngu (Aboriginal people of Northeast Arnhem Land) do not speak English as their first language and few health staff share the language and cultural background of their clients. Semi-structured interviews were conducted with Yolngu community members and health staff in their preferred language in small groups or individually, in an approach that was flexible and responsive to the concerns and priorities of Yolngu researchers and participants. As well, health education interactions were videotaped to facilitate more in-depth understanding of the strengths and challenges in communication (one video can be viewed at http://informahealthcare.com/doi/abs/10.3109/17549507.2012.663791). An iterative and collaborative process of analysis, interpretation, and verification revealed that communication and education related to chronic disease is highly ineffective, restricting the extent to which Yolngu can make informed decisions in managing their health. Yolngu participants consistently stated that they wanted a detailed and direct explanation about causes and management of chronic disease from health staff, and rarely believed this had been provided, sometimes assuming that information about their health is deliberately withheld. These serious limitations in communication and education have extensive negative consequences for individuals, their families, and health services. These findings also have broader relevance to all areas of healthcare, including allied health services, which share similar challenges in achieving effective communication. Without addressing the profound and pervasive inadequacies in communication, other interventions designed to close the gap in Indigenous health are unlikely to succeed.
It had to be my choice' Indigenous smoking cessation and negotiations of risk, resistance and resilience.
(20120903) Bond C.; Brough M.; Spurling G.; Hayman N.
While Australia is considered a world leader in tobacco control, smoking rates within the Aboriginal and Torres Strait Islander population have not declined at the same rate. This failure highlights an obvious shortcoming of mainstream anti-smoking efforts to effectively understand and engage with the socio-cultural context of Indigenous smoking and smoking cessation experiences. The purpose of this article is to explore the narrative accounts of 20 Indigenous ex-smokers within an urban community and determine the motivators and enablers for successful smoking cessation. Our findings indicated that health risk narratives and the associated social stigma produced through anti-smoking campaigns formed part of a broader apparatus of oppression among Indigenous people, often inspiring resistance and resentment rather than compliance. Instead, a significant life event and supportive relationships were the most useful predictors of successful smoking cessation acting as both a motivator and enabler to behavioural change. Indigenous smoking cessation narratives most commonly involved changing and reordering a person's life and identity and autonomy over this process was the critical building block to reclaiming control over nicotine addiction. Most promisingly, at an individual level, we found the important role that individual health professionals played in encouraging and supporting Indigenous smoking cessation through positive rather than punitive interactions. More broadly, our findings highlighted the central importance of resilience, empowerment and trust within health promotion practice. © 2012 Copyright Taylor and Francis Group, LLC.
"From your own thinking you can't help us": intercultural collaboration to address inequities in services for Indigenous Australians in response to the world report on disability.
(2013-07-01) Lowell A.
Inequity in service provision for Indigenous Australians with communication disability is an issue requiring urgent attention. In the lead article, Wylie, McAllister, Davidson, and Marshall (2013) note that, even in the relatively affluent Minority World, including Australia, equity in service provision for people with communication disability has not been achieved. In remote communities in the Northern Territory (NT) almost all residents speak a language other than English as their primary language. However, there are no speech-language pathologists (SLPs) in the NT who speak an Indigenous language or who share their cultural background. Specific data on the prevalence of communication disability in this population are unavailable due to a range of factors. The disability data that are available, for example, demonstrating the high level of conductive hearing loss, indicates that the risk of communication disability in this population is particularly high. Change is urgently needed to address current inequities in both availability of, and access to, culturally responsive services for Indigenous people with communication disability. Such change must engage Indigenous people in a collaborative process that recognizes their expertise in identifying both their needs and the most effective form of response to these needs.
Genetic research and Aboriginal and Torres Strait Islander Australians.
(2014-03-10) Kowal E.; Pearson G.; Peacock C.S.; Jamieson S.E.; Blackwell J.M.
While human genetic research promises to deliver a range of health benefits to the population, genetic research that takes place in Indigenous communities has proven controversial. Indigenous peoples have raised concerns, including a lack of benefit to their communities, a diversion of attention and resources from non-genetic causes of health disparities and racism in health care, a reinforcement of "victim-blaming" approaches to health inequalities, and possible misuse of blood and tissue samples. Drawing on the international literature, this article reviews the ethical issues relevant to genetic research in Indigenous populations and considers how some of these have been negotiated in a genomic research project currently under way in a remote Aboriginal community. We consider how the different levels of Indigenous research governance operating in Australia impacted on the research project and discuss whether specific guidelines for the conduct of genetic research in Aboriginal and Torres Strait Islander communities are warranted. © 2012 Springer Science+Business Media B.V.

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