Lowitja Funded Research

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The Lowitja Institute is committed to investing in Aboriginal and Torres Strait Islander community-driven health research that privileges Indigenous ways of knowing, being and doing. The Lowitja Institute's investment upholds Aboriginal and Torres Strait Islander rights to sovereignty and self-determination throughout all stages of the research process and within the health research workforce. This collection features research funded by the Lowitja Institute and its predecessors, encompassing community-led studies and publications by researchers affiliated with the Lowitja Institute.
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A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.
(2020-08-21) Geia L.; Baird K.; Bail K.; Barclay L.; Bennett J.; Best O.; Birks M.; Blackley L.; Blackman R.; Bonner A.; Bryant Ao R.; Buzzacott C.; Campbell S.; Catling C.; Chamberlain C.; Cox L.; Cross W.; Cruickshank M.; Cummins A.; Dahlen H.; Daly J.; Darbyshire P.; Davidson P.; Denney-Wilson E.; De Souza R.; Doyle K.; Drummond A.; Duff J.; Duffield C.; Dunning T.; East L.; Elliott D.; Elmir R.; Fergie Oam D.; Ferguson C.; Fernandez R.; Flower Am D.; Foureur M.; Fowler C.; Fry M.; Gorman E.; Grant J.; Gray J.; Halcomb E.; Hart B.; Hartz D.; Hazelton M.; Heaton L.; Hickman L.; Homer Ao C.S.E.; Hungerford C.; Hutton A.; Jackson Ao D.; Johnson A.; Kelly M.A.; Kitson A.; Knight S.; Levett-Jones T.; Lindsay D.; Lovett R.; Luck L.; Molloy L.; Manias E.; Mannix J.; Marriott A.M.R.; Martin M.; Massey D.; McCloughen A.; McGough S.; McGrath L.; Mills J.; Mitchell B.G.; Mohamed J.; Montayre J.; Moroney T.; Moyle W.; Moxham L.; Northam Oam H.; Nowlan S.; O'Brien A.P.; Ogunsiji O.; Paterson C.; Pennington K.; Peters K.; Phillips J.; Power T.; Procter N.; Ramjan L.; Ramsay N.; Rasmussen B.; Rihari-Thomas J.; Rind B.; Robinson M.; Roche M.; Sainsbury K.; Salamonson Y.; Sherwood J.; Shields L.; Sim J.; Skinner I.; Smallwood G.; Smallwood R.; Stewart L.; Taylor S.; Usher Am K.; Virdun C.; Wannell J.; Ward R.; West C.; West R.; Wilkes L.; Williams R.; Wilson R.; Wynaden D.; Wynne R.
Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.
An Australian national survey of First Nations careers in health services.
(2024-10-18) Nathan S.; Meyer L.; Joseph T.; Blignault I.; Bailey J.; Demasi K.; Newman J.; Briggs N.; Williams M.; Lew Fatt E.
A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia's First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non-Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. "Racism from colleagues"and "lack of cultural awareness,""not feeling supported by their manager,""not having role models or mentors,"and "inflexible human resource policies"predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations' staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies. Copyright © 2023 S. Nathan et al.
Barriers and enablers to Aboriginal and Torres Strait Islander careers in health: a qualitative, multisector study in western New South Wales.
(2022-01-17) Bailey J.; Blignault I.; Renata P.; Naden P.; Nathan S.; Newman J.
Objective: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non-Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. Design: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. SETTING: Western New South Wales. PARTICIPANTS: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non-Aboriginal; n = 28). MAIN OUTCOME MEASURES: Identified barriers and enablers and regional strategies for improving career pathways. Results: Aboriginal people interested in pursuing a career in health face barriers in: pre-employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. Conclusions: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self-determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members.Copyright © 2021 National Rural Health Alliance Ltd.
"Bridging two worlds?": Towards cultural safety within schools of nursing in Australian universities.
(2022-04-08) Petric S.; Hart B.; Mohamed J.
Background: Cultural safety has a stronghold within nursing practice and nursing education in Australia and is seen as a philosophy and practice that challenges and refutes previous concepts and frameworks of cultural awareness and cultural competence (Petric, 2019). Cultural safety practices are required for all members of the nursing profession, with a gaze now focused upon Australian Schools of Nursing to demonstrate their commitment and readiness towards cultural safety. AIM: This research study measures the commitment and readiness towards cultural safety within Schools of Nursing in Australian universities. Methods: This research study utilises a quantitative descriptive survey design, inviting the Deans of Schools of Nursing in Australia to respond to a modified Occupational Commitment and Health Professional Program Readiness Assessment Compass (DOH, 2014), that measures the current levels of commitment and readiness towards cultural safety. FINDINGS: This research study provides evidence of cultural safety strategies within Australian Schools of Nursing with leadership and commitment being the highest scoring factor (M = 34.81; SD 6.34). However, structures towards and support for the implementation of cultural safety strategies and practices were demonstrated as weaknesses (M = 21.18; SD 4.71). DISCUSSION: There is a valuable opportunity for leadership and knowledge sharing between Schools of Nursing in Australia. The research outcomes highlight the importance for Schools of Nursing to review, reflect upon, and fully implement the Nursing and Midwifery Curriculum Framework (CATSINaM, 2017) and to audit and report levels of cultural safety. Conclusions: There are cultural safety champions and their leadership is important to the continuing development of curricula, organisations and the profession. These individuals' actions must also be reflected within and supported by organisational cultures, as they fundamentally encourage or obstruct the development of cultural safety in nursing students and academics; material, cultural and human resources are fundamental to the transformations towards cultural safety and to the decolonising practices of the nursing profession (Petric, 2019).Copyright © 2021. Published by Elsevier Ltd.
Co-designing a health journey mapping resource for culturally safe health care with and for First Nations people.
(2024-06-13) Cormick A.; Graham A.; Stevenson T.; Owen K.; O'Donnell K.; Kelly J.
Background: Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method(s): Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Result(s): The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion(s): The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.Copyright © 2024 CSIRO. All rights reserved.
Communication, collaboration and care coordination: the three-point guide to cancer care provision for Aboriginal and Torres Strait Islander Australians.
(2020-06-17) de Witt A.; Matthews V.; Bailie R.; Garvey G.; Valery P.C.; Adams J.; Martin J.H.; Cunningham F.C.
Aim: To explore health professionals' perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland. Method(s): Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and non-Indigenous health professionals who had experience caring for Indigenous cancer patients in the PHC and hospital setting. The World Health Organisation integrated people-centred health services framework was used to analyse the interview data. Result(s): Seventeen health staff from six Aboriginal Community Controlled Services and nine health professionals from one tertiary hospital participated in this study. PHC sites were in urban, regional and rural settings and the hospital was in a major city. Analysis of the data suggests that timely communication and information exchange, collaborative approaches, streamlined processes, flexible care delivery, and patient-centred care and support were crucial in improving the continuity and coordination of care between the PHC service and the treating hospital. Conclusion(s): Communication, collaboration and care coordination are integral in the provision of quality cancer care for Indigenous Australians. It is recommended that health policy and funding be designed to incorporate these aspects across services and settings as a strategy to improve cancer outcomes for Indigenous people in Queensland. Copyright © 2020 The Author(s).
Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care.
(2017-12-15) Kelly J.; Dwyer J.; Mackean T.; O'Donnell K.; Willis E.
This paper describes the rationale and process for developing a set of Aboriginal patient journey mapping tools with Aboriginal patients, health professionals, support workers, educators and researchers in the Managing Two Worlds Together project between 2008 and 2015. Aboriginal patients and their families from rural and remote areas, and healthcare providers in urban, rural and remote settings, shared their perceptions of the barriers and enablers to quality care in interviews and focus groups, and individual patient journey case studies were documented. Data were thematically analysed. In the absence of suitable existing tools, a new analytical framework and mapping approach was developed. The utility of the tools in other settings was then tested with health professionals, and the tools were further modified for use in quality improvement in health and education settings in South Australia and the Northern Territory. A central set of patient journey mapping tools with flexible adaptations, a workbook, and five sets of case studies describing how staff adapted and used the tools at different sites are available for wider use.Journal compilationCopyright © La Trobe University 2017.
Culturally appropriate training for remote Australian Aboriginal health workers: evaluation of an early child development training intervention.
(2016-06-21) D'Aprano A.; Silburn S.; Johnston V.; Oberklaid F.; Tayler C.
Objective: This study aimed to design, implement, and evaluate training in early childhood development (ECD) and in the use of a culturally adapted developmental screening tool, for remote Australian Aboriginal Health Workers (AHWs) and other remote health practitioners. METHOD: A case-study evaluation framework was adopted. Two remote Australian Aboriginal health services were selected as case-study sites. Materials review, semistructured interviews, posttraining feedback surveys, and workplace observations contributed to the evaluation, guided by Guskey's 5-level education evaluation model. Results: Remote health practitioners (including AHWs and Remote Area Nurses) and early childhood staff from the sites participated in a customized 21/2 day training workshop focusing on the principles of ECD and the use of the culturally adapted Ages and Stages Questionnaire, third edition. Consistent with adult learning theories and recommendations from the literature regarding culturally appropriate professional development methods in this context, the workshop comprised interactive classroom training, role-plays, and practice coaching in the workplace, including booster training. The qualitative findings demonstrated that mode of delivery was effective and valued by participants. The workshop improved practitioners' skills, knowledge, competence, and confidence to identify and manage developmental difficulties and promote child development, evidenced on self-report and workplace clinical observation. Conclusion: The findings suggest that the practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners. This is an important finding that has implications in other Indigenous contexts, as effective training is a critical component of any practice improvement intervention. Further research examining factors influencing practice change is required.
Evaluation of 'Ask the Specialist': a cultural education podcast to inspire improved healthcare for Aboriginal peoples in northern Australia.
(2022-07-12) Kerrigan V.; McGrath S.Y.; Herdman R.M.; Puruntatameri P.; Lee B.; Cass A.; Ralph A.P.; Hefler M.; Larrakia; Yolnu; Tiwi
In Australia's Northern Territory (NT) most people who access health services are Aboriginal and most healthcare providers are non-Indigenous; many providers struggle to deliver culturally competent care. Cultural awareness training is offered however, dissatisfaction exists with the limited scope of training and the face-to-face or online delivery format. Therefore, we developed and evaluated Ask the Specialist: Larrakia, Tiwi and Yolnu stories to inspire better healthcare, a cultural education podcast in which Aboriginal leaders of Larrakia, Tiwi and Yolnu nations, known as the Specialists, answer doctors' questions about working with Aboriginal patients. The Specialists offer 'counterstories' which encourage the development of critical consciousness thereby challenging racist narratives in healthcare. After listening to the podcast, doctors reported attitudinal and behavioural changes which led to stereotypes being overturned and more culturally competent care delivery. While the podcast was purposefully local, issues raised had applicability beyond the NT and outside of healthcare. Our approach was shaped by cultural safety, critical race theory and Freirean pedagogy. This pilot is embedded in a Participatory Action Research study which explores strategies to improve culturally safe communication at the main NT hospital Royal Darwin Hospital.
Growing and supporting the Aboriginal and Torres Strait Islander health workforce.
(2021-12-08) Mohamed D.J.
Indigenous cultural training for health workers in Australia.
(20110526) Downing R.; Kowal E.; Paradies Y.
Purpose: Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to Indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia. Data sources: CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest. Study selection: The review focuses on the conceptual and empirical literature on Indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction: Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations. Results of data synthesis: Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian Indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect. Conclusion(s): This review shows that the evidence for the effectiveness of Indigenous cultural training programmes in Australia is poor. Critiques of cultural training from Indigenous and non-Indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for Indigenous Australians. ©The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
"It's a big conversation": views of service personnel on systemic barriers to preventing smoking relapse among pregnant and postpartum Aboriginal and Torres Strait Islander women - a qualitative study.
(2024-09-13) Rahman T.; Bennett J.; Kennedy M.; Baker A.L.; Gould G.S.
Background: Providing smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers. AIM: This paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal). Methods: Twenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed. FINDINGS: Themes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women's needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation. Conclusions: To drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals' capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.Copyright © 2024. Published by Elsevier Ltd.
Learning about Aboriginal health and wellbeing at the postgraduate level: novel application of the growth and empowerment measure.
(2019-05-15) Fitzpatrick S.A.; Haswell M.R.; Williams M.M.; Nathan S.; Meyer L.; Ritchie J.E.; Jackson Pulver L.R.
Introduction: Public health education strives to transform and empower students to engage in policy and practice improvement. However, little is known of the nature of such change among students, especially when studying Aboriginal health and wellbeing, which may involve disrupting long held assumptions and prejudices. This article reports findings regarding the feasibility, specificity and sensitivity of the Growth and Empowerment Measure (GEM) in the evaluation of two innovative Australian 13-week postgraduate public health electives focused on Aboriginal health and wellbeing. The GEM's 14-item Emotional Empowerment Scale (EES14) and its subscales Inner Peace and Self-Capacity, and 12 Scenarios (S12) and its subscales Healing and Growth and Connection and Purpose were used to examine transformative experiences. A new short form of the S12, the Core6, was also trialled as a briefer measure of functional empowerment. Method(s): Pre-course GEM responses and demographic information were collected from consenting students during the mandatory, face-to-face workshops of the Aboriginal public health Perspectives course and the Aboriginal empowerment and wellbeing Lifespan course. The two-day Perspectives course workshop introduced a group scenario-building activity towards ending health inequality. Lifespan students experienced a 3-day immersion based on Stage 1 of the Aboriginal Family Well Being empowerment program. Insights from both workshops were further integrated through structured online discussions and written assessments. At the end of semester, a post-course GEM was mailed to students for completion and return. Students could also provide feedback through evaluation surveys and semistructured focus groups. Effect sizes were assessed using paired t-tests, Wilcoxon signed-rank tests and multiple ANOVA. Cronbach's alpha confirmed internal consistency. Result(s): Baseline GEM data was provided for 147 out of a total of 194 workshop experiences from participating students. Twenty students attended workshops for both Perspectives and Lifespan. Fifty-five matched pairs (representing 52 individual participants) were obtained from 170 students who completed one or both courses. Statistically significant positive change of small to medium effect size was detected in all GEM scales, subscales and some individual items. Lifespan yielded larger effects than Perspectives, most markedly on two subscales: Inner Peace, and Connection and Purpose. Participating students reported significant growth in the Scenario item 'knowing and being who I am' following Perspectives and Lifespan. Those completing Perspectives also reported a significant increase in 'gaining voice and being heard', consistent with its action-oriented scenario-building assessment. In contrast, the psychosocial development approach embedded in Lifespan stimulated strong development in spirituality, responding constructively to judgement, appreciating empowerment in their communities and skills to make changes in their lives. Feedback indicated that students valued these personal and professional growth experiences. Conclusion(s): The GEM was sensitive and specific in measuring components of empowering change among participants. Challenges included low post-course response rates that limited extrapolation to overall course impact, and attention needed to starting point when comparing the increment of change. The GEM is a promising tool for studying postgraduate courses designed to stimulate transformative learning, wellbeing and cultural competence through empowerment, and relevant in the education of health professionals in the fields of Aboriginal and rural health. Copyright © 2019, ARHEN - Australian Rural Health Education Network Ltd.
Messages for good practice: Aboriginal hospital liaison officers and hospital social workers.
Orr E.; Frederico M.; Long M.
This article reports the findings of a study about the work of Aboriginal hospital liaison officers (AHLOs) and hospital social workers in Victoria. Guided by an Aboriginal Critical Reference Group, in-depth interviews were held with nine AHLOs, 10 social workers, and three Aboriginal health policy and program informants. Telephone focus groups held with study participants confirmed an analysis of the narratives of good practice and themes identified by participants. Focusing on the strengths of collaborative work, six key principles for good practice were defined. These principles relate to nonbiomedical knowledge and skills that non-Aboriginal social workers and AHLOs require to work well with Aboriginal patients. Implications for training and further research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Re-framing the Indigenous kidney health workforce.
(2019-07-09) Hughes J.T.; Lowah G.; Kelly J.
Rural primary care workforce views on trauma-informed care for parents experiencing complex trauma: a descriptive study.
(2023-02-28) Reid C.; Bennetts S.K.; Nicholson J.M.; Amir L.H.; Chamberlain C.
Background: An important service system for rural parents experiencing complex trauma is primary health care. AIM: To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care. MATERIAL & METHODS: This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions. Results: The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches. DISCUSSION & Conclusions: Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.Copyright © 2022 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.
Sharing the true stories: improving communication between Aboriginal patients and healthcare workers.
(2002-06-11) Cass A.; Lowell A.; Christie M.; Snelling P.L.; Flack M.; Marrnganyin B.; Brown I.
Objectives: To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication. Design(s): Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication. Setting(s): A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001. Participant(s): Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers. Main Outcome Measure(s): Factors influencing the quality of communication. Result(s): A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters. Conclusion(s): Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.
Tactics at the interface: Australian Aboriginal and Torres Strait Islander health managers.
(2000-12-13) Hill P.S.; Wakerman J.; Matthews S.; Gibson O.
Over the past thirty years in Australia, there has been a recognition of the need for increasing Aboriginal and Torres Strait Islander participation in the management of their health services as part of the strategy to improve the poor health of Australia's Indigenous peoples. The proliferation of Aboriginal Community-Controlled Health Services and the vigorous advocacy of groups such as the National Aboriginal Community Controlled Health Organisation have significantly contributed to this recognition. This, combined with additional management opportunities in government service, has drawn attention to difficulties in recruiting and retaining appropriately experienced Aboriginal and Torres Strait Islander managers, particularly in the northern states of Australia. (C) 2001 Elsevier Science Ltd.
Trauma and violence informed care through decolonising interagency partnerships: a complexity case study of Waminda's model of systemic decolonisation.
(2020-11-03) Cullen P.; Mackean T.; Worner F.; Wellington C.; Longbottom H.; Coombes J.; Bennett-Brook K.; Clapham K.; Ivers R.; Hackett M.; Longbottom M.
Through the lens of complexity, we present a nested case study describing a decolonisation approach developed and implemented by Waminda South Coast Women's Health and Welfare Aboriginal Corporation. Using Indigenous research methods, this case study has unfolded across three phases: 1) Yarning interviews with the workforce from four partner health services (n = 24); 2) Yarning circle bringing together key informants from yarning interviews to verify and refine emerging themes (n = 14); 3) Semi-structured interviews with a facilitator of Waminda's Decolonisation Workshop (n = 1) and participants (n = 10). Synthesis of data has been undertaken in stages through collaborative framework and thematic analysis. Three overarching themes and eight sub-themes emerged that centred on enhancing the capabilities of the workforce and strengthening interagency partnerships through a more meaningful connection and shared decolonisation agenda that centres Aboriginal and Torres Strait Islander families and communities. Health and social services are complex systems that function within the context of colonisation. Waminda's innovative, model of interagency collaboration enhanced workforce capability through shared language and collective learning around colonisation, racism and Whiteness. This process generated individual, organisational and systemic decolonisation to disable power structures through trauma and violence informed approach to practice.Copyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

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