Lowitja Institute Repository

https://lowitja.intersearch.com.au/handle/1/1

We are Australia’s only Aboriginal and Torres Strait Islander community controlled health research institute, named in honour of our namesake and co-patron, the late Dr Lowitja O’Donoghue AC CBE DSG. We deliver high-impact quality research, knowledge exchange, and by supporting a new generation of Aboriginal and Torres Strait Islander health researchers. This repository contains information on Lowitja research outputs.
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A collaborative Indigenous-non-Indigenous partnership approach to understanding participant experiences of a community-based healthy lifestyles program.
(2021-08-27) Wild C.E.K.; Rawiri N.T.; Cormack D.M.; Willing E.J.; Hofman P.L.; Anderson Y.C.
We describe the approach of an Indigenous-non-Indigenous research partnership in the context of a qualitative study which aimed to understand barriers and facilitators to engagement in a community-based healthy lifestyles program in Aotearoa/New Zealand. Informed by Kaupapa Maori research principles and by "Community-Up" research values, this collaborative approach between the mixed Maori-non-Maori research team effectively engaged with Maori and non-Maori families for in-depth interviews on participant experience, including with non-service users. "Community-Up" research principles allowed for a respectful process which upheld the mana (status, dignity) of the interview participants and the research team. Challenges included maintaining flexibility in our conceptions of ethnicity to reflect the complexity of modern family life in Aotearoa/New Zealand. We were committed to ongoing communication, awareness, and attention to the relationships that formed the basis of our research partnership, which allowed effective navigation of challenges and was critical to the study's success.
A community-based co-designed genetic health service model for Aboriginal Australians.
(2021-01-15) Elsum I.; Massey L.; McEwan C.; LaGrappe D.; Kowal E.; Savarirayan R.; Baynam G.; Jenkins M.; Garvey G.; Kelaher M.
Background Aboriginal and Torres Strait Islander people experience a greater burden of disease and die younger than non-Indigenous Australians, with Aboriginal people living in remote areas of the Northern Territory of Australia having the lowest life expectancy estimates. Despite a high burden of chronic disease among Aboriginal and Torres Strait Islander people, access to specialist health services remains low and models of care that increase engagement, may improve health outcomes. Methods We describe client and staff perspectives of a model of clinical genetics services provided by the MJD Foundation (MJDF) in geographically and culturally complex contexts within the Northern Territory of Australia. We seek to understand the MJDF model's success in supporting Aboriginal families with the familial, neurodegenerative condition Machado-Joseph disease and how it could be applied in the provision of other specialist services. Thematic analysis was undertaken on semi-structured interviews with primary health care staff (n = 2), Non-Aboriginal MJDF Staff (n = 7) and Aboriginal MJDF Clients / Community workers (n = 13). Results Four key themes regarding the MJDF model of service delivery were identified with the service being; 1) client led 2) accepting of various understandings of genetic disease causation 3) focused on relationships, continuity and trust between the service provider and the clients, and 4) committed to incorporating an inclusive whole-of-family practice. The MJDF model takes a community-based, person-and family-centred approach to successfully deliver effective specialist genetic health services in remote community settings. We propose that these approaches have broad application in the future design and delivery of specialist health services particularly in culturally complex settings.Copyright © 2020 Elsum et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A comparative field efficacy trial of three treatment programs against endo- and ectoparasites in naturally infected dogs.
(2024-09-27) Raw C.; Traub R.J.; Wiethoelter A.
Introduction: Tropical climates in remote Aboriginal and Torres Strait Islander communities in northern Australia are conducive to the transmission of canine helminths such as hookworms, as well as ectoparasites such as fleas and ticks. In addition to their veterinary importance, these parasites may present a zoonotic risk either directly, or as potential vectors for bacterial pathogens. These factors necessitate efficacious and effective antiparasitic treatment programs for community dogs. Method(s): A cluster-randomised trial was performed on three islands in the Torres Strait to examine the short-term efficacy and medium-term effectiveness of three treatment programs. Treatments administered included oral oxibendazole/praziquantel (Paragard) and oral afoxolaner (Nexgard); topical moxidectin/imidacloprid (Advocate) and imidacloprid/flumethrin collars (Seresto); and off-label oral ivermectin (Bomectin). Canine faecal samples were collected and examined for endoparasites by faecal flotation and real-time PCR at baseline, 7-11 days after treatment and 6 months later. Result(s): The proportion of dogs positive for Ancylostoma caninum at baseline and negative at day 7-11 was 9% (95% CI 4.4-17.4) for dogs treated with oxibendazole, 56.4% (95% CI 41-70.7) for moxidectin, and 89.7% (95% CI 73.6-96.4) for ivermectin. Faecal flotation results showed a greater than 90% egg reduction in 29.2% (95% CI 19.9-40.5) of dogs treated with oxibendazole, 79.4% (95% CI 63.2-89.7) for moxidectin, and 95% (95% CI 76.4-99.1) for off-label ivermectin. Elimination of ectoparasite infestation was observed at day 7-11 in 69.9% (95% CI 56.7-80.1) of dogs treated with afoxolaner, 80% (95% CI 60.9-91.1) with imidacloprid/flumethrin collars, and 0% (95% CI 0-11.7) for off-label ivermectin. Mixed effects modelling revealed only treatment group to be significantly associated with outcome measures. Discussion(s): Based on these study results, the poor efficacy of oxibendazole against A. caninum renders it inept for treatment, while ivermectin and moxidectin were suitable. Ivermectin was unsuitable for ectoparasite treatment due to its poor efficacy, while afoxolaner and imidacloprid/flumethrin collars appear suitable.Copyright © 2024 Raw, Traub and Wiethoelter.
A comprehensive analysis of well-being frameworks applied in Australia and their suitability for Indigenous peoples.
Sangha K.K; Dinku Y.; Costanza R.; Poelina A.
Purpose: Well-being is a complex, multi-dimensional, dynamic, and evolving concept, covering social, economic, health, cultural and spiritual dimensions of human living, and often used synonymously with happiness, life satisfaction, prosperity, and quality of life. We review the existing key wellbeing frameworks applied in Australia both for the wider public and Indigenous peoples. The aim is to provide a comprehensive overview of various applied frameworks, along with a critical analysis of domains or dimensions comprising those frameworks, and to analyse the role of nature in those frameworks. Methodology: We conducted a critical analysis of the main frameworks applied in Australia to date to measure the well-being of the mainstream (mainly non-Indigenous) and Indigenous populations. This study is particularly timely given the Australian Government's interest in revising the well-being frameworks as mentioned in the Government "Measuring What Matters" statement. Results: The existing well-being frameworks in Australia either overlook or hardly consider the role of nature and its services which are important to support human well-being. Likewise, for Indigenous peoples "Country" (Indigenous clan land) is vital for their well-being as their living is imbued with "Country". The role of nature/"Country" needs to be considered in revising the well-being frameworks, indicators and measures to inform and develop appropriate policies and programs in Australia. Conclusion: To develop appropriate welfare policies and programs for achieving socio-economic and other wellbeing outcomes, it is essential to evolve and conceptualize wellbeing frameworks (and related indicators and measures) in line with people's contemporary values, particularly considering the role of nature and its services. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A critique of measures of emotion and empathy in First Peoples' cultural safety in nursing education: a systematic literature review.
(2022-04-04) Mills K.; Creedy D.K.; Sunderland N.; Allen J.; Corporal S.
Background: In Australia, undertaking cultural safety education often evokes strong emotional responses by health students. Despite the potential for emotion to drive transformative learning in this space, measures of emotion are uncommon. AIM: To review existing tools that intend to measure emotional components of learning in relation to cultural safety education. Methods: Articles published in English from January 2005 to January 2020; reported studies from Australia, New Zealand, Canada and United States of America; and measured an emotional construct/s after an education intervention offered to university students enrolled in a health programme were included. Studies were assessed for quality according to the Critical Appraisals Skills Programme criteria. Results: Eight articles were reviewed; five conducted in the United States of America, and three in Australia. Intervention type, measures, methodological rigour and outcomes varied. Studies predominately measured empathy, guilt and/or fear. Conclusions: Although students' emotional responses were measured, processes for students to reflect upon these reactions were not incorporated in the classroom. The review has implications for future research and curricula through developments in measuring and acting upon emotion in cultural safety education for nursing students in Australia.
A culturally responsive trauma-informed public health emergency framework for Aboriginal and Torres Strait Islander communities in Australia, developed during COVID-19.
(2022-12-24) Graham S.; Kamitsis I.; Kennedy M.; Heris C.; Bright T.; Bennetts S.K.; Jones K.A.; Fiolet R.; Mohamed J.; Atkinson C.; Chamberlain C.
The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples' livelihoods and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia continue to experience intergenerational trauma associated with colonization and may experience trauma-related distress in response to government responses to public health emergencies. We aimed to develop a culturally responsive trauma-informed public health emergency response framework for Aboriginal and Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led study involved: (i) a review of trauma-informed public health emergency responses to develop a draft framework (ii) interviews with 110 Aboriginal and Torres Strait Islander parents about how COVID-19 impacted their lives, and (iii) a workshop with 36 stakeholders about pandemic experiences using framework analysis to refine a culturally responsive trauma-informed framework. The framework included: an overarching philosophy (cultural humility, safety and responsiveness); key enablers (local leadership and Eldership); supporting strategies (provision of basic needs and resources, well-functioning social systems, human rights, dignity, choice, justice and ethics, mutuality and collective responsibility, and strengthening of existing systems); interdependent core concepts (safety, transparency, and empowerment, holistic support, connectedness and collaboration, and compassion, protection and caring); and central goals (a sense of security, resilience, wellbeing, self- and collective-efficacy, hope, trust, resilience, and healing from grief and loss).Copyright © 2022 by the authors.
A flow that comes when we're talking: water metaphors for exploring intercultural communication during early childhood assessment interactions in a Yolnu (First Nations Australian) community.
Armstrong E.; Maypilama L.; Bukulatjpi Y.; Gapany D.; Fasoli L.; Ireland S.; Baker R.D.; Hewat S.; Lowell A.; Yolnu
Culture mediates how all people think and communicate and intercultural communication skills are required for effective collaboration. This study (2017-2021) explored intercultural communication with 40 participants in one very remote First Nations Australian community in Northern Australia. We explored the perspectives of both Yolnu (First Nations Australian people from North-East Arnhem Land) and Balanda (non-Indigenous people, in this case Australian) on interactions during early childhood assessments of Yolnu children (0-6 years). Our intercultural research team used a culturally responsive form of video-reflexive ethnography, a Yolnu approach to in-depth discussion and collaborative analysis. In this article, we explore nine intercultural communication processes that were recognized and enacted by study participants. Each process is represented by a metaphor drawn from water traveling in North-East Arnhem Land. We share these processes so that others may consider exploring their relevance in other intercultural communication contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A framework for operationalising Aboriginal and Torres Strait Islander data sovereignty in Australia: results of a systematic literature review of published studies.
(2022-03-01) Trudgett S.; Griffiths K.; Farnbach S.; Shakeshaft A.
Background: Racial health disparities are only likely to be meaningfully improved by tailoring public health and clinical interventions to the specific needs of Indigenous people and their communities. Accurate tailoring relies on the availability of high-quality Indigenous-specific data. The potential benefits of increased availability of Indigenous data need to be balanced by efforts to ensure those data are collected and used appropriately. This paper identifies characteristics of Indigenous Data Sovereignty (IDS) principles and considers a framework for operationalisation. Method(s): A PRISMA compliant search of the literature was undertaken, using methods detailed in the Cochrane Collaboration Handbook on Systematic Reviews of Health Promotion and Public Health Interventions (1). The search strategy comprised two steps: a search of 11 scientific electronic databases and five grey literature sources. The search was limited by date of publication (1 January 2000 to 1 December 2021). The following keywords and subject heading terms were used: (exp Aboriginal and Torres Strait Islander or Aborigin* or Torres Strait Island* or, Oceanic ancestry group) and (exp research or biomedical research or population surveillance or translational medical research or, research design) and (exp data or datasets or data collection or data management or health surveys or information dissemination or, intellectual property) and (exp self-determination or ownership or control or access or possession or OCAP or sovereignty or, ethics) and, (exp Australia). IDS principles: (i) ownership; (ii) control; (iii) accessibility; (iv) custodianship; (v) accountability to Indigenous people; (vi) amplify Community voice; (vii) relevant and reciprocal; and (viii) sustainably self-determining. Using standard data extraction forms, we examined relevant Australian studies to identify key characteristics and frequency with which they cited IDS principles. These findings were consolidated into an operationalisation framework. Finding(s): 34 relevant Australian published studies were identified. The most frequently cited IDS principles were Accountability to Aboriginal and Torres Strait Islander peoples and sustainably self-determining. The least frequently cited principle was Access. A framework to operationalise IDS principles is proposed that is both standardised internationally and able to be tailored to the diverse contexts of Indigenous peoples. Interpretation(s): IDS is emergent in Australia and there is a clear need to establish an agreed set of International IDS principles and a framework for their operationalisation and contextualisation across diverse Indigenous communities and contexts. Funding(s): This research project is funded through an Australian Research Council (ARC) Discovery Grant from 2017 to 2022. The National Drug and Alcohol Research Centre (NDARC) is funded by the Australian Government Department of Health. The 1st author (ST) is supported by a scholarship co-funded by NDARC and the Lowitja Institute.Copyright © 2022 The Author(s)
A framework to assess cultural safety in Australian public policy.
(2020-12-29) Mackean T.; Fisher M.; Friel S.; Baum F.
The concept of cultural safety (CS) has been developed as a critical perspective on healthcare provided to Indigenous service users in neo-colonial countries such as New Zealand, Australia and Canada. Unlike other frameworks for culturally competent healthcare, a CS approach recognizes impacts of colonization and power inequalities on Indigenous peoples and asks how these may manifest in healthcare settings. It has been argued that CS thinking is suited to critical analysis of public policy, but there has been limited work in this direction. Drawing on literature on CS in Australian healthcare, we defined a CS framework consisting of five concepts: reflexivity, dialogue, reducing power differences, decolonization and regardful care. Our research examined whether and in what terms this framework could be adapted as a tool for critical analysis of Australian public policy as it affects Aboriginal and Torres Strait Islander peoples. We used a collaborative inquiry process combining perspectives of an Aboriginal researcher and a non-Indigenous researcher. We developed a thematic analysis framework to examine how the five concepts might be reflected in contemporary writings on policy by leading Aboriginal or Torres Strait Islander thinkers. We found the framework is applicable as a tool for policy analysis; bringing together key concerns raised by Aboriginal and Torres Strait Islander leaders and critical concepts such as sovereignty and interface thinking. We concluded the framework is likely to be a useful tool for critical, systemic thinking about public policy as it affects Indigenous peoples and for specifying areas where performance can be improved to achieve culturally safe policy.Copyright © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
A need for tailored programs and policies to reduce rates of alcohol-related crimes for vulnerable communities and young people: an analysis of routinely collected police data.
(2018-10-29) Snijder M.; Calabria B.; Dobbins T.; Knight A.; Shakeshaft A.
Background and aims: Given ongoing community concern about high rates of alcohol-related crimes (ARCs) experienced by disadvantaged populations, a more specific and nuanced understanding of factors associated with ARCs would help inform the development of more sophisticated programs and policies aimed at reducing ARCs. This study estimates rates of ARCs across all communities in New South Wales (NSW), Australia, using routinely collected police data; investigates whether there are differences between communities; and identifies individual and community characteristics that are significantly associated with higher rates of ARCs. Short summary: This study analysed routinely collected police data in New South Wales, Australia, to identify individual and community characteristics associated with alcohol-related crimes. Young people, Aboriginal Australians, socio-economically disadvantaged communities, remote and regional communities and communities with higher per capita rate of on-venue liquor licenses are at risk of alcohol-related crimes. Method(s): Age standardized rates of ARCs were calculated. A multi-level Poisson regression analysis was conducted to investigate the individual and community factors that were statistically significantly associated with higher rates of ARC, separately for Aboriginal and non-Aboriginal Australians. Result(s): Rates of ARCs were statistically significantly higher for Aboriginal Australians, young people (aged 13-37 years) and on weekends. ARCs varied significantly across communities, and were significantly higher in remote or regional communities, in communities with a higher per capita rate of on-venue licences, and for socio-economically disadvantaged communities for non- Aboriginal Australians, but not for Aboriginal females. Conclusion(s): This analysis shows that the impact of national-level and jurisdictional-level legislation and policies is uneven across communities and defined populations, leaving young people, socio-economically disadvantaged communities and Aboriginal Australians at increased risk of ARCs. To more equitably reduce the exposure of all Australians to ARC, mechanisms that effectively engage vulnerable communities and defined populations, need to be developed in consultation with them, implemented and evaluated.Copyright © 2018 The Author(s).
A network approach to policy framing: a case study of the national Aboriginal and Torres Strait Islander health plan.
(2016-11-24) Browne J.; de Leeuw E.; Gleeson D.; Adams K.; Atkinson P.; Hayes R.
Aboriginal health policy in Australia represents a unique policy subsystem comprising a diverse network of Aboriginal-specific and "mainstream" organisations, often with competing interests. This paper describes the network structure of organisations attempting to influence national Aboriginal health policy and examines how the different subgroups within the network approached the policy discourse. Public submissions made as part of a policy development process for the National Aboriginal and Torres Strait Islander Health Plan were analysed using a novel combination of network analysis and qualitative framing analysis. Other organisational actors in the network in each submission were identified, and relationships between them determined; these were used to generate a network map depicting the ties between actors. A qualitative framing analysis was undertaken, using inductive coding of the policy discourses in the submissions. The frames were overlaid with the network map to identify the relationship between the structure of the network and the way in which organisations framed Aboriginal health problems. Aboriginal organisations were central to the network and strongly connected with each other. The network consisted of several densely connected subgroups, whose central nodes were closely connected to one another. Each subgroup deployed a particular policy frame, with a frame of "system dysfunction" also adopted by all but one subgroup. Analysis of submissions revealed that many of the stakeholders in Aboriginal health policy actors are connected to one another. These connections help to drive the policy discourse. The combination of network and framing analysis illuminates competing interests within a network, and can assist advocacy organisations to identify which network members are most influential.Copyright © 2016 Elsevier Ltd
A pilot investigation into Aboriginal people's understandings of depression and anxiety.
Axleby-Blake T.; Bilney P.; Elliott P.; Evans C.; Fitz J.; Graham S.; Herbert P.; Kassman-Reid H.; Mills R.; Mundy D.; Naden M.; Peters R.; Moller J.; Malin M.
This project was conducted as part of the Certificate IV in Indigenous research capacity building in response to Aboriginal community concern about the extensive level of grief and high rates of psychological stress and mental illness being documented in Aboriginal communities. The research addressed the questions of what is known about depression and anxiety in Aboriginal communities, and how these conditions are dealt with and talked about. Thirteen semi-structured interviews were conducted with Aboriginal people working or studying at an Aboriginal community controlled health agency seeking people's stories about depression and anxiety. A survey questionnaire was then administered to 75 Aboriginal community people who were not health practitioners or teachers. The interviews were thematically analysed and the questionnaire data were analysed using Excel pivot tables. The project found that almost all the Aboriginal research participants had personal knowledge of someone suffering from depression or anxiety. All but two of the participants understood these to be serious conditions and had sound understandings of the antecedents, triggers, symptoms and long term impacts. Several stories were told of resilience where, despite harrowing life circumstances, people worked to overcome their depression or anxieties, in their own time, by becoming informed about the condition and, with professional support where necessary, devised strategies for managing them. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
A pilot study of the quality of informed consent materials for Aboriginal participants in clinical trials.
(2005-08-31) Russell F.M.; Carapetis J.R.; Liddle H.; Edwards T.; Ruff T.A.; Devitt J.
Objective: To pilot informed consent materials developed for Aboriginal parents in a vaccine trial, and evaluate their design and the informed consent process. Method(s): Cross sectional quantitative and qualitative survey of 20 Aboriginal and 20 non-Aboriginal women in Alice Springs. Information about the proposed research was presented to Aboriginal participants by an Aboriginal researcher, using purpose designed verbal, visual, and written materials. Non-Aboriginal participants received standard materials developed by the sponsor. Questionnaires were used to evaluate recall and understanding immediately and five days later. Qualitative analysis of Aboriginal participants' interviews was performed. Result(s): There were no differences between the groups in understanding of diseases prevented by the vaccine, the potential risks of participating, or the voluntary nature of participation. Most Aboriginal participants had difficulty with the concept of a "licensed" versus "unlicensed" vaccine. The non-Aboriginal group had a good understanding of this. Aboriginal participants identified the use of the flipchart, along with a presentation by a doctor and Aboriginal health worker, as preferred delivery modes. Group presentations were preferred rather than one-on-one discussions. The use of the questionnaire posed considerable methodological difficulties. Conclusion(s): A one-off oral presentation to Aboriginal participants is unlikely to produce "informed consent". Key but unfamiliar concepts require identification and particularly considered presentation.
A postcolonial analysis of Indigenous cultural awareness training for health workers.
Downing R.; Kowal E.
Indigenous cultural training for health workers is an increasingly popular intervention designed to improve the health services provided to Indigenous peoples in Australia. The provision of this training is based on the recognition that the measured discrepancy between Indigenous and non-Indigenous health outcomes is in part influenced by cultural difference and a history of racism in Australian society. Indigenous cultural training in Australia predominantly draws on a 'cultural awareness' framework which seeks to educate health workers about 'Indigenous culture'. To date, evaluations of Indigenous cultural training programs have found them to have questionable efficacy, although most of these evaluations have been methodologically inadequate. This article draws on postcolonial theory to explore the limitations of Indigenous cultural training as it is commonly conceptualised. Issues of essentialising 'Indigenous culture', 'otherness' and the absence of systemic responsibility for culturally appropriate health service provision are discussed. Finally, we consider future directions for Indigenous cultural training that are useful to both Indigenous service users and the health workers charged with 'closing the gap' between Indigenous and non-Indigenous health outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
A prospective evaluation of First People's health promotion program design in the Goulburn-Murray rivers region.
(2016-11-16) Doyle J.; Atkinson-Briggs S.; Atkinson P.; Firebrace B.; Calleja J.; Reilly R.; Cargo M.; Riley T.; Crumpen T.; Rowley K.
Background: Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and culturally safe services for First Peoples in Australia, including crisis intervention and health promotion activities, in a holistic manner. The ecological model of health promotion goes some way towards describing the complexity of such health programs. The aims of this project were to: 1) identify the aims and purpose of existing health promotion programs conducted by an alliance of ACCOs in northern Victoria, Australia; and 2) evaluate the extent to which these programs are consistent with an ecological model of health promotion, addressing both individual and environmental determinants of health. Method(s): The project arose from a long history of collaborative research. Three ACCOs and a university formed the Health Promotion Alliance to evaluate their health promotion programs. Local community members were trained in, and contributed to developing culturally sensitive methods for, data collection. Information on the aims and design of 88 health promotion activities making up 12 different programs across the ACCOs was systematically and prospectively collected. Result(s): There was a wide range of activities addressing environmental and social determinants of health, as well as physical activity, nutrition and weight loss. The design of the great majority of activities had a minimal Western influence and were designed within a local Aboriginal cultural framework. The most common focus of the activities was social connectedness (76 %). Physical activity was represented in two thirds of the activities, and nutrition, weight loss and culture were each a focus of about half of the activities. A modified coding procedure designed to assess the ecological nature of these programs showed that they recruited from multiple settings; targeted a range of individual, social and environmental determinants; and used numerous and innovative strategies to achieve change. Conclusion(s): First Peoples' health promotion in the Goulburn-Murray Rivers region encompasses a broad range of social, cultural, lifestyle and community development activities, including reclaiming and strengthening cultural identity and social connectedness as a response to colonisation. Copyright © 2016 The Author(s).
A systematic review and meta-analysis of human and zoonotic dog soil-transmitted helminth infections in Australian Indigenous communities.
(2022-12-16) Raw C.; Traub R.J.; Zendejas-Heredia P.A.; Stevenson M.; Wiethoelter A.
Soil-transmitted helminths (STH) infect 1.5 billion people and countless animals worldwide. In Australian Indigenous communities, STH infections have largely remained endemic despite control efforts, suggesting reservoirs of infection may exist. Dogs fulfil various important cultural, social and occupational roles in Australian Indigenous communities and are populous in these settings. Dogs may also harbour zoonotic STHs capable of producing morbidity and mortality in dogs and humans. This review provides an overview of human and zoonotic STH infections, identifies the Australian Indigenous locations affected and the parasite species and hosts involved. The meta-analysis provides estimates of individual study and pooled true prevalence of STH infections in Australian Indigenous communities and identifies knowledge gaps for further research on zoonotic or anthroponotic potential. A systematic literature search identified 45 eligible studies documenting the presence of Strongyloides stercoralis, Trichuris trichiura, Ancylostoma caninum, Ancylostoma duode-nale, Ancylostoma ceylanicum, undifferentiated hookworm, and Ascaris lumbricoides. Of these studies, 26 were also eligible for inclusion in meta-analysis to establish true prevalence in the light of imperfect diagnostic test sensitivity and specificity by Rogan-Gladen and Bayesian methods. These studies revealed pooled true prevalence estimates of 18.9% (95% CI 15.8-22.1) for human and canine S. stercoralis infections and 77.3% (95% CI 63.7-91.0) for canine A. caninum infections indicating continued endemicity, but consider-ably more heterogenous pooled estimates for canine A. ceylanicum infections, and A. duo-denale, undifferentiated hookworm and T. trichiura in humans. This review suggests that the prevalence of STHs in Australian Indigenous communities has likely been underestimated, principally based on imperfect diagnostic tests. Potential misclassification of hookworm species in humans and dogs due to outdated methodology, also obscures this picture. High-quality contemporary studies are required to establish current true prevalence of parasite species in all relevant hosts to guide future policy development and control decisions under a culturally sound One Health framework.Copyright © 2022 Raw et al.
A systematic review of barriers and facilitators to participation in randomized controlled trials by Indigenous people from New Zealand, Australia, Canada and the United States.
(2016-01-10) Glover M.; Kira A.; Johnston V.; Walker N.; Thomas D.; Chang A.B.; Bullen C.; Segan C.J.; Brown N.
Approach: The literature was systematically searched for published articles including information on the barriers and facilitators for Indigenous people's participation in health-related RCTs. Articles were identified using a key word search of electronic databases (Scopus, Medline and EMBASE). To be included, papers had to include in their published work at least one aspect of their RCT that was either a barrier and/or facilitator for participation identified from, for example, design of intervention, or discussion sections of articles. Articles that were reviews, discussions, opinion pieces or rationale/methodology were excluded. Results were analysed inductively, allowing themes to emerge from the data. Issue: Many randomized controlled trials (RCTs) are conducted each year but only a small proportion is specifically designed for Indigenous people. In this review we consider the challenges of participation in RCTs for Indigenous peoples from New Zealand, Australia, Canada and the United States and the opportunities for increasing participation. Key findings: Facilitators enabling Indigenous people's participation in RCTs included relationship and partnership building, employing Indigenous staff, drawing on Indigenous knowledge models, targeted recruitment techniques and adapting study material. Challenges for participation included both participant-level factors (such as a distrust of research) and RCT-level factors (including inadequately addressing likely participant barriers (phone availability, travel costs), and a lack of recognition or incorporation of Indigenous knowledge systems. Implication: The findings from our review add to the body of knowledge on elimination of health disparities, by identifying effective and practical strategies for conducting and engaging Indigenous peoples with RCTs. Future trials that seek to benefit Indigenous peoples should actively involve Indigenous research partners, and respect and draw on pertinent Indigenous knowledge and values. This review has the potential to assist in the design of such studies.Copyright © The Author(s) 2014.
A systematic review of EPDS cultural suitability with Indigenous mothers: a global perspective.
(2020-12-01) Chan A.W.; Reid C.; Skeffington P.; Marriott R.
The Edinburgh Postnatal Depression Scale (EPDS) is used extensively as the "gold standard" perinatal depression and anxiety screening tool. This study contributes to an emerging discussion about the tool's shortcomings, specifically around cultural suitability for use with Indigenous women. A systematic search was conducted in ProQuest, PsycINFO, MEDLINE (Web of Science), PubMed, Scopus, Informit, and CINAHL research databases, and grey literature. The quality of the body of evidence was assessed using the NHMRC Level of Evidence framework. Three studies supported the cultural validation of the EPDS with Indigenous groups in Canada (n = 2) and the USA (n = 1). The remaining eleven Australian studies demonstrated that cultural concerns were suggested by either Indigenous mothers, healthcare professionals (Indigenous and non-Indigenous), or both, though cultural concerns were more weighted from the perspectives of healthcare professionals. The quality of the evidence was not strong, and thus, there is a critical and urgent need for targeted research in this area. This review identified and recommended Indigenous-specific methodologies that can be adopted for more trustworthy, culturally safe, and effective research in this area. Given that the EPDS is currently considered gold standard in routine perinatal mental health screening practice in countries around the world, these findings raise significant concerns. Using culturally relevant research methodologies, such as the use of mixed-methods design, could lay stronger groundwork for further investigation of the broader utility and cultural relevance of the tool.Copyright © 2020, The Author(s).
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.
Aboriginal and Torres Strait Islander children with obesity: a review of programmes for children and young people aged 5-17 years.
(2023-03-17) Wallace S.; Scarcella M.; Sealy L.; Alexander S.; Zwi K.
A literature review of overweight and obesity prevention and management programmes for Australian Aboriginal and Torres Strait Islander children 5-17 years to inform a co-design weight management intervention in an urban Aboriginal community. Systematic searching of PubMed, Science Direct, Lowitja LitSearch and hand-searching of references, government and Aboriginal websites. Programmes were categorised as including nutrition and food literacy, cooking skills, health education and cultural components. Quality was assessed against the CREATE QAT Tool. Eight programmes, including two evaluations and six programme descriptions, were identified. Interventions ranged in duration from 1 day to 10 weeks involving nutrition education, health information, cooking skills, exercise and cultural content. There were no significant reductions in weight outcomes, although there were reported positive health changes to the children including a reduction in waist circumference and an increase in exercise levels. Insights for future research include effective co-design with community and the delivery of flexible content through an Aboriginal-led, multifaceted programme. There is limited evidence for the prevention and management of weight in Aboriginal children with overweight and obesity. Future research efforts should include more time-intensive, multifaceted, community-run programmes that are supported by medical, advocacy and evaluation expertise from health services.Copyright © 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

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