Lowitja Funded Scholars

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Lowitja Institute Scholarships aim to support the next generation of Aboriginal and Torres Strait Islander health researchers. Our scholarships contribute to Aboriginal and Torres Strait Islander leadership of health research by providing opportunities for Aboriginal and Torres Strait Islander people to develop skills in areas relevant to meaningful health research. This collection contains the research publications from Lowitja supported scholars.
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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 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 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 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.
Aboriginal and Torres Strait Islander complex trauma and strengths questionnaire: psychometric evaluation.
Gee G.; Bright T.; Morgan A.; Atkinson C.; Andrews S.; Clark Y.; Glover K.; Hirvonen T.; Davis E.; Jones K.A.; Reilly R.; Mensah F.; Hudson-Buhagiar M.; Bennetts S.K.; Herrman H.; Milroy H.; Mackinnon A.; Chamberlain C.e
Objective: Complex post-traumatic stress disorder (complex trauma) describes a cluster of symptoms frequently associated with prolonged exposure to inescapable threats or abuse. For Aboriginal and Torres Strait Islander peoples in Australia impacted by complex trauma, there may be compounding factors, such as experiences of historical trauma, loss and socio-economic deprivation stemming from colonisation. However, there is no culturally appropriate tool to assess complex trauma. This paper presents the psychometric evaluation of a preliminary version Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ). Methods: Following 2 years of rigorous Aboriginal-led co-design, participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory (October 2020-May 2022). A trained interviewer contacted Aboriginal (n = 109) and Torres Strait Islander (n = 1) parents aged > 16 years by phone to complete the ACTSQ. Underlying domain structures were investigated with exploratory factor analysis and reviewed by experts to refine. Reliability and inter-rater reliability were assessed using McDonald's Omega and Intraclass Correlation Coefficient (ICC). Results: Forty-four items on five factors were retained. Factors were labelled complex trauma symptoms (16 items), grief, loss and disconnection (6 items), support and relationships (9 items), sense of self and strengths (7 items), and Cultural connections and resources (6 items). There were moderate correlations between factors, with the exception of factor 5. Omega was > 0.75 for all factors. The inter-rater reliability for each factor was fair to good (ICC 0.5-0.7). Conclusions: This study conducted a comprehensive psychometric validation that provides initial evidence towards the cultural validity of the ACTSQ to support assessment of complex trauma and strengths among Aboriginal and Torres Strait Islander peoples. Future studies are required to replicate and further evaluate the psychometric properties of the ACTSQ using larger samples. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Aboriginal experiences of cancer and care coordination: lessons from the cancer data and Aboriginal disparities (CANDAD) narratives.
(2019-06-19) Reilly R.; Micklem J.; Yerrell P.; Banham D.; Morey K.; Stajic J.; Eckert M.; Lawrence M.; Stewart H.B.; Brown A.
Background: Aboriginal people with cancer experience worse outcomes than other Australians for a range of complex and interrelated reasons. A younger age at diagnosis, higher likelihood of more advanced cancer or cancer type with poorer prognosis, geographic isolation and cultural and language diversity mean that patient pathways are potentially more complex for Aboriginal people with cancer. In addition, variation in the quality and acceptability of care may influence cancer outcomes. OBJECTIVE(S): This study sought to understand how care coordination influences Aboriginal people's experiences of cancer treatment. Methods: Interviews with 29 Aboriginal patients or cancer survivors, 11 carers and 22 service providers were carried out. Interviews were semi-structured and sought to elicit experiences of cancer and the health-care system. The manifest content of the cancer narratives was entered onto a cancer pathway mapping tool and underlying themes were identified inductively. Results: The practice of cancer care coordination was found to address the needs of Aboriginal patients and their families/carers in 4 main areas: "navigating the health system"; "information and communication"; "things to manage at home"; and "cultural safety". Conclusions: The CanDAD findings indicate that, when the need for cancer care coordination is met, it facilitated continuity of care in a range of ways that may potentially improve cancer outcomes. However, the need remains unmet for many. Findings support the importance of dedicated care coordination to enable Aboriginal people to receive adequate and appropriate patient-centred care, so that the unacceptable disparity in cancer outcomes between Aboriginal and non-Aboriginal people can be addressed.Copyright © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.
An ecological approach to health promotion in remote Australian Aboriginal communities.
(2010-05-20) McDonald E.; Bailie R.; Grace J.; Brewster D.
Poor environmental conditions and poor child health in remote Australian Aboriginal communities are a symptom of a disjuncture in the cultures of a disadvantaged (and only relatively recently enfranchised) minority population and a proportionally large, wealthy dominant immigrant population, problematic social policies and the legacy of colonialism. Developing effective health promotion interventions in this environment is a challenge. Taking an ecological approach, the objective of this study was to identify the key social, economic, cultural and environmental factors that contribute to poor hygiene in remote Aboriginal communities, and to determine approaches that will improve hygiene and reduce the burden of infection among children. The methods included a mix of quantitative and qualitative community-based studies and literature reviews. Study findings showed that a combination of crowding, non-functioning health hardware and poor standards of personal and domestic hygiene underlie the high burden of infection experienced by children. Also, models of health promotion drawn from developed and developing countries can be adapted for use in remote Australian Aboriginal community contexts. High levels of disadvantage in relation to social determinants of health underlie the problem of poor environmental conditions and poor child health in remote Australian Aboriginal communities. Measures need to be taken to address the immediate problems that impact on children's health-for example, by ensuring the availability of functional and adequate water and sanitation facilities-but these interventions are unlikely to have a major effect unless the underlying issues are also addressed.
"Anybody can make kids; it takes a real man to look after your kids": Aboriginal men's discourse on parenting.
(2019-11-27) Canuto K.; Towers K.; Riessen J.; Perry J.; Bond S.; Chee D.A.; Brown A.
Background The realms of parenting have long belonged to females. In many cultures it has been a female who has predominantly cared for and raised children. For many Aboriginal and Torres Strait Islander male parents this has resulted in them being largely overlooked from contributing to the parenting conversation. Predictably, such a dominant discourse has led to an inadequate distribution of opportunities available and a societal perception that Aboriginal and Torres Strait Islander male parents are disinterested in and/or disengaged from their parental roles and responsibilities, however, this is far from the truth. Methods This study is entrenched in an Indigenist research approach which privileges Indigenous lives, Indigenous knowledges and Indigenous voices, and utilised the Research Topic Yarning method to capture participants stories. Results Four yarning groups were conducted across South Australia in Coober Pedy, Yalata, Port Lincoln and metropolitan Adelaide. In total, 46 Aboriginal men contributed their experiences and stories of their roles and responsibilities as parents to this study. Men described being a dad as a privilege, emotionally fulfilling and rewarding and although at times it can be challenging, neglecting their roles and responsibilities are not considered options. Lack of employment and therefore financial security were described as a challenge to fatherhood especially for fathers who live in remote communities. Aboriginal culture, connection to country and family were identified as critical elements and strengths for Aboriginal male parents. Furthermore, Aboriginal male parents are yearning for opportunities to participate in parenting programs including men's parenting groups. Conclusion Consideration of and concern for Aboriginal and Torres Strait Islander men's involvement and experiences prior to conception, prenatal and postpartum has slowly gained momentum in recent years, yet there has been little improvement in the overall provision of appropriate parenting support services and/or programs for these men.Copyright © 2019 Canuto 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.
Associations between participation in a ranger program and health and wellbeing outcomes among Aboriginal and Torres Strait Islander people in central Australia: a proof of concept study.
(2018-07-24) Jones R.; Thurber K.A.; Wright A.; Chapman J.; Donohoe P.; Davis V.; Lovett R.
Culture can be viewed as an integral part of Aboriginal and Torres Strait Islander health and wellbeing. This study explores the association between caring for country, through participation in a Ranger program, and wellbeing. We analyzed cross-sectional data collected in Central Australia in 2017, comparing health and wellbeing (life satisfaction, general health, psychological wellbeing and family wellbeing) among Aboriginal and Torres Strait Islander peoples employed as Rangers (n = 43) versus not employed as Rangers (n = 160). We tested if any differences in outcomes were explained by differences in key demographic or health factors. Ranger participation was significantly associated with very high life satisfaction (PR = 1.69, 95% CI: 1.29, 2.20) and high family wellbeing (PR = 1.47, 95% CI: 1.13, 1.90); associations remained significant after individual adjustment for education, income, employment, health risk factors and health conditions. The magnitude and direction of associations were similar for very good general health, but results were not significant. We did not identify an association between Ranger participation and psychological wellbeing. While based on a small sample, these findings support the assertion that participation in the Ranger program is associated with positive health and wellbeing outcomes. This supports the continuation of cultural participation and practice through the Ranger program and has implications for funding, program and policy development.Copyright © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Blak women's healing: cocreating decolonial praxis through research yarns.
Balla P.; Jackson K.; Price R.; Quayle A.F.; Sonn C.C.
This article is informed by decolonial frameworks that seek to delink from ways of knowing, doing, and being that have served to oppress, racialize, and dehumanize communities. We share key insights developed through the intentional dialogues, the behind-the-scenes discussions, of our research collective in imagining and enacting the Blak women's healing project(s) as decolonial praxis. Within the culturally safe space of our community of practice, we shared stories of our past and present, stories about oppression, marginalization, and exclusion, as well as stories of survival, resistance, and love. We sought to engage with these stories to discern and document processes central to a decolonial praxis aimed at supporting Aboriginal women through the creation of a culturally safe, affirming, and intergenerational space for yarning together in and through cultural practice. The work is an enactment of solidarity that challenges the violence of colonialism, racism, and patriarchy that erase and/or delegitimize Aboriginal women's ways of knowing, doing, and being. These stories show the persistence of coloniality and its psychosocial effects, but also the everyday ways in which people resist, restore culture, and mobilize cultural practices for community. We suggest that these journeys of telling stories from below in counterspaces through embodied cultural practice are important strategies of decolonial resistance in the everyday and are expressions of Aboriginal sovereignty. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Public Significance Statement-Drawing on decolonial, feminist, and critical race methods of storytelling, especially the Aboriginal practices of yarning-we elevate stories shared by our research collective led by Aboriginal women. These stories convey various strategies and pathways of embodied resistance and recovery that have informed the development of the Blak Women's Healing project(s) as decolonial praxis. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Cancer outcomes for Aboriginal and Torres Strait Islander Australians in rural and remote areas.
(2017-04-05) Diaz A.; Whop L.J.; Valery P.C.; Moore S.P.; Cunningham J.; Garvey G.; Condon J.R.
Objective: To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Design: Systematic review and matched retrospective cohort study. SETTING: Australia. PARTICIPANTS: Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). MAIN OUTCOME MEASURES: Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Results: Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. Conclusion: More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians.Copyright © 2015 National Rural Health Alliance Inc.
Carers' perspectives on an effective Indigenous health model for childhood asthma in the Torres Strait.
Valery P.C.; Whop L.J.; Morseu-Diop N.; Garvey G.; Masters I.B.; Chang A.B.
Objective: To describe parents'/carers' views of the characteristics of a clinical service model shown to improve asthma outcomes. Design: A randomised controlled study on education intervention for childhood asthma by Indigenous health care workers. Setting: Thursday Island, Horn Island and Bamaga. Participants: Thirty-five children received the intervention and 53 were in the control group. At the last study visit 12 months after enrolment, carers were asked to give feedback about the clinical service delivered by paediatric respiratory physicians and the asthma education intervention. Intervention: Additional asthma education. Main outcome measures: Carers' responses to the open-ended questions were analysed separately by three Indigenous investigators who assigned codes and developed the themes. These were then cross-checked and combined to develop an overall interpretation of the data. Results: The carers (n = 81) of 88 children in the Torres Strait region of North Queensland reported positively to the clinical service delivery. Service was rated as excellent = 26.8%, very good = 51.2%, good = 19.5% and poor = 2.4%. Parents'/carers' views about the clinical service model were grouped into seven themes: clear communication by health professionals, service delivery, professional approach, clear transfer of knowledge and education/clinical knowledge of asthma, established rapport/caregiver satisfaction, importance of coming into the local community, and areas of concern for the carers/parents. Conclusion: Community-based perspectives of an effective health service model include empowered Indigenous health care workers currently attached to the medical specialist service with elements of high expertise and appropriate cultural awareness that enabled clear communication and transfer of knowledge. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Cervical abnormalities are more common among Indigenous than other Australian women: a retrospective record-linkage study, 2000-2011.
(2016-04-22) Whop L.J.; Baade P.; Garvey G.; Cunningham J.; Brotherton J.M.L.; Lokuge K.; Valery P.C.; O'Connell D.L.; Canfell K.; Diaz A.; Roder D.; Gertig D.M.; Moore S.P.; Condon J.R.
Indigenous Australian women have much higher incidence of cervical cancer compared to non-Indigenous women. Despite an organised cervical screening program introduced 25 years ago, a paucity of Indigenous-identified data in Pap Smear Registers remains. Prevalence of cervical abnormalities detected among the screened Indigenous population has not previously been reported. We conducted a retrospective cohort study of populationbased linked health records for 1,334,795 female Queensland residents aged 20-69 years who had one or more Pap smears during 2000-2011; from linked hospital records 23,483 were identified as Indigenous. Prevalence was calculated separately for Indigenous and non-Indigenous women, for cytology-detected low-grade (cLGA) and highgrade abnormalities (cHGA), and histologically confirmed high-grade abnormalities (hHGA). Odds ratios (OR) were estimated from logistic regression analysis. In 2010-2011 the prevalence of hHGA among Indigenous women (16.6 per 1000 women screened, 95% confidence interval [CI] 14.6-18.9) was twice that of non-Indigenous women (7.5 per 1000 women screened, CI 7.3-7.7). Adjusted for age, area-level disadvantage and place of residence, Indigenous women had higher prevalence of cLGA (OR 1.4, CI 1.3-1.4), cHGA (OR 2.2, CI 2.1-2.3) and hHGA (OR 2.0, CI 1.9-2.1). Our findings show that Indigenous women recorded on the Pap Smear Register have much higher prevalence for cLGA, cHGA and hHGA compared to non-Indigenous women. The renewed cervical screening program, to be implemented in 2017, offers opportunities to reduce the burden of abnormalities and invasive cancer among Indigenous women and address long-standing data deficiencies.Copyright © 2016 Whop 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.
Challenges in monitoring the development of young children in remote Aboriginal health services: clinical audit findings and recommendations for improving practice.
(20210615) D'Aprano A.; Silburn S.; Johnston V.; Bailie R.; Mensah F.; Oberklaid F.; Robinson G.
Introduction: Early detection of developmental difficulties is universally considered a necessary public health measure, with routine developmental monitoring an important function of primary healthcare services. This study aimed to describe the developmental monitoring practice in two remote Australian Aboriginal primary healthcare services and to identify gaps in the delivery of developmental monitoring services. Method(s): A cross-sectional baseline medical record audit of all resident children aged less than 5 years in two remote Aboriginal health centres in the Northern Territory (NT) in Australia was undertaken between December 2010 and November 2011. Result(s): A total of 151 medical records were audited, 80 in Community A and 71 in Community B. Developmental checks were more likely among children who attended services more regularly. In Community A, 63 (79%) medical records had some evidence of a developmental check and in Community B there were 42 (59%) medical records with such evidence. However, there was little indication of how assessments were undertaken: only one record noted the use of a formal developmental screening measure. In Community A, 16 (16%) records documented parent report and 20 (20%) documented staff observations, while in Community B, the numbers were 2 (3%) and 11 (19%), respectively. The overall recorded prevalence of developmental difficulties was 21% in Community A and 6% in Community B. Conclusion(s): This is the first study to describe the quality of developmental monitoring practice in remote Australian Aboriginal health services. The audit findings suggest the need for a systems-wide approach to the delivery and recording of developmental monitoring services. This will require routine training of remote Aboriginal health workers and remote area nurses in developmental monitoring practice including the use of a culturally appropriate, structured developmental screening measure. Copyright © James Cook University 2016, http://www.jcu.edu.au
Decolonising Australian psychology: the influences of Aboriginal psychologists.
Clark Y.; Hirvonen T.
Aboriginal and Torres Strait Islander peoples in Australia have been profoundly impacted by colonisation and continue to counter its affects by rebuilding language, regaining access to lands and living culture, and enhancing social and emotional wellbeing. The discipline of psychology has played a major role in perpetuating harm towards Aboriginal and Torres Strait Islander peoples by utilising oppressive and culturally biased mainstream psychological approaches. However, the discipline is slowly shifting with efforts to decolonise Australian psychology. This has been aided by Aboriginal and Torres Strait Islander psychologists and with the formation of the Australian Indigenous Psychologists Association (AIPA) which will be discussed and described within this chapter. Decolonising efforts are further illustrated by the experiences of two Aboriginal Clinical Psychologists who are aligned with community psychology paradigms and members of AIPA. The first example presents decolonising strategies that recognise and address the intersect amongst trauma, oppression, and lateral violence and outlines community awareness workshops. The second example discusses the inadequacy of mainstream psychology whilst advocating for multiple modalities for collective and traditional healing. Both psychologists within in their cultural practice and collectively within AIPA aim toward the improvement of social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Developing Aboriginal and Torres Strait Islander cultural indicators: an overview from Mayi Kuwayu, the national study of Aboriginal and Torres Strait Islander wellbeing.
(2022-08-23) Bourke S.C.; Chapman J.; Jones R.; Brinckley M.-M.; Thurber K.A.; Calabria B.; Doery K.; Olsen A.; Lovett R.
Background: For Aboriginal and Torres Strait Islander peoples, culture is foundational to health and wellbeing. However, its inherent conceptual complexity and diversity across and within different Aboriginal and Torres Strait Islander cultural groups means that it has rarely been explored in depth by epidemiological research. As a result, there are very few measures which adequately represent the heterogeneity and importance of Aboriginal and Torres Strait Islander cultures for health and wellbeing. Tools grounded in the social determinants of health are mostly based on European academic opinion about what constitutes culture and wellbeing, and the views of Indigenous peoples are rarely included. Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, developed a new survey tool based on health and wellbeing as perceived by Aboriginal and Torres Strait Islander people. This paper describes several of the key processes used to identify cultural domains and develop questionnaire items for the survey tool, reflecting the importance of culture to Aboriginal and Torres Strait Islander peoples. Method(s): Focus groups were conducted at community organisations and conferences with Aboriginal and Torres Strait Islander people. These sessions were aimed at identifying key cultural domains to be addressed by the Mayi Kuwayu questionnaire and to field test drafts of the questionnaire, which were then modified according to focus group feedback and expert input. Result(s): Extensive community consultations allowed us to identify key cultural domains, generate questionnaire items, and test initial content validity. The six overarching cultural domains identified during the development of the Mayi Kuwayu questionnaire were: Connection to Country; Beliefs and knowledge; Language; Family, kinship, and community; Cultural expression and continuity; and Self-determination and leadership. Conclusion(s): The processes used by Mayi Kuwayu have generated meaningful cultural items for use in Aboriginal and Torres Strait Islander health and wellbeing research. Further assessment of these processes, including a comparison with best practice guidelines and psychometric testing of the items and scales developed, will be conducted in a future program of work.Copyright © 2022, The Author(s).
Dilemmas in public health research: methodologies and ethical practice.
Baum F.
This chapter considers recent debates about the nature of public health research. It does this in terms of the methodologies and methods used in public health research and through consideration of ethical issues that have become apparent as lay people have questioned the style and usefulness of public health research. The term 'public health' can mean different things in different contexts. This chapter accepts a view of public health that has been described as the 'new public health' (Ashton and Seymour, 1988; Baum, 2002). It draws on the conceptualisation provided by a number of key international documents, including the World Health Organisation's series of documents and statements on health promotion (most importantly the Ottawa Charter for Health Promotion (WHO, 1986) and also The People's Charter for Health (People's Health Movement, 2000). (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Equity, gender and health: new directions for global men's health promotion.
(2020-04-12) Smith J.A.; Watkins D.C.; Griffith D.M.
Evaluation of a first peoples-led, emotion-based pedagogical intervention to promote cultural safety in undergraduate non-Indigenous health professional students.
(2021-11-20) Mills K.; Creedy D.K.; Sunderland N.; Allen J.; Carter A.; Corporal S.
Background: Undergraduate health students learn cultural safety in complex and emotional ways. Pedagogies that account for these complexities must be developed and evaluated. Objective(s): To evaluate a First Peoples-led emotion-based pedagogical intervention on non-Indigenous health professional students' development towards cultural safety. Design(s): A pre-post mixed-methods intervention design. Setting and participants: All undergraduate health students undertaking a semester-long First Peoples cultural safety course (n = 395) were invited to participate. Method(s): The intervention involved students' written reflections and comfort (1 = very uncomfortable to 5 = very comfortable) with workshop content, using a gawugaa-gii-mara (head, heart, hands) form. The educator analysed student responses collected on the form, to prompt discussion in a series of four workshops. Students also completed the online 20-item Student Emotional Learning in Cultural Safety Education Instrument (SELCSI) which has two scales, Witnessing and Comfort. gawugaa-gii-mara responses were thematically coded. Paired sample t-tests examined differences over time. Eta squared determined effect size. Result(s): There were 102 matched pre-post-intervention surveys. Both SELCSI scales had excellent internal consistency (Witnessing alpha = 0.80, Comfort alpha = 0.92). A statistically significant difference was observed between students' mean scores on the Witnessing scale prior to the course (M = 47.10, SD = 6.51) compared to post-course (53.04, SD = 4.80), t(95) = 8.70, p < 0.001 (two-tailed) with a large effect size (d = 0.88). Most Comfort scale items increased but were not statistically significant. Data from the gawugaa-gii-mara intervention (n = 162 written responses) revealed students were challenged by self-reflexivity. There was a disconnect between what students had learnt (gawugaa), what they had felt (gii) and how this would be applied in professional practice (mara). Conclusion(s): The First Peoples-led, emotions-based pedagogical intervention was brief, meaningful and effective. As students grappled with their emotional connection to self-reflexivity as well as their ability to translate new knowledge into culturally safe practice, these offer important avenues for future research. Copyright © 2021
Examining the transformative potential of emotion in education: a new measure of nursing and midwifery students' emotional learning in first peoples' cultural safety.
(2021-03-13) Mills K.; Creedy D.K.; Sunderland N.; Allen J.
Background: There is growing evidence that non-Indigenous health students engage with cultural safety content in complex emotional ways. Identifying those emotions may contribute to transformative learning. Objective(s): To develop and test a measure of student emotion using an approach that centres relevant theory and First Peoples' perspectives, values and lived realities. Design(s): This study used a descriptive, cohort design. Participants and setting: All health professional students enrolled in an undergraduate Australian First Peoples health course (n = 616) were invited to complete an online survey. Method(s): A staged approach to tool development included: (1) item generation; (2) response selection; (3) expert review; (4) pilot testing, and (5) psychometric testing of the 20-item draft tool. Tests included item analysis, principal components analysis with varimax rotation, subscale analysis, and internal reliability. Result(s): One hundred and nine surveys were analysed (17.7% response rate) predominantly from nursing and midwifery students (n = 96, 88.1%). Testing resulted in the development of the two-scaled Student Emotional Learning in Cultural Safety Instrument (SELCSI). The 12-item Witnessing scale revealed three factors explaining 62.17% of variance, and the 8-item Comfort scale had two factors explaining 67.62% of the variance. Cronbach's alpha showed good internal consistency (Witnessing scale alpha = 0.78; Comfort scale alpha = 0.88). There was a correlation between mean Witnessing (M = 50.06, SD 5.66) and Comfort (M = 32.44, SD 5.01) scores (r = 0.47, p < 0.001, 95% CI [0.304-0.643]). Conclusion(s): The two scales of students' emotional learning were found to have preliminary validity and reliability. Use of the tool has important theoretical, pedagogical and methodological considerations for cultural safety in nursing and midwifery education. This tool may contribute to understanding how nursing and midwifery students learn to practice in culturally safe ways. Copyright © 2021 Elsevier Ltd

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