Welcome to the Lowitja Institute Repository
This institutional research repository is for the work of the Lowitja Institute, Australia’s national Aboriginal and Torres Strait Research Institute. Our work focuses on the health and wellbeing of Aboriginal and Torres Strait Islander peoples and Indigenous peoples across the globe. This Repository tracks the research outputs of Lowitja Institute employees, funded researchers and scholars as well as showcases community-led Aboriginal and Torres Strait Islander health research.
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Recent Submissions
Racism and cultural safety for Indigenous general practice trainees: An exploratory study of how to support training, careers and professional wellbeing
(2025-02-14) Milroy T.; Frayne J.
Purpose
Racism as a social determinant of health has known impacts on the physical and mental health of Indigenous peoples, which extends to Indigenous doctors in training and is a barrier to the growth of the Indigenous health workforce in Australia. This study aimed to explore racism and cultural safety within the professional experiences of Australian Indigenous general practice (GP) trainees, to elucidate barriers and facilitators to their training, careers and professional wellbeing.
Methods
A sequential exploratory mixed methods study was conducted in 2020 and 2021 through an initial quantitative online administered questionnaire followed by qualitative semi-structured interviews with Indigenous GP registrars, from either metropolitan or rural areas, undertaking GP training in Australia. The main outcome measures included online responses to the Measure of Indigenous Racism Experiences (MIRE) questionnaire, which measures several dimensions of racism, and data from thematic analysis of semi-structured interviews undertaken following the online questionnaire.
Main findings
The MIRE questionnaire responses revealed experiences of racism across multiple levels. These findings were integrated and expanded with the central themes drawn from the interviews. Themes focused on GP training and training environments and operated across interactions with peers, supervisors and patients. The identified themes were i) cultural identity, with the subthemes of professional wellbeing and professional goals and identity; ii) training challenges, including racism and career development; and iii) training facilitators, including specific support and mentorship.
Principal conclusions
Australian Indigenous GP trainees value their cultural identity in relation to their professional goals and wellbeing. However, challenges for trainees centre around the lack of cultural safety and presence of racism, which is pervasive across their professional life. Strategies to address this could include further provision of specific support, specific culturally safe training placements, networking and mentorship.
Critical Indigenist examination of the impact on efficiency and sustainability of quality management systems in the Aboriginal primary health care.
(2025-01-23) Darr J.
Background: Two streams of business are primarily responsible for providing primary health care (PHC) at the first tier of the Australian health industry. These are general practice health services and Aboriginal community-controlled organisations (ACCOs). In 2008, the Australian federal government legislated a national framework for the Australian healthcare industry. In 2010, the Aboriginal community-controlled health sector (ACCHS) was mandated to apply a second certification standard known as ISO 9001:2015 to their business. Over the ensuing decade, our research explored the types of quality frameworks in practice and learned that general practice health services apply one accreditation standard: the Royal Australian College of General Practice (RACGP) Standard. Conversely, the ACCHS applies up to 11 mandated, multiple, yet different accreditation standards. There is an underlying assumption that quality management system (QMS) improves ACCO service performance, and this research tests this assumption.
Determining health professional students' self-perceived cultural capability following participation in clinical placement with Aboriginal and Torres Strait Islander Peoples: a systematic review.
(2024-12-20) Paisley K.; Sadler S.; West Wiradjuri M.; Gerrard J.; Wilson Wiradjuri R.; Searle A.; Chuter V.
Background: Collective evaluation of studies assessing students' self-perceived cultural capability following clinical placement is required to help inform future cultural capability training for both university and healthcare service environments. Therefore, the aim of this systematic review was to evaluate studies investigating health professional students' self-perceived cultural capability following participation in a clinical placement with First Nations Peoples. Methods: Electronic database searchers were conducted in MEDLINE, EMBASE, AMED, PsychINFO, Pubmed, CINAHL and Informit. Hand Searches of grey literature were conducted including Lowitja institute, Australian Indigenous HealthInfoNet, Menzies School of Health Research, Services for Australian Rural and Remote Allied Health, and the Australian Institute of Health and Welfare. Studies published in English that investigated health professional students' self-perceived cultural capability before and after clinical placement undertaken with First Nations people in Australia were eligible for inclusion. Two authors independently screened potentially eligible studies and performed quality appraisal and data extraction. Results: A total of 14 studies were included (n = 307 participants). Studies included undergraduate students from podiatry, medicine, nursing, pharmacy, and mixed health professions. The results of this systematic review suggest that clinical placements in health services or settings for Aboriginal and Torres Strait Islander Peoples that involve elements of co-design are effective in increasing aspects of health professional students' self-perceived cultural capability. This outcome was consistent across studies regardless of the location of clinical placements (urban or rural), type of clinical placement (health setting or Community), or length of placement. Conclusions: The findings from this systematic review suggest that clinical placement in health services or settings for Aboriginal and Torres Strait Islander Peoples may contribute to increased self-perceived cultural capability in health professions graduates. However, the impact of the placements on the cultural safety of student-led care, from a First Nations perspective, remains to be established.Copyright © 2024 The Author(s). Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.
Young Aboriginal people in Australia who have never used marijuana in the 'next generation youth well-being study': a strengths-based approach.
(2021-10-18) Graham S.; Heris C.L.; Gubhaju L.; Eades F.; Williams R.; Davis K.; Whitby J.; Hunt K.; Chimote N.; Eades S.J.
Background: Being young is a period of experimentation which can lead to increased vulnerability to poor health choices and outcomes. Aboriginal and Torres Strait Islander (Aboriginal) people have a long and strong history of resilience; however, a deficit approach is often taken with messages of poor health and low socioeconomic status. This study takes a strengths-based approach and examines the demographic factors and behaviours associated with never using marijuana among young Aboriginal people in Australia. Method(s): Overall, 521 Aboriginal people aged 16-24 years from Western Australia, Central Australia and New South Wales participated in the Next Generation: Youth Wellbeing Study. The baseline survey examined demographics, health-related behaviours and clinical indicators of young Aboriginal people. We calculated the number and proportion of young Aboriginal people who never used marijuana by demographics and behavioural factors. Logistic regression was used to assess the demographic and behavioural factors associated with never using marijuana. Result(s): Of the 521 participants, 458 (87.9%) answered the question about marijuana use of which 220 had incomplete demographic or behavioural questions, leaving a final cohort of 301 participants. A total of 174 (57.8%) had never used marijuana. A higher proportion of young Aboriginal people who never used marijuana were younger (16-19 years old), female, queer, single, lived in Central Australia, were students, had never smoked tobacco, had never drank alcohol, never had anxiety and never had depression. Never using marijuana was independently associated with being a parent or carer of a child (Adjusted Odds Ratio (AOR): 2.80, 95% CI: 1.03-7.59, p = 0.043), never smoking tobacco (AOR: 29.73, 95 CI: 13.32-66.37, p < 0.001), never drinking alcohol (AOR: 2.78, 95 CI: 1.12-6.93, p = 0.028), not having anxiety (AOR: 3.49, 95 CI: 1.19-10.23, p = 0.022), and having lower levels of distress (AOR: 2.63, 95 CI: 1.20-5.77, p = 0.016). Conclusion(s): Our study shows that more than half of young Aboriginal people did not use marijuana, smoke, or drink alcohol and that those who had not used marijuana had lower levels of distress.Copyright © 2021 Elsevier B.V.
Yarning about foot care: evaluation of a foot care service for Aboriginal and Torres Strait Islander peoples.
(2022-04-12) West M.; Sadler S.; Charles J.; Hawke F.; Lanting S.; Munteanu S.E.; Chuter V.
Background: Aboriginal and Torres Strait Islander Peoples have high rates of diabetes-related foot disease including foot ulcer and amputation. There has been limited evaluation of foot care services for Aboriginal and Torres Strait Islander Peoples. This project aimed to evaluate an Aboriginal and Torres Strait Islander foot care service (the Buridja Clinic) for prevention and management of diabetes-related foot disease embedded in a university podiatry program from a Community perspective using culturally appropriate methods. Method(s): This mixed-methods study took place from March 2018 to April 2021 in the Buridja Clinic on the Central Coast of New South Wales, Australia, and included an audit of occasions of service (March 2018 to March 2020), and review of the Buridja Clinic via research yarns with Aboriginal and Torres Strait Islander clients of the clinic and a written 10-item customised clinic feedback survey. Research yarns were transcribed and analysed thematically. Descriptive analysis of quantitative occasions of use and survey data was undertaken, with the open-ended survey responses thematically analysed. Result(s): Total occasions of service across the review period was 548, with a total of 199 individual clients treated. Most common service types were general treatments (nail and skin care) and diabetes assessments. Nine participants who attended the Buridja Clinic were recruited to the two research yarns. An additional 52 participants who attended the clinic completed the customised clinic feedback survey. Specific clinic design elements, including yarning circles and group booking as well as student placement, were identified as strengths of the clinic. Participants reported difficulty with transport and restricted opening hours and encouraged increased Community engagement by clinic staff. Conclusion(s): Evaluation of a foot care service for Aboriginal and Torres Strait Islander Peoples embedded in a university-based podiatry program demonstrated that the incorporation of specific service design elements, including yarning circles and group appointments as well as student placements, encouraged ongoing Community engagement with the service. Participants reported improved foot health, greater foot and self-care knowledge, and overall better general health and management as a result of attendance to the clinic. Consideration needs to be given to addressing limited access to transport and flexible operating hours when establishing similar services. Graphical abstract: [Figure not available: see fulltext.] Artist Jenni McEwen (Bundjalung) lives on Darkinjung Country. The story of her art shows people sitting in yarning circles sharing knowledges but looking outwards to connect with Country too, the Ochre of Wiradjuri Country around Wellington, and the Blue of Darkinjung Country around Central Coast. These are locations where podiatry service provision takes place. These are locations where everyone is sharing and learning. Students, teachers, patients, non-Indigenous people, and First Nations people, learning from each other, and learning from Country. Copyright © 2022, The Author(s).