If you are unable to access full-text directly copy and paste the article title into SWSLHD Ovid Discovery to access the full-text or request document delivery. You may need to login using either your staff ID (for CIAP resources) or Athens (for SWSLHD LIbrary resources)
Ryder, C., D'Angelo, S., Sharpe, P., Mackean, T., Cominos, N., Coombes, J., Bennett-Brook, K., Cameron, D., Gloede, E., Ullah, S., & Stephens, J. (2024). Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families. Rural and remote health, 24(1), 8328. https://doi.org/10.22605/RRH8328
Introduction: Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay, than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which includes additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals. Methods: Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data. Results: A total of seven yarning sessions were conducted with 10 participants. Seven themes were identified: travel, barriers to health care, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets and not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden. Conclusion: Aboriginal families are significantly burdened by OOPHE when needing to travel for health care. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access that does not create additional financial hardship in communities already experiencing economic disadvantage.
PMID: 38670163
DOI: 10.22605/RRH8328
Kennedy, M., Longbottom, H., Mersha, A., Maddox, R., Briscoe, K., Hussein, P., . . . Bar-Zeev, Y. (2023). Which Way? Indigenous-led Smoking Cessation Care: Knowledge, Attitudes and Practices of Aboriginal and Torres Strait Islander Health Workers and Practitioners - A National Cross-sectional Survey. Nicotine Tob Res, 25(4), 788-795. https://doi.org/10.1093/ntr/ntac256
INTRODUCTION: Tobacco is the leading preventable cause of morbidity and mortality for Aboriginal and Torres Strait Islander people. Accordingly, the provisions of culturally safe and effective smoking cessation strategies are crucial. While previous research has suggested Aboriginal Health Workers/Practitioners are well placed to provide smoking cessation care, no research to date has explored the workforce knowledge, attitudes and practices in offering best practice cessation care. METHODS: A cross-sectional study was conducted among Aboriginal Health Workers/Practitioners from June to September 2021. Descriptive and inferential statistics were conducted to examine participant characteristics, provision of smoking cessation care, and explore the factors associated with smoking cessation care. RESULTS: Out of 1052 registered Aboriginal Health Workers/Practitioners, 256 participants completed the full survey (24.3%). Smoking cessation counseling was always provided by 41.9%; provided some of the time by 42.4%, and never provided by 12.9%. Combination NRT and Quitline referral were always offered by 23.1% and 44.9% of participants, respectively. Those that received training, felt smoking cessation care was part of their role, and were based in Aboriginal Community Controlled Health Organization were significantly more likely to offer best practice smoking cessation care. CONCLUSION: Aboriginal Health Workers/Practitioners and Aboriginal Community Controlled Health Organizations play a critical role in delivering high quality, evidence based and culturally safe care to Aboriginal and Torres Strait Islander people. Aboriginal Health Workers/Practitioners are well placed to offer smoking cessation care. Ongoing funding and implementation of a targeted smoking cessation workforce with appropriate training and resources are urgently required. IMPLICATIONS: Aboriginal Health Workers/Practitioners are well placed to offer culturally safe, best practice smoking cessation care. However, due to the magnitude and complexity of Aboriginal Health Workers/Practitioners roles, it is challenging for smoking cessation care to be consistently and feasibly integrated into usual care. Acknowledging Australia's National Preventative Health Strategy target of 27% or less Aboriginal and Torres Strait Islander people smoking by 2030, urgent investment and resourcing must be directed to building a skilled workforce to support quitting and maintaining smokefree behaviors, ensuring equitable access to smoking cessation care for Aboriginal and Torres Strait Islander peoples.
PMCID: PMC10032178
DOI: 10.1093/ntr/ntac256
Matsumoto, A., Blackburn, K., Spicer, B., Seear, K., & Johnson, C. (2023). A Mixed Methods Study of 15 Years of Aboriginal Health Research in the Kimberley: ‘We’ve Been Researched, We Think, from Head to Toe, Inside and Outside, Upside Down’. International Journal of Environmental Research and Public Health, 20(6), 4823. https://doi.org/10.3390/ijerph20064823
Indigenous peoples have long been the subjects of research, with the burden generally outweighing the benefit. This mixed methods study investigates the characteristics and outcomes of Aboriginal health research in the Kimberley region of Western Australia from 2006–2020 to inform future research practices. Quantitative data from projects submitted to the Kimberley Aboriginal Health Planning Forum Research Subcommittee were reviewed, and key characteristics were recorded and descriptively analysed. Fifteen individuals from a range of local organisations who were involved with research during this time participated in qualitative semi-structured interviews, including 11 Aboriginal people. The project team, including Aboriginal investigators, integrated quantitative and qualitative findings. Three major interview themes were questionable ‘research world’ behaviours; translation of findings and impact of research; and local involvement and control. The experiences of interviewees were congruent with quantitative data for the larger body of projects (N = 230). Most projects (60%) were not initiated within the Kimberley, with positive impact for local communities often not clear. There were, however, examples of Kimberley Aboriginal-led research excellence. A way forward includes research that is developed, driven, and led by the community; alignment with research priorities; local Aboriginal involvement that is resourced and acknowledged; and comprehensive knowledge translation plans embedded in projects.
DOI: 10.3390/ijerph20064823
Moloney, A., Stuart, L., Chen, Y., & Lin, F. (2023). Healthcare professionals' cultural safety practices for indigenous peoples in the acute care setting - a scoping review. Contemporary nurse, 59(4-5), 272–293. https://doi.org/10.1080/10376178.2023.2271576 Background: For Indigenous Peoples the disparities in health status are largely associated with the direct social determinants of invasion and colonisation, marginalisation, intergenerational traumas, and lack of conscious government policy to address these ongoing effects. There is currently limited evidence in the literature on what Cultural Safety practices mean in acute care settings. Objective: We aimed to understand the extent and type of evidence in relation to current knowledge and evidence regarding Cultural Safety practices for Indigenous Peoples in acute care settings. Design: This is a scoping review. Methods: We searched six databases in consultation with a librarian experienced in health research. Results: A total of 16 papers were included in the scoping review. Four main barriers to Cultural Safety in practice were identified; Among the included studies, only one quality improvement study reported an intervention, which improved culturally safe care. Conclusion: The four barriers identified each have a variable impact on Indigenous Peoples' health outcomes and are dependent upon the circumstances and experiences of both Indigenous Peoples and healthcare professionals.
Calvin, Z., Skinner, J., Dimitropoulos, Y., Stan, G., Satur, J., Cartwright, S., Widmer, R. P., Schafer, T., Williams, R., Sohn, W., Raphael, S., Bradley, C., Parter, C., Blatchford, L., Rambaldini, B., Partridge, S. R., Cain, E., & Gwynne, K. (2022). The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol. International Journal of Environmental Research and Public Health, 19(15), 9104. https://doi.org/10.3390/ijerph19159104
Background: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. Methods: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. Discussion: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. Trial registration: TRN: ISRCTN15496753 Date of registration: 20 October 2021.
DOI: 10.3390/ijerph19159104
Gatwiri, K., Rotumah, D., & Rix, E. (2021). BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. International journal of environmental research and public health, 18(9), 4399. https://doi.org/10.3390/ijerph18094399
Despite decades of evidence showing that institutional and interpersonal racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience 'epidemic' levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of 'doing' healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.
George, A., Villarosa, A. R., Ingram, S., Fatema, K., Elliott, K., Grace, R., . . . Comino, E. (2021). Oral health status, behaviours, food and beverage consumption of Aboriginal children in Australia. Health Promotion Journal of Australia, 32(2), 208-215. https://doi.org/10.1002/hpja.354 ISSUE ADDRESSED: Dental decay is prevalent among Australian Aboriginal children, yet little is known about their oral health-related behaviours. This study explored the oral health status, behaviours, food and beverage consumption of Aboriginal school children aged 7-9 years in Sydney, Australia. METHODS: Parents who were part of an existing longitudinal birth cohort ("Gudaga") were surveyed when their child was between 7 and 9 years. Children (n = 110) also received oral health screening by a trained nurse. RESULTS: A number of children (62%-91%) had at least one visible oral health problem across the 2 years. Around two thirds (62%-67%) of parents rated their child's oral health as excellent/very good and less than half the children (32%-45%) had received dental check-ups. Most children (79%-90%) brushed their teeth and drank water (97%) but more than half (57%-70%) also drank sugar sweetened beverages daily. CONCLUSIONS: Parents are instilling good oral health behaviours, however, the oral health screening suggests children are experiencing oral health issues of which parents may be unaware. Parents also seem to be unaware of beverage consumption practices that can increase the risk of childhood decay. SO WHAT?: The findings highlight the need for greater oral health awareness among Aboriginal families on how to recognise early symptoms dental decay and risk factors like sugar sweetened beverages among school going children. This suggests that existing health promotion strategies may not be reaching many Aboriginal families in the urban areas and more culturally appropriate programs may be needed.
DOI: 10.1002/hpja.354
Denney-Wilson, E., Fatema, K., Elcombe, E., Ingram, S., Harris, M., & Comino, E. (2020). Associations between rapid weight gain in infancy and weight status among urban Aboriginal children participating in the Gudaga study: nine-year results from a cohort study. BMC Pediatrics, 20(1), 224. https://doi.org/10.1186/s12887-020-02121-w
BACKGROUND: Rapid weight gain (RWG) in infants is associated with overweight and obesity in childhood and beyond, highlighting the need for early intervention. METHODS: Data from a birth cohort of Australian Aboriginal and Torres Strait Islander children living in an urban area were analysed to determine the prevalence of RWG in infancy and the association between RWG and overweight and obesity, categorised using both body mass index and waist to height ratio from birth to 9 years. RESULTS: The prevalence of overweight and obesity is higher in this cohort (at 47%) than the population average. The Australian population as a whole has seen steady increases. In this cohort although the prevalence of combined overweight and obesity remained relatively stable between 2 and 9 years, the proportion of children categorized as obese using BMI has increased. 42% of children who were overweight or obese at 9 years had experienced RWG in infancy. Children were 2.7 and 3.9 times more likely to be overweight at 9 years if they experienced RWG or were overweight at 2 years, respectively. CONCLUSION: RWG was common in this cohort and the strongest predictor of excess weight at 2 years and at 9 years. Early intervention is crucial in the first year of life across the whole population to prevent obesity in children. Culturally appropriate interventions developed with the community are required for Aboriginal and Torres Strait Islander babies and their parents.
DOI: 10.1186/s12887-020-02121-w
Kemp, L., Grace, R., Comino, E., Jackson Pulver, L., McMahon, C., Harris, E., . . . Mack, H. A. (2018). The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: a quasi-experimental trial - the Bulundidi Gudaga study. BMC Health Services Research, 18(1), 599. https://doi.org/10.1186/s12913-018-3394-1 BACKGROUND: In Australia there is commitment to developing interventions that will 'Close the Gap' between the health and welfare of Indigenous and non-Indigenous Australians and recognition that early childhood interventions offer the greatest potential for long term change. Nurse led sustained home visiting programs are considered an effective way to deliver a health and parenting service, however there is little international or Australian evidence that demonstrates the effectiveness of these programs for Aboriginal infants. This protocol describes the Bulundidi Gudaga Study, a quasi-experimental design, comparing three cohorts of families from the Macarthur region in south western Sydney to explore the effectiveness of the Maternal Early Childhood Sustained Home-visiting (MECSH) program for Aboriginal families. METHODS: Mothers were recruited when booking into the local hospital for perinatal care and families are followed up until child is age 4 years. Participants are from three distinct cohorts: Aboriginal MECSH intervention cohort (Group A), Non-Aboriginal MECSH intervention cohort (Group B) and Aboriginal non-intervention cohort (Group C). Eligible mothers were those identified as at risk during the Safe Start assessment conducted by antenatal clinic midwives. Mothers in Group A were eligible if they were pregnant with an Aboriginal infant. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant. Mothers in Group C are part of the Gudaga descriptive cohort study and were recruited between October 2005 and May 2007. The difference in duration of breastfeeding, child body mass index, and child development outcomes at 18 months and 4 years of age will be measured as primary outcomes. We will also evaluate the intervention effect on secondary measures including: child dental health; the way the program is received; patterns of child health and illness; patterns of maternal health, health knowledge and behaviours; family and environmental conditions; and service usage for mothers and families. DISCUSSION: Involving local Aboriginal research and intervention staff and investing in established relationships between the research team and the local Aboriginal community is enabling this study to generate evidence regarding the effectiveness of interventions that are feasible to implement and sustainable in the context of Aboriginal communities and local service systems. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001721493 Registered 14 Dec 2016. Retrospectively registered.
DOI: 10.1186/s12913-018-3394-1
George, A., Grace, R., Elcombe, E., Villarosa, A. R., Mack, H. A., Kemp, L., . . . Comino, E. (2018). The oral health behaviours and fluid consumption practices of young urban Aboriginal preschool children in south-western Sydney, New South Wales, Australia. Health Promotion Journal of Australia, 29(1), 23-30. https://doi.org/10.1002/hpja.29 ISSUE ADDRESSED: Australian Aboriginal children have a higher risk of dental caries yet there is limited focus on oral health risk factors for urban Aboriginal preschool children. This study examined the oral health behaviours and fluid consumption practices of young children from an urban Aboriginal community in south-western Sydney, Australia. METHODS: In total, 157 Aboriginal children who were recruited to the "Gudaga" longitudinal birth cohort participated in this study. A survey design was employed and parents responded to the oral health questions when their child was between 18 and 60 months. RESULTS: Few parents (20%) were concerned about their child's oral health across the time period. By 60 months, only 20% of children had seen a dentist while 80% were brushing their teeth at least once daily. High levels of bottle use were seen up to 30 months. Consumption of sugary drinks was also very high in the early years, although this was replaced by water by 36 months. CONCLUSIONS: While there are some encouraging findings, such as the rates of tooth brushing and increasing rates of water consumption, the findings do highlight the poor uptake of dental services and high levels of bottle usage among urban aboriginal children during their early years. SO WHAT?: Targeted oral health promotional programs are needed in the urban Aboriginal community to better support parents understanding of good oral health practices in the early years and engagement with dental health services.
DOI: 10.1002/hpja.29
Short, K., Eadie, P., Descallar, J., Comino, E., & Kemp, L. (2017). Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors. Child Care Health and Development, 43(6), 906-917. https://doi.org/10.1111/cch.12492 BACKGROUND: Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non-Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non-Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes. AIM: To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development. METHOD: One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research. RESULTS: Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non-verbal cognitive skills had vocabulary skills that remained below those with stronger non-verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age. CONCLUSIONS: The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non-verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.
DOI: 10.1111/cch.12492