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Biles, B. J., Serova, N., Stanbrook, G., Brady, B., Kingsley, J., Topp, S. M., & Yashadhana, A. (2024). What is Indigenous cultural health and wellbeing? A narrative review. The Lancet regional health. Western Pacific, 52, 101220. https://doi.org/10.1016/j.lanwpc.2024.101220
Indigenous cultural health is an emerging field of research and reflects the unique connections Indigenous peoples have with their Country, culture, and knowledge systems. This narrative review explores the concept of cultural health focusing on the interplay between culture, health, and wellbeing within settler colonial contexts. The review is mostly focused on Australian research, despite its international scope. A narrative review methodology was employed, search terms were compiled, and a title and abstract search was executed across two databases (Scopus, PubMed), confined to English language papers, with a focus on Australia. Three key themes were identified: Country; culture, and Indigenous knowledges. Country is vital to health. Culture practices offer frameworks for healing nurturing the relationship between people, Country and culture. Privileging Indigenous knowledges is a means to achieving health and wellbeing. Indigenous cultural health encompasses the interconnectedness of Country, people and culture, demanding a holistic approach that integrates Indigenous knowledges and practices. In Australia, these core components of cultural health must be situated in a contemporary context of ongoing colonisation. This narrative review underscores the importance of culturally centred approaches in addressing health inequities and enhancing the wellbeing of Indigenous peoples.
Marchand, M., McCallum, R. K., Marchand, K., Anand, S. S., Moulson, N., Taylor, C. M., & Dulay, D. (2024). Indigenizing Cardiac Rehabilitation: The Role for Cultural Adaptation. The Canadian journal of cardiology, 40(6), 1069–1076. https://doi.org/10.1016/j.cjca.2023.12.006
Cardiac rehabilitation (CR) is an integral component of cardiovascular care, which reduces morbidity and mortality, and improves quality of life. Largely as a result of Canada's colonial history, Indigenous communities face higher rates of cardiovascular morbidity and mortality. Indigenous Peoples in Canada have a unique cultural, historical, and geographic context that limits access to high-quality cardiovascular care, including CR, which has traditionally been delivered in an urban, hospital-based setting. Culturally adapted, holistic exercise and diet programs and CR programs have been successful in Canada, Australia, and New Zealand, demonstrating acceptability to the community, safety, and improvements in cardiovascular risk factors. Key components of a successful culturally adapted CR program include program leadership and development by Indigenous community members and key partners, cultural sensitivity training for health care providers and financial and geographic accessibility. Encouragement of traditional practices, including healthy traditional dietary practices, and recognizing land-based activities as exercise have also proved important in the successful delivery of CR in Indigenous communities. This review summarizes the current evidence for culturally adapted CR programming for Indigenous patients, including strategies to engage communities in education on cardiovascular risk-factor optimization and to promote guideline-based exercise and diet through an Indigenous lens.
McNeil, D., Elliott, S. A., Wong, A., Kromm, S., Bialy, L., Montesanti, S., Purificati-Fuñe, A., Juul, S., Roach, P., Bromely, J., Tailfeathers, E., Amyotte, M., & Oster, R. T. (2024). Indigenous maternal and infant outcomes and women's experiences of midwifery care: A mixed-methods systematic review. Birth (Berkeley, Calif.), 10.1111/birt.12841. Advance online publication. https://doi.org/10.1111/birt.12841
Background: The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge gap, we conducted a mixed-methods systematic review to understand Indigenous maternal and infant outcomes and women's' experiences with midwifery care. Methods: We searched nine databases to identify primary studies reporting on midwifery and Indigenous maternal and infant birth outcomes and experiences, published in English since 2000. We synthesized quantitative and qualitative outcome data using a convergent segregated mixed-methods approach and used a mixed-methods appraisal tool (MMAT) to assess the methodological quality of included studies. The Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSI QAT) was used to appraise the inclusion of Indigenous perspectives in the evidence. Results: Out of 3044 records, we included 35 individual studies with 55% (19 studies) reporting on maternal and infant health outcomes. Comparative studies (n = 13) showed no significant differences in mortality rates but identified reduced preterm births, earlier prenatal care, and an increased number of prenatal visits for Indigenous women receiving midwifery care. Quality of care studies indicated a preference for midwifery care among Indigenous women. Sixteen qualitative studies highlighted three key findings - culturally safe care, holistic care, and improved access to care. The majority of studies were of high methodological quality (91% met ≥80% criteria), while only 14% of studies were considered to have appropriately included Indigenous perspectives. Conclusion: This review demonstrates the value of midwifery care for Indigenous women, providing evidence to support policy recommendations promoting midwifery care as a physically and culturally safe model for Indigenous women and families.
James, M. H., Prokopiv, V., Barbagallo, M. S., Porter, J. E., Johnson, N., Jones, J., & Smitherson, T. (2024). Indigenous experiences and underutilisation of disability support services in Australia: a qualitative meta-synthesis. Disability and rehabilitation, 46(8), 1438–1449. https://doi.org/10.1080/09638288.2023.2194681
Purpose: Aboriginal and Torres Strait Islander People with a disability continue to experience barriers to service engagement such as mistrust of government services, lack of culturally appropriate support, marginalisation and disempowerment. This meta-synthesis reviews current literature regarding these experiences to explain why services are underutilised. Methods: The meta-synthesis was conducted using a meta-ethnographic approach to synthesise existing studies into new interpretive knowledge. The approach was supported by a search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).Results: Ten original research papers utilising a qualitative methodology were extracted. Synthesis of the articles revealed four concepts that were developed into a conceptual model. These include:1) History Matters; 2) Cultural Understanding of Disability Care; 3) Limitations to Current Service Provision; and 4) Delivery of Effective Services. Conclusions: Disability services do not adequately consider the cultural needs of Aboriginal and Torres Strait Islander People or communicate in a culturally appropriate manner. There are expectations that Aboriginal and Torres Strait Islander People acknowledge their disability in alignment with western definitions of disability in order to access services. More work is needed to align disability services with culturally appropriate support to provide better health outcomes. Implications for Rehabilitation Aboriginal and Torres Strait Islander people with a disability continue to experience barriers to service engagement which must be addressed. An essential gap that must be filled in providing disability services to Aboriginal and Torres Strait Islander people is the acknowledgment of culture as a resolute influence on all client interactions with providers. A cultural model of disability may better align with the experiences of Aboriginal and Torres Strait Islander people than current medical and social models used in healthcare. Disability services need to align better with culturally appropriate support to provide better health outcomes for Aboriginal and Torres Strait Islander people.
Clark Adnyamathanha, J. R., Buck Kamilaroi, J., Richards-Satour Adnyamathanha And Barngarla, A., Lyons Jaadwa, L., & Brown Yuin, A. (2024). Towards precision cancer medicine for Aboriginal and Torres Strait Islander cancer health equity. The Medical journal of Australia, 221(1), 68–73. https://doi.org/10.5694/mja2.52346
Delivering cancer control at scale for Aboriginal and Torres Strait Islander communities is a national priority that requires Aboriginal and Torres Strait Islander leadership and codesign, as well as significant involvement of the Aboriginal community-controlled health sector. The unique genomic variation observed among Aboriginal and Torres Strait Islander peoples may have implications for standard and precision medicine. Yet, Aboriginal and Torres Strait Islander peoples are absent from, or under-represented within, human reference genome resources, genomic studies, cancer studies, cancer cell lines, patient-derived xenografts and cancer clinical trials. Genomics-guided precision cancer medicine offers an opportunity to reduce cancer health disparities experienced by Aboriginal and Torres Strait Islander peoples through personalising prevention, diagnosis, treatment and long term management. Here, we describe what is required to ensure that Aboriginal and Torres Strait Islander peoples can receive the benefits of precision cancer medicine. Equity of access to care, an Aboriginal and Torres Strait Islander cancer workforce, and appropriate genome reference resources are important for safe and effective cancer medicine. Building Indigenous data sovereignty principles and Aboriginal and Torres Strait Islander governance into research is required to protect Aboriginal and Torres Strait Islander rights and collective interests. Aboriginal and Torres Strait Islander community engagement should be undertaken to develop an understanding of the unique cultural and ethical considerations for precision cancer research. Local and national genomic health research guidelines are needed to define a consensus best practice in genomics research with Aboriginal and Torres Strait Islander peoples.
Sines, J., Cai, K., Cashman, B., Abbott, P., Zengin, A., Manolios, N., & Wong, P. K. K. (2024). The burden of rheumatologic disease in Aboriginal and Torres Strait Islander Australians. Internal medicine journal, 54(10), 1603–1615. https://doi.org/10.1111/imj.16489
The objective of this article is to summarise the current knowledge regarding the prevalence of six rheumatological conditions in indigenous Australians - rheumatoid arthritis (RA), osteoarthritis (OA), osteoporosis (OSP), systemic lupus erythematosus (SLE), gout and musculoskeletal (MSK) pain. Online medical literature databases were searched for 'indigenous', 'Aboriginal' and 'Torres Strait Islander', as well as the names of the six conditions. Other included search terms were 'crystal', 'urate', 'arthritis' and 'arthropathy'. No limitations were placed on publication data or language. Forty-five articles examining the prevalence of the six conditions were identified. Based on the published literature, SLE appears to have a higher prevalence, while RA appears to have a lower prevalence in indigenous Australians compared to the non-indigenous community. MSK pain is prevalent, has a significant impact on indigenous people and is perceived as an important area of need. There is a paucity of data regarding these conditions in indigenous Australians. This may be impacted by the uncertainty of case ascertainment by self-report, differences in disease phenotypes and prevalence between the metropolitan compared to the rural or remote indigenous population, and difficulty with access to healthcare. Further studies in conjunction with local indigenous communities are needed to accurately determine the burden of rheumatological disease in the indigenous population. This will assist with resource and workforce planning to deliver culturally appropriate interventions. Strategies for future clinical work and research include the development and dissemination of culturally safe rheumatology resources, rheumatology training of Aboriginal Health Workers and wider integration of rheumatology clinics into community-controlled Aboriginal Health Services.
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.
