Search

Assessing future demand for a wide range of services requires good quality population forecasts. Unfortunately, many past forecasts of the Aboriginal and Torres Strait Islander (Indigenous) population of Australia have proved highly inaccurate. This is due to poor data quality, missing data, and demographers' incomplete understanding of Indigenous population change. In addition, because Indigenous population estimates are published only every 5 years and long after the reference date, forecasts are often used as preliminary population estimates. These form the denominators of various metrics used to monitor programmes aimed at improving health and social outcomes. The aim of this paper is to present an evaluation of alternative forecasting models and forecasts of the Indigenous population of Australia's States and Territories by age and sex. Four models, differing substantially in complexity, were evaluated: (1) the simple Hamilton–Perry method, (2) the synthetic migration cohort-component model, (3) a uniregional cohort-component model with net migration, and (4) a bi-regional cohort-component model. The population forecasting methods were evaluated against several criteria, including forecast accuracy over the 2016–21 period, input data requirements, conceptual adequacy, output detail, time required to prepare, ability to create scenarios and select alternative assumptions, and ease of implementation. The Hamilton–Perry and synthetic migration cohort-component models provided greater forecast accuracy and scored well against the evaluation criteria. In the challenging data environment for modelling Indigenous populations, simpler forecasting methods offer several practical advantages and are likely to produce more accurate forecasts than more data-intensive models. [ABSTRACT FROM AUTHOR]

Simple Summary: The current evidence regarding Indigenous* women and breast cancer in Australia shows lower prevalence but higher mortality rates. There are a range of reasons for this, including co-morbidities, lack of access to health services and low health information fluency. Perhaps most importantly, breast cancer health policy and service delivery practice do not meet the needs of Indigenous women in Australia, according to Indigenous women. Talking and listening to Indigenous women about breast cancer highlight that the solutions to improve breast cancer outcomes are available and that they are not complex. Indigenous women must be involved in the improvement of policy and practice in order for these outcomes to improve. *Terminology: We respectfully refer to Aboriginal and Torres Strait Islander people as "Indigenous". In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia. This research employed the Context–Mechanism–Outcome (CMO) framework to reveal potential mechanisms and contextual factors that influence breast cancer outcomes for Indigenous women, stratified into multiple levels, namely, micro (interpersonal), meso (systemic) and macro (policy) levels. The CMO framework allowed us to interpret evidence regarding Indigenous women and breast cancer and provides nine practical ways to improve health outcomes and survival rates. [ABSTRACT FROM AUTHOR]

Concern exists that the growing over-representation of Aboriginal and Torres Strait Islander children and young people in out-of-home care (OOHC) across Australia is perpetuating historical, discriminatory child removal policies and practices. The disproportionate number of Indigenous children in OOHC is increasing at the same time as growing multi-jurisdictional policy and legal mandate for Indigenous self-determination, leadership, and cultural connectedness in the OOHC space. This study aims to provide evidence and instruction to social work educators, policymakers and practitioners in Australia's complex child protection, wellbeing, and justice systems about why and how Aboriginal and Torres Strait Islander-controlled organizations are best placed to lead OOHC service delivery for Indigenous children, their family and community. The qualitative research, located in Queensland, engages the knowledge and experience of Elders, Indigenous child safety professionals and Aboriginal and Torres Strait Islander young adults who have recently exited OOHC to explore the importance of Indigenous-led OOHC service provision for generating genuine, intergenerational systemic change. Ten themes or authoritative Directives to non-Indigenous stakeholders are elicited and discussed. The paper concludes with three recommendations that press for a shift in the Western values and practices that underscore the monitoring and evaluation of Indigenous-led OOHC service providers by government. [ABSTRACT FROM AUTHOR]

In contrast to most Western jurisdictions, social work in Australia is not currently a registered profession. However, in late 2021, the South Australian Parliament passed a Bill to register social workers in that state. This follows a long‐standing but previously unsuccessful campaign by the Australian Association of Social Workers (AASW) to attain social work registration at a national level. Yet, to date, there has been no empirical research on the views of social workers—whether members or the AASW or not—concerning the merits of registration. This paper presents the findings of a qualitative study of the views of 15 social workers regarding registration. The findings suggest that the profession holds diverse views concerning the potential benefits or harms emanating from registration. Some conclusions are drawn regarding priorities for future research including particularly the impact of registration on Aboriginal and Torres Strait Islander social workers and service users. [ABSTRACT FROM AUTHOR]

Contemporary Australian planning has for too long ignored its fundamental responsibilities in its relations with Aboriginal and Torres Strait Islander peoples in urban and regional Australia. Australian land-use planning and development processes do not have a good track record of taking account of the rights and interests of Aboriginal and Torres Strait Islander peoples, or of adequately involving them, especially in our capital cities and major regional centres where the larger proportion of Aboriginal and Torres Strait Islander peoples live and the where the extent of dispossession is perhaps at its greatest. It is a sad indictment of our planning system that more than 30 years after the High Court of Australia's landmark decision in Mabo (No. 2), that most of the planning statutes around Australia still do not require prior consultation with or the direct involvement of registered native title holders or claimants during plan formulation or decision-making about land uses for an area of land or waters. This paper examines the current state of affairs with respect to how well or otherwise our planning statutes still fail to give adequate recognition to Aboriginal and Torres Strait Islander peoples' rights and interests in contemporary statutory planning processes. [ABSTRACT FROM AUTHOR]

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. 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. [ABSTRACT FROM AUTHOR]

This paper examines the University of Sydney Library's development and piloting of a methodology to survey its Aboriginal and Torres Strait Islander cultural collections, to enhance catalogue metadata and allow culturally sensitive material to be identified and protected. The research falls broadly within the interpretivist epistemology and draws methodologically on Participative Action Research. The pilot survey was conducted using a qualitative, collection-based approach, more specifically Direct Collection Analysis. A broad syntax was used to identify cultural content within the catalogue metadata, and items individually examined to determine the nature of their contents. The findings surface the benefits and shortcomings of the initial methodology. It is recommended future surveys be conducted using more specific terminology checklists and undertaken by a dedicated team that has received care and handling training for cultural materials and is led by an Aboriginal or Torres Strait Islander expert in cultural collections. [ABSTRACT FROM AUTHOR]

Introduction: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018–2019. This paper seeks to better understand smoke‐free behaviours, and to systematically quantify associations between a range of SDOH and non‐smoking/never‐smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. Objective: To explore the social determinants of health (SDOH) related to non‐ and never‐smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Design: Cross‐sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never‐smokers and non‐smokers (ex‐ and never‐smokers). The social determinants of health exposures related to socioeconomic position, well‐being and access to healthcare. Setting: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018–2019. Participants: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). Results: High income was associated with non‐smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66–2.57) and never‐smoking (PR = 2.02; 1.46–2.79), as was completing year 10 (non‐smoking PR = 1.34; 1.12–1.61 and never‐smoking PR = 1.56; 1.20–2.03). Better food security was associated with a higher prevalence of never‐smoking (PR = 2.42; 1.48–3.98). Lower psychological distress scores were associated with non‐smoking (PR = 1.30; 1.10–1.53) and never‐smoking (PR = 1.56; 1.21–2.01). Never‐smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22–2.06). Having a usual healthcare provider was associated with non‐smoking (PR = 1.38; 1.02–1.86). Positive exposure to the SDOH were associated with non‐ and never‐smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non‐smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

Objectives: We set out to examine the volume, scope and quality of research related to First Nations peoples' perceptions of, and experiences with, child rearing and/or parenting programs. Methods: We systematically reviewed the literature published between 2000 and 2020. Sixty-eight studies identified through electronic databases and references lists met inclusion criteria. Results: The study found an 8% increase in publications in the field each year (P -value = 0.002), mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 29, 41%). Scope included positive and negative experiences relating to: parenting from adult (n = 19 studies) and teenager (n = 4) perspectives; and pregnancy, antenatal and postnatal care from the perspective of adults (n = 23) and teenagers (n = 2). Descriptive studies included qualitative (n = 40; 58%), quantitative (n = 8, 12%) or mixed methods (n = 7, 10%). Thirteen experimental studies reported the development, acceptability and/or effectiveness of programs (19%), of which three met the Cochrane Effective Practice and Organisation of Care design criteria. Conclusions: Despite an overall increase in volume, research efforts do not demonstrate a clear scientific progression. Further methodologically rigorous studies examining child rearing and/or parenting programs developed in collaboration with First Nations populations are needed. What is known about the topic? Examining research output, effectiveness and acceptability of existing existing parenting and child rearing programs for First Nations parents can inform research priorities and service development.. What does this paper add? Rigorous research to inform the development and evaluation of parenting programs is limited. Strengths-based, community-wide approaches should integrate community identities, expertise and resources, encourage ownership and engagement, and build capacity.. What are the implications for practitioners? Continued efforts are necessary to develop programs uniquely informed by, and tailored to, First Nations parents. [ABSTRACT FROM AUTHOR]

The gap between Aboriginal and Torres Strait Islander and non-Indigenous health, education, mental health, and social and emotional wellbeing remains a major concern. Bridging these gaps and working in culturally safe and responsive ways with people of Aboriginal and Torres Strait Islander descent presents considerable challenges, including for the discipline and profession of psychology. At the Australian Psychological Society's ( APS) inaugural congress in September 2016, the APS issued an Apology to Aboriginal and Torres Strait Islander people. The apology was a formal acknowledgment of the role of the discipline and profession of psychology in failing to listen and show respect to Indigenous Australians. The apology was also a commitment to change. This paper provides the background and context to, and motivation for, the apology. The APS received highly positive reactions to the apology across Australia and internationally. However, further change and work needs to be undertaken as the challenge for the discipline and profession now is to demonstrate a commitment to the apology by supporting and engaging in culturally safe practices. [ABSTRACT FROM AUTHOR]

Copyright of Australian Journal of Political Science is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: There is currently little nationally representative diagnostic data available to quantify how many Aboriginal and Torres Strait Islander people may need a mental health service in any given year. Without such information, health service planners must rely on less direct indicators of need such as service utilisation. The aim of this paper is to provide a starting point by estimating the prevalence ratio of 12-month common mental disorders (i.e. mood and anxiety disorders) for Indigenous peoples compared to the general Australian population. Methods: Analysis of the four most recent Australian Indigenous and corresponding general population surveys was undertaken. Kessler-5 summary scores by 10-year age group were computed as weighted percentages with corresponding 95% confidence intervals. A series of meta-analyses were conducted to pool prevalence ratios of Indigenous to general population significant psychological distress by 10-year age groups. The proportion of respondents with self-reported clinician diagnoses of mental disorders was also extracted from the most recent survey iterations. Results: Indigenous Australians are estimated to have between 1.6 and 3.3 times the national prevalence of anxiety and mood disorders. Sensitivity analyses found that the prevalence ratios did not vary across age group or survey wave. Conclusions: To combat the current landscape of inequitable mental health in Australia, priority should be given to populations in need, such as Indigenous Australians. Having a clear idea of the current level of need for mental health services will allow planners to make informed decisions to ensure adequate services are available. [ABSTRACT FROM AUTHOR]

A clear understanding of the nature and extent of suicidal behaviour and other mental health issues in Aboriginal and Torres Strait Islander populations has been limited by the national failure to develop clinically and culturally valid assessments and to ensure the cultural competence of practitioners. The default position for Australian mental health researchers is to continue to adapt existing mainstream assessments. The problem with this approach is it doesn't enable researchers to determine culture-specific symptoms or phenomena that are critical to establishing true cultural validity. The mental health field needs culturally co-designed psychometric tools to capture culture-specific expression and manifestation of symptoms, and to capture culture-specific symptoms. Two such tools exist: the WASC-Y and WASC-A. However, there are few data on their psychometric properties beyond the initial developmental research reported in the test manuals. This needs to be a focus for future research. What is already known about this topic: Aboriginal and Torres Strait Islander people in Australia have suicide rates that are at least twice that of non-Indigenous Australians. Research into Aboriginal and Torres Strait Islander people's mental health is limited by the continued failure to use culturally valid, psychometrically sound, and clinically valid screening tools. For decades researchers have been drawing attention to the need for screening tools and other psychological assessments to be specifically validated for use with Aboriginal and Torres Strait Islander people. What this paper adds: Some attempts have been made to develop culturally valid tools or to validate mainstream instruments for use with Aboriginal and Torres Strait Islander people, but these tools are significantly limited. Attempting to validate mainstream instruments with Aboriginal and Torres Strait Islander people fails to determine unique aetiologies and explain the over-representation of Indigenous people in suicide deaths. The Westerman Aboriginal Symptom Checklists are culturally and clinically valid screening tools that warrant further exploration of their value in addressing the unacceptable gaps in understanding the nature and extent of mental health problems and suicidal behaviour among Aboriginal people. [ABSTRACT FROM AUTHOR]

Objective: Aboriginal and Torres Strait Islander women (hereafter Aboriginal) and their babies experience poor health outcomes for which smoking is a major risk factor. This paper explores Aboriginal women's perspectives on and experiences of smoking cessation, within and outside pregnancy, and their use of smoking cessation services using the COM‐B (Capability, Opportunity, Motivation as determinants of Behaviour) model to understand Aboriginal women's capabilities, opportunities, and motivation for smoking cessation. Methods: Data came from 11 focus groups conducted in regional New South Wales, Australia, with 80 women aged between 16 and 68 years. Thematic analysis was performed following the COM‐B model. Results: Seven themes related to capability, opportunity, motivation, and smoking cessation behaviors were identified. The themes highlighted that agency, knowledge, and self‐efficacy (as capability), a supportive social environment, and access to culturally appropriate services and resources (as opportunities), together with automatic and reflective motivations for quitting, may enable short‐ or long‐term smoking cessation. Conclusion: Smoking cessation interventions may be more effective if the dynamics of the COM‐B factors are considered. Policy and practice changes for further enhancing regional Aboriginal women's psychological capability and supportive social environments, and making smoking cessation services culturally appropriate are warranted. Synopsis: This paper explores Aboriginal women's perspectives on and experiences of smoking cessation, within and outside of pregnancy, and their use of smoking cessation services using the COM‐B model to understand Aboriginal women's capabilities, opportunities, and motivation for smoking cessation. Thematic analysis of data coming from 11 focus groups conducted in regional New South Wales, Australia, with 80 women aged between 16–68 years revealed seven themes related to capability, opportunity, motivation, and smoking cessation behaviours were identified. The themes highlighted that agency, knowledge, and self‐efficacy (as capability), a supportive social environment and access to culturally appropriate services and resources (as opportunities), together with automatic and reflective motivations for quitting, may enable short‐ or long‐term smoking cessation. Policy and practice changes for further enhancing regional Aboriginal women's psychological capability, supportive social environments and making smoking cessation services culturally appropriate are warranted. [ABSTRACT FROM AUTHOR]

Overcoming the socio-economic disparity between Aboriginal and Torres Strait Islander and non-Indigenous Australians is a long-standing social policy objective: one largely shared by Indigenous people. Achievement will require Indigenous individuals and households to be socially mobile, a process integrally involved with social capital, existing and requisite. The lack of research on Indigenous social mobility or its attendant social capital connections is addressed in this paper through an exploratory analysis of this interaction across three dimensions: distinctive patterns of Indigenous social capital; the transferability of Indigenous social capital; and traversing the social capital divide. The implications drawn, while tentative, indicate that for Aboriginal and Torres Strait Islander people the intersection of the processes of social mobility and social capital is vexed, and contains hazards and costs not fully shared by socially mobile non-Indigenous households. The Indigenous-specific factors of a gendered professional class, the identity- social capital link, and Indigenous labour market circumstances all indicate that more research and a more nuanced understanding of Indigenous social mobility is necessary. Social policy recommendations include broadening the concept of cultural leave to include bonding social capital obligations, especially for women, and re-evaluation of how to support Indigenous career trajectories and transferable skill sets. [ABSTRACT FROM AUTHOR]

Background: Increasingly, strength-based approaches to health and wellbeing interventions with Aboriginal and Torres Strait Islander Australians are being explored. This is a welcome counter to deficit-based initiatives which can represent a non-Indigenous view of outcomes of interest. However, the evidence base is not well developed. This paper presents the protocol for evaluating a strengths-based initiative which provides life coaching services to Aboriginal and Torres Strait Islander community housing tenants. The study aims to evaluate the effect of life coaching on social and emotional wellbeing (SEWB) of tenants in three Victorian regions.Methods: The More Than a Landlord (MTAL) study is a prospective cohort study of Aboriginal Housing Victoria tenants aged 16 years and over that embeds the evaluation of a life coaching program. All tenant holders in one metropolitan and two regional areas of Victoria are invited to participate in a survey of SEWB, containing items consistent with key categories of SEWB as understood and defined by Aboriginal and Torres Strait Islander peoples, and key demographics, administered by Aboriginal and Torres Strait Islander peer researchers at baseline, 6 and 18 months. Survey participants are then invited to participate in strengths based life coaching, using the GROW model, for a duration of up to 18 months. Indigenous life coaches provide tenants with structured support in identifying and making progress towards their goals and aspirations, rather than needs. The study aims to recruit a minimum of 200 survey participants of which it is anticipated that approximately 73% will agree to life coaching.Discussion: The MTAL study is a response to Aboriginal and Torres Strait Islander community and organisational requests to build the evidence base for an initiative originally developed and piloted within an Aboriginal controlled organisation. The study design aligns with key principles for research in Indigenous communities in promoting control, decision making and capacity building. The MTAL study will provide essential evidence to evaluate the effectiveness of strengths-based initiatives in promoting SEWB in these communities and provide new evidence about the relationship between strengths, resilience, self-determination and wellbeing outcomes.Trial Registration: This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID: ISRCTN33665735 . [ABSTRACT FROM AUTHOR]

Issue Addressed: Little is known about the complex relationships between Australian Indigenous people's use of social media and "health‐seeking" – seeking help for issues related to health and well‐being. This paper has emerged from a broader sociological research project focusing on the help‐seeking and help‐giving practices of Aboriginal and Torres Strait Islander people on social media, specifically aiming to unlock its potential to create vital and creative connections between help‐seekers and help‐givers. Methods: Semi‐structured interviews were conducted with 52 Indigenous Facebook users from five sites across Australia. Results: The use of grounded theory and Indigenous‐centred methodologies for analysis showed clearly that users draw on the connections made possible through Facebook to health‐seek. We identify five primary health‐seeking strategies that differ in form, purpose and directness: soliciting health‐related information, gaining emotional support, producing social health‐seeking collectives, engaging in motivational and "eudaimonic" content, and connecting with formal health sources. Conclusion: While far from being a panacea to health disparities, these findings show that Facebook does provide unique opportunities for many Indigenous help‐seekers and help‐givers in times of need. So What?: Social media offers pathways for health‐seeking both beyond and outside the dominant western biomedical models of public health promotion. These already‐existing pathways should be considered by people working on social media public health promotion campaigns for Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Background: Effective implementation can maximise the beneficial impacts of health services. It is therefore important to review implementation in the context of Indigenous populations, who suffer some of the greatest disadvantage within developed countries. This paper analyses Aboriginal and Torres Strait Islander (hereafter Indigenous) Australian health implementation reviews to examine the research question: What is the effectiveness of implementation, as reported in the Indigenous Australian health implementation literature? Methods: Eight databases were systematically searched to find reviews of Indigenous Australian health services and/or programs where implementation was the focus. Search terms included Aborigin* OR Indigen* OR Torres AND health AND service OR program* OR intervention AND implementation (or like terms) AND Australia AND review. Review findings were analysed through the lens of the PARiHS framework which theorises that successful implementation occurs through the interplay of evidence, context and facilitation. The review followed Cochrane methods but was not registered. Results: Six reviews were found; these encompassed 107 studies that considered health service/program implementation. Included studies described many health services implemented across Australia as not underpinned by rigorous impact evaluation; nevertheless implementers tended to prefer evidence-based interventions. Effective implementation was supported by clearly defined management systems, employment of Indigenous health workers as leaders, community control, partnerships, tailoring for diverse places and settings; and active facilitation methods. Short-term funding meant most studies focused on implementation in one site through pilot initiatives. Only two mentioned cost effectiveness. Indigenous Australian studies incorporated two elements not included in the PARiHS reference guide: the value of community control and equity of service provision across sites. Conclusions: Comparison of the Indigenous Australian review findings against the PARiHS reference guide elements suggested a fledgling but growing state of Indigenous implementation research, and considerable scope to improve the effectiveness of implementation. Further research is required to explore Indigenous people's understandings of what is important in healthcare implementation; particularly in relation to the value of community control and equity issues. [ABSTRACT FROM AUTHOR]

Efforts to address Indigenous health disadvantage require a refocus on urban settings, where a rapidly increasing majority (79%) of Indigenous Australians live. Proximity to mainstream primary care has not translated into health equity, with the majority of the Indigenous burden of disease (73%) remaining in urban areas and urban Indigenous people continuing to face significant barriers in accessing comprehensive and culturally appropriate care. This paper presents a case study of how the Institute for Urban Indigenous Health (IUIH) has strategically responded to these challenges in South East Queensland – home to Australia's largest and equal fastest growing Indigenous population. The IUIH has developed a new regional and systematised model – a regional health 'ecosystem' – for how primary care is delivered and intersects with the broader health system. Through intentional action, which strengthens the self-efficacy of community, the IUIH System of Care has delivered real gains for the Indigenous population of the region and has the capacity to deliver similar improvements in health access and outcomes in other regions. [ABSTRACT FROM AUTHOR]

The aims of National Disability Insurance Scheme (NDIS) are to provide long-term, personcentred care and support to all Australians with a significant and ongoing disability, including individuals with an acquired brain injury (ABI). The scheme has significant potential to provide equitable opportunity of access to health and disability services. Historically, however, service provision in remote and outer regional areas of Australia lags behind more densely populated centres. Aboriginal and Torres Strait Islanders living with disability are already significantly marginalised. Further to this, people with an ABI are very often misunderstood and overlooked by disability services, health professionals and governments, and frequently fall victim to the criminal justice system. This paper provides an overview of the state of ABI disability for Aboriginal and Torres Strait Islanders in remote and outer regional settings, and the present sets of barriers they face to obtaining quality care and effective interventions. A significant opportunity has emerged with the advent of the NDIS but equitable benefit can only be achieved if additional and specialised measures are devised and implemented to appropriately screen for, and assess, incidence of ABI; disability services are appropriately resourced to overcome the pre-existing disadvantage, and education, training and recruitment of Aboriginal and Torres Strait Islanders with the NDIS is undertaken to lead attitudinal changes in community to disability and health services. This paper concludes with recommendations for the NDIS to meet its laudable objectives. [ABSTRACT FROM AUTHOR]

Background: Achieving increased participation of Aboriginal and Torres Strait Islander peoples in Australia’s health workforce, particularly nursing, is federal government policy imperative. However, the uptake of Aboriginal and Torres Strait Islander students into nursing has stalled and their attrition from tertiary nursing courses is considerably higher than for other students. Aim: To alert the profession to issues impacting enrolled nursing education for Aboriginal and Torres Strait Islander students. Design: Discussion paper. Results: Studies of Aboriginal and Torres Strait Islander students mainly focus on tertiary education for registered nurses whereas vocational education and training (VET) for enrolled nurses is usually overlooked. It is generally assumed that the issues influencing the recruitment, attrition, and retention of Aboriginal and Torres Strait Islander students in higher education universities and other institutions similarly impact enrolled nursing students in the VET sector. Conclusion: Research that contributes robust evidence-based knowledge specifically on strategies addressing issues in enrolled nursing education for Aboriginal and Torres Strait Islander students and their employment uptake is required. [ABSTRACT FROM AUTHOR]

Introduction: Indigenous women experience high rates of family violence‐related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence‐related traumatic brain injury (TBI), including impacts on life, as well as decision‐making processes about healthcare access and engagement. Methods: Purposeful sampling was used to complete semi‐structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Results: Three themes were conceptualised based on the data and research aims: interweaving of the past and the present—ways women experience brain injury; factors that inform decision‐making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long‐term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. Conclusions: The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow‐up support, co‐designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Public or Patient Contribution: Indigenous women shared their views and experiences of TBI from family violence as well as decision‐making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to demonstrate the work being done to develop a trusted digital archive for social sciences data relating to the indigenous peoples of Australia. It explores the issues that arise through respectful engagement with both indigenous communities and research communities as well as the development of pragmatic and effective data management planning strategies for higher education researchers. Design/methodology/approach – As a conceptual paper, the approach consists of a review of the current situation, a discussion of the work already undertaken by the project team, and an analysis of the challenges being faced and plans for ongoing development of the project. Findings – There are major challenges in tackling a project with issues of such complexity but the project has great significance because its success could contribute enormously to the indigenous communities to which the research relates while building the capacity of researchers to design respectful and effective data management strategies. Practical implications – This project is rapidly evolving and the strategies for managing it are dynamic as the layers of complexity are unfolded and the project team addresses issues arising from the materials and groups with which it is working. Social implications – The impact of this project has already reaped dividends for the communities involved. Indigenous communities whose intellectual property or knowledge has seeded the research are having material returned to them in digital formats that are useful to them and which provide accurate portrayals of their knowledge, communities and culture. Researchers using the service provided by ATSIDA are confident that their material is being curated and reused appropriately. The work done by the ATSIDA team in building protocols and guidelines around research data will influence public policy, particularly in the work of collecting agencies and in their application to situations other than indigenous. Originality/value – ATSIDA fills a gap in informed research management. There is no other project like it anywhere in the world. This paper is valuable to anyone working in or considering higher education research in an indigenous area and is applicable to other research dealing with identifiable and vulnerable communities. [ABSTRACT FROM AUTHOR]

Background: While web conferencing technologies are being widely used in communication and collaboration, their uptake in conducting research field work has been relatively slow. The benefits that these technologies offer researchers for engaging with hard-to-reach populations are beginning to be recognised, however, the acceptability and feasibility of using web conferencing technology to engage Aboriginal and Torres Strait Islander young people in research is unknown.Objective: This study aims to evaluate whether the use of web conferencing to engage Aboriginal and Torres Strait Islander young people in research is an acceptable and feasible alternative to conventional face-to-face methods.Methods: Aboriginal and Torres Strait Islander young people aged between 18 and 24 years were recruited via emails, flyers and snowballing to participate in an Online Yarning Circle (OYC) about wellbeing conducted via web conferencing. Five young Aboriginal and Torres Strait Islander Australians were trained as peer facilitators and each conducted one or more OYCs with support from an experienced Aboriginal and Torres Strait Islander researcher. The OYCs were recorded and the researchers conducted post-OYC interviews with the facilitators. OYC recordings, facilitator interviews and researchers' reflections about the method were analysed to assess acceptability and feasibility for use with this population.Results: 11 OYCs were conducted with 21 participants. The evaluation focused on (a) acceptability of the method for participants and facilitators and (b) feasibility of data collection method and procedures for use in research. Our evaluation revealed good acceptability and feasibility of the method, with only minor challenges experienced, which were predominantly logistical in nature and related to scheduling, obtaining documentation of consent, and technical issues. These challenges were offset by the greater control over the level of engagement that was comfortable for individual participants and the greater ease with which they felt they could withdraw from participating. This shift in the traditional researcher-participant power dynamic was recognised by both participants and peer facilitators and was regarded as a support for Aboriginal and Torres Strait Islander young people's participation in research.Conclusions: The use of web conferencing to engage Aboriginal and Torres Strait Islander young people in research offers an acceptable and feasible alternative to face-to-face research methods. The benefits conferred by these technologies associated with yielding greater control and power to the research participant has broad relevance to research with marginalised populations. [ABSTRACT FROM AUTHOR]

Almost half of the world population lives in rural and remote areas facing more challenging and hazardous life conditions than the rest of the population. This paper and proposed method contribute to addressing an apparent gap in modelling travel-related decisions of rural and remote populations to enhance equitable access to basic amenities (e.g., education, health services, retail) for these populations. The application of these models is highly relevant for planning and policy purposes in remote communities. This paper uses data obtained from a mobility survey of remote Aboriginal communities in Central Australia to estimate purpose-specific destination choice models for access to basic services. The analysis is based on stated preference data to measure the attractiveness of destinations. Then, the models are used to analyse the impact of increasing the number of services provided in the remote communities. A better understanding of the impact of local development on travel patterns in remote communities is provided by analysing three aspects: attracted trips to the destinations, reduction of distance travelled by travellers in all the communities and improved equity in the distribution of travel distance among the communities. The case study illustrates the method successfully determines the most relevant parameters in the decisions of the surveyed individuals and determines potential destinations for local development, with the final objective of contributing to the alleviation of accessibility and inclusion problems in remote areas. [ABSTRACT FROM AUTHOR]

Since the 1971 Census, the Australian Aboriginal and Torres Strait Islander (Indigenous) population has grown faster than predicted by births, deaths and migration. An important and likely source of this unexplained growth is identification change, where a person changes how they identify or are identified by the household between one census and the next. In this paper, we use the Australian Census Longitudinal Dataset to detect identification change between 2006 and 2011 and include this information in a multistate population projection model. The projection model is applied to Australia, New South Wales and the Northern Territory over the period 2011-2061. The results indicate that identification change, particularly in the youngest age groups (0-9 years), had a positive impact on Indigenous population growth between 2006 and 2011. The projected Indigenous population initially grows faster than otherwise due to a net increase in people identifying as Indigenous, but slows as it interacts with the slow-growing non-Indigenous population. The results also suggest that the way in which identification change is modelled substantially affects projected trajectories, particularly in areas where identification change is substantial. While demographic modelling would benefit from further multidisciplinary research on the drivers and populations at risk of Indigenous status change, this study underscores the importance of incorporating identification change to improve projections of the Indigenous population in Australia. [ABSTRACT FROM AUTHOR]

Background: Persistent disparities exist between Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) and non-Indigenous Australians associated with cancer, with Aboriginal and Torres Strait Islander peoples experiencing a longer time to treatment, higher morbidity rates, and higher mortality rates. This systematic review aimed to investigate findings and recommendations in the literature about the experiences and supportive care needs of Aboriginal and Torres Strait Islander peoples with cancer in Australia. Methods: A qualitative systematic review was conducted using thematic analysis. Database searches were conducted in CINAHL, Informit, MEDLINE, ProQuest, Scopus, and Web of Science for articles published between January 2000 and December 2021. There were 91 included studies which were appraised using the Mixed Methods Appraisal Tool. The included studies reported on the experiences of cancer and supportive care needs in Aboriginal and Torres Strait Islander populations. Results: Six key themes were determined: Culture, family, and community; cancer outcomes; psychological distress; access to health care; cancer education and awareness; and lack of appropriate data. Culture was seen as a potential facilitator to achieving optimal cancer care, with included studies highlighting the need for culturally safe cancer services and the routine collection of Aboriginal and Torres Strait Islander status in healthcare settings. Conclusion: Future work should capitalize on these findings by encouraging the integration of culture in healthcare settings to increase treatment completion and provide a positive experience for Aboriginal and Torres Strait Islander peoples with cancer. [ABSTRACT FROM AUTHOR]

For First Peoples across Australia, birds have important connections to kin and Country. We draw on a recent analysis of all Australia's threatened bird taxa to identify on whose traditional Country they occur. Of the 201 imperilled (threatened or Near Threatened) bird taxa facing threats within Australian territory (including Commonwealth waters and offshore islands), 64% occur on lands and waters to which at least 463 First Peoples' groups have a connection. Fourteen bird taxa occur only on Country of a single First Peoples' group while 15 taxa occur on Country of over 50 First Peoples' groups. Four First Peoples' groups, in north Queensland and south-eastern Australia, have over 20 imperilled bird taxa on their Country. Taxa on First Peoples' Country face 78% of the total national threat load on imperilled birds and have 75% of both the research and management needs for relieving threats. All the threats are a consequence of colonisation, suggesting that supporting First Peoples to manage the threats to birds is a moral, and potentially legal, responsibility. Many First Peoples have chosen to engage actively in the conservation of imperilled species but there are numerous additional opportunities for monitoring and active management of Country that will yield benefits. Our analysis can help First Peoples identify which birds on their Country are listed as threatened under western conventions and that they may wish to help conserve; and assist conservation managers to identify First Peoples who might wish to lead or become more involved in imperilled bird management. The Global Biodiversity Framework strongly supports maximising the involvement of First Peoples in environmental management. There are at least 460 First Peoples' groups on which imperilled birds occur, which provides a wide range of opportunities for management if people so choose. The Countries of many First Peoples' groups supports 10 or more imperilled bird taxa, suggesting that support for Country management will often benefit many taxa. The depth and longevity of First Peoples' connection to Country provides them with a perspective lacking in much management. Because all threats to imperilled birds on First Peoples' Country are derived from settlers, there is a moral, and possible legal, case for supporting First Peoples to manage them. [ABSTRACT FROM AUTHOR]

The health and wellbeing of Australian Indigenous peoples is a nationally sanctioned priority, but despite this, few studies have comprehensively analyzed the features and characteristics of the research in the field. In this regard, a comprehensive scientometric analysis and knowledge mapping to systematically summarize and discuss the current state of research, research trends, and emerging areas of research were conducted. Original articles and reviews published between 2003 and 2022 were obtained from the Web of Science Core Collection. CiteSpace and VOSviewer software were used to perform scientometric analysis and knowledge mapping. An examination of document and citation trends, authors, institutions, countries/regions, journals, and keywords was untaken, while co-citation, cooccurrence, and burst analysis provide insights and future development in this area. A total of 2,468 documents in this field were retrieved. A gradual increase in the number of documents over the past two decades is observed, with the number of documents doubling every ~7.5 years. Author Thompson SC and Charles Darwin University published the most documents, and 85.6% were affiliated with only Australian-based researchers. The Australian and New Zealand Journal of Public Health is the most prominent journal publishing in the field. The most commonly co-occurring keyword was "health," and the keyword "risk" had the longest citation burst. Five keyword clusters were identified; "cultural safety" was the largest. This study articulates the knowledge structure of the research, revealing a shift from population-level and data-driven studies to more applied research that informs Indigenous peoples health and wellbeing. Based on this review, we anticipate emergent research areas to (1) reflect a more comprehensive understanding of the multidimensional factors that shape Indigenous health and wellbeing; (2) move beyond a deficit-based perspective; (3) respect cultural protocols and protect the rights and privacy of Indigenous participants; (4) address racism and discrimination within the healthcare system; (5) foster respectful, equitable, and collaborative research practices with Indigenous peoples; (6) provide culturally appropriate and effective interventions for prevention, early intervention, and treatment; and (7) ensure equitable change in systems to enhance access, quality, and outcomes in health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Indigenous Australians experience significantly disproportionate poorer health outcomes compared to their non-Indigenous counterparts. Despite the recognised importance of maternal infant health (MIH), there is surprisingly little empirical research to guide service redesign that successfully addresses the disparities. This paper reports on a service evaluation that also compared key MIH indicators for Indigenous and non-Indigenous mothers and babies over a 12-year period 1998-2009.Methods: Trend analysis with logistic regression, using the independent variables of ethnicity and triennia, explored changes over time (1998-2009) between two cohorts: 1,523 births to Indigenous mothers and 43,693 births to non-Indigenous mothers. We included bivariate and multivariate analysis on key indicators (e.g. teenage births, preterm birth, low birth weight, smoking) and report odds ratios (ORs), 95% CIs and logistic regression adjusting for important confounders. We excluded transfers in from other areas which are identified within the database.Results: Bivariate analysis revealed Indigenous women were statistically more likely to have spontaneous onset of labour and a non-instrumental vaginal birth. They were less likely to take epidurals for pain relief in labour, have assisted births, caesarean sections or perineal trauma. Despite better labour outcomes, Indigenous babies were more likely to be born preterm (< 37 weeks) and be low birth weight (< 2500 g); these differences remained significant in multivariate analysis. The trend analysis revealed relatively stable rates for teenage pregnancy, small for gestational age, low birth weight babies, and perinatal mortality for both cohorts, with the gap between cohorts consistent over time. A statistical widening of the gap in preterm birth and smoking rates was found with preterm birth demonstrating a relative increase of 51% over this period.Conclusions: The comprehensive database from a large urban hospital allowed a thorough examination of outcomes and contributing factors. The gap between both cohorts remains static in several areas but in some cases worsened. Alternative models for delivering care to Indigenous women and their babies have shown improved outcomes, including preterm birth, though not all have been sustained over time and none are available Australia-wide. New models of care, which recognise the heterogeneity of Indigenous communities, incorporate a multiagency approach, and are set within a research framework, are urgently needed. [ABSTRACT FROM AUTHOR]

The timely release of the World Report on Disability serves as a challenge to members of the health professions to review and renew their response to inequity of access and provision of services to children and adults with a disability. This paper responds to the lead article by Wylie, McAllister, Davidson, and Marshall, and provides commentary on two of the recommendations of the World Report on Disability in the context of a novel inter-professional service for Aboriginal and Torres Strait Islander children with communication and learning needs. Speech-language pathology and occupational therapy students reported on their learning within a model of service delivery based on partnership with an Aboriginal and Torres Strait Islander school community and inter-professional collaboration. Lessons learned have the potential to inform future services for under-served populations and to impact on capacity building through health professionals gaining experiential knowledge and understanding of an urban Aboriginal and Torres Strait Islander community. [ABSTRACT FROM AUTHOR]

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care. [ABSTRACT FROM AUTHOR]

Background: Chronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures. Methods: The model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1–5. This data has been de-identified and aggregated. Results: CYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities. Conclusion: The CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required. [ABSTRACT FROM AUTHOR]

Objective: To investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice. Methods: Cross-sectional study of 1,258,581 women (18–49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia. Results: The prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.37 per 1,000) than for non-Indigenous females (16.62 per 1,000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.30% vs. 19.90%); tests for luteinizing hormone (31.89% vs. 25.65%); testosterone (14.93% vs. 9.96%) and; glycated haemoglobin (HbA1c) (6.32% vs. 3.41%),but less likely to receive an anti-müllerian hormone test (2.78% vs. 7.04%). Conclusions: Lower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander peoples may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility. Implications for public health: Future efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a need for further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Objective: To evaluate if existing Australian public policy related to screening, diagnosis, treatment and follow up care for breast cancer addresses the needs of and outcomes for Indigenous1 women? Methods: This review of policy employed a modified Delphi method via an online panel of experts (n = 13), who were purposively recruited according to experience and expertise. A series of online meetings and online surveys were used for data collection. The aims of the study were to: Identify all existing and current breast cancer policy in Australia; Analyse the extent to which consideration of Indigenous peoples is included in the development, design and implementation of the policy; and Identify policy gaps and make recommendations as to how they could be addressed. The policies were evaluated using 'A Guide to Evaluation under the Indigenous Evaluation Strategy, 2020'. Results: A list of current breast cancer policies (n = 7) was agreed and analysed. Five draft recommendations to improve breast cancer outcomes for Indigenous women were developed and refined by the panel. Conclusions: Current breast cancer policy in Australia does not address the needs of Indigenous women and requires change to improve outcomes. [ABSTRACT FROM AUTHOR]

This article draws on the first qualitative research on lived experiences of autism in Aboriginal and Torres Strait Islander communities in Australia. Twelve women supporting 16 autistic children living in remote, regional and urban areas of Australia participated in a semi-structured interview. Through thematic analysis, we identified four focal themes in women's conceptualisation of the practical work of mothering autistic children. These are (i) navigating a complex autism system to 'achieve' diagnosis and connect to culturally-safe services and supports; (ii) helping children to learn to live in the big world by engaging in everyday care and enhancing capacities; (iii) protecting children by keeping them safe, dealing with stigma and respecting individuality and; (iv) asserting family belonging by emphasising children's strengths, encouraging extended family relationships and advocating for others. Listening to these marginalised voices is vital to establishing a participatory research agenda in a field that has received inadequate attention. This is the first research on lived experiences of autism in Aboriginal and Torres Strait Islander communities in Australia. Twelve women from remote, regional and urban areas spoke about their experiences of loving and supporting their autistic children. Women talked about the practical work of mothering their autistic children including achieving autism diagnosis, trying to access culturally safe services and supports, undertaking everyday care needs and enhancing capacities and abilities. Women emphasised children's strengths and their belonging in community; they were very concerned with protecting them and keeping them safe in the context of intersecting racist and ableist attitudes. More participatory research on autism within Aboriginal and Torres Strait Islander communities is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Lack of access, late engagement and limited referral for palliative care remain critical issues in supporting Indigenous Australians with life limiting illness. Aim: To explore the experiences and perspectives of Indigenous and non-Indigenous health professionals regarding the provision of palliative care for Indigenous people with advanced disease. Design: Qualitative study involving semi-structured focus groups/interviews with analysis following an inductive thematic approach. Setting/participants: A purposive sample (n = 54) of medical, nursing, allied health and Indigenous Hospital Liaison Officers engaged in caring for Indigenous patients at a metropolitan teaching hospital in Australia. Results: Four overarching themes were identified regarding provision of palliative care for Indigenous patients. These were (1) the intersection of cultures – Indigenous peoples, health and palliative care, (2) bridging the cultural divide: the integral role of Indigenous Hospital Liaison Officers, (3) health professionals devolve their responsibility to provide culturally appropriate care and (4) building towards a more holistic, culturally aware provision of palliative care. Conclusions: For many Indigenous people, the health system may be experienced as inflexible, narrowly focused and even prejudiced and traumatising. For Indigenous patients at the end of life, these challenges are heightened. The Indigenous Hospital Liaison Officers, working at the intersections of these two cultures, are key to negotiating such challenges as they seek opportunities to facilitate communication and understanding between firmly held cultural needs. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander (hereafter Aboriginal) people are a priority population for HIV care in Australia; however, no HIV cascade exists for this population. We developed annual HIV cascades for 2010–2017 specific to Aboriginal peoples. By 2017, an estimated 595 Aboriginal people were living with HIV (PLWH); however, 14% remained undiagnosed. Cascade steps below global targets were: PLWH aware of their diagnosis (86%), and retention in care (81% of those who had received any care in previous two years in a sentinel network of clinics). For people retained in care, treatment outcomes surpassed global targets (92% receiving treatment, 93% viral suppression). Increases occurred across all HIV cascade steps over time; however, the least improvement was for retention in care, while the greatest improvement was achieving viral suppression. The HIV cascade for Aboriginal peoples highlights both gaps and strengths in the Australian HIV care system, and importantly highlights where potential interventions may be required to achieve the global UNAIDS targets. [ABSTRACT FROM AUTHOR]

Yolŋu (Aboriginal Australians of northeast Arnhem Land) are interested in developing augmentative and alternative communication (AAC) systems in their own languages to support communication opportunities and participation for their family members living with Machado–Joseph disease. Designing AAC systems in Aboriginal languages requires consideration of unique linguistic and cultural elements. Participatory action research in strength-based communication contexts was carried out by Yolŋu and Balanda (the Yolŋu word for non-Aboriginal people) researchers working together through a collaborative intercultural process. Culturally responsive literacy, language, and AAC activities were used to develop four prototype Yolŋu AAC sytems for Yolŋu with varied literacy skills. Data were coded using gerunds to identify and focus on action in the data. Reflective and analytical collaborative, oral group discussions were used to identify key considerations and, ultimately, a Yolŋu metaphor for the research. Yolŋu language, culture and worldview impacted all aspects of prototype design and decision making. Salient considerations related to representation, organization, layout, and access, are presented. Clinical implications and future research considerations are outlined. [ABSTRACT FROM AUTHOR]

Background: Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve‐in‐valve (TMViV) replacement has emerged as an alternative to redo surgery in high‐risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. Methods: A single‐centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post‐operative trans‐thoracic echocardiogram (TTE) results. Results: There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre‐operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post‐operative median length of hospital stay was 4 days with no post‐operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post‐operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow‐up of 22 months. Conclusion: Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD. [ABSTRACT FROM AUTHOR]

Introduction: First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood. Methods: We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms. Results: Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing. Discussion and Conclusions: First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives. [ABSTRACT FROM AUTHOR]

Background: Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children.Methods/design: This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3-16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken.Discussion: INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies.Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12617001652369 . Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander ('Indigenous') Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments. Methods: We performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score. Results: The primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients. Conclusions: Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported. [ABSTRACT FROM AUTHOR]

Background: Social housing provides homes for some of the most vulnerable in society. Those in social housing often have complex issues that may require support. Limited research has examined the unmet needs of those living in social housing from the tenant perspective. This exploratory study aimed to embark on filling this gap.Methods: A cross-sectional study survey of adult social housing tenants in New South Wales, Australia. Consenting tenants completed a survey asking about their support needs across five domains: transport, employment and financial stress; housing and safety; health and health behaviour; access to services; and control over one's life. Negative binomial regression analysis was used to examine associations between the mean number of support needs and characteristics.Results: Of the 104 tenants invited, 101 agreed to participate (97%) of which 100 completed the survey. Paying unexpected bills' (43%), feeling sad or anxious (40%), feelings of anger or frustration (34%), and memory or concentration problems (33%) were the most prevalent reported needs. Other needs included antisocial behaviour from neighbours (31%) and having control in the direction your life is taking (27%). Seventy-five percent of tenants reported at least one need, with an average of seven needs across the sample (median 5.5, range 0-24). Tenants who identified as Aboriginal or Torres Strait Islander had a higher number of needs compared to other tenants (RR 1.87 95% CI 1.08 to 3.35).Conclusions: More research describing tenant wellbeing needs is required to guide initiatives improving tenant wellbeing. Development of a standardised tool to measure and prioritise tenant wellbeing needs would be beneficial. There is a need for well-controlled research to establish the potential effectiveness and cost effectiveness of initiatives implemented at the policy or housing provider level. Future research must consider the multifaceted needs of this population. Further, Aboriginal and Torres Strait Islander people are generally overrepresented in social housing in Australia, and in this study Aboriginal and Torres Strait Islander tenants reported a higher number of needs compared to non-Aboriginal and Torres Strait Islander tenants. Given this, future research should ensure measurement tools or strategy initiatives are culturally sensitive and appropriate, and are developed in collaboration with Aboriginal and Torres Strait Islander communities. [ABSTRACT FROM AUTHOR]

Background: Indigenous Australians are disproportionately affected by end stage kidney disease. Despite this, they face significant delays being assessed and waitlisted for kidney transplant. Aims: To examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous Australians and non‐Indigenous patients, and identify major sources of delay. Methods: We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between‐group differences were used to compare the time between commencement of dialysis and completion of each component of assessment. Patients who had more than 1 year between commencement of dialysis and waitlisting were further analysed for major sources of delay. Results: Twenty‐five patients were included (20 Indigenous Australians and 5 non‐Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 vs 264 days, P = 0.032). Indigenous Australian patients waited longer before commencing the transplant assessment process and before completing dental assessment, tissue typing and review by the transplant nephrologist and surgeon. Five patients (two Indigenous Australians, three non‐Indigenous) were waitlisted within 1 year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay. Conclusion: Indigenous Australian patients face significant delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve equity of access to kidney transplantation. [ABSTRACT FROM AUTHOR]

Objective: A shortened version of a presentation to the Australian Institute of Aboriginal and Torres Strait Islander Studies, this paper raises questions regarding policy and program directions in Indigenous affairs with consequences for Indigenous health. Method: The author notes the inadequate Indigenous mental health database, and describes contemporary conflicts in the arena of Indigenous mental health, drawing on personal experience in clinical service delivery, policy and programme development. Results: Medicalized responses to the Stolen Generations report and constructions of suicide that accompanied the Royal Commission into Aboriginal Deaths in Custody are presented to demonstrate unforeseen health outcomes. Examples are also given of well-intentioned social interventions that, in the context of contemporary Indigenous society appear to be contributing to, rather than alleviating, harm. Problems of setting priorities that confront mental health service planners are considered in the light of past and continuing social disadvantage that informs the burden of mental disorder in Indigenous communities. Conclusions: The importance of acknowledging untoward outcomes of initiatives, even when motivated by concerns for social justice, is emphasized. The tension within mental health services of responding to the underpinning social issues versus providing equity in access to proven mental health services for Indigenous populations is considered. [ABSTRACT FROM AUTHOR]

Purpose: Australian Aboriginal and Torres Strait Islander diagnosed with cancer are known to experience poorer survival, with these survival disparities mainly restricted to the first 2 years after diagnosis. With improved accuracy and completeness of identifying Aboriginal and Torres Strait Islander peoples over the whole study period, our goal was to examine whether the survival disparity among Aboriginal and Torres Strait Islander peoples diagnosed with cancer in Queensland has changed over time.Methods: Population-based data from the Queensland Cancer Register between 1998 and 2017 for Queenslanders aged 15 years and over at diagnosis (n = 377,963; 1.6% Aboriginal and/or Torres Strait Islander) were used to determine whether this disparity has reduced over time. Flexible parametric survival models incorporating time-varying coefficients were used to examine the association between Aboriginal and Torres Strait Islander status and cancer-specific survival within 5 years of diagnosis.Results: The adjusted 5-year cancer-specific survival rate for Aboriginal and Torres Strait Islander people diagnosed with cancer increased from 60.5% (95% CI 59.2-61.9%) in 1998-2007 to 65.5% (95% CI 64.3-66.6%) in 2008-2017, with the corresponding estimates for other Queenslanders being 66.6% (95% CI 66.4-66.8%) and 70.1% (95% CI 69.9-70.3%). The survival disparity was significant only for the first 3 years since diagnosis for 1998-2007; however, it was significantly (p ≤ 0.02) elevated for all five time intervals for 2008-2017, with similar average hazard ratios (95% CIs) over the 5-year interval after diagnosis of 1.45 (1.36-1.55) for 1998-2007 and 1.42 (1.34-1.50) for 2008-2017.Conclusion: Although survival has increased over time, the lack of improvement in the disparity in cancer survival experienced by Aboriginal and Torres Strait Islander cancer patients highlights the urgent need to better understand the multifaceted and completed factors that underlie this gap to guide targeted, evidence-based interventions and support their implementation across the health sector. [ABSTRACT FROM AUTHOR]

Background: The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations' and other babies in Australia. The program is based on the United States' Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting. Methods: A qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate 'yarning' method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis. Results: Seventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over 'ownership' of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums. Conclusion: Effective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context. [ABSTRACT FROM AUTHOR]

Background There are health disparities in many countries between First Nations and non-- First Nations populations. In Australia, the Aboriginal and Torres Strait Islander population have several risk factors and are more likely to experience higher rates of post-operative morbidity complications and mortality. Purpose To develop a culturally appropriate pre-surgery screening tool, administered by phone, to check health and wellness, identify relevant factors and support Aboriginal and Torres Strait Islander patients to ensure they are appropriately prepared to undertake surgery. The screening tool aims to reduce rates of patient-initiated cancellations of surgery and gain a greater understanding of factors contributing to patient-initiated cancellations of Aboriginal and Torres Strait Islander patients. Methods This quality improvement project uses the Model for Improvement methodology and integrates 'Plan, Do, Study, Act' (PDSA) cycles to implement, assess and improve the intervention. The rate of Aboriginal and Torres Strait Islander patient-initiated surgical cancellations was measured for an Australian tertiary referral hospital. Results The six-month phase after implementation demonstrated a decreased mean rate (0.078 to 0.060) of Aboriginal and Torres Strait Islander patient-initiated cancellations. Responses were thematically analysed to identify contributing factors for surgical cancellations. Conclusions Implementing a culturally appropriate pre-surgery screening tool, developed by suitably qualified staff, positively advocated for Aboriginal and Torres Strait Islander patient's health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander Community-Controlled Health Organisations (ACCHOs) provides culturally appropriate primary care for Aboriginal and Torres Strait Islander people in Australia. The population of North Queensland has a higher proportion of Aboriginal and Torres Strait Islander people, a greater population coverage of ACCHOs, and higher cervical screening participation than the Rest of Queensland. The association between regional differences in the use of ACCHOs for cervical screening and variations in screening participation among Aboriginal and Torres Strait Islander women is currently unknown. Methods: This is a population-based study of 1,107,233 women, aged 20–69 years who underwent cervical screening between 2013 and 2017. Of these women, 132,972 (12%) were from North Queensland, of which 9% were identified as Aboriginal and Torres Strait Islander women (2% Rest of Queensland) through linkage to hospital records. Regional differentials in screening by Aboriginal and Torres Strait Islander status were quantified using participation rate ratios (PRRs) with 95% confidence intervals (CIs) from negative binomial regression models. Logistic regression was used to identify factors associated with Aboriginal and Torres Strait Islander women being screened at ACCHOs. Results: Aboriginal and Torres Strait Islander women from North Queensland (versus) Rest of Queensland had higher odds of screening at ACCHOs after adjusting for age and area-level variables. After adjustment for non-ACCHO variables, the regional differential in screening among Aboriginal and Torres Strait Islander women was significantly higher (PRR 1.28, 95% CI 1.20–1.37) than that among other Australian women [PRR = 1.11 (1.02–1.18)], but was attenuated on further adjustment for ACCHO variables, [PRR = 1.15, (1.03–1.28)] to become similar to the corresponding point estimate for other Australian women [PRR = 1.09, (1.01–1.20)]. However, the significant interaction between Aboriginal and Torres Strait Islander status and region (p < 0.001) remained, possibly reflecting the large cohort size. Screening participation increased with better access to health services for all women. Conclusions: Improving access to primary health care for Aboriginal and Torres Strait Islander women, especially through ACCHOs, may reduce existing disparities in cervical screening participation. Further gains will require greater levels of local community engagement and understanding of the experiences of screened Aboriginal and Torres Strait Islander women to inform effective interventions. [ABSTRACT FROM AUTHOR]