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American Indian and Alaska Native (Native) Veterans enrolled in the U.S. Department of Veterans Affairs (VA) benefits program are far less likely to access health care compared to other racial/ethnic groups, in part driven by challenges posed by often distant, complex, and culturally unresponsive health care that does not easily interface with the Indian Health Service (IHS) and local Tribal Health Care. To address this disparity, in 2020 the Veteran's Health Administration's (VHA) Office of Rural Health (ORH) initiated the development of a patient navigation program designed specifically for rural Native Veterans. There are no navigation programs for rural Native Veterans to guide development of such a program. Hence, the project team sought perspectives from rural Native Veterans, their families, and community advocates, (n = 34), via video and phone interviews about the role and functions of a Veteran patient navigator and personal characteristics best be suited for such a position. Participants believed a navigator program would be useful in assisting rural Native Veterans to access VHA care. They emphasized the importance of empathy, support, knowledge of local culture, and of Veteran experience within tribal communities, adeptness with VHA systems, and personnel consistency. These insights are critical to create a program capable of increasing rural Native Veteran access to VHA services. [ABSTRACT FROM AUTHOR]

Background: Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method: Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Results: The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion: The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care. We have co-designed Health Journey Mapping tools and resources with First Nations patients and families and with First Nations and non-First Nations healthcare professionals to address current gaps in care. These pragmatic, strengths-based tools and resources enhance and incorporate cultural safety, continuous quality and improvement and comprehensive care and can be used collaboratively by healthcare consumers and professionals to assess and improve the quality, access, experiences and outcomes of care. [ABSTRACT FROM AUTHOR]

The article emphasizes the necessity of establishing a networked clinical trial system that aligns with values and purpose to address health equity disparities in regional, rural, and First Nations communities. It underscores the challenges these communities face in accessing clinical trials and advocates for a decentralized approach to trial access. It discusses the cultural barriers within the healthcare system that hinder participation in clinical trials.

Background: Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government's "Closing the Gap" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice. Methods: Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non‐government providers in the absence of a local Aboriginal‐controlled organisation. Findings were examined critically to identify implications for occupational therapy. Results: Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non‐Indigenous participants. Participants identified the need to move beyond a rhetoric of "working with" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal‐controlled services are best positioned to conduct and respond to community consultation. Conclusion: A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal‐controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes. PLAIN LANGUAGE SUMMARY: Aboriginal and Torres Strait Islander people are often asked to give advice or share ideas on how health and education services are provided to community. We asked people in Southern Adelaide what this was like when the Closing the Gap strategy was first introduced in the region. People explained that Aboriginal leaders were not really listened to, and even when there are meant to be partnerships, it often does not work out as planned. There are lessons we can take from this for occupational therapy so that we stop making the same mistakes over and over. Health and education services need to really listen and respond appropriately, so that services are safer for Aboriginal and Torres Strait Islander people and communities. Aboriginal leadership must be valued and respected if we are to close the gaps in health and education. This is important for the future of occupational therapy. [ABSTRACT FROM AUTHOR]

Although evidence-based parenting programs are widely available, they remain inaccessible to many families of children with social, emotional and behavioural problems, particularly in remote settings. In partnership with Aboriginal communities in the remote Fitzroy Valley, Western Australia, we introduced and evaluated the Indigenous Triple P – Positive Parenting Program, with additional Stepping Stones Triple P strategies (for children with complex needs). Implementation followed community consultation and program adaptation to acknowledge local culture, social complexities and language. The initiative was named Jandu Yani U, meaning "for all families" in the local Bunuba language. Local practitioners (parent coaches) were trained to deliver Triple P. Parents and carers (henceforth carers) of children up to 15 years of age were invited to participate. Families attending the program reported on child behaviour, parenting practices, self-efficacy, wellbeing and empowerment pre- and post-intervention and at 8-month follow-up using standardised assessment tools delivered by local community navigators. Of 30 participating families, 100% completed Triple P and reported the program was culturally appropriate. Of the index children, 93% were Aboriginal, 63% boys, median age 6.83 years. Following the program, carers reported high levels of empowerment and reaching goals for behaviour change (p <.001) and less use of unhelpful parenting strategies (over-reactivity and hostility; p <.05), and this maintained at 8-month follow-up (p <.001). At follow-up, improvement in carer self-efficacy (p <.001) and reduced anxiety (p <.001) were documented. Significant improvements in prosocial behaviour, reductions in challenging behaviour and decreased intensity and frequency of behavioural problems (all p <.05) were reported in children at follow-up. The average level of goal attainment was 65% at post, which was maintained at follow-up. This study demonstrates the feasibility of delivering Indigenous Triple P to Aboriginal families in remote settings, and the importance of partnership with communities. Program tailoring, flexible delivery, use of Aboriginal parent coaches and provision of practical support to families resulted in a culturally acceptable parent support program. With local Aboriginal co-design, this initiative should be generalisable to similar remote communities elsewhere. What is already known about the topic: Aboriginal and Torres Strait Islander families are more often exposed to stressful life events than non-Indigenous families, with children overrepresented in hospitalisation rates, poor health outcomes, early school dropout, out-of-home care, involvement with the justice system and youth suicide. There is a significant evidence base that parenting programs, such as Triple P, built on the principles of social learning and self-regulation, can be effective in addressing emotional and behavioural problems in children in the short and longer term. Despite the availability of evidence-based parenting programs, a minority of parents of children with behavioural and emotional problems access such programs, and access by Aboriginal and Torres Strait Islander families is lower. What this topic adds: This study determined the feasibility of delivering a community tailored, evidence-based parenting program to families in a very remote Western Australian Aboriginal community. Families reported significant reductions in unhelpful parenting strategies, carer anxiety and challenging child behaviours and significant increases in parenting confidence and empowerment and prosocial child behaviour following the program. Co-design methods, community-led modifications to resources, two-way learning with Aboriginal and non-Indigenous trainers, training local parent coaches, flexible program delivery and long-term practical support were essential for delivering a culturally acceptable parenting program implementation strategy that could be adapted for remote communities elsewhere. [ABSTRACT FROM AUTHOR]

National and state governments in settler colonial countries are increasingly committing to policies and practices aimed at strengthening Indigenous frameworks, programmes and leadership in child protection services. However, research‐based information on Indigenous child welfare services and programmes is sparse. This qualitative literature review explores and documents key features of Indigenous child welfare and protection models and/or frameworks in an international context, with a specific focus on Indigenous children, young people, families, and communities. Twenty‐four publications meeting the inclusion criteria were included in the analysis. Published frameworks, models, services, interventions and/or programmes within the broader area of child welfare and children protection that are Indigenous‐designed and/or led or developed in partnership or collaboration with Indigenous peoples were identified. The review highlights 11 key dimensions that underpin the frameworks, models, services, interventions and/or programmes. Findings of the review also reveal commonalities across Indigenous cultures and contexts that from an Indigenous perspective are considered fundamental to supporting Indigenous children, young people and families involved with child protective services. Additionally, the findings point to the critical need for ongoing advocacy for Indigenous‐designed and led services and programmes, including support for Indigenous research, evaluation and intellectual leadership. [ABSTRACT FROM AUTHOR]

Background: There is a growing interest in employing community wellness worker models in Indigenous populations to address inequities in healthcare access and outcomes, concerns about shortage in health and mental health human resources, and escalating burden of chronic and complex diseases driving significant increase in health services demand and costs. A thorough review of Indigenous community wellness worker models has yet to be conducted. This rapid review sought to outline the characteristics of a community wellness worker model in Indigenous contexts across the globe, detailing factors shaping implementation challenges and success. Methods: A rapid review of the international peer-reviewed and grey literature of OVID Medline, Global Index Medicus, Google, and Google Scholar was conducted from January to June 2022 for Indigenous community wellness/mental health worker models and comparative models. Articles were screened and assessed for eligibility. From eligible articles, data pertaining to study design and sample; description of the program, service, or intervention; model development and implementation; terminology used to describe workers; training features; job roles; funding considerations; facilitators and barriers to success; key findings; outcomes measured; and models or frameworks utilized were extracted. Data were synthesized by descriptive and pattern coding. Results: Twenty academic and eight grey literature articles were examined. Our findings resulted in four overarching and interconnected themes: (1) worker roles and responsibilities; (2) worker training, education, and experience; (3) decolonized approaches; and (4) structural supports. Conclusion: Community wellness worker models present a promising means to begin to address the disproportionately elevated demand for mental wellness support in Indigenous communities worldwide. This model of care acts as a critical link between Indigenous communities and mainstream health and social service providers and workers fulfill distinctive roles in delivering heightened mental wellness supports to community members by leveraging strong ties to community and knowledge of Indigenous culture. They employ innovative structural solutions to bolster their efficacy and cultivate positive outcomes for service delivery and mental wellness. Barriers to the success of community wellness worker models endure, including power imbalances, lack of role clarity, lack of recognition, mental wellness needs of workers and Indigenous communities, and more. [ABSTRACT FROM AUTHOR]

Objective: Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally. Methods: A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective. Results: In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research. Conclusion: There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research. [ABSTRACT FROM AUTHOR]

As social work gains strength as a global profession, indigenous social work has emerged within the growing calls to decolonize the profession and offers an alternative worldview. This article uses a systematic literature review to engage with the application of this indigenous social work paradigm in practice with older persons from an international perspective. Using the knowledge mobilization perspective, it examines the current state of knowledge on indigenous social work and draws implications for practice with older persons. It concludes by advocating for a political stance to practice rooted in indigenous ways of knowing, being and doing. [ABSTRACT FROM AUTHOR]

Background: Plants deliver livelihood and food for millions of people in the world. Indeed, wild edible plants support rural communities in developing countries to overcome seasonal unfavorable conditions. In rural areas of Ethiopia, wild edible plants play an indispensable role in fighting food insecurity as emergency or supplementary foods. Hence, this research was aimed at studying the ethnobotanical assessment of wild edible plants in Dibatie district, Metekel zone, western Ethiopia. Methods: Ethnobotanical data was collected using a semi-structured interview, field observation, focus group discussions, a market survey, and the ranking of selected plants. Besides, voucher specimens were collected and stored at the National Herbarium of Ethiopia. Descriptive statistics, preference ranking, direct matrix ranking, and familiarity index were computed for data analysis. Results: This study has documented 54 wild edible plant species belonging to 33 plant families and 46 genera. Of these, most (38.90%) had tree growth habits. Wild edible plants bear mostly fruits (72.20%) as edible parts. Local people usually consume these plants freshly raw as complementary foods, though some wild edibles require processing. They were mostly harvested in the January (31.48%) and May (27.78%) months, with the least collected in September (7.41%). Most wild edible plants (78.57%) were available in uncontrolled habitats, while others (21.43%) live in farmlands, home gardens, and as live fences. Out of the recorded plants, about 98% had additional uses besides their nutritional values. Conclusion: Wild edible plants assist the livelihoods of the local people in food security, agriculture, energy sources, construction, medicines, ecological services, aesthetics, income generation, and household utensils. Nevertheless, wild edible plants are recently threatened due to various anthropogenic factors in the study area. Thus, they need wise use and in-situ and ex-situ conservation measures from all the concerned bodies for sustainable use in the future. [ABSTRACT FROM AUTHOR]

Introduction: The importance of primary health care (PHC) to Aboriginal Australians is widely acknowledged, as is the underservicing of the Aboriginal Australian population. Aboriginal People continue to face significant obstacles when accessing and using health care services. Objective: This study identifies environmental factors (beyond personal and service delivery) that functioned as barriers and enablers to Aboriginal Australians' experiences accessing PHC during crises and recommends approaches during future events. Design: This research utilised a case study approach. Data were collected through in‐depth interviews and analysed using thematic analysis. The study was set in Lakes Entrance, a regional Victorian locality with a sizable Aboriginal community, which was affected by bushfires during 2019/2020 and COVID‐19 restrictions during 2020‐2021. Participants were 18 Aboriginal People over the age of 18 living in the locality during either bushfires or COVID‐19. Findings: The barriers identified included the impact on PHC access of priorities other than health, including housing; financial constraints; difficulties with transport; medical bureaucracy and the physical environment of the health care setting, including appointment‐making processes; interactions with medical reception staff; and waiting room environments. Enablers identified included the supportive role of the local Aboriginal Community Controlled Health Organisations (ACCHO) and their staff, which was highlighted in participant responses. Discussion: The preference of many Aboriginal people to access PHC via their local ACCHO, rather than mainstream health care services, appears even more salient during crises than in normal times. This research identified that ACCHOs are ideally placed to promote and protect the health of Aboriginal communities during crises. Conclusion: Results may help direct interventions to improve PHC access and experiences for regional Aboriginal communities both during and outside periods of crisis. [ABSTRACT FROM AUTHOR]

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation – The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children. Self-determination informed policies are key to improved outcomes for Aboriginal health. The paper presents work on an oral health policy, undertaken under Loddon Mallee Aboriginal Reference Group's leadership on an Australian state (Victoria) regulation – The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners) Regulations 2022, as an exemplar of a self-determination informed change. The amendment translates to a culturally appropriate integrated oral health promotion model that addresses dental access barriers experienced by Aboriginal people. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]

Warning: This article contains terms, descriptions and opinions that may be culturally sensitive for Aboriginal and Torres Strait Islander peoples. Background: Pelvic health conditions among Aboriginal and Torres Strait Islander women and men are under-recognised and under-reported despite indication of the significant burden of these conditions. Access to effective management provided in a culturally safe manner appears lacking. The study aims were to: (1) summarise the burden of pelvic health conditions among Aboriginal and Torres Strait Islander peoples; (2) explore barriers and enablers to Aboriginal and Torres Strait Islander peoples accessing pelvic healthcare services; and (3) provide considerations on how to implement culturally safe pelvic healthcare services for Aboriginal and Torres Strait Islander peoples. Methods: This study involved a systematic literature search informing a narrative review. Results: Fourteen specific articles were identified. Burden related to pelvic health conditions was identified for both women and men, noting high likelihood of under-reporting. Barriers to effective culturally safe treatment included racism, shame and stigma associated with women's and men's business, lack of culturally safe services and geographical distance. Enablers included building trust with local communities, using yarning principles and codesign of pelvic health services with Aboriginal health workers and services. Strategies to improve pelvic health care for Aboriginal and Torres Strait Islander peoples were described at the systems, health service and clinician levels. Conclusion: Efforts are needed to improve the diagnosis and management of pelvic health conditions for Aboriginal and Torres Strait Islander peoples. Actions are required to engage with local Aboriginal Community Controlled Aboriginal Community Controlled Health Organisations, professionals overseeing service provision and healthcare providers to address the burden of these conditions among Aboriginal and Torres Strait Islander peoples. Warning: This article contains terms, descriptions and opinions that may be culturally sensitive for Aboriginal and Torres Strait Islander peoples. Pelvic health conditions are under-recognised and under-reported by Aboriginal and Torres Strait Islander peoples. Access to effective conservative (non-surgical) management options provided in a culturally safe manner appear to be lacking. We provide strategies to improve pelvic health care of Aboriginal and Torres Strait Islander women and men by highlighting considerations that facilitate culturally safe pelvic health care at the systems, health service and clinician levels. [ABSTRACT FROM AUTHOR]

Background: Few general practitioners (GPs) pursue a career in Aboriginal and Torres Strait Islander health. This research examined factors motivating Australian General Practice Training Program (AGPT) graduates to remain in, or leave, Aboriginal Medical Services (AMSs). Methods: AGPT graduates who remained (n = 11) and left (n = 9) AMSs after placements participated in semi-structured interviews across two studies. Thematic analysis informed by grounded theory was employed. Results: Both participant groups highlighted similar motivations for requesting an AMS placement, particularly their interest in Aboriginal health or culture. Participants enjoyed organisational structures and relationships, and faced similar barriers to working in AMSs. Those who left placed greater emphasis on the politics and bureaucracy, and unpredictability, and also faced the barrier of ties to their current practice. Those who remained in Aboriginal health more proactively addressed barriers and had a more external view of barriers. Conclusions: Factors influencing career decisions of GPs in Aboriginal health overlap with those for GPs in rural and other under-served areas. Training providers can better prepare (e.g. more comprehensive orientations) and support registrars during their placements (e.g. greater mentoring). Registrars' perceptions of, and reactions to, barriers may be pivotal in determining whether they remain in Aboriginal health. This article provides guidance for training providers to better support AMS registrars and encourage more GPs to work in this sector. The authors compared the experiences of general practitioners who did and did not remain in Aboriginal health after completing an Aboriginal health placement as a GP registrar. Despite largely similar experiences, those who left placed stronger emphasis on certain barriers, whereas those who remained more proactively addressed barriers and adopted more of an external focus. The results highlight strategies for better supporting trainees to remain in Aboriginal health. [ABSTRACT FROM AUTHOR]

Mental health challenges appear common among adolescents in American Samoa. There is a community‐identified need to better understand the health burden and identify opportunities to strengthen the mental health system to better meet adolescent mental health needs. The goal of this qualitative study was to gather community stakeholders' perceptions of common mental health problems among adolescents in American Samoa, identify existing services for adolescent mental health, and highlight strength‐based opportunities to enhance care. Using the Fa'afaletui research framework, semi‐structured in‐depth interviews (n = 28) were conducted between October 2020 and February 2021 using Zoom. Key informants were adults living in American Samoa, sampled for diversity in profession, age, gender, education, and region of residence. Transcripts were coded in duplicate and analysed using deductive thematic analysis. Participants reported that suicide, depression, anxiety, and post‐traumatic stress disorder are the conditions of highest burden. Participants identified an impressive amount of infrastructure and community mobilization, but also limitations in these services in addressing adolescents' health needs. Four themes arose related to the need to: (1) strengthen existing infrastructure; (2) reduce barriers to treatment access; (3) improve sustainability; and (4) encourage collaboration among leaders. Policymakers should prioritize the allocation of resources to strengthen infrastructure, public education, and stakeholder collaboration to improve adolescent mental health in American Samoa. [ABSTRACT FROM AUTHOR]

Introduction: Health and self‐determination are recognised as universal human rights. Health professional education research and practice hold the capacity to prioritise values, worldviews and agendas that envisage sustainable and equitable futures for the entire community served. This paper explores the need for the co‐location of Indigenous research paradigms in health professional education research and teaching. Indigenous communities have a long history of science, research and sustainable living and are holders of ways of knowing, being and doing that can shape actions and priorities in health research that value equity and sustainability. Discussion: Knowledge construction in health professional education research does not occur in isolation nor is it value neutral. A continued dominance of the biomedical approach to health creates a system of innovation that is unbalanced and unable to deliver health outcomes demanded by contemporary society. As power and hierarchies are embedded in health professional education research and praxis, transformative action is required to bring forth marginalised voices in research processes. Critical reflexivity regarding the ontological, epistemological, axiological and methodological positioning of researchers is an important step towards creating and sustaining research structures that effectively value and co‐locate different perspectives in knowledge production and translation. Conclusion: Working towards more equitable and sustainable futures for Indigenous and non‐Indigenous communities requires health care systems to be informed and guided by different knowledge paradigms. This can work to avoid the ongoing reproduction of inefficient biomedical structures and purposefully disrupt the status quo of health inequities. Realising this requires the effective co‐location of Indigenous research paradigms and ways of working into health professional education research that centre relationality, wholism, interconnectedness and self‐determination. This calls for a raising of the critical consciousness of health professional education research academies. This critical review calls for greater critical consciousness regarding whose voices are heard, valued and prioritised in health professional education research. [ABSTRACT FROM AUTHOR]

Introduction: Responsiveness of health care systems is a global concept defined as the ability of systems to function in a manner that meets the expectations of individuals, and is under‐studied. In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are valued by Aboriginal and Torres Strait Islander Peoples for the provision of holistic culturally safe primary health care and are well positioned to be responsive to community needs. Objective: To develop a conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal and Torres Strait Islander Peoples in their service region. Design: A qualitative interview study using abductive reasoning was conducted. Interviews conducted with Aboriginal clients, key informants, and ACCHO health personnel from two evaluations undertaken in partnership with a rural ACCHO located in Victoria, Australia, were analysed through an iterative process of identifying key concepts from the data and evidence. Key concepts were used to develop a conceptual framework. Findings: Across the two evaluations, 22 participants were involved in data collection and 28 interviews were undertaken. A conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal Peoples within their service region was developed and encompassed three concepts: operating within a complex adaptive system, mechanisms of responsiveness used by the ACCHO, and challenges experienced by the ACCHO when being responsive. Discussion: The developed conceptual framework expands on research supporting the value of ACCHOs in providing holistic culturally safe health care to their communities, particularly in rural settings. A key finding is the importance for ACCHOs to meet the health care needs of their community whilst navigating needs in the context of the broader health care system. When dissonance is encountered between external system components and community needs, challenges can be experienced such as adequately resourcing models of service delivery and maintaining the provision of services. Conclusion: Conceptualising the health care system as a complex adaptive system in which an ACCHO operates and is responsive, highlights the competing demands experienced. Findings expand on mechanisms of responsiveness used at the service–user interface. Future research should examine how the broader health care system can support the role and functions of ACCHOs in being responsive to the health care needs of their communities. [ABSTRACT FROM AUTHOR]

This study aimed to examine the extent and nature of Australian news media coverage of commercial industry activities that explicitly speak to Aboriginal and Torres Strait Islander contexts. We undertook content and framing analysis of Australian newspaper and online media articles published between January 2018 and March 2022 that included terms related to 'Indigenous', 'commercial' and 'health'. Analysis focused on the nature of coverage, framing of responsibility, patterns over time and stakeholder representation. Forty-six media articles were included in the analysis. Half of these articles related to the actions of three companies (Woolworths, WAM Clothing and Rio Tinto). Most articles described negative health and well-being impacts of commercial activity, while four described positive impacts. The most common voice represented in media articles was from industry (n = 25). Aboriginal or Torres Strait Islander voices were represented in 21 articles. This analysis highlights how commercial activities in Australia are reported to negatively influence Aboriginal and Torres Strait Islander health and well-being, and that industry voices are more commonly represented in the media related to these issues. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to conduct a process evaluation of the Kimberley Dental Team (KDT), a not‐for‐profit, volunteer organization providing care to remote Aboriginal communities in Western Australia. Methods: A logic model was constructed to detail the operational context of the KDT model. Subsequently, the fidelity (the extent to which each of the programme's elements were implemented as planned), dose (types and quantity of services provided) and reach (demographic characteristics and communities serviced) of the KDT model were evaluated using service data, deidentified clinical records and volunteer rosters maintained by KDT from 2009 to 2019. Trends and patterns of service provision were analysed using total counts and proportions over time. A Poisson regression model was used to explore changed in the rates of surgical treatment over time. The associations between volunteer activity and service provision was also investigated using correlation coefficients and linear regression. Results: A total of 6365 patients (98% identifying as Aboriginal or Torres Strait Islander) were seen over the 10‐year period with services being provided across 35 different communities in the Kimberley. Most services were provided to school‐aged children, consistent with the programme's objectives. The peak preventive, restorative and surgical rates occurred among school‐aged children, young adults and older adults respectively. A trend was observed indicating a reducing rate of surgical procedures from 2010 to 2019 (p <.001). The volunteer profile showed significant diversity beyond the conventional dentist–nurse structure and 40% being repeat volunteers. Conclusions: The KDT programme maintained a strong focus on service provision to school‐aged children over the last decade with the educational and preventive components being central to the care being provided. This process evaluation found that the dose and reach of the KDT model grew with an increase in resources and was adaptive to perceived community need. The model was shown to evolve through gradual structural adaptations contributing to its overall fidelity. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare COVID-19 health policy and programme responses in 16 Northern and Indigenous regions in Canada. The goal was to summarise strategies used to mitigate the initial spread of the pandemic while highlighting aspects that reflect Indigenous values. Methods: A scoping review of grey literature was completed, focusing on territorial, regional health authority, and community level websites. Further media analysis was conducted to reach saturation regarding policy changes and programmes implemented to prevent transmission, improve health communication, access testing, provide health services effectively, secure borders, and provide financial assistance. Common responses were mapped on the Women's College Hospital's Wholistic Framework for Safe Wellness to identify aspects that reflected Indigenous values. This framework utilises the medicine wheel to discuss physical health (body), ceremony (spirit), community health (heart), and assessment (mind). Results: The Women's College Hospital's Wholistic Framework for Safe Wellness quadrants of the body, spirit and heart were covered by most regions via health communication efforts, adaptations to traditional practices, and continuation of care during the pandemic, respectively. It was found that 13 regions had pandemic responses adapted for Indigenous populations. Conclusions: The responses in each Northern region show that protecting each community was a priority; however, policies and programmes were developed as a kaleidoscope of what can be done quickly and evaluated later. Assessment, risk, and prevention, covered by the mind quadrant of the Women's College Hospital's Wholistic Framework for Safe Wellness, were missing in initial emergency responses. Increasing capacity for emergency management in Northern and Indigenous regions will require contingency planning that acknowledges and builds off traditional knowledge. [ABSTRACT FROM AUTHOR]

The transmission of generational knowledge in Alaska Native communities has been disrupted by colonization and led to declining health among Alaska Natives, as evidenced by the loss of knowledge regarding traditional foods and foodways and increasing rates of cardiometabolic disorders impacting Alaska Natives. Elders play a central role in passing down this generational knowledge, but emerging Elders may have difficulty in stepping into their roles as Elders due to the rapid social and cultural changes impacting their communities. The Center for Alaska Native Health Research (CANHR) and the Denakkanaaga Elders Program are partnering with the Center for Indigenous Innovation and Health Equity to uplift and support traditional food knowledge and practices to promote health in Alaska Native communities. Guided by a decolonizing and Indigenizing framework, researchers at CANHR are working with Athabascan Elders in the Interior of Alaska to strengthen and protect the intergenerational transmission of cultural knowledge and practices for emerging Elders. This community-academic partnership will implement and evaluate an Elders Mentoring Elders Camp to focus on repairing and nurturing relationships through the practice and preservation of cultural knowledge and practices, including traditional foodways. This initiative contributes to the intergenerational transmission of knowledge, which is necessary to keep culture alive and thriving. [ABSTRACT FROM AUTHOR]

The Center for Indigenous Innovation and Health Equity (CIIHE) at Oklahoma State University Center for Health Sciences (OSU-CHS) is a community–academic partnership with Indigenous peoples from Alaska, Hawai'i, and Oklahoma. The CIIHE supports communities to strengthen traditional food practices and food sovereignty and evaluate the impact of those efforts on health. In February 2022, the CIIHE sponsored and hosted a virtual conference to better understand how food sovereignty initiatives can improve health. More than 600 participants gathered to hear the latest research and practice in the areas of public health and agriculture, nutrition, community-based and Indigenous knowledge, and health economics. Community-led food sovereignty initiatives being implemented as part of the CIIHE were featured along with other Indigenous initiatives in urban, rural, and reservation communities. A survey was administered to conference participants to assess food sovereignty topics and priorities for future research. In this Practice Note, we describe innovative community-led initiatives presented as part of the conference and recommendations for action emerging from qualitative and quantitative data collected from conference participants. [ABSTRACT FROM AUTHOR]

Background: The Australian geographically rural and remote disability workforce has historically demonstrated difficulties to keep up with the demand for quality services and supports for people with disability. In 2013, the National Disability Insurance Scheme (NDIS) was launched to provide individualised disability support packages to meet people's needs. To receive funding, people with disability are required to develop a NDIS plan. That plan is then funded by the National Disability Insurance Agency (NDIA), the government agency responsible for managing the NDIS. Although the NDIS has been operating for almost 10 years, there is limited research into the planning experiences of the workforce in regional, rural and remote regions of Australia. This review aims to ascertain the level of scholarly investigation into workers' experiences of NDIS planning. Methodology: Research publication databases were searched using a specific search string to identify publications that included reference to the workforce's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications that focused on those working with Aboriginal and Torres Strait Islander people were also appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications was undertaken to ascertain disability and health workforce experiences of the NDIS planning process. Results: Seven papers met the selection criteria. Two papers were policy reviews and reported the improvements of the NDIS planning process since its inception. These studies reported four reoccurring themes: (1) cultural/socioeconomic and geographical factors; (2) administrative burden and bureaucracy; (3) values, culture and geography; and (4) burden on allied health workers. Conclusion: The NDIS planning process has developed and progressed since its rollout in 2013. There are limited research papers available that describe the workforce's experience of the planning process in regional, rural and remote regions. More research in this area is needed to identify the experiences of the disability workforce in relation to the NDIS planning process. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the delivery of primary health care internationally, particularly for the most marginalised groups. This project investigated the impact of the initial response to the COVID-19 pandemic on the delivery of primary health care in a remote First Nations community in Far North Queensland with a high chronic disease burden. There were no confirmed cases of COVID-19 circulating in the community at the time of the study. A comparison was conducted of patient numbers presenting to a local primary healthcare centre (PHCC) in the periods before, during and after the initial peak of Australian COVID-19 restrictions in 2020, compared to the same period in 2019. A significant proportional decrease was observed in the number of patients that presented from the target community during the initial restrictions. A sub-analysis of preventative services delivered to a defined high-risk group found that services delivered did not decrease to this particular group during the periods of interest. This study has highlighted that there is a risk of underutilisation of primary healthcare services during a health pandemic in remote settings. Strengthening the primary care system to adequately provide ongoing services during natural disasters requires further consideration to reduce the risk of long-term impacts of service disengagement. The COVID-19 pandemic has disrupted the delivery of primary health care internationally. This research investigated the impact of the initial response to the COVID-19 pandemic on the delivery of primary health care in a remote First Nations community in Far North Queensland. It highlighted there is a risk of underutilisation of primary healthcare services during a health pandemic in remote settings and that strengthening the primary care system is required to reduce the risk of long-term impacts of service disengagement. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to externally validate the Commonwealth's Health Care Homes (HCH) algorithm for Aboriginal Australians living in the Northern Territory (NT). Methods. A retrospective cohort study design using linked primary health care (PHC) and hospital data was used to analyse the performance of the HCH algorithm in predicting the risk of hospitalisation for the NT study population. The study population consisted of Aboriginal Australians residing in the NT who have visited a PHC clinic at one of the 54 NT Government clinics at least once between 1 January 2013 and 31 December 2017. Predictors of hospitalisation included demographics, patient observations, medications, diagnoses, pathology results and previous hospitalisation. Results. There were a total of 3256 (28.5%) emergency attendances or preventable hospitalisations during the study period. The HCH algorithm had an area under the receiver operating characteristic curve (AUC) of 0.58 for the NT remote Aboriginal population, compared with 0.66 in the Victorian cohort. A refitted model including 'previous hospitalisation' had an AUC of 0.72, demonstrating better discrimination than the HCH algorithm. Calibration was also improved in the refitted model, with an intercept of 0.00 and a slope of 1.00, compared with an intercept of 1.29 and a slope of 0.55 in the HCH algorithm. Conclusion. The HCH algorithm performed poorly on the NT cohort compared with the Victorian cohort, due to differences in population demographics and burden of disease. A population-specific hospitalisation risk algorithm is required for the NT. [ABSTRACT FROM AUTHOR]

COVID-19 has disproportionately affected Indigenous communities. The Whiteriver Service Unit (WRSU) took an integrated public health–health care system delivery approach in collaboration with the White Mountain Apache Tribe to decrease the case fatality rate (CFR). The WRSU performed daily data analyses identifying risk factors, expeditiously treating and proactively vaccinating people during at-home visits. The WRSU's CFR was 0.3% lower than Arizona's (P =.04). Among communities disproportionally affected, an integrated approach using data to drive real-time decision-making among a culturally competent workforce can contribute to decreased CFR. (Am J Public Health. 2023;113(10):1089–1092. https://doi.org/10.2105/AJPH.2023.307364) [ABSTRACT FROM AUTHOR]

Background: Women living in indigenous communities in Peru currently experience extremely high rates of intimate partner violence (IPV). Over the past 10 years, there has been a large multi-sectoral initiative to establish a national network of Centros de Emergencia de la Mujer (Women's Emergency Centres) that integrate health and police services, and substantial increase in efforts from non-governmental organisations in supporting survivors of violence. However, there is currently little evidence on how existing services meet the needs of indigenous women experiencing violence in Peru. Methods: As part of a broader mixed-methods participatory VAWG prevention study, we assessed existing service provision for women experiencing violence in an indigenous Quechua community from Amantaní, Peru. This involved 17 key informant interviews with legal, government, police, and civil society representatives. We used the UN Women Essential Services Package for Women and Girls Subject to Violence framework to guide our analysis. Results: Participants identified major gaps in existing services for indigenous women survivors of violence in Peru. They discussed survivors and perpetrators not being identified by the health system, a lack of IPV response training for health professionals, IPV not being prioritised as a health concern, and a lack of health services that are culturally appropriate for indigenous populations. Survivors who report to police are often treated poorly and discriminated against. Legal systems were perceived as insufficient and ineffective, with inadequate legal measures for perpetrators. While legal and policy frameworks exist, they are often not applied in practice. Service provision in this region needs to adopt an intercultural, rights based, gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations. Conclusion: The role of structural violence in perpetuating indigenous women's experiences of violence and undermining their access to services must be central to designing and implementing appropriate policies and services if they are to meet the needs of indigenous women in Peru. Key messages: - Intimate partner violence is a serious health and human rights issue affecting women who have been traditionally discriminated against and excluded from support services in the Andes - Services available in the region need to adopt an intercultural, rights based and gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations in Peru - Structural violence needs to be considered in assessing indigenous women's experiences of violence and their access to services [ABSTRACT FROM AUTHOR]

The article stresses the importance of research to address the health inequalities of Indigenous people in urban areas in Australia. Topics mentioned include the factors that contributed to the urbanization of Indigenous people, the key reasons for poor service of health care centers in urban areas, and a description of the key elements of the Birthing in Our Community Model.

The future of Indigenous STBBI (sexually transmitted and blood-borne infections) research must address the unique needs of diverse First Nations, Inuit, and Métis (FNIM) communities across Canada. This requires the expansion of culturally responsive research approaches centred on FNIM ways of being, knowing, and doing. The Feast Centre for Indigenous STBBI Research (Feast Centre) is dedicated to expanding the use of FNIM research methods in response to the unique needs of distinct Indigenous communities and foregrounds the voices of Indigenous Peoples living with or affected by STBBI. Indigenous Peoples in Canada experience higher rates of STBBI compared to other populations, and this is linked to significant health disparities, meaning that conventional public health approaches are not meeting the needs of Indigenous communities. Canada's colonial health policies sustain health disparities through a lack of culturally responsive approaches to STBBI prevention, treatment, and care. In this article we examine Indigenous STBBI initiatives foundational to the Feast Centre by focusing on the outcomes of a CAAN Communities, Alliances & Networks–led national Indigenous community consultation, the findings of the project's Indigenous HIV and AIDS scoping review, and vital theoretical insights from Indigenous STBBI literature. We provide key recommendations that emphasize culturally responsive approaches to STBBI research that strive to meet community-identified needs while cultivating the inherent strengths of FNIM communities. We envision these key recommendations within the theoretical framework of Indigenous futurisms in ways that reconceptualize Indigenous STBBI research through cultural strengths and offer guidance for the direction of future research. [ABSTRACT FROM AUTHOR]

Using thematic analysis, this study examined social workers' (n = 21) descriptions of what Indigenised social work practice in Uganda entails. Responses from semi-structured interviews revealed the following three themes that inform social workers' understanding of Indigenised social work practice: (1) collective action and mutuality, (2) communal welfare and respect for life and (3) liberation and restoration. The discussion aims at understanding the hallmarks of each description in relation to the notions of Indigenised social work as culturally inclusive and responsive practice, developmental social work and political action. [ABSTRACT FROM AUTHOR]

Background: There is sparse evidence in the literature in relation to indications and outcomes among adult indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between indigenous and non‐indigenous patients were assessed. Aim: To assess the similarities and differences of FB indications and outcomes between indigenous and non‐indigenous patients. Methods: Self‐reported indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between indigenous and non‐indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes. Results: Of the 403 patients, 111 (28%) were indigenous, and indigenous patients were younger (mean difference 11 years) and had a higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, although indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, indigenous patients had a higher presence of Streptococcus pneumoniae (30% vs 9%), while non‐indigenous patients had a higher presence of Pseudomonas aeruginosa (43% vs 11%) and mycobacteria (15% vs 4%). There was no significant difference between indigenous and non‐indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%). Conclusions: This study has demonstrated that adult indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and demonstrate differing microbiology with no significant difference in the diagnostic outcomes for lung malignancy. Ethnic status or remoteness should not preclude indigenous patients to undergo a FB if clinically indicated. [ABSTRACT FROM AUTHOR]

With growing overrepresentation of Aboriginal and Torres Strait Islander children and young people in out‐of‐home care (OOHC), cultural disconnection is an omnipresent threat. Despite research and inquiries that have highlighted the risk of cultural disconnection for Aboriginal and Torres Strait Islander children living in OOHC, limited research has explored Indigenous children and young people's experiences of cultural connection in the Australian context. Informed by Indigenous Standpoint Theory, this Aboriginal‐led qualitative study sought to understand 10 OOHC‐experienced Aboriginal young people's experiences of cultural connection over time, including after exit from OOHC, through retrospective interviews that employed a phenomenological lens. It was found that Aboriginal young people experienced cultural connection as a heterogenous process involving identity formation and the practice of culture, enacted as a choice over time. The complexity of Aboriginal young people's experiences of cultural connection over time gives rise to a new understanding of cultural connection as a journey of culturally connecting, wherein the risk of cultural disconnection is complicated by intergenerational child removals, dominant discourse about what constitutes Aboriginal culture, and removal from an Aboriginal cultural milieu. [ABSTRACT FROM AUTHOR]

This article highlights the significance of prioritizing Indigenous voices and knowledge systems, using whānau-centred initiatives (a concept that encompasses the broader family and community) as a foundation for health promotion within an Indigenous context. Tū Kahikatea, a conceptual framework, is used to demonstrate the relationship between the values underpinning different whānau-centred initiatives and their corresponding outcomes. The framework highlights the capacity of whānau-centred initiatives to support whānau in attaining mana motuhake, which represents collective self-determination and the ability to exercise control over their own future. By doing so, these initiatives contribute to the improvement of whānau health outcomes. With recent changes to Aotearoa New Zealand's health system, the findings underscore the benefits and potential of whānau-centred initiatives in enhancing whānau health outcomes, and advocate for continued strengths-based practices in Aotearoa New Zealand's health system. By bridging the gap between academia and grassroots community action, the article demonstrates the potential of whānau-centred initiatives and contributes to a global call for integrating Indigenous viewpoints and practices into Westernized healthcare, in order to improve Indigenous health outcomes. [ABSTRACT FROM AUTHOR]

For Indigenous Peoples the disparities in health status are largely associated with the direct social determinants of invasion and colonisation, marginalisation, intergenerational traumas, and lack of conscious government policy to address these ongoing effects. There is currently limited evidence in the literature on what Cultural Safety practices mean in acute care settings. We aimed to understand the extent and type of evidence in relation to current knowledge and evidence regarding Cultural Safety practices for Indigenous Peoples in acute care settings. This is a scoping review. We searched six databases in consultation with a librarian experienced in health research. A total of 16 papers were included in the scoping review. Four main barriers to Cultural Safety in practice were identified; Among the included studies, only one quality improvement study reported an intervention, which improved culturally safe care. The four barriers identified each have a variable impact on Indigenous Peoples' health outcomes and are dependent upon the circumstances and experiences of both Indigenous Peoples and healthcare professionals. [ABSTRACT FROM AUTHOR]

Addiction is a multidimensional issue affecting North American, Indigenous peoples. Most federal and provincial-funded treatment programs follow a Western model. We argue for more comprehensive culturally responsive training for workers, and the concept of neurodecolonization be covered. We also call for developing policy within education, licensing bodies, and front-line organizations for a working knowledge of the historical and racial contexts affecting Indigenous peoples. These policies must engage with the Kehte-ayak (Old Ones), while harmonizing Indigenous and Western knowledge systems that incorporate contemplative practices such as Indigenous ceremonies and neurodecolonzation approaches to healing. [ABSTRACT FROM AUTHOR]

As federal partners, the Veterans Health Administration (VA) and the Indian Health Service (IHS) agreed to share resources, such as education. The VA Geriatric Scholars Program, a workforce development program, provides one of its training programs on team-based primary care of elders to clinicians working in IHS and Tribal Health Programs. The practical impact of that training is described. A mixed methods approach was applied to the course's evaluation survey at five clinics in the Northwestern Plains, Southwest, Pacific Coast, and Alaska. Quantitative approaches assessed participants' self-reported intention to improve recognition and assessment of common geriatric syndromes. A qualitative approach applied to open-ended text responses revealed intensions to improve team-based care. Among the 51 respondents in our sample, we found significant improvements in self-reported ability to recognize previously unfamiliar potential risks to elders' health and safety, t(49) = 8.0233, p <.001, as well as increased comfort with conducting geriatric assessments and increased confidence in interprofessional team-based communication. Improvements to team-based care included enhanced clinical skills, organizational factors and the need to train additional employees. This evaluation demonstrates the value of sharing resources among federal partners and its value for participants in IHS and Tribal Health Programs. [ABSTRACT FROM AUTHOR]

This methodological article explores using Indigenous methodologies to elicit, gather, and report Indigenous knowledge as it relates to maternal health and mortality in the North Wollo Zone of Ethiopia. The authors demonstrate how attention to recruitment procedures (i.e. researcher and research assistant familiarity with the zone), data collection (i.e. interviews, visual dialogues, and observations), and data analysis (i.e. Circles and talking pieces) facilitated the elicitation and gathering of Indigenous knowledge. The authors contend using Indigenous methodologies to elicit, gather, and report Indigenous knowledge is essential to developing and implementing effective maternal health and mortality policies and programs in the region. [ABSTRACT FROM AUTHOR]

The article focuses on serious illness considerations for Indigenous People of North America (IPNA), covering topics such as the epidemiology of IPNA, key aspects of serious illness and end-of-life care, and myths that may affect EOL care for IPNA. It emphasizes the importance of cultural sensitivity, respect for core values, and effective communication in providing palliative care for this diverse population.

Background: In 2015, a Brisbane tertiary hospital's cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients' voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members. Methods: This descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones' hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants' stories to be heard and understood from their perspectives. Results: Relationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys. Conclusions: Empowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient's needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality. [ABSTRACT FROM AUTHOR]

Indigenous health is becoming a top priority globally. The aim is to ensure equal health opportunities, with a focus on Indigenous populations who have faced historical disparities. Effective health interventions in Indigenous communities must incorporate Indigenous knowledge, beliefs, and worldviews to be culturally appropriate. [ABSTRACT FROM AUTHOR]

Background: There is evidence of disparities between non-Indigenous and Indigenous incidence of psychotic disorders. Despite these disparities being a clear signpost of the impact of structural racism, there remains a lack of evidence to target institutional factors. We aimed to investigate non-Indigenous and Indigenous differences in government service use prior to first episode diagnosis as a means of identifying points of intervention to improve institutional responses. Methods: We used a previously established national New Zealand cohort of 2385 13 to 25-year-old youth diagnosed with psychosis between 2009 and 2012 and a linked database of individual-level multiple government agency administration data, to investigate the differences in health, education, employment, child protection and criminal-justice service use between non-Indigenous (60%) and Indigenous youth (40%) in the year preceding first episode diagnosis. Further comparisons were made with the general population. Results: A high rate of health service contact did not differ between non-Indigenous and Indigenous youth (adjusted rate ratio 1.0, 95% confidence interval [0.9, 1.1]). Non-Indigenous youth had higher rates of educational enrolment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and employment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and were 40% less likely to have contact with child protection services (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.8]) and the criminal-justice system (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.7]). Both first episode cohorts had a higher risk of criminal justice contact compared to the general population, but the difference was greater for non-Indigenous youth (risk ratio 3.0, 95% confidence interval [2.7, 3.4] vs risk ratio 2.0, 95% confidence interval [1.8, 2.2]), explained by the lower background risk. Interpretation: The results indicate non-Indigenous privilege in multiple sectors prior to first episode diagnosis. Indigenous- based social disparities prior to first episode psychosis are likely to cause further inequities in recovery and will require a response of health, education, employment, justice and political systems. [ABSTRACT FROM AUTHOR]

Vaccines are temperature‐sensitive, and they may lose effectiveness without correct storage. Research in remote Australia raised questions regarding the integrity of the vaccine cold chain to Aboriginal communities and prompted the development of a video resource, Vaccine Story, to raise awareness of maintaining the cold chain. This study describes the development and evaluation of the Vaccine Story video. Local engagement helped to refine and produce the video. Ethics approval was gained from the Menzies School of Health Research Human Ethics Committee (20–3807) and the Central Australian Human Ethics Committee (17–2869) in 2020. The evaluation was considered low risk to all participants. An online anonymous survey tested the appropriateness and effectiveness of the Vaccine Story video to enhance knowledge and awareness of risks to the vaccine cold chain and the potential implementation of the Vaccine Story video. Diverse health professionals and other staff (n = 83) completed the survey. Responses highlighted a lack of training around the packing and transport of vaccines, particularly for non‐clinical support staff. Respondents stated the health messaging in the Vaccine Story video was effective. Over half of respondents (52%) recommend the use of the video as a training tool. The Vaccine Story video addresses some concerns regarding vaccine transportation and storage in remote Aboriginal communities through strengthening understanding of the importance of cold chain. [ABSTRACT FROM AUTHOR]

Background: Syphilis is among the most common sexually transmitted infections worldwide. When it occurs during pregnancy, it can seriously affect the fetus and newborn's health. The scarcity of studies on maternal and congenital syphilis in Indigenous Peoples remains an obstacle to its control in these populations. This study aimed to explore the breadth of the literature, map updated evidence, and identify knowledge gaps on maternal and congenital syphilis in Indigenous Peoples worldwide. Methods: We conducted a Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews. In March 2021, we collected data through a priority search on PubMed, Web of Science, Embase, and SciELO. Results: The strategy yielded 24 studies for analysis. Data in the articles were collected from 1989 to 2020, half from 2015 onwards. Studies were in Oceania and the Americas, mainly in South America (66.7%), particularly in Brazil (50.0%). The topics assessed were Data quality related to maternal and congenital syphilis (20.8%); Diagnosis, provision, access, and use of health services (62.5%); Disease frequency and health inequities (54.2%); Determinants of maternal syphilis and congenital syphilis (20.8%); and Outcomes of maternal and congenital syphilis in the fetus (20.8%). The results show that the available literature on maternal and congenital syphilis is sparse and concentrated in some geographic areas; the frequency of these diseases in Indigenous Peoples varies but is generally higher than in the non-indigenous counterparts; the quality of surveillance data and health information systems is poor; multiple healthcare barriers exist; and the diversity of terms to identify Indigenous Peoples is a challenge to mapping scientific outputs on Indigenous Peoples' health. Conclusions: Maternal and congenital syphilis in Indigenous Peoples is a double-neglected condition and research in this area should be given the priority and encouragement it deserves globally. Reliable data and improving access to health care are needed to reduce the burden of syphilis and correctly inform policies and health services response to mitigate ethnic-racial inequalities in maternal and congenital syphilis. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander people have higher rates of diabetes and its complications than non‐Aboriginal people. Rumbalara Aboriginal Co‐operative is the major primary healthcare provider for Aboriginal people in the Greater Shepparton region. Aims: To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co‐operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. Methods: Clinical and biochemical characteristics, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro‐ and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG‐CoA reductase inhibitors and antiplatelet agents, were determined. Results: One hundred and twenty‐six individuals had diabetes, 121 had type 2 diabetes. One hundred and thirteen identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48–68) years, median HbA1c was 7.8% (6.8–9.6) and median BMI was 33.4 kg/m2 (29–42.3). Compared with other Australian Aboriginal and Torres Strait Islander populations, this population was older and had more obesity, but with better glycaemia management. Compared with specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. Conclusions: Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the past 5 years. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the authors experience of being people known as the original descendants, traditional right holders, and custodians.

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]

Background: Patient-reported outcome measures (PROMs) provide clinicians and consumers a platform to inform and improve healthcare planning and management. Aboriginal people experience disproportionately high rates of chronic diseases, including type 2 diabetes. Treatment and management require holistic approaches that draw on culturally relevant resources and assessment tools. This study explored perceptions of Aboriginal people about two diabetes management-related PROMs (PROMIS-29, PAID Scale). Methods: Twenty-nine Aboriginal people living with diabetes in the Shoalhaven discussed two PROMs in one of four focus groups or at an individual interview. Preliminary data coding was conducted by clinician researchers, with thematic analysis overseen by Aboriginal co-researchers. Subsequent individual interviews with participants were undertaken to seek further feedback and articulate what is needed to improve methods of evaluating Aboriginal people's self-reported quality of life and diabetes management. Results: The PROMs did not capture information or knowledge that Aboriginal people considered relevant to their diabetes-related health care. Participants' recommendations included adapting survey materials to be more culturally sensitive; for example, by improving the alignment of measures with common day-to-day activities. This study also describes a genuine collaborative, Aboriginal community-guided approach to evaluate 'fit-for-purpose' diabetes management tools. Conclusions: Appropriate evaluation methods are paramount to address the disproportionate burden of diabetes experienced by Aboriginal peoples and overcome inverse diabetes care. Our learnings will contribute to development of tools, resources or methods that capture culturally tailored outcome measures. Study findings are relevant to clinicians and researchers using and/or developing Patient Reported Measures, particularly in relation to the practicality of tools for First Nations peoples. Diabetes is a complex condition that substantially impacts quality of life and disproportionately affects Aboriginal Australians. This qualitative study identified that patient-reported outcome measures do not adequately capture the health-related quality of life of Aboriginal adults in the Shoalhaven. Development of culturally tailored health outcome measure tools, resources or methods is feasible if Aboriginal community and researcher-led approaches are prioritised. [ABSTRACT FROM AUTHOR]