78.2 Impact of Climate Change on the Health and Well-Being of Indigenous Communities in Australia

There has been insufficient research involving Aboriginal and Torres Strait Islander peoples living in urban areas to inform strategies required to improve inequitable health outcomes and life expectancy for Aboriginal and Torres Strait Islander peoples. The injustice of these health inequities motivated me to investigate the use of computerised Aboriginal and Torres Strait Islander health assessments in primary care as a source of research data which can be used to respond to community priorities. I conducted this research at the Inala Indigenous Health Service, a Queensland Government funded primary health care service for Aboriginal and Torres Strait Islander peoples. Inala is a suburb in south- western Brisbane with a strong sense of community and identity, but also significant social and economic challenges. Staff at the Inala Indigenous Health Service have been using Aboriginal and Torres Strait Islander health assessments for both clinical and research purposes since their introduction in 2004 for adults, and 2006 for children.In this thesis, I used a mixed methods approach. The first two research projects of this thesis are situated in the postpositivist paradigm where researchers accept that scientific research produces evidence which helps establish the probability that a finding is true rather than truth itself. The first research project evaluated the feasibility of implementing computerised health assessments in primary care for dual clinical and research purposes. After finding that it was feasible, the second research project established that computerised health assessment data were sufficiently representative, complete, reliable, and valid to produce credible research findings.The final two research projects of this thesis are situated in the transformative paradigm with the explicit goal of improving the social world. I acknowledge that my position as a white, non-Indigenous, male, medical researcher influenced the conduct and outcome of all the research projects in this inquiry. To minimise the risk that this research would reproduce the damaging effects of research for Aboriginal and Torres Strait Islander peoples conducted by non-Indigenous researchers, I listened to community voices to inform my approach to research using computerised health assessment information.I conducted a qualitative study involving thematic analysis of semi-structured interviews with key informants in the Inala Aboriginal and Torres Strait Islander community regarding their priorities for health and research based on health assessment data. Rather than a discrete set of health priorities, key informants articulated an authoritative understanding of how interrelated, inter-generational, social, cultural, and environmental determinants of health operated in a “cycle” to influence the community’s health. Furthermore, some key informants were ambivalent about Aboriginal and Torres Strait Islander health assessments because of their biomedical emphasis. These findings supported the addition of questions to health assessments at the Inala Indigenous Health Service regarding psychosocial stressors, social determinants of health, and community participation. Because of key informants’ emphasis on the social determinants, I conducted an epidemiological investigation of social, cultural, and environmental determinants of health using adult computerised health assessment data. From this investigation, I found that the experience of a range of social, cultural, and environmental determinants of health varied significantly according to the age and sex of participants suggesting opportunities for demographically targeted policy intervention.Findings from this doctoral research demonstrate that Aboriginal and Torres Strait Islander computerised health assessments can be implemented in the primary health care setting, and used to produce credible research findings which respond to community priorities. Presently, the widespread application of computerised health assessment based research has been limited by commonly used general practice software systems in Australia which include non-customisable health assessments, and are not suited to research. At the Inala Indigenous Health Service, future research based on computerised health assessments will seek to further investigate social, cultural, and environmental determinants of health, and could include longitudinal analysis and data linkage.The results of key informant interviews and the investigation of social, cultural, and environmental determinants will be fed back to community organisations and health services as a community report. This community report was designed to assist community organisations and health services plan, monitor, advocate, and apply to policy makers for funding for activities, programs, and services to address social, cultural, and environmental determinants of health.This research also revealed tensions inherent in attempting to reconcile the health priorities of community key informants situated in the social world with a medical researcher, a health service setting, and research tool, the health assessment, all situated within the privileged biomedical model of health. By positioning research in this thesis in the transformative paradigm using a mixed methods approach, I endeavoured to acknowledge and explore these tensions. These research findings encourage a policy discourse which does not emphasise the biomedical model of health, but rather emphasises the importance of taking the holistic view of health expressed by both the National Aboriginal Health Statement Working Party and Inala Aboriginal and Torres Strait Islander key informants.

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

Kidney Outcomes for First Nations Children

Alcohol-related harm is a significant health and social issue for Aboriginal and Torres Strait Islander communities. Primary healthcare can play a part in preventing these harms. The aim of this paper is to describe three domains for action in preventing alcohol-related harm in Aboriginal and Torres Strait Islander communities: addressing the social and economic determinants of health; supporting population-level action on alcohol availability; and providing culturally safe treatment for individual clients. General practice has a role in treating and preventing illness both on an individual and at a population level. In preventing alcohol-related harm in Aboriginal and Torres Strait Islander communities, this dual role may include screening and brief interventions; referral pathways and access to multidisciplinary care; cultural safety; support for action on alcohol availability; advocacy on the social and economic determinants of health; reorienting general practice towards population health; and support for Aboriginal Community Controlled Health Services.

BackgroundPreventing and treating methamphetamine-related harm in Aboriginal and Torres Strait Islander populations is a significant challenge for health care services. Digital health care may offer opportunities to support individuals and families in ways that complement existing methamphetamine treatment options. This study responds to a community-identified priority as Aboriginal Community Controlled Health Services identified methamphetamine use as a key concern and sought support to respond to the needs of people who use methamphetamine and their families.ObjectiveThis paper reports on a process evaluation of the web application’s acceptability and feasibility when used by clients and clinicians in residential rehabilitation services and primary care. This study is part of a larger project entitled “Novel Interventions to address Methamphetamine use in Aboriginal and Torres Strait Islander Communities” (NIMAC), which seeks to develop culturally appropriate and strengths-based prevention and treatment interventions to reduce methamphetamine related harm. “We Can Do This” was a web application developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use.MethodsClinicians and clients who had used the web application were recruited through Aboriginal Community Controlled Health Services and Aboriginal residential rehabilitation services in urban and regional Victoria and South Australia. Unidentified usage data was collected from all participants. After using the web application, those who indicated a willingness to be interviewed were contacted and interviewed by phone or in person and asked about the feasibility and acceptability of the web application. The framework method of analysis was used to structure and summarise the resulting qualitative data.ResultsInterviews with 24 clients and 11 clinicians explored the acceptability and feasibility of the web application. Acceptability incorporated the following domains: affective attitude, burden, ethicality, cultural appropriateness, coherence, opportunity cost, perceived effectiveness, and self-efficacy. The evaluation of feasibility assessed barriers and facilitators to the implementation of the program, with a focus on demand, practicality, fidelity, and integration. Results indicated that both clients and clinicians found the web application content coherent, relatable, empowering, and culturally safe. Barriers to using the web application for clients included a lack of internet connectivity and personal issues such as scheduling.ConclusionsProcess evaluation is often under-valued. However, as “We Can Do This” was new, innovative and targeted a hard-to-reach population, understanding its feasibility and acceptability as a clinical tool was essential to understanding its potential. “We Can Do This” is unique as the only evidence-based, culturally appropriate internet-based therapeutic program specifically designed for Aboriginal and Torres Strait Islander people who use methamphetamine. Findings suggest it was both acceptable and feasible as a low-cost adjunct to usual care in residential rehabilitation and primary care settings.

To describe the pattern of disease and other health problems in children living in remote Far North Queensland (FNQ). Retrospective review of the FNQ Paediatric Outreach Service's Medical Director database for the period June 2001 to February 2006. Three subpopulations were compared: children from predominantly Aboriginal communities, predominantly Torres Strait Islander communities, and other communities. All children referred to the service during the study period were reviewed. Number of children seen and common diagnoses. 3562 children were referred during the study period, and a total of 3932 diagnoses were made; 56% of the paediatric population of the Aboriginal communities and 23% of the paediatric population of Torres Strait Islander communities were seen. Of 40 separate diseases/health problems reviewed, the three most common reasons for presentation were chronic suppurative otitis media, suspected child abuse and neglect, and failure to thrive. In the paediatric population of Aboriginal communities, the prevalence of fetal alcohol spectrum disorder was at least 15/1000 (1.5%), and in Torres Strait Islander children, rheumatic heart disease prevalence was at least 6/1000 (0.6%). Rheumatic fever rates were among the highest in Australia. Rates of preventable complex and chronic health problems in Aboriginal and Torres Strait Islander children in remote FNQ are alarmingly high. Areas requiring urgent public health intervention include alcohol-related conditions and rheumatic fever.

Rethinking the use of ‘vulnerable’

Burden of the Beast

Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease.

Respiratory illness in urban Indigenous children: risk and cultural context

The validation of a self-report measure and physical activity of Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children.

Commentary on Rémond et al.

Otitis media (OM) is a significant health concern, particularly among Aboriginal and/or Torres Strait Islander children who experience one of the highest rates of OM globally. This study aimed to evaluate the use and differences of wideband absorbance at ambient pressure (WBA) among urban Aboriginal and/or Torres Strait Islander and non-Aboriginal children with suspected OM based on standard tympanometry. We conducted a cross-sectional observational study in Perth, Western Australia, recruiting children from both tertiary and community-based healthcare settings. A total of 53 children (106 ears) were included in this study, of which 30 children (60 ears) were Aboriginal and/or Torres Strait Islander (mean age 4.67 ± 3.76, range: 0.59 to 14.96 years) and 23 children (46 ears) were non-Aboriginal (mean age 3.94 ± 1.53, range: 1.93 to 6.01 years). Each child underwent an audiological assessment, which included otoscopy, single-frequency tympanometry, WBA, otoacoustic emissions, and age-appropriate audiometry. Audiologist examination and interpretation of standard audiological results served as the reference standard for a suspected OM diagnosis. WBA analysis was performed on 104 ears, of which 30 ears were diagnosed with suspected OM using single-frequency tympanometry results. When comparing ears, mean WBA was similar between non-Aboriginal children and Aboriginal and/or Torres Strait Islander children without suspected OM at all frequencies (p > 0.05). Mean WBA was significantly reduced between 500 and 4000 Hz in all children with suspected OM, with a peak difference at 1600 Hz observed between groups (p < 0.001). Overall, WBA was more reduced in Aboriginal and/or Torres Strait Islander children with suspected OM compared with non-Aboriginal children with suspected OM, the only significant difference was observed at 800 Hz (p = 0.037). For this sample of children living in an urban area, WBA is significantly reduced in the ears of children with suspected OM compared with those children with healthy middle ears. Aboriginal and/or Torres Strait Islander children without suspected OM show comparable WBA results to non-Aboriginal children with normal ears. However, Aboriginal and/or Torres Strait Islander children with suspected OM exhibit lower overall WBA than their non-Aboriginal peers with OM, with a significant difference observed at 800 Hz. These findings support previous research that suggests WBA may be a valuable tool in detecting OM, particularly in high-risk populations. Further research is needed to investigate the factors contributing to reduced WBA in Aboriginal and/or Torres Strait Islander children with OM and to validate WBA's potential in addressing the under-detection of OM in this population.

Scabies has recently gained international attention, with the World Health Organization (WHO) recognizing it as a neglected tropical disease. The International Alliance for the Control of Scabies recently formed as a partnership of more than 15 different countries, with an aim to lead a consistent and collaborative approach to preventing and controlling scabies globally. Scabies is most prevalent in low-resource and low socioeconomic areas that experience overcrowding and has a particularly high prevalence in children, with an estimated 5% to 10% in endemic countries. Scabies is widespread in remote Aboriginal and Torres Strait Islander communities in Australia with the prevalence of scabies in Aboriginal and Torres Strait Islander children in remote communities estimated to be as high as 33%, making it the region with the third highest prevalence in the world. This population group also have very high rates of secondary complications of scabies such as impetigo, poststreptococcal glomerulonephritis (PSGN), and rheumatic heart disease (RHD). This article is a narrative review of scabies in remote Aboriginal and Torres Strait Islander populations in Australia, including clinical manifestations of disease and current treatment options and guidelines. We discuss traditional approaches to prevention and control as well as suggestions for future interventions including revising Australian treatment guidelines to widen the use of oral ivermectin in high-risk groups or as a first-line treatment.

To develop and validate two age-specific, strength-based measures of social and emotional well-being (SEWB) for Aboriginal and Torres Strait Islander children and youth. Following development of a conceptual framework comprising six domains of SEWB and identification of existing SEWB tools, an iterative process of item refinement took place. Items were assigned to corresponding SEWB domains, and their content validity and face validity were examined. Community-Controlled Health Services provided expert feedback. Statistical analyses were conducted to assess floor and ceiling effects, item redundancy, network structure, item stability, model fit and reliability. An ant colony optimisation (ACO) algorithm was employed to identify a reduced number of items with adequate model fit. Data on SEWB were generated as part of the baseline assessment for a national study involving Aboriginal and Torres Strait Islander Communities. 11 Aboriginal and Torres Strait Islander Communities from six states and territories. Aboriginal and Torres Strait Islander children and youth aged 2-18 years. Network structure, item stability, model fit and reliability and reduced scales. Different sets of items were developed to accommodate the needs of different age groups. A total of 235 participants and 162 guardians answered the self-report and the carer-report tool, respectively. A unidimensional structure was identified for both scales. Adequate item stability, model fit and reliability were obtained. The short versions of the SEWB tools offer a friendly, age-appropriate and time-efficient approach while capturing all relevant domains of SEWB.