Aboriginal Health Programs Research Articles

Healthy Community Healthy Mind: An Evidence-based Culturally Sensitive Aboriginal Child and Adolescent Mental Health Program

Healthy Community Healthy Mind: An Evidence-based Culturally Sensitive Aboriginal Child and Adolescent Mental Health Program

An Aboriginal-led, systemic solution to Aboriginal baby removals in Australia: Development of the Bringing Up Aboriginal Babies at Home program

The increasing rate of statutory Aboriginal infant removal in Australia, which has reached almost 10% of live births in the state of Victoria, is a crisis motivating radical change in child protection pathways. This paper describes the problem analysis and design phases of an Aboriginal-led systems change project intended to ensure Aboriginal infants are raised safe and strong in family, Community, and culture by creating a response capable of shifting underlying system factors. Dialogue and deliberation processes involving 27 practitioners working within Aboriginal health and social care programs in the Bayside Peninsula Area of metropolitan Melbourne, the traditional land of the Bunurong people, was the overarching method used to develop a shared understanding of the problem of Aboriginal infant removals and reach a consensus about what to do in the local system. The themes that emerged during problem analysis reflect a risk/bias theoretical perspective, and in the design phase, it was deemed necessary to reduce both child safety-related risk as well as bias in the child protection system that responds to risk. The ensuing Bringing Up Aboriginal Babies at Home program has a clear systems theory of change, and a service blueprint describing how it is going to be implemented. Bringing Up Aboriginal Babies at Home practice resonates with other programs that have evolved independently in Australia and in other western child protection jurisdictions to reduce infant removals, including building trust for engagement, inspiring hope, openness and transparency, activating extended networks of formal and informal supports, and close collaboration with antenatal and child protection services. Program evaluation will determine whether Bringing Up Aboriginal Babies at Home (BUABAH) can be implemented with fidelity, tackle identified system flaws, reduce the number of Aboriginal infants taken into statutory care and become sustainable.

Exposure to the Family Wellbeing program and associations with empowerment, health, family and cultural wellbeing outcomes for Aboriginal and Torres Strait Islander peoples: a cross-sectional analysis

BackgroundEmpowerment is an internationally recognised concept commonly incorporated in First Nations and in this instance Aboriginal and Torres Strait Islander health and wellbeing programs. The Family Wellbeing Program is an empowerment program developed in partnership with Aboriginal and Torres Strait Islander peoples that has been widely delivered to Aboriginal and Torres Strait Islander communities across Australia for close to 30 years. To date, there has been limited quantitative analysis of how this program is linked to health and empowerment outcomes.MethodsCross sectional analysis of Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, baseline data (n = 9,843) recruited using multi-mode random sampling including mail out survey and in community convenience sampling. Logistic regression models were performed to calculate Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) to examine the association between personal control, life satisfaction, general health, family wellbeing and cultural wellbeing outcomes for Family Wellbeing participants (n = 718) versus non-participants (n = 9,125).ResultsCompared with non-FWB participants, FWB participants are more likely to be female (67.1% versus 58.4%), be aged 35–54 (41.8% versus 32.0%) and live in a remote area (17.7% versus 10.4%) and have educational attainment at the Year 12 level or above (57.8% versus 53.2%). Family Wellbeing participation was associated with a 13% higher reporting of family functioning, a 74% higher reporting of cultural participation and a 21% in higher reporting of local decision making in the local community compared to non-FWB participants. There were significant associations between FWB exposure compared to non-FWB exposure including reporting lower levels of health risk factors including quitting alcohol (26.4% versus 20.4%), regular exercise (67.7% versus 66.3%), quitting smoking (33.4% versus 31.9%). and e. FWB participants who had experienced both prison and youth detention were nearly double that of Non-FWB (3.5% versus 1.4%) and more reported being removed from their families as children (Stolen) (7.0% versus 4.1% Non-FWB).ConclusionThere are significant associations between Family Wellbeing exposure and organisation and community level empowerment outcomes, but only for some individual level empowerment outcomes. There is a lower reporting health risk factors including increased physical exercise, reduced alcohol use and smoking; and educational attainment among FWB participants compared to non-FWB participants. The results suggest individual, community and organisational empowerment needs to be explored further with more robust study designs that can attribute causality and direction of association.

Co-design of dementia prevention program for Aboriginal Australians (DAMPAA).

Dementia is highly prevalent in older Aboriginal Australians, with several modifiable risk factors. Currently, there is limited evidence on how to prevent cognitive decline in Aboriginal Australians. Based on our Theory of Change (ToC) framework, we co-developed the Dementia risk management and prevention program for Aboriginal Australians (DAMPAA) aged over 45 years in partnership with Aboriginal community-controlled organizations (ACCOs) and Elders. Qualitative data were collected through ACCO staff workshops, Elders yarning, and governance groups to inform the protocol. Additionally, we conducted a small pilot study. Expected DAMPAA ToC outcomes are: (1) improved daily function, (2) better cardiovascular risk management, (3) falls reduction, (4) improved quality of life, and (5) reduced cognitive decline. Attendance enablers are social interaction, environment, exercise type/level, and logistics. Findings suggest that ToC is an effective collaborative approach for co-designing Aboriginal health programs.

Assessing community readiness to reduce consumption of sugary drinks in remote Aboriginal and Torres Strait Islander communities: A useful tool for evaluation and co-design.

There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non-Indigenous practitioners culturally adapted and applied the Tri-Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness. Aboriginal community-controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12-month follow-up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks. The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre-defined issue, time and resource-intensiveness of the process, and need to review appropriateness prior to implementation in other regions. The adapted CRT was valuable for evaluating the project and co-designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. SO WHAT?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns.

Scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs: a systematic review

ObjectivesIdentify the number, type, scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs. MethodsA systematic review of peer‐reviewed and grey literature was conducted for articles published from 2010 to 2020 that reported a full economic evaluation of Aboriginal and Torres Strait Islander health programs. Data extraction included: type of economic evaluation, comparators, data sources and concerns, and outcome measures. Methodological quality was assessed using the Drummond checklist. ResultsThirteen publications met inclusion criteria: two cost‐consequence analyses, two cost‐effectiveness analyses, five cost‐utility analyses, and four cost‐benefit/return on investment analyses. Most studies (n=10) adopted a health system perspective and used a range of key data sources for economic analyses. Ten studies identified data access limitations that restricted analyses and two studies identified data quality concerns. Twelve studies were of good methodological quality and one was of average quality. ConclusionsDespite significant investment in strategies to close the gap in health outcomes for Aboriginal and Torres Strait Islander people, there is limited evidence about what constitutes a cost‐effective investment in Aboriginal and Torres Strait Islander healthcare. Implications for public healthMore economic evaluation is required to justify the significant investment in health programs for Aboriginal and Torres Strait Islander people.

Messages for Good Practice: Aboriginal Hospital Liaison Officers and Hospital Social Workers

ABSTRACT This article reports the findings of a study about the work of Aboriginal hospital liaison officers (AHLOs) and hospital social workers in Victoria. Guided by an Aboriginal Critical Reference Group, in-depth interviews were held with nine AHLOs, 10 social workers, and three Aboriginal health policy and program informants. Telephone focus groups held with study participants confirmed an analysis of the narratives of good practice and themes identified by participants. Focusing on the strengths of collaborative work, six key principles for good practice were defined. These principles relate to nonbiomedical knowledge and skills that non-Aboriginal social workers and AHLOs require to work well with Aboriginal patients. Implications for training and further research are discussed. IMPLICATIONS Similar elements of shared good practice between AHLOs and social workers were identified across a range of hospital types in Victoria suggesting that this is an important area of social work practice to understand and develop. The relationship and practice between AHLOs and social workers were previously underexplored, and the strengths and challenges of their working together practice have the potential to positively impact the hospital stay and health outcomes of Aboriginal patients. This study calls for opportunities to further strengthen and facilitate the ongoing, dynamic, and positive relationships between hospital social workers and AHLOs. Working together, they contribute to the creation of cultural safety and care for Aborignal patients and their families.

How can dementia diagnosis and care for Aboriginal and Torres Strait Islander people be improved? Perspectives of healthcare providers providing care in Aboriginal community controlled health services

BackgroundAboriginal and/or Torres Strait Islander people experience dementia at a rate three to five times higher than the general Australian population. Aboriginal Community Controlled Health Services (ACCHSs) have a critical role to play in recognising symptoms of cognitive impairment, facilitating timely diagnosis of dementia, and managing the impacts of dementia. Little is known about the barriers and enablers to Aboriginal people receiving a timely dementia diagnosis and appropriate care once diagnosed.This study aims to explore, from the perspective of healthcare providers in the ACCHS sector across urban, regional and remote communities, the barriers and enablers to the provision of dementia diagnosis and care.MethodsA qualitative study involving semi-structured interviews with staff members working in the ACCHS sector. Aboriginal Health Workers, General Practitioners, nurses, practice or program managers, and Chief Executive Officers were eligible to participate. Consenting ACCHS staff completed a telephone interview administered by a trained interviewer. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis.ResultsSixteen staff from 10 ACCHSs participated. Most participants perceived their communities had a limited understanding of dementia. Symptoms of dementia were usually noticed by the GP or another healthcare worker at the ACCHS who had an ongoing relationship with the person. Most participants reported that their service had established referral pathways with either hospital-based geriatricians, geriatricians located with aged care assessment teams, or specialists who visited communities periodically. Key enablers to high quality dementia care included the use of routine health assessments as a mechanism for diagnosis; relationships within communities to support diagnosis and care; community and family relationships; comprehensive and holistic care models; and the use of tailored visual resources to support care. Key barriers to high quality care included: denial and stigma; dementia being perceived as a low priority health condition; limited community awareness and understanding of dementia; lack of staff education and training about dementia; and numerous gaps in service delivery.Conclusions Substantially increased investments in supporting best-practice diagnosis and management of dementia in Aboriginal communities are required. ACCHSs have key strengths that should be drawn upon in developing solutions to identified barriers to care.

Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia

BackgroundIn Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory’s publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion.MethodsA retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion.Results39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, ‘needs assessment’ findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded.ConclusionThis is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.

Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review

BackgroundTargeted chronic disease programs are vital to improving health outcomes for Indigenous people globally. In Australia it is not known where evaluated chronic disease programs for Aboriginal and Torres Strait Islander people have been implemented. This scoping review geographically examines where evaluated chronic disease programs for Aboriginal people have been implemented in the Australian primary health care setting. Secondary objectives include scoping programs for evidence of partnerships with Aboriginal organisations, and use of ethical protocols. By doing so, geographical gaps in the literature and variations in ethical approaches to conducting program evaluations are highlighted.MethodsThe objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a published protocol. This scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) scoping review methodology. The search included 11 academic databases, clinical trial registries, and the grey literature.ResultsThe search resulted in 6894 citations, with 241 retrieved from the grey literature and targeted organisation websites. Title, abstract, and full-text screening was conducted by two independent reviewers, with 314 citations undergoing full review. Of these, 74 citations evaluating 50 programs met the inclusion criteria. Of the programs included in the geographical analysis (n = 40), 32.1% were implemented in Major Cities and 29.6% in Very Remote areas of Australia. A smaller proportion of programs were delivered in Inner Regional (12.3%), Outer Regional (18.5%) and Remote areas (7.4%) of Australia. Overall, 90% (n = 45) of the included programs collaborated with an Aboriginal organisation in the implementation and/or evaluation of the program. Variation in the use of ethical guidelines and protocols in the evaluation process was evident.ConclusionsA greater focus on the evaluation of chronic disease programs for Aboriginal people residing in Inner and Outer Regional areas, and Remote areas of Australia is required. Across all geographical areas further efforts should be made to conduct evaluations in partnership with Aboriginal communities residing in the geographical region of program implementation. The need for more scientifically and ethically rigorous approaches to Aboriginal health program evaluations is evident.

Ngaa-bi-nya Aboriginal and Torres Strait Islander program evaluation framework

The Ngaa-bi-nya framework presented here is a practical guide for the evaluation of Aboriginal and Torres Strait Islander health and social programs. It has a range of prompts to stimulate thinking about critical success factors in programs relevant to Aboriginal and Torres Strait Islander people’s lives. Ngaa-bi-nya was designed from an Aboriginal practitioner-scholar standpoint and was informed by the holistic concept of Aboriginal health, case studies with Aboriginal-led social and emotional well-being programs, human rights instruments, and the work of Stufflebeam. Aboriginal and Torres Strait Islander health and social programs have been described as suffering from a lack of evaluation. Ngaa-bi-nya is one of the few tools developed specifically to reflect Aboriginal and Torres Strait Islander peoples’ contexts. It prompts the user to take into account the historical, policy, and social landscape of Aboriginal and Torres Strait Islander people’s lives, existing and emerging cultural leadership, and informal caregiving that supports programs. Ngaa-bi-nya’s prompts across four domains—landscape factors, resources, ways of working, and learnings—provide a structure through which to generate insights necessary for the future development of culturally relevant, effective, translatable, and sustainable programs required for Australia’s growing and diverse Aboriginal and Torres Strait Islander populations.

The Aboriginal Australian Family Wellbeing Program: A Historical Analysis of the Conditions That Enabled Its Spread.

Spreading proven or promising Aboriginal health programs and implementing them in new settings can make cost-effective contributions to a range of Aboriginal Australian development, health and wellbeing, and educational outcomes. Studies have theorized the implementation of Aboriginal health programs but have not focused explicitly on the conditions that influenced their spread. This study examined the broader political, institutional, social and economic conditions that influenced negotiations to transfer, implement, adapt, and sustain one Aboriginal empowerment program-the Family Wellbeing (FWB) program-to at least 60 geographical sites across Australia over 24 years. A historical account of the spread of the FWB Program was constructed using situational analysis, a theory-methods package derived from a poststructural interpretation of grounded theory methods. Data were collected from published empirical articles, evaluation reports and project articles, and interviews with 18 key actors in the spread of FWB. Social worlds and arenas maps were used to determine the organizations and their representative agents who were involved in FWB spread and to analyze the enabling and constraining conditions. The program was transferred through three interwoven social arenas: employment and community development; training and capacity development; and social and emotional wellbeing promotion and empowerment research. Program spread was fostered by three primary conditions: government policies and the availability and Aboriginal control of funding and support; Aboriginal leadership, associated informal networks and capability; and research evidence that built credibility for the program. The continued demand-driven transfer of empowerment programs requires policies that enable Aboriginal control of funding and Aboriginal leadership and networks. Flexible and sustained coordination of program delivery is best leveraged through regional innovation hubs that can work with partner organizations to tailor the program to local end-user needs. Associated research is also needed to evaluate, continually improve program quality, and build program credibility through evidence.

First Nation and Métis Youth Perspectives of Health

This article describes an Indigenous and qualitative research project with 13 First Nation (FN) and Métis youth attending an Aboriginal youth health and wellness program located in the Canadian prairies. Our goal was to collaborate with the youth to co-create knowledge concerning their definitions of health using a convergence of Indigenous and qualitative methodologies. Independent but interconnected themes that emerged are discussed as related to neurodecolonization and the recovery of traditional practices and their contribution to youth resilience. The resilience of youth was reflected in these themes as well as their definitions of health. Our findings point to the importance of acknowledging and validating the role that neurodecolonization practices contribute to healing, both at individual and collective levels. Furthermore, we suggest recognizing resilience as well as viewing health holistically to more adequately understand and address the health-related concerns of FNs, Métis, and Inuit (FNMI) youth.

Federal Aboriginal health programs

A recent CMAJ news article, “Aboriginal health programming under siege, critics charge,”[1][1] did not include key facts that would have provided a balanced view of federal Aboriginal health programs. I would like to make your readers aware of the following: As a Northerner, I am well aware of

Building a strategic approach to improve Aboriginal health research and evaluation in NSW.

A 5-year strategic plan for Aboriginal health research and evaluation has been developed to support the NSW Ministry of Health in its efforts to create the evidence for what works in addressing the health disparity between Aboriginal and non-Aboriginal people. The plan has the following objectives: that all Aboriginal health policies and programs are evidence informed; that programs and strategies are rigorously evaluated and contribute to building the evidence for improving Aboriginal health outcomes; that new research evidence is generated for improving Aboriginal health outcomes; and that robust monitoring and accountability mechanisms in Aboriginal health are in place, with improved data quality. This paper describes the development of the NSW Ministry of Health's Aboriginal Health Research and Evaluation Strategic Plan 2011-15, including a review of the evidence and policy documents, facilitated planning sessions, and consultation with staff within the Population and Public Health Division of the Ministry.

An evidence-based formative evaluation of a cross cultural Aboriginal mental health program in Canada

AbstractThis article reports on a formative evaluation of a Canadian cross cultural Aboriginal mental health program that combined the healing properties of the Aboriginal healing circle and the self-awareness and empowerment practices of the psychotherapy technique known as ‘focusing’. The study was formative in nature and grounded in qualitative inquiry. Out of the data analysis, five salient themes surfaced that captured the breadth of the participants’ first-hand experiences of the piloted program: experience, relationships, spirituality and connectedness, empowerment, and self-awareness. The findings were interpreted using the therapeutic criteria for both the focusing and healing circle components of the program. Implications of the research include the need for further research to be conducted with, for and by Aboriginal people to ensure that their worldview is acknowledged and put into practice, and the need to acknowledge existing frameworks of healing and knowledge within Aboriginal communities.

Clearing the Path for Community Health Empowerment: Integrating Health Care Services at an Aboriginal Health Access Centre in Rural North Central Ontario

The article provides a critical examination of the rewards and challenges faced by communitybased Aboriginal health organizations to integrate the rapidly evolving provincially- and federallyfunded Aboriginal health program streams within an existing mainstream rural and federal First Nations health care system in Ontario. The shift to self-governance in health care means Aboriginal health organizations are dealing with rapid organizational changes. In addition, community health program planners at the First Nations level are faced with the challenge of developing local Aboriginal models of care and integrating these within the often-conflicting backdrop of the existing mainstream model of community health. While political leadership and health organization typically both have mandates to work towards the health and well-being in their communities, the two sectors may not always have the same expectations on how to realize these goals. While autonomy in the development of services is essential to self-determination in health, there is also a need for Aboriginal health agencies to collaborate regionally in order to improve health at the community level in the most effective and timeliest manner. Using the example of the mental health and traditional Aboriginal health services, this article provides an analysis of the role of an Aboriginal health access centre in regional community health empowerment.

Koori Primary Health Care in Victoria: Developments in Service Planning

The Alma Ata 1978 Declaration on primary health care has conventionally been applied in developing countries, where medically trained personnel and other highly skilled health professionals and medical infrastructure are limited. Although such concepts have salience in relatively resource rich countries such as Australia, it is in Aboriginal and Torres Strait Islander health policy that they have become pivotal. A growing national focus on the development of Aboriginal primary health care capacity followed the release of the National Aboriginal Health Strategy (NAHS) in 1989 (Anderson, 1997). This focus consolidated further, following the evaluation of the National Aboriginal Health Strategy implementation in 1994 which preceded the transfer of administrative responsibility for the Commonwealth Aboriginal health program from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the Commonwealth Health portfolio (DHFS, 1994). Within the strategic framework provided by federal state agreements, the development of primary health care services is a priority. In the current national policy framework domains of policy and strategy development have been identified as key developmental themes.

Health Promotion Needs of Older Aboriginal People

This paper explores the health promotion needs of older Aboriginal people. A qualitative study was conducted in Brisbane of both younger and older Aborigines' conceptions of what ageing is and what the needs of older Aborigines are. It discusses the areas of health which are identified as being particularly significant to the Aboriginal community, the difference in perceptions according to age and gender, and strategies which will increase the relevance and success of Aboriginal health programs.

Aboriginal health--current status.

An analysis of the limited available data confirms that the health status of Australia's Aborigines remains much worse than that of non-Aboriginal Australians. Despite significant improvements over the past decade Aboriginal fetal and infant mortality is still approximately three times that of non-Aborigines. Aboriginal life expectancy remains at least twenty years less than that of the total Australian population. Levels of Aboriginal hospitalisation have declined markedly, but remain well in excess of overall levels, particularly for infants and children. For Aborigines, the reduced overall impact of the communicable diseases has been balanced by a worsening of the "lifestyle" diseases, particularly hypertension, coronary heart disease and diabetes mellitus. Alcohol abuse plays an important role in these diseases, and in the level of accidents and violence amongst Aborigines. The current patterns require a reassessment of Aboriginal health priorities, with more attention being directed at the health problems of Aboriginal adults. Special Aboriginal health programs need to be expanded, and integrated with broad wide-ranging programs aimed at alleviating Aboriginal social inequality.