Aboriginal Health Research Articles

Culturally Safe and Integrated Primary Health Care: A Case Study of Yerin Eleanor Duncan Aboriginal Health Services’ Holistic Model

Objective To understand the importance of culturally safe integrated primary health care for Aboriginal families in the Central Coast of New South Wales, where their social and emotional wellbeing is impacted through a range of health issues related to domestic and family violence. Methods An Indigenous methodology of yarning through conversational semi-structured interviews with seven primary health care workers at Yerin, an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales. Yarning sessions explored factors that enable and/or inhibit the provision of holistic and comprehensive trauma and culturally informed responses to Aboriginal and Torres Strait Islander women who experience violence. Results Five key themes were identified: 1) The importance of integrated primary health to support women and families; 2) Soft entry pathways; 3) Culturally safe care delivered by health workers experienced in trauma informed care; 4) Community partnerships; and 5) Funding sustainable programs that are community led and delivered by Aboriginal and Torres Strait Islander people. Lessons Learned Culturally safe and trauma informed and responsive care that is integrated within primary health care is important in comprehensively meeting the needs of Aboriginal and Torres Strait Islander women who experience domestic and family violence. The provision of soft entry pathways creates rapport and trust through an integrated team approach, highlighting the importance of more holistic service provision focusing on recovery and healing.

Factors Associated with Thoughts of Self-Harm or Suicide among Aboriginal and Torres Strait Islander People Presenting to Urban Primary Care: An Analysis of De-Identified Clinical Data.

Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres Strait Islander people attending an urban primary health care service and identify factors associated with these thoughts. Multilevel mixed-effects modified Poisson regression models were employed to analyse three years of data gathered during the annual Aboriginal and Torres Strait Islander health assessments. At their first health assessment, 11.5% (191/1664) of people reported thoughts of suicide or self-harm in the prior two weeks. Having children, participating in sport or community activities or being employed full-time decreased the risk of such thoughts. Conversely, factors relating to social exclusion including homelessness, drug use, unemployment and job insecurity increased the risk of thoughts of self-harm or suicide. Individual clinicians, health services, and policy-makers all have a role in suicide prevention. Clinicians need appropriate training to be able to respond to people expressing these thoughts. Aboriginal and Torres Strait Islander community organisations need sovereignty and self-determination over resources to provide programs that promote cultural connectivity and address social exclusion, thereby saving lives.

Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other?

The ethics of research involving Aboriginal populations and low and middle-income country populations each developed out of a long history of exploitative research projects and partnerships. Commonalities and differences between the two fields have not yet been examined. This study undertook two independent literature searches for Aboriginal health research ethics and global health research ethics. Content analysis identified shared and differently emphasised ethical principles and concepts between the two fields. Shared ethical concepts like "benefit" and "capacity development" have been developed to guide collaborations in both Aboriginal health research and global health research. However, Aboriginal health research ethics gives much greater prominence to ethical principles that assist in decolonising research practice such as "self-determination", "community-control", and "community ownership". The paper argues that global health research ethics would benefit from giving greater emphasis to these principles to guide research practice, while justice as approached in global health research ethics may inform Aboriginal health research practice. With increasing attention being drawn to the need to decolonise global health research, the lessons Aboriginal health research ethics can offer may be especially timely.

Aboriginal Australian mental health during the first 100 years of colonization, 1788-1888: a historical review of nineteenth-century documents.

Past histories charting interactions between British healthcare and Aboriginal Australians have tended to be dominated by broad histological themes such as invasion and colonization. While such descriptions have been vital to modernization and truth telling in Australian historical discourse, this paper investigates the nineteenth century through the modern cultural lens of mental health. We reviewed primary documents, including colonial diaries, church sermons, newspaper articles, medical and burial records, letters, government documents, conference speeches and anthropological journals. Findings revealed six overlapping fields which applied British ideas about mental health to Aboriginal Australians during the nineteenth century. They included military invasion, religion, law, psychological systems, lunatic asylums, and anthropology.

Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way.

Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6-16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14-7.69) among the First Nations compared to the non-First Nations clinical group. Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.

Randomised clinical trial research within Aboriginal and Torres Strait Islander primary health services: a qualitative study

ObjectiveTo better understand how to undertake valuable, ethical and sustainable randomised controlled clinical trial (RCT) research within Aboriginal and Torres Strait Islander primary health services.DesignIn a qualitative approach, we utilised...

Youth Resilience Education and 13-Year Motor Vehicle Crash Risk.

DRIVE is a prospective cohort study of a large (≥20 000) nonrepresentative sample of newly licensed young drivers in New South Wales, Australia.1 Its objective is to identify risk and protective factors for motor vehicle crashes (MVCs) (or crashes) by observing subgroup differences over time. A previously observed protective factor was participation in the New South Wales Health Reduce Risk Increase Student Knowledge (RRISK) resilience program.2 RRISK brings together grade 11 students from diverse schools for a 1-day, whole-of-community seminar that is preceded and followed by multiple peer-led teacher and parent support activities. It addresses common youth risks, including alcohol and drug use, partying, and driver and passenger risks. The focus is on empowering students to personalize learning into awareness of their own and their friends’ risk propensities, contributing factors, and how to minimize these, including forward planning and back-up strategies. The current research aims were to explore whether crash differences by program participation persisted over 13 years and to explore any differences by crash type, including severity.Detailed DRIVE methods are reported elsewhere.1,3 Briefly, all drivers aged 17 to 24 in New South Wales, Australia, on their first independent (postlearner) license during 2003–2004 were invited to complete a detailed online questionnaire, which included RRISK participation, and gave permission to access their police-recorded MVC records in future years. Survey and crash data to 2016 were linked by an independent body and were provided deidentified (ethics approvals: Aboriginal Health & Medical Research Council, University of New South Wales, and New South Wales Population & Health Services; reference: HREC/16/CIPHS/9).Univariate and multivariate negative binomial regression models were analyzed, with the number of MVCs of legally permitted vehicles as the primary outcome and MVC police codes for wet road surface, dark lighting, and severity (no injury versus minor injury to fatal) as secondary outcomes (other MVC types were too infrequent to include). We imputed missing values in the survey data using chained equations with 30 imputation cycles. Table 1 includes baseline survey variables considered as potential confounders, with time in study (from survey completion to either December 31, 2016, or [all cause] date of death) included as an offset. Analyses were performed by using Stata 15 (Stata Corp, College Station, TX).The cohort comprised 20 806 participants; 54.1% of the cohort was female (Table 1). Other demographics differed by group, with more program participants aged 17 and living in a regional and disadvantaged area, reflecting program delivery locations. Overall, 20.4% of the cohort had at least 1 crash as a driver, including 4.7% crashes on wet roads, 6.1% crashes in dark lighting, and 9.5% crashes resulting in injury.Table 2 summarizes resulting rate ratios. Unadjusted models revealed lower risk for program participants than nonparticipants for all crashes, crashes in dark lighting, and injury crashes but not crashes on wet roads. When adjusted for confounders, injury crashes were no longer statistically different; however, program participants were 24% less likely to have had any crash and 42% less likely to crash in darkness than nonparticipants.In this prospective study, rich baseline information on known confounders and access to statewide records were available for a large cohort of drivers for up to 13 years. Even when known confounders were accounted for, a lower risk of crash persisted for resilience program participants, including crashes in darkness. Injury crashes indicated similar positive findings but were not statistically different after adjustment for confounders.Limitations of the observational study design, including potential selection bias (more by schools than individuals) and complex changes in baseline measures over time, such as crash risk exposures and lifestyle changes (including cessation of driving), albeit unlikely influenced by program participation, have been reported previously.2,3 At-fault status was unknown; however, driver errors contribute to the majority of young novice crashes.4 Regardless, positive outcomes persisted, strongly indicating that setting up youth to be safer, responsible drivers early has real potential to reduce their lifetime risk of a crash that is significant enough to warrant police attendance. Research increasingly identifies that road risks cluster with other youth risks and that addressing these collectively and early (including at predriving age) is likely to have better outcomes than addressing them in isolation.5–7High-quality evaluations of school-based road safety initiatives are limited or treat any driver education program as equal.8,9 This contributes to overriding beliefs that driver education does not work rather than that good programs need to be identified from the proliferation of traditional programs. Positive outcomes are evident for more nuanced initiatives.10With road crashes persisting as a leading cause of preventable deaths and serious injuries, the current research warrants increased efforts to improve the evidence base and thereby the quality of youth road safety initiatives to set them up for a lifetime of safer driving.

Risk of severe illness from COVID‐19 among Aboriginal and Torres Strait Islander adults: the construct of ‘vulnerable populations’ obscures the root causes of health inequities

ObjectiveTo quantify the prevalence of known health‐related risk factors for severe COVID‐19 illness among Aboriginal and Torres Strait Islander adults, and their relationship with social determinants. MethodsWeighted cross‐sectional analysis of the 2018‐19 National Aboriginal and Torres Strait Islander Health Survey; Odds Ratios for cumulative risk count category (0, 1, or ≥2 health‐related risk factors) by social factors calculated using ordered logistic regression. ResultsOf the adult population, 42.9%(95%CI:40.6,45.2) had none of the examined health‐related risk factors; 38.9%(36.6,41.1) had 1, and 18.2%(16.7,19.7) had ≥2. Adults experiencing relative advantage across social indicators had significantly lower cumulative risk counts, with 30‐70% lower odds of being in a higher risk category. ConclusionsAboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID‐19 illness. Indigeneity itself is not a ‘risk’ factor and must be viewed in the wider context of inequities that impact health Implications for public healthMulti‐sectoral responses are required to improve health during and after the COVID‐19 pandemic that: enable self‐determination; improve incomes, safety, food security and culturally‐safe healthcare; and address discrimination and trauma.

Markers of chronic disease risk in a cohort of Aboriginal children: findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)

ObjectiveThis study investigated chronic disease risk markers among a cohort of Aboriginal children in New South Wales. MethodsDistributions of body mass index (BMI), blood lipids and haemoglobin A1c (HbA1c) among Aboriginal children aged 5‐<19 years were investigated. Prevalence ratios (PR) were calculated for borderline/high total cholesterol, low‐density lipoprotein (LDL) cholesterol and HbA1c, and low high‐density lipoprotein (HDL) cholesterol, by age group, sex and BMI. ResultsAlmost half (46.8%) of the cohort, had a normal BMI and 53.3% had overweight or obesity. Prevalence of chronic disease risk markers was low, with no individuals having high total cholesterol (0.0%) and few having high LDL (3.0%) or borderline/high HbA1c (2.6%); 85.5% of the cohort had normal HDL. There was no significant variation in the prevalence of chronic disease risk markers by age group or sex. The prevalence of borderline total cholesterol was 28% higher (PR 1.28, 95%CI 1.06‐1.54), and the prevalence of low HDL was double (2.00, 1.19‐3.35) for participants with obesity versus normal BMI. ConclusionsDyslipidaemia and elevated HbA1c prevalence was low in the cohort, increasing with high BMI. Overweight and obesity were common, which increase the risk of developing chronic disease later in life. Implications for public healthFindings indicate few Aboriginal children have dyslipidaemia and hyperglycaemia, supporting screening for chronic disease risk factors from 18 years of age. Opportunities to reduce overweight and obesity among children should be considered to decrease the future risk of chronic disease.

Caring for Spirit: Developing online dementia education and training with Aboriginal and Torres Strait Islander Australians

AbstractBackgroundAboriginal and Torres Strait Islander peoples (hereafter Aboriginal Australians) experience rates of dementia 3‐5 times higher than the general Australian population. Promoting dementia health literacy in culturally appropriate ways has been identified by Aboriginal communities as a priority to improve awareness of dementia and support timely diagnosis and service access, enhance care, and support wellbeing for family caregivers. This project aimed to respond to the need for culturally relevant, evidence‐based and accessible dementia education with this population.MethodThe ‘Caring for Spirit’ project sought to develop a dementia education website and online training program for the Aboriginal health and aged care workforce, as well as for family caregivers. Resource development applied the following overarching principles: (1)Dementia information was produced from Aboriginal cultural perspectives, foregrounding research evidence and lived experience in Aboriginal populations; (2)The project was led by an Aboriginal project manager and engaged Aboriginal consultants throughout; (3)Training was designed using appropriate and engaging pedagogical methods; (4)Resources needed to be accessible to a wide range of users, taking into consideration cultural diversity, technology access, disabilities and literacy levels; (5)Extensive community consultation and engagement guided the development and dissemination of the resources. The project team worked beside Aboriginal Elders, colleagues and wider networks, established community research partners, and dementia researchers.ResultWorkshops were conducted with community‐based researchers and service providers to scope education needs and plan the content, and later, seek feedback on initial website content and design. Infographics and videos were important elements, including interviews with Aboriginal and non‐Aboriginal dementia experts from across Australia, and scripted drama to illustrate key concepts in understanding dementia. To complement the website, an interactive online training program featured exploratory non‐linear progression across four modules, reflective exercises, voice‐over narrations, and multimedia. Training modules were evaluated by our network of project collaborators to ensure that information provided was accurate, supported by research, and presented in a way that is culturally safe, respectful, practical, and easy to understand and apply.ConclusionThese resources, designed with older Aboriginal people and their communities, will contribute to reducing the high burden of dementia in this population, and enhance dementia care.

Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers\u2019 perceptions of the barriers and facilitators

BackgroundSexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do not receive treatment, or it is considerably delayed. Point-of-care testing (POCT) provides an opportunity for same day diagnosis and treatment. Molecular POC testing for STIs was available at 31 regional or remote primary health care clinic sites through the Test-Treat-And-GO (TANGO2) program. This qualitative study sought to identify barriers and facilitators to further scaling up STI POCT in remote Aboriginal communities within Australia.MethodsA total of 15 healthcare workers (including nurses and Aboriginal health practitioners) and five managers (including clinic coordinators and practice managers) were recruited from remote health services involved in the TTANGO2 program to participate in semi-structured in-depth interviews. Health services’ clinics were purposively selected to include those with high or low STI POCT uptake. Personnel participants were selected via a hybrid approach including nomination by clinic managers and purposive sampling to include those in roles relevant to STI testing and treatment and those who had received TTANGO2 training for POCT technology. Milat’s scaling up guide informed the coding framework and analysis.ResultsAcceptability of STI POCT technology among healthcare workers and managers was predominantly influenced by self-efficacy and perceived effectiveness of POCT technology as well as perceptions of additional workload burden associated with POCT. Barriers to integration of STI POCT included retention of trained staff to conduct POCT. Patient reach (including strategies for patient engagement) was broadly considered an enabler for STI testing scale up using POCT technology.ConclusionsRemote healthcare clinics should be supported by both program and clinic management throughout scaling up efforts to ensure broad acceptability of STI POCT as well as addressing local health systems’ issues and identifying and enhancing opportunities for patient engagement.

COVID‐19 restrictions should only be lifted when it is safe to do so for Aboriginal communities

The NSW Government has proposed a blanket lifting of COVID‐19 restrictions when the proportion of fully vaccinated people rate reaches 70% of the adult population. If implemented, this would have devastating effects on Aboriginal populations. At the present time, vaccination rates in Aboriginal communities remain low. Once restrictions are lifted, unvaccinated people will be at high risk of infection. The risks of serious illness and death among Aboriginal people from a variety of medical conditions are significantly greater than for the wider population. This is also the case with COVID‐19 in First Nations populations around the world. The vulnerability of Aboriginal people is an enduring consequence of colonialism and is exacerbated by the fact that many live in overcrowded and poorly maintained houses in communities with under‐resourced health services. A current workforce crisis and the demographic structure of the population have further hindered the effectiveness of vaccination programmes. Aboriginal organisations have called on state and federal governments to delay any substantial easing of restrictions until full vaccination rates among Aboriginal and Torres Strait Islander populations aged 16 years and older reach 90–95%. They have also called for additional support in the form of supply of vaccines, enhancement of workforce capacity and appropriate incentives to address hesitancy. Australia remains burdened by the legacy of centuries of harm and damage to its First Nations people. Urgent steps must be taken to avoid a renewed assault on Aboriginal and Torres Strait Islander health.

Helen Milroy: pioneer in Indigenous and child mental health

In 1983, Helen Milroy became Australia's first Indigenous doctor to qualify medicine—a pivotal moment in the country's history. She never envisioned being a trailblazer, but her list of firsts in Australia includes being the first Indigenous psychiatrist and the first Indigenous Commissioner to the Australian Football League. Reflecting today as the Stan Perron Chair of Child and Adolescent Psychiatry at Perth Children's Hospital and the University of Western Australia (UWA) and the Co-Director of Embrace at Telethon Kids Institute, she says: “My passion is to make sure we get the best wellbeing and mental health outcomes for our kids right across Australia.” Pat Dudgeon, Professor of Indigenous Psychology at UWA, recognises her contribution to strengthening support services for children's mental health, and comments: “Helen has created a bridge between Aboriginal and mainstream mental health and understandings. Her pioneering work developing cultural models of care and healing, using art and narratives alongside psychiatric concepts, has enabled her to combine Aboriginal and western knowledge systems to train and educate mental health workers all over the world.”

Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians: harms, getting help and awareness of local treatments

BackgroundFew studies have examined links between current alcohol dependence and specific harms among Indigenous Australians. We investigated these associations as well as help seeking for drinking, awareness of local treatments and recommendations to help family or friends cut down or stop drinking in two Indigenous communities.MethodsA representative sample of Indigenous Australians was surveyed in one urban and one remote community in South Australia. Data were collected via the Grog Survey App. Participants were dependent if they reported two or more symptoms of alcohol dependence (ICD-11). Pearson chi-square tests were used to describe relationships between employment by gender, and dependence by awareness of medicines and local treatment options. Multivariate logistic regressions were used to predict the odds of dependent drinkers experiencing harms and getting help for drinking, controlling for age, gender, schooling and income.ResultsA total of 775 Indigenous Australians took part in the study. After controlling for confounders, dependent drinkers were nearly eight times more likely to report a harm and nearly three times more likely to get help for their drinking—compared with non-dependent drinkers. Participants recommended accessing local support from an Aboriginal alcohol and other drugs worker, or a detoxification/ rehabilitation service.Discussion and conclusionsMore support and funding is needed for Indigenous Australians to ensure local treatment options for dependent drinkers are readily available, appropriate and accessible. Involvement of local Aboriginal or Torres Strait Islander health professionals in delivery of care can help ensure that it is appropriate to an individual’s culture and context.

Factors Associated with Smoke-Free Pregnancy among Aboriginal and Torres Strait Women and Their Experience of Quitting Smoking in Pregnancy: A Mixed Method Cross-Sectional Study.

Smoke-free pregnancies have long-term health benefits for mothers and babies. This paper quantitatively examines factors associated with smoke-free pregnancies among Aboriginal and Torres Strait Islander women (hereafter Aboriginal women) and qualitatively explores their smoking cessation (SC) experiences during pregnancy. An Aboriginal-led online cross-sectional study on SC was conducted with Aboriginal women and in partnership with Aboriginal communities, between July and October 2020. The present analysis includes participants who made a pregnancy-related quit attempt (N = 103). Chi-squared tests, logistic regression models, and thematic analysis of free-form text responses were performed. The adjusted odds of having smoke-free pregnancies were 4.54 times higher among participants who used Aboriginal Health Services (AHS) (AOR = 4.54, p-value 0.018). Participants living in urban settings had 67% lower odds of having smoke-free pregnancies compared to their regional/remote counterparts (AOR = 0.33, p-value 0.020). Qualitative data revealed strong motivations to reduce tobacco-related harms to the fetus and variability in quitting experiences at different stages of and across pregnancies. Smoking cessation care (SCC) can support Aboriginal women meaningfully if their quitting experiences are considered in SCC development and implementation. Consistent funding for AHS-led SCC is needed to garner health benefits for Aboriginal peoples. More research into urban versus regional/remote differences in maternal SC is recommended.

Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial.

Background and aimsThere is a higher prevalence of unhealthy alcohol use among Indigenous populations, but there have been few studies of the effectiveness of screening and treatment in primary health care. Over 24 months, we tested whether a model of service‐wide support could increase screening and any alcohol treatment.DesignCluster‐randomized trial with 24‐month implementation (12 months active, 12 months maintenance).SettingAustralian Aboriginal Community Controlled primary care services.ParticipantsTwenty‐two services (83 032 clients) that use Communicare practice software and see at least 1000 clients annually, randomized to the treatment arm or control arm.Intervention and comparatorMulti‐faceted early support model versus a comparator of waiting‐list control (11 services).MeasurementsA record (presence = 1, absence = 0) of: (i) Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) screening (primary outcome), (ii) any‐treatment and (iii) brief intervention. We received routinely collected practice data bimonthly over 3 years (1‐year baseline, 1‐year implementation, 1‐year maintenance). Multi‐level logistic modelling was used to compare the odds of each outcome before and after implementation.FindingsThe odds of being screened within any 2‐month reference period increased in both arms post‐implementation, but the increase was nearly eight times greater in early‐support services [odds ratio (OR) = 7.95, 95% confidence interval (CI) = 4.04–15.63, P < 0.001]. The change in odds of any treatment in early support was nearly double that of waiting‐list controls (OR = 1.89, 95% CI = 1.19–2.98, P = 0.01) but was largely driven by decrease in controls. There was no clear evidence of difference between groups in the change in the odds of provision of brief intervention (OR = 1.95, 95% CI = 0.53–7.17, P = 0.32).ConclusionsAn early support model designed to aid routine implementation of alcohol screening and treatment in Aboriginal health services resulted in improvement of Alcohol Use Disorders Identification Test—Consumption screening rates over 24 months of implementation, but the effect on treatment was less clear.

Role of Aboriginal Health Practitioners in administering and increasing COVID-19 vaccination rates in a Victorian Aboriginal Community Controlled Health Organisation.

The COVID-19 pandemic has devastated communities throughout the world and has required rapid paradigm changes in the manner in which health care is administered. Previous health models and practices have been modified and changed at a rapid pace. This commentary provides the experiences of a regional Victorian Aboriginal Community Controlled Organisation in a COVID-19 vaccination program led and managed by Aboriginal Health Practitioners.

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations.

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations.

Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study

ObjectivesTo evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors...

Victor(iou)’s myologists: snapshots of a legacy

Victor(iou)’s myologists: snapshots of a legacy