Experiences Of Aboriginal People Research Articles

‘It’s Us, Or Maybe No One’: Yarning With Aboriginal Social and Emotional Wellbeing Workers From the Kimberley Region of Western Australia

Objective Social and Emotional Wellbeing (SEWB) describes the holistic model of health and wellbeing advocated for by Aboriginal and Torres Strait Islander peoples. This research explored the experiences of Aboriginal peoples employed in SEWB service delivery to identify enablers, challenges, and requirements of growing a sustainable, and empowered SEWB workforce. Methods We used a yarning methodology with seven Aboriginal SEWB workers located at Aboriginal Community Controlled Health Organisations across the Kimberley region of Western Australia. Results Three key SEWB service delivery themes were identified: 1) Role of cultural identity; 2) Barriers and enablers of SEWB service provision; 3) Building the future of the SEWB workforce. Lessons Learned SEWB services, as delivered by Aboriginal peoples within Aboriginal Community Controlled Health Organisations, have great potential to comprehensively meet the health and wellbeing needs of Aboriginal peoples and communities. To optimally undertake their role, Aboriginal SEWB staff need to: have a clear understanding of their role; good relationships within their workplace; relevant sector knowledge; a strong sense of cultural safety within the workplace; and access to meaningful professional development. Understanding the barriers and enablers experienced by SEWB staff provides a platform to meaningfully develop the future Aboriginal SEWB workforce, and delivery of SEWB services.

Aboriginal people's perceptions of patient-reported outcome measures in the assessment of diabetes health-related quality of life.

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). 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. 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. 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.

Safety Mapping: An Indigenist Approach to Action Research

Aboriginal people in Alice Springs mapped the safe places in their Town Camps. This participatory research led to the implementation of safety features. Safety mapping was developed in response to deficit-based research which pathologized Aboriginal people in Alice Springs. Safety mapping was conducted with Aboriginal people in Town Camps to identify safe places and improve safety. A strengths-based approach showed that problems and their solutions are known, and there are considerable safety assets within Town Camps. The safety mapping centred the voices and experiences of Aboriginal people to produce research that was of benefit to Town Campers, over which Indigenous people retained ownership. This paper highlights that an Indigenist approach to participatory action research is strengthened by Indigenous knowledge in driving social justice.

Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia.

Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. Three communities were selected for their high proportion of Aboriginal people and diverse regional and remote locations. Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted in the three communities (n = 5 coastal, n = 13 remote, and n = 13 border) and six themes identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

Decolonizing Indigenous health: Generating a productive dialogue to eliminate Rheumatic Heart Disease in Australia

In common with colonized Indigenous people worldwide, many Australian Aboriginal people experience inequitable health outcomes. While the commitment and advocacy of researchers and health practitioners has resulted in many notable improvements in policy and practice, systemic and structural impediments continue to restrain widespread gains in addressing Indigenous health injustices. We take Rheumatic Heart Disease (RHD), a potent marker of extreme health inequity, as a case study, and critically examine RHD practitioners' perspectives regarding the factors that need to be addressed to improve RHD prevention and care. This study is an important explanatory component of a broader study to inform new clinical practices, and health system strategies and policies to reduce RHD. A decolonising, critical medical anthropology (CMA) analysis of findings from 22 RHD practitioner in-depth interviews conducted in May 2016 revealed both practitioners' perceptions of health system shortcomings and a sense of hopelessness and powerlessness to transform existing health system inequities, the negative impacts of which were subsequently confirmed in a separate study of RHD patients' lived realities. We reveal how biomedical dominance, normalized deficit discourses and systemic racism influence the current policy and practice landscape, narrowing the intercultural space for productive dialogue and reinforcing the conditions that cause disease. To counter biomedical approaches that contribute to existing health inequities in health care, we recommend localized, strength-based, community-led research projects focused on actions that use critical decolonizing social science approaches to achieve system change. We demonstrate the importance of integrating biological and social sciences approaches in research, education/training, and practice to: 1) be guided by Indigenous strengths, knowledges and worldview, and 2) adopt a critical reflexive stance to examine systems, structures and practices. Such an approach facilitates productive cross-cultural dialogue and social transformation; providing direction and hope to practitioners, enhancing their knowledge, skills and capacity and improving Aboriginal health outcomes.

A systematic literature review of Aboriginal and Torres Strait Islander engagement with disability services

This systematic review aims to identify the factors that facilitate or impede the engagement of Aboriginal people living with a disability with disability services through review of the current academic and industry literature. Aboriginal and Torres Strait Islander people are twice as likely to experience disability as non-Indigenous Australians, yet often have more difficulty accessing support. 17 documents were included in the final review. The review revealed the super-ordinate theme of culture and Indigeneity which pervades the three additional themes of accessibility, engagement and lack of support. All four themes can be viewed as barriers or facilitators of engagement for Aboriginal people. Quality assessment highlighted the need for research exploring the experiences of Aboriginal and Torres Strait Islander people living with disability and for more culturally appropriate and scientifically rigorous research. The findings provide guidance for policy makers and service providers in relation to supporting Aboriginal people living with disability. Points of interest Aboriginal people living with a disability experience numerous barriers to positively engaging with disability services. The current literature that examines the lived experience of Aboriginal people living with a disability is limited in scope and quality. Aboriginal and Torres Strait Islander access and engagement with disability services may best be facilitated through the consideration of Aboriginal cultural beliefs, individual cultural needs, and Aboriginal perspectives of health. There is a need for disability services to become more culturally aware and more inclusive of Aboriginal cultural understandings to better inform inclusive policy and practice. The study recommends more collaborative research into the lived experience of Aboriginal people living with a disability, particularly relating to the way that inclusion can improve wellbeing and engagement with support services.

The Politics of Policy Development to End Obesity for Aboriginal Youth in the Educational Environment

Canada, a country of considerable wealth and resources, has one of the highest standards of living in the world. This country is politically organized as a democracy that is supportive of political and civil freedoms, yet inequalities among certain populations prevail. In general, Aboriginal people experience poorer economic, social, and environmental conditions than those of non-Aboriginal people (Canadian Population Health Initiative, 2005) and lower involvement in political and civil activity. This report also illustrates the inferior health status among Aboriginal people. Within the school system, an educational policy can serve to address an inequality. Hence, the purpose of the paper is to apply the tools outlined by Deborah Stone in her book, Policy Parodox: The Art of Political Decision Making (2002), to demonstrate why I believe school policies should be developed to prevent obesity among Aboriginal youth, to understand the politics of implementing these policies and to analyze and critique the ideas from hypothesized political opponents. Addressing these injustices provides recognition of the racism in present-day educational policy decision-making processes, which can result in more significant progress toward an equal and just society which ensures the health of Aboriginal peoples and successive generations.

The Occasional Evil of Angels: Learning from the Experiences of Aboriginal Peoples and Social Work

This paper explores how the propensity of social workers to make a direct and unmitigated connection between good intentions, rationale thought and good outcomes forms a white noise barrier that substantially interferes with our ability to see negative outcomes resulting directly or indirectly from our works. The paper begins with outlining the harm experienced by Aboriginal children before moving to explore how two fundamental philosophies that pervade social service practice impact Aboriginal children: 1) an assumption of pious motivation and effect and 2) a desire to improve others. Finally, the paper explores why binding reconciliation and child welfare is a necessary first step toward developing social work services that better support Aboriginal children and families.

Understanding Aboriginal Peoples' Cultural and Family Connections Can Help Inform the Development of Culturally Appropriate Cancer Survivorship Models of Care.

PURPOSETo explore the cancer diagnosis, treatment, and survivorship experiences of Aboriginal people in the Gippsland region, Victoria, Australia, and identify factors critical to the development of a culturally appropriate cancer survivorship model of care.PATIENTS AND METHODSYarning circles were used to capture the stories of 15 people diagnosed with cancer and/or those of family members. Yarning circles were conducted in two locations in the Gippsland region. Sessions were facilitated by an Aboriginal Elder, audio recorded, and transcribed verbatim. Thematic analysis of the data were triangulated among three researchers and incorporated researcher reflexivity.RESULTSCultural connections and family were critical supports on the cancer journey. Putting the needs of the family first and caring for sick family members were more important than an individual’s own health. There was “no time to grieve” for one’s own cancer diagnosis and look after oneself. Cancer was a private experience; however, the constancy of deaths highlighted the importance of raising family awareness. Health professionals did not always understand the importance of people’s cultural and family supports in their treatment and recovery. There were negatives attitudes in hospitals when family come to visit, seeing family as too large and overstaying visiting times. Health professionals did not seek family assistance with communication of information to family members whose literacy level was low, nor did they include family in treatment decision-making. Access to services depended on family support with transport, finances, and family responsibilities, often resulting in lapses in treatment and follow-up services.CONCLUSIONUnderstanding the importance of Aboriginal peoples’ cultural and family connections can help to inform the development of culturally safe cancer survivorship models of care.

“You felt like a prisoner in your own self, trapped”: the experiences of Aboriginal people with acquired communication disorders

Purpose Aboriginal Australians are under-represented in brain injury rehabilitation services despite a high incidence of both stroke and traumatic brain injury in this population. This study aimed to explore the experiences of Aboriginal Australian adults with acquired communication disorders (ACDs) after brain injury for the first time to inform the development of accessible and culturally secure service delivery models. Methods and materials Semi-structured interviews were undertaken with 32 Aboriginal people who had experienced a brain injury resulting in ACDs (aged 35–79 years) and 18 family members/carers across Western Australia. Thematic analysis identified common themes across participants. Results Overall themes related to communication (both related to the communication disorder and general healthcare interactions), health and social contexts, recovery, and support, being away from family and country, knowledge and beliefs about brain injury, and follow-up. Conclusions An increase in healthcare staff’s appreciation of the health and social contexts of Aboriginal people after brain injury is needed in order to improve communication with Aboriginal patients and the ability to offer accessible rehabilitation services. Ongoing support is required, with cultural identity noted as key to ensuring cultural security and ultimately recovery. Involvement of family and other Aboriginal people in recovery processes, as well as access to relevant Aboriginal languages and proximity to ancestral lands is central. Implications for rehabilitation Acknowledgment of cultural identity and strengths through involvement of extended family and Aboriginal Hospital Liaison Officers, access to language and proximity to country all central to rehabilitation planning for Aboriginal people after brain injury. Cultural security training for rehabilitation staff is recommended focusing on clear two-way communication skills to make medical information accessible for Aboriginal patients and to listen to patients’ concerns in a way that respects cultural context. Information regarding practical support and implications for ongoing management of life after brain injury (for the person and their family) is essential, and should supplement the medical-related information provided. Follow-up post discharge from hospital best facilitated through establishing contact with local Aboriginal community through Aboriginal community controlled health services, community elders, and Aboriginal health workers across organisations.

The Occasional Evil of Angels: Learning From the Experiences of Aboriginal Peoples and Social Work1

This paper explores how the propensity of social workers to make a direct and unmitigated connection between good intentions, rational thought, and good outcomes form a white noise barrier that substantially interferes with our ability to see negative outcomes resulting directly or indirectly from our works. The paper begins with outlining the harm experienced by Aboriginal children before moving to explore how two fundamental philosophies that pervade social service practice impact Aboriginal children: 1) an assumption of pious motivation and effect and 2) a desire to improve others. Finally, the paper explores why binding reconciliation and child welfare is a necessary first step toward developing social work services that better support Aboriginal children and families.

A Collaborative Approach To Engaging Aboriginal People In Their Health

We must invest in our Aboriginal population and take a holistic view of their health incorporating not only physical, but psychological, cultural, social and emotional wellbeing. Indigenous Australians have hospitalisation and death rates with cardiovascular disease (CVD) as the underlying cause at twice the rate of non-Indigenous Australians. For instance, in 2015–16, there were over 1.1 million indigenous Australians hospitalized with CVD related events, and one in three deaths were due to CVD. A collaborative partnership between West Australian Aboriginal Health Strategy Directors and the Training Centre in subacute care (TRACS WA) has developed a cultural training module addressing Aboriginal Person-Centered Care. This aims to ensure WA Health Service Providers consider the broader social and cultural determinants of Aboriginal health and well-being, including their cardiovascular health. We adopted a strengths-based approach which values the extremely high levels of emotional and social intelligence held by Aboriginal peoples. Acknowledging their wisdom, resilience, courage and strong cultural identities, the training module uses authentic story telling of Aboriginal people's experience of healthcare and is designed to engage health professionals of all disciplines to develop a deep and lasting empathy for Aboriginal people. Facilitators from TRACS WA, working and walking alongside Aboriginal facilitators aim to break down barriers within the WA health system to better meet the CVD healthcare needs of Aboriginal people. Challenging and reducing unsafe practices, improving engagement and compassion in care delivery shifts the power and ownership to the Aboriginal consumer and their care givers and positively impacts the health and well-being of Aboriginal people.

Understanding lived experiences of Aboriginal people with type 2 diabetes living in remote Kimberley communities: diabetes, it don't come and go, it stays!

This study aimed to explore the lived experiences of Kimberley Aboriginal people with type 2 diabetes managed by remote Aboriginal Community Controlled Health Services using phenomenological analysis. Semi-structured interviews formulated by Aboriginal Health Workers, researchers and other clinicians were used to obtain qualitative data from 13 adult Aboriginal patients with type 2 diabetes managed in two remote communities in the Kimberley. Together with expert opinion from local Aboriginal Health Workers and clinicians, the information was used to develop strategies to improve diabetes management. Of 915 regular adult patients in the two communities, 27% had type 2 diabetes; 83% with glycated haemoglobin A >10%. Key qualitative themes included: the need for culturally relevant education and pictorial resources; importance of continuous therapeutic relationships with healthcare staff; lifestyle management advice that takes into account local and cultural factors; and the involvement of Aboriginal community members and families in support roles. Recommendations to improve diabetes management in the remote communities have been made collaboratively with community input. This study provides a framework for culturally relevant recommendations to assist patients with diabetes, for collaborative research, and for communication among patients, Aboriginal Health Workers, community members, researchers and other clinicians. Interventions based on recommendations from this study will be the focus of further collaborative research.

Young Aboriginal People's Perspective on Access to Health Care in Remote Australia: Hearing Their Voices.

Young Australian Aboriginal people experience poor health outcomes, yet young people and Aboriginal people have low use of health care. To identify barriers and enablers of access for adolescent and young adult Aboriginal people at Derby Aboriginal Health Service (DAHS), a remote Western Australian Aboriginal Community Controlled Health Service (ACCHSs), to assist in improving access. This qualitative study was in the remote Kimberley town of Derby and three Aboriginal communities serviced by DAHS. Semistructured interviews with 26 young Aboriginal people in 2014 and 2015 were used to identify barriers and enablers to accessing local health care services. Participants appreciated interacting with Aboriginal staff, local staff, and longer term DAHS staff. This improved communication and interpersonal interactions, which were reported to be of prime importance for young Aboriginal people accessing health services. Maintaining confidentiality, minimizing shame, and gender matching with health staff were also key issues for young people. Seeking health care was often based on acute need rather than proactive or preventive care; however, participants recognized that providing health education and health promotion should be a priority for the service. A number of approaches to improving health service use by young remote Aboriginal people may be effective. Improving youth engagement seems to be central to increasing acceptability and, hence, use. This requires that staff able to engage with young people are recruited, trained, and retained. More immediately, a range of simpler changes to service provision focus and environment for young people could potentially make important differences.

Situating Intergenerational Trauma in the Educational Journey

The impact of trauma on learning in post-secondary institutions is largely ignored. However, recent studies on how Aboriginal people experience mental health issues are bringing attention to Aboriginal students’ experiences of intergenerational trauma (IGT). IGT occurs when the maladaptive effects of an original trauma experience, such as historic trauma inclusive of Indian Residential Schools (IRS), results in unhealthy effects on the first generation being passed down to the next generation or multiple generations. Given the lengthy history of collective historic trauma experienced by Aboriginal people, it is reasonable to expect that Aboriginal students’ learning is affected by IGT. As post-secondary educators, we engaged a limited study to further our knowledge of the impact of IGT on Aboriginal students. We were puzzled by Aboriginal students’ attrition within university programs—students we believed who were more than capable of success. We chose to explore this issue from the perspective of trauma-informed education principles (Mordoch & Gaywish, 2011). Building on past work, this qualitative study explores how IGT affects the educational journeys of Aboriginal students. A conceptual framework based on an Anishinabe teaching of Four Lodges (directional)—Talking, Planning, Teaching, and Healing—guided our research. The researchers formulated questions for each Lodge to frame our research on how IGT is understood by students enrolled in select programs for mature Indigenous students. We asked about the effects of IGT in the classroom and the resultant problems students face in their educational journey. Sixteen Indigenous students, 10 instructors, and nine administrators employed in Aboriginal focus or access programs for at least three years participated in semi-structured interview conversations. Findings reflect their perceptions of the interplay between IGT and educational experiences and potential strategies to redress resultant issues. Keywords: intergenerational trauma; post-secondary education; trauma-informed education

Understanding child neglect in Aboriginal families and communities in the context of trauma

AbstractChild neglect is a significant concern for Aboriginal families and communities both in Australia and internationally. Service responses to child neglect are largely informed by child neglect theories, which explain the nature and causes of child neglect. However, child neglect is a problem that is worsening for Aboriginal children, suggesting that these theories are not appropriate. This paper argues that to meet the needs of Aboriginal families and communities where there is child neglect, policy and practice needs to acknowledge and address the impact of trauma in shaping the lived experiences of Aboriginal people.International literature discusses the impact and consequence of historical trauma within Indigenous families and communities, and separately, child maltreatment theorists have discussed the ecological nature of child neglect. However, the literature and evidence‐base linking the two, child neglect and historical trauma in Indigenous contexts, are very scant. This paper aims to fill this gap and emphasize the importance of addressing child neglect within Aboriginal families and communities in the context of historical trauma. Although this paper focuses on the post‐colonial experiences of Aboriginal people in Australia, the arguments can extend to many Indigenous cultures universally where child welfare interventions have resulted in significant and ongoing trauma.

Aboriginal experiences of cancer and care coordination: Lessons from the Cancer Data and Aboriginal Disparities (CanDAD) narratives.

BackgroundAboriginal people with cancer experience worse outcomes than other Australians for a range of complex and interrelated reasons. A younger age at diagnosis, higher likelihood of more advanced cancer or cancer type with poorer prognosis, geographic isolation and cultural and language diversity mean that patient pathways are potentially more complex for Aboriginal people with cancer. In addition, variation in the quality and acceptability of care may influence cancer outcomes.ObjectiveThis study sought to understand how care coordination influences Aboriginal people's experiences of cancer treatment.MethodsInterviews with 29 Aboriginal patients or cancer survivors, 11 carers and 22 service providers were carried out. Interviews were semi‐structured and sought to elicit experiences of cancer and the health‐care system. The manifest content of the cancer narratives was entered onto a cancer pathway mapping tool and underlying themes were identified inductively.ResultsThe practice of cancer care coordination was found to address the needs of Aboriginal patients and their families/carers in 4 main areas: “navigating the health system”; “information and communication”; “things to manage at home”; and “cultural safety”.ConclusionsThe CanDAD findings indicate that, when the need for cancer care coordination is met, it facilitated continuity of care in a range of ways that may potentially improve cancer outcomes. However, the need remains unmet for many. Findings support the importance of dedicated care coordination to enable Aboriginal people to receive adequate and appropriate patient‐centred care, so that the unacceptable disparity in cancer outcomes between Aboriginal and non‐Aboriginal people can be addressed.

Improving the efficacy of healthcare services for Aboriginal Australians.

Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.

Emplacing Indigeneity and rurality in neoliberal disability welfare reform: The lived experience of Aboriginal people with disabilities in the West Kimberley, Australia

This article maps the impact of neoliberal restructuring of disability services and income support measures on Aboriginal people with disabilities living in rural areas of the West Kimberley in Australia. The international literature has extensively documented disability and Indigenous neoliberal welfare retraction measures, though as discrete areas of research. We aim to emplace the intersectional experience of such reforms by exposing their unique and qualitatively different dynamics and processes of disablement and Indigenous dispossession in the lived experiences of Aboriginal Australians with disabilities in rural Australia. Interviews conducted with Aboriginal people with disabilities living in the West Kimberley revealed the impact of neoliberal policies of retracting disability supports and rationalising services. The effects were felt in terms of people’s mobility, autonomy and economic security, with chronic, and at times crisis, levels of socio-economic insecurity experienced. Neoliberal spatial structures have led to further peripheralisation of rural and remote populations and a resulting increase in levels of inequality, deprivation and marginalisation for Aboriginal Australians with disabilities, who endure and survive by navigating these disabling spaces.

A Companion to Australian Aboriginal Literature

A Companion to Australian Aboriginal Literature