Indigenous Communities In Australia Research Articles

The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence

Background Despite the availability of testing and treatment, bacterial sexually transmissible infections (STIs) continue to occur at endemic levels in many remote Indigenous communities in Australia. New generation molecular point-of-care (POC) tests have high sensitivity, comparable with conventional diagnostic tests, and have the potential to increase the impact of STI screening. We developed mathematical models of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) transmission in remote Indigenous communities in Australia to evaluate screening and treatment strategies that utilise POC tests. The introduction of POC testing with 95% sensitivity could reduce the prevalence of gonorrhoea and chlamydia from 7.1% and 11.9% to 5.7% and 8.9%, respectively, under baseline screening coverage of 44% per year. If screening coverage is increased to 60% per year, prevalence is predicted to be reduced to 3.6% and 6.7%, respectively, under conventional testing, and further reduced to 1.8% and 3.1% with the introduction of POC testing. Increasing screening coverage to 80% per year will result in a reduction in the prevalence of gonorrhoea and chlamydia to 0.6% and 1.5%, respectively, and the virtual elimination of both STIs if POC testing is introduced. Modelling suggests that molecular POC tests of high sensitivity have great promise as a public health strategy for controlling chlamydia and gonorrhoea. However, evaluation of the cost-effectiveness of POC testing needs to be made before widespread implementation of this technology can be considered.

Pharmaceuticals and personal care products in the environment: Cultural and spiritual perspectives

Pharmaceuticals and personal care products in the environment: Cultural and spiritual perspectives

What is the responsibility of mathematics education to the Indigenous students that it serves?

Although refuted many times, the commonly accepted story about Indigenous communities in Australia is that they had few counting words and thus were lacking in ways to quantify amounts. In this paper, we use the case of quantifying to discuss how Indigenous mathematics can be used, not just to help Indigenous students transition into the classroom but also back into their home communities. We argue that mathematics education must take seriously its responsibility to support Indigenous students to gain school mathematics and also to help maintain the use of traditional mathematical ideas. If this does not occur, mathematics educators will contribute, intentionally or unintentionally to the loss of Indigenous knowledge that present and future generations of Indigenous people will hold them responsible for.

Using mobile phones as placed resources for literacy learning in a remote Indigenous community in Australia

Despite massive funding from the Australian government, the literacy achievement of Australian Indigenous children remains significantly lower than for non-Indigenous. With the aim of identifying innovative ways to improve Indigenous children's literacy achievement, this study explored the social practices surrounding everyday mobile phone use by Indigenous people in a remote Australian community. Informed by the notion of ‘placed resources’, which highlights the understanding that digital literacies are best considered as resources situated by social practices that have local effect, the study surveyed 95 people living in a remote Indigenous community about their mobile phone practices. The study also examined a video of a literacy event between a mother and her child around the use of a mobile phone. The findings revealed the strong relational aspects of phone use in remote communities. Integral to the concept of placed resources is a respect for the practices communities find important as they adopt artefacts for their everyday communication.

Closing the Gap through Respect, Relevance, Reciprocity and Responsibility: Issues in the Evaluation of Programs for Indigenous Communities in Australia

This article outlines key considerations and issues inherent in undertaking effective evaluations of programs developed for Indigenous Australians, written from the perspective of a non-Indigenous evaluator. The considerations identified include a number of professional practice areas, namely the need for evaluators to: operate with an understanding and appreciation of the historical and systemic context experienced by Indigenous Australians; work from the basis of a solid code of ethics and practice standards; and operate with high levels of cultural sensitivity and the ability to appreciate Indigenous world views and differences. Another central consideration identified in the article is that evaluators need to hold a commitment to produce useful and useable evaluation findings that can inform future program design and social policy in relation to improving the health and wellbeing of Indigenous Australians. The article develops a number of principles for evaluators to follow in evaluating programs developed for Indigenous Australians. These include: having respect for the importance of historical, socioeconomic and psychological context; commitment to ensuring relevance in methodologies and approaches used; reciprocity in considering the benefits for participating Indigenous communities; and responsibility in undertaking effective communication and consultation. While most evaluators would agree with the above principles and values, the latter can be more challenging to apply in practice and examples of their application to evaluation, and the inherent challenges in the Indigenous context, are described. Such challenges include: operating within the restrictions of government silos with difficulties portraying the complex interrelationships that reflect the lives of Indigenous Australians; reaching consensus on evaluation design and implementation; working within restricted time frames with lack of opportunity to appreciate and reflect the unique differences among Indigenous communities across Australia; limitations inherent in engaging a broad and representative group of Indigenous stakeholders; and lack of control by the evaluator over the dissemination and influence of evaluation findings and results that link with subsequent decision-making processes.

“Makes you proud to be black eh?”: Reflections on meaningful Indigenous research participation

IntroductionThis article outlines the meaningful participation of eight Aboriginal and Torres Strait Islander community members employed as community researchers investigating the impact of pandemic influenza in rural and remote Indigenous communities in Australia. Aboriginal and Torres Strait Islander participation is now a requirement of health research involving Aboriginal and Torres Strait Islander communities. There is a growing literature on the different approaches to such involvement. Fundamental to this literature is an acknowledgement that Indigenous communities are no longer prepared to be research objects for external, mostly non-Indigenous researchers, and demand a role in decisions about what is researched and how it will be researched. In this paper, we describe the protracted process for site identification and recruitment and training of community researchers. We focus on the backgrounds of the Indigenous researchers and their motivations for involvement, and the strengths and challenges posed by Indigenous people researching in their own communities. Throughout the paper our concern is to document how genuine participation and the building of research capacity can occur.DiscussionA key feature of the research was the employment, training and strengthening the capacity of local Aboriginal and Torres Strait Islander community members in the role of community researchers. A series of training workshops were conducted in northern Australia and focussed on qualitative research methods, including data collection, data analysis and writing. The Indigenous researchers collected the community-based data, and worked in partnership with experienced academic researchers in the analysis and compilation of community reports. Parts of those community reports, as well as additional information supplied by the community researchers, forms the basis of this article. As the demand increases for involvement of Indigenous community members as researchers, focus needs to be paid to what constitutes meaningful participation. If active participation in all aspects of the research process is intended, this necessitates close attention to the knowledge and skills required for this to occur at every stage. Building research capacity means not simply equipping local people to undertake research on a particular project, but to have the knowledge and skills to undertake research in other areas.ConclusionsThere are considerable benefits for Indigenous people researching in their own communities. Most important for the community researchers on this project was the sense that they were doing important health work, not just conducting research. Given the persistent gaps between Indigenous and non-Indigenous health, this is perhaps one of the most important contributions of this type of research. Whilst research outcomes are undoubtedly important, in many cases the process used is of greater importance.

‘Why isn’t it solved?’: Factors affecting improvements in housing outcomes in remote Indigenous communities in Australia

A range of factors has affected the design and construction of Indigenous housing in remote areas of Australia in recent times, including: socio-demographic issues; culture and design; consultation processes; the costs of remoteness; and procurement and delivery processes. Their implications for appropriate design and construction of remote Indigenous housing are analysed in this paper. Most significantly, these factors cannot be separated from cost because the need to spread available funds broadly to build the largest number of houses at the best price affects design and construction quality, and these are often neglected in the short-term budgeting within this process.

Culture shock and healthcare workers in remote Indigenous communities of Australia: what do we know and how can we measure it?

Culture shock or cultural adaptation is a significant issue confronting non-Indigenous health professionals working in remote Indigenous communities in Australia. This article is presented in two parts. The first part provides a thorough background in the theory of culture shock and cultural adaptation, and a comprehensive analysis of the consequences, causes, and current issues around the phenomenon in the remote Australian healthcare context. Second, the article presents the results of a comprehensive literature review undertaken to determine if existing studies provide tools which may measure the cultural adaptation of remote health professionals. A comprehensive literature review was conducted utilising the meta-databases CINAHL and Ovid Medline. While there is a plethora of descriptive literature about culture shock and cultural adaptation, empirical evidence is lacking. In particular, no empirical evidence was found relating to the cultural adaptation of non-Indigenous health professionals working in Indigenous communities in Australia. In all, 15 international articles were found that provided empirical evidence to support the concept of culture shock. Of these, only 2 articles contained tools that met the pre-determined selection criteria to measure the stages of culture shock. The 2 instruments identified were the Culture Shock Profile (CSP) by Zapf and the Culture Shock Adaptation Inventory (CSAI) by Juffer. There is sufficient evidence to determine that culture shock is a significant issue for non-Indigenous health professionals working in Indigenous communities in Australia. However, further research in this area is needed. The available empirical evidence indicates that a measurement tool is possible but needs further development to be suitable for use in remote Indigenous communities in Australia.

Successful application of a simple specimen transport method for the conduct of respiratory virus surveillance in remote Indigenous communities in Australia

Summary Objective Surveillance programs and research for acute respiratory infections in remote Aboriginal communities are complicated by difficulties in the storage and transport of frozen samples to urban laboratories for testing. This study assessed the sensitivity of a simple method for transporting respiratory samples from a remote setting for viral PCR compared with frozen specimens. Methods We sampled every individual who presented to a remote Aboriginal community clinic in a non‐epidemic respiratory season. Two anterior nasal swabs were collected from each participant. The left nare specimen was mailed to the laboratory via routine postal services. The right nare specimen was transported frozen. Testing for 16 viruses was undertaken using real‐time multiplex PCR. Results A total of 140 participants were enrolled who contributed 150 study visits. Respiratory illnesses accounted for 10% of the reasons for presentation. Sixty‐one viruses were identified in 50 (33.3%) presentations for 40 (28.6%) individuals; bocavirus and rhinovirus were the most common viruses identified (14.0% and 12.6% of episodes respectively). The sensitivity for any virus detected in mailed specimens was 67.2% (95%CI 55.4, 78.9) compared to 65.6% (95%CI 53.7, 77.5) for frozen specimens. Conclusion The mailing of unfrozen nasal specimens from remote communities does not compromise the viability of the specimen for viral studies.

Extending Business Education Beyond Traditional Boundaries: A Case Study in Negotiated Problem Resolution in a Remote Regional Indigenous Community in Australia

It is widely accepted that the concepts and practices of management can only be of benefit when they are anchored to the contextual architecture of people, processes, structures, and technologies. The challenge of establishing a bridging program for providing managerial competencies to Australian Indigenous people has become a serious one for multinational mining companies. As the wings of globalization interact with the long-ignored reality of marginalized local milieu, a need for an innovative management education system has become a major imperative compelling multinational mining companies to work collaboratively with the government, educational institutions, and Indigenous communities. The article outlines a specific decision-making dilemma in an Indigenous context, while explaining the imperatives for educators, who have the challenging task of instructing potential graduates how to manage the unique contextuality of rural Australian Aboriginal communities. The article presents implications for large-scale modern multinationals as they move to geographically remote regions of the world where large number of marginalized local people need to be drawn into the workforce not only as an act of a social responsibility imperative, but also as sound business pragmatism.

Culture at the centre of community based aged care in a remote Australian Indigenous setting: a case study of the development of Yuendumu Old People's Programme

Yuendumu is a Warlpiri Aboriginal community 300 km north west of Alice Springs in Central Australia. Since emerging from the welfare period in the early 1970s, a range of services have evolved with the aim of developing a comprehensive community based aged care service. In 2000 Mampu Maninja-kurlangu Jarlu Patu-ku Aboriginal Corporation (Yuendumu Old Peoples Programme; YOPP) commenced operation to manage the developing services. This case study aims to describe, from the analytic standpoint of community control and cultural comfort, the main features of the 'Family Model of Care', which underpins the operations of the service and YOPP management processes. Data were mostly generated from participant observation by the authors in the development and management of YOPP between 1993 and 2009. A literature review of Indigenous history and public health in Central Australia was also undertaken, which was supplemented by a review of Programme documentation, including evaluations, needs assessments and annual reports. The design and operations of YOPP are embodied in a documented 'Family Model of Care' which provides important lessons for the provision of aged care in a cross-cultural context. According to the concepts 'community control' and 'cultural comfort' outlined in this article, mainstream services can function in a complementary and supportive manner with professional services being accountable and responsive to a local management system that is governed by the structures and norms of community tradition. The notions of 'cultural comfort' and 'community control' as operating principles have enabled YOPP to continue under the management of local people, sustain core cultural strengths and values, and meet the needs for increased quality of care for the aged in Yuendumu. This model of care emphasizes and recognizes paradigms of mutual competence between traditional and mainstream human service culture, and offers important lessons for improvement to the quality of aged care in remote Indigenous communities in Australia and elsewhere.

Non‐cystic fibrosis bronchiectasis

Non-cystic fibrosis (CF) bronchiectasis is said to be a declining problem in developed countries, although its prevalence in indigenous communities in Australia and New Zealand is among the highest reported in the world. Early childhood pneumonia and underlying conditions such as immunodeficiency and primary ciliary dyskinesia need to be considered in the aetiology. A high-resolution computerised tomography scan is the key investigation in children with a chronic wet cough in whom bronchiectasis is suspected. Regardless of the cause, the treatment of bronchiectasis is centred upon facilitating the clearance of airway secretions and the treatment of pulmonary exacerbations. This review aims to provide general paediatricians with an update on the presenting features, investigation and management of non-cystic fibrosis bronchiectasis.

Surveillance for viral pathogens causing acute respiratory infections in remote indigenous communities in Australia: a comparison of sample transport methods

Surveillance for viral pathogens causing acute respiratory infections in remote indigenous communities in Australia: a comparison of sample transport methods

Aboriginal Practical Experience and its Impact on Pre-service Teachers' Decisions About Living and Working in Remote Indigenous Communities in Australia

In June 2008, 10 pre-service teachers and 2 teacher educators from Edith Cowan University (ECU) participated in an existing community education program in rural and remote Indigenous communities in central Australia. From an intrepid start with a mountain of overloaded baggage and camping cutlery; setting off the scanning machine at the airport, these educational risk takers trekked off into the desert. Our explorers joined 60 pre-service teachers and several teacher educators from the Victoria University (VU) Story Writing in Rural Locations (SWIRL) project. This project has been operating annually for 14 years in communities around Alice Springs, some up to 400 km of dirt track away. This paper reports the powerful effect of a short lived experience on pre-service teachers' attitudes and experience of living and teaching in a remote community. The experience described here represents the beginning of an authentic approach to giving experiences to pre-service teachers which may support them to consider teaching in remote Indigenous communities as part of their teaching career.

Tobacco use and measuring nicotine dependence among urban Indigenous pregnant women

To examine patterns of nicotine dependence, the value of the Fagerström Test for Nicotine Dependence (FTND) and its correlation with self-reported tobacco use and urinary cotinine concentrations among pregnant Indigenous women in Townsville. Cross-sectional study of 201 consecutive women who self-reported tobacco use at their first antenatal visit to Townsville Aboriginal and Islander Health Service (TAIHS) between 1 November 2005 and 31 October 2007. All smokers were to be assessed by FTND, and 108 women participating in the Tilly's Tracks project (a randomised trial of an intervention to reduce smoking in pregnant Aboriginal and Torres Strait Islander women) were to have a comprehensive smoking history taken and urinary cotinine samples collected. Self-reported smoking status, FTND scores and urinary cotinine concentrations. Of 302 Indigenous women presenting to TAIHS, 201 (66.6%) identified as current tobacco users at their first antenatal visit; this proportion rose to 79.6% in women aged<20 years. An FTND was completed for 152 women (75.6%), with a median score of 4, and 40.1% scoring 3 or less, indicating low levels of nicotine dependence. There were significant correlations between the FTND and number of cigarettes smoked (r=0.56; P<0.001) and urinary cotinine concentrations (r=0.25; P=0.030). Of those who provided comprehensive smoking histories, the median age of starting smoking was 15 years, with a median of two previous quit attempts; 71.4% reported partners who smoked and 27.3% reported smoking occurred inside the house. The use of the FTND in Indigenous pregnant women may assess physical nicotine dependence, thus providing information that will help in preparing quit-smoking plans, including tailoring of pharmacological support to individual need. Quit-smoking programs that better address the behavioural and psychological aspects of smoking within the Indigenous community in Australia are needed.

Community business: the internet in remote Australian Indigenous communities

This article reports on the findings of a research project that mapped the patterns of internet access and use in remote Indigenous communities in Australia. Remote Indigenous communities comprise some of Australia’s most disadvantaged users of internet services. Taking a case-study approach, the article raises challenging theoretical questions for those seeking to understand the extent and nature of the digital divide in relation to indigeneity and remoteness. It suggests approaches for more sustainable introduction of internet facilities to remote Indigenous communities in Australia and improved practices for better delivery of training to users. It reinforces the need for research and collaboration at the community level so that the introduction of facilities is conducted in a culturally and technically appropriate manner.

Care for chronic conditions for indigenous Australians: Key informants’ perspectives on policy

The WHO's 2002 global report, Innovative Care for Chronic Conditions proposes a comprehensive framework for health systems to meet the challenges posed by chronic conditions. This paper uses the policy environment component of the WHO framework as a lens through which to examine key informants' perspectives on the management and prevention of chronic conditions in rural and remote Aboriginal communities in Australia. Twenty one semi-structured telephone interviews were conducted with a purposive sample of stakeholders, including senior commonwealth, state/territory and regional public servants and health service staff. All of the interviews were audio recorded, from which written summaries were produced. These summaries were then content analysed to build a composite picture of this area. The results indicate substantial success in developing national and sub-national strategies and refining funding and reporting arrangements. But much work remains to be done in strengthening partnerships, developing and retaining the workforce, and further shifting the focus from acute to chronic conditions. This paper provides a snapshot of the main policy issues, as identified by key informants, facing chronic disease management in rural and remote Indigenous communities in Australia. It has the potential to contribute to new national policy directions in Indigenous health.

Cannabis use in remote Indigenous communities in Australia: endemic yet neglected

Medical Journal of AustraliaVolume 190, Issue 5 p. 228-229 Editorial Cannabis use in remote Indigenous communities in Australia: endemic yet neglected K S Kylie Lee BMus(Hons), Corresponding Author K S Kylie Lee BMus(Hons) PhD Student; and Research Assistant kylie.lee@usyd.edu.au School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, QLD. Faculty of Medicine, University of Sydney, Sydney, NSW.Correspondence: kylie.lee@usyd.edu.auSearch for more papers by this authorKatherine M Conigrave FAFPHM, FAChAM, PhD, Katherine M Conigrave FAFPHM, FAChAM, PhD Associate Professor; and Addiction Medicine Specialist Faculty of Medicine, University of Sydney, Sydney, NSW. Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW.Search for more papers by this authorGeorge C Patton MD, FRANZCP, George C Patton MD, FRANZCP Professor Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, VIC.Search for more papers by this authorAlan R Clough PhD, Alan R Clough PhD Associate Professor School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, QLD.Search for more papers by this author K S Kylie Lee BMus(Hons), Corresponding Author K S Kylie Lee BMus(Hons) PhD Student; and Research Assistant kylie.lee@usyd.edu.au School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, QLD. Faculty of Medicine, University of Sydney, Sydney, NSW.Correspondence: kylie.lee@usyd.edu.auSearch for more papers by this authorKatherine M Conigrave FAFPHM, FAChAM, PhD, Katherine M Conigrave FAFPHM, FAChAM, PhD Associate Professor; and Addiction Medicine Specialist Faculty of Medicine, University of Sydney, Sydney, NSW. Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW.Search for more papers by this authorGeorge C Patton MD, FRANZCP, George C Patton MD, FRANZCP Professor Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, VIC.Search for more papers by this authorAlan R Clough PhD, Alan R Clough PhD Associate Professor School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, QLD.Search for more papers by this author First published: 02 March 2009 https://doi.org/10.5694/j.1326-5377.2009.tb02379.xCitations: 16Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume190, Issue5March 2009Pages 228-229 RelatedInformation

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Control of intestinal helminths in Indigenous communities

Parasite infections, like most other infectious diseases disproportionately affect people living in poverty. Thus, it is no surprise that the prevalence of intestinal helminth infections has remained higher in Indigenous communities in Australia, compared to that observed in more affluent groups in the population.