Indigenous Populations In Australia Research Articles

Indigenous approaches to health assessment: a scoping review protocol

BackgroundHealth assessment tools developed using mainstream or Western concepts have been widely used in clinical practice worldwide. However, even culturally adapted or culturally based tools may not be relevant in other social contexts if they are grounded in Western beliefs and perspectives. The application of mainstream assessment tools, when used in Indigenous populations, can lead to the inappropriate application of normative data and inaccurate or biased diagnosis of conditions as Indigenous concepts of health differ from Western biomedical concepts of health. Thus, considering the need for culturally meaningful, sensitive, safe, and unbiased health assessment approaches and instruments over recent years, tools have been developed or adapted by and with Indigenous populations in Australia, Aotearoa/New Zealand, Canada, and the United States. However, there is no existing systematic or scoping review to identify the methods and approaches used in adapting or developing health assessment tools for use with the Indigenous population in Australia, Aotearoa/New Zealand, Canada, and the United States.MethodsIn response to these gaps, we are working with a First Nations Community Advisory Group in Northern Ontario, Canada, to undertake a scoping review following the 2020 JBI methodology for scoping reviews. A systematic search will be conducted in PubMed, APA PsychINFO, CINAHL, MEDLINE, Web of Science, Bibliography of Native North Americans, Australian Indigenous Health info data set, and Indigenous Health Portal. Two reviewers will independently screen all abstracts and full-text articles for inclusion using criteria co-developed with an advisory group. We will chart the extracted information and summarize and synthesize the data. The summarized findings will be presented to a Community Advisory Group, including First Nations community partners, an Elder, and community members, and their feedback will be incorporated into the discussion section of the scoping review.DiscussionThis scoping review involves iterative consultation with the Indigenous and non-Indigenous scholars, First Nations Community Advisory Group, and community partners throughout the research process. This review aims to summarize the evidence on standard ethical approaches and practices used in Indigenous research while adapting or developing health assessment tools. It will inform the larger study focused on developing an Indigenous Functional Assessment tool. Further, it will seek whether the Indigenous ways of knowing and equitable participation of Indigenous people and communities are incorporated in the Indigenous research process.Systematic review registrationOpen Science Framework https://osf.io/yznwk.

Comparison of the epidemiology of invasive pneumococcal disease between Australia and New Zealand in 2017–2021: an observational study based on surveillance data

The Australian immunisation schedule uses 13-valent pneumococcal conjugate vaccine (PCV13), while New Zealand (NZ) changed from PCV13 to 10-valent PCV (PCV10) in 2017. In NZ, cases of serotype 19A (not in PCV10) have been increasing since 2017. We compared invasive pneumococcal disease (IPD) epidemiology between Australia and NZ in 2017-2021. We collated IPD notification data from national surveillance systems. Between Australia and NZ, we compared IPD incidence rates and assessed the proportion of serotype 19A, and stratified for ethnicity and age. Between 2017 and 2021, the crude IPD incidence per 100,000 in Australia ranged from 4.3 to 8.4, and ranged from 6.9 to 11.4 in NZ. The highest age-adjusted IPD rates were observed in Australian Indigenous people (range: 27.3-35.5) followed by NZ Māori/Pacific peoples (range 19.7-30.4). For children <2 years, ethnicity-adjusted IPD rates were similar between Australia and NZ in 2017-2020. In 2021, however, the ethnicity-adjusted incidence in children <2 years was higher in NZ (30.2; 95% CI 21.1-39.4) than in Australia (23.3 95% CI: 19.5-27.1) (p<0.01). In Australia, the proportion of serotype 19A remained 5%, whereas in NZ serotype 19A increased from 11.5% to 29.5% with the largest increase in children <2 years and 2-4 years. Despite higher risks in Indigenous populations in Australia compared to all other groups, the overall IPD rate in NZ is increasing, particularly among children. The numbers and proportions of IPD due to serotype 19A are increasing in NZ especially in children. These data support the NZ decision from December 2022 to change to PCV13. This research received no specific funding.

A Socio-Cognitive Review of Healthy Eating Programs in Australian Indigenous Communities.

Purpose: This paper aims to understand the challenges to healthy eating for Indigenous Australians using a Social Cognitive Theory lens. Understanding the environmental, cognitive, and behavioural barriers to healthy eating for Indigenous populations in Australia will help identify current gaps and highlight future actions needed in this area to close the gap for Indigenous Australians. Study design: Narrative review of interventions of healthy eating programs in Australian Indigenous communities sourced using a systematic search protocol to understand the environmental, cognitive, and behavioural barriers to healthy eating among Indigenous Australians and to identify gaps and future actions needed to address this from 2010–2020. Results: The search produced 486 records, after duplicates were removed and the inclusion and exclusion process were utilised, seven interventions were retained in nine studies. The seven interventions had multiple study designs, from randomised control trials to case studies. Conclusions: Further work needs to explore the long-term feasibility of providing fruit and vegetable discounts and the impact of remoteness for the delivery of healthy food. Dietary interventions need to be clearly described, and fidelity and process of the design and implementation process to help with replication of work.

"Learning from “Our Relations” Indigenous Peoples of Australia, Canada, New Zealand, and United States: A Review of Culturally Relevant Diabetes and Obesity Interventions for Health

Globally, Indigenous Peoples suffer disproportionately higher rates and complications of diabetes and obesity than non-Indigenous people. Western health interventions combined with culturally appropriate Traditional approaches can reduce incidence, prevalence, and related co-morbidities. This literature review reports effective culturally relevant Traditional and Western diabetes and obesity prevention and management intervention programs for Indigenous populations in Australia, Canada, New Zealand, and the United States. Experiential, immediate, interactive, and low-cost programs, co-developed and delivered by local Indigenous people within the communities they live, are most effective in improving health and wellbeing. Key themes of success of Togetherness, Empowerment, and Local Familiarity inform action for policy and practice changes adaptable for chronic disease prevention, treatment, and self-management programs for Indigenous Peoples globally.

Age‐distributed composition of the Indigenous population in Australia

The standard measure of composition of a group within a country or a region is its headcount relative to the overall population. However, the headcount ratio of a given group ignores the age-based variability of its population with respect to the whole population. In this paper, a measure capturing the groups' age-wise distribution is proposed, which can be useful for policymakers in identifying potential demographic distortions experienced by population subgroups. An empirical exercise on the Australian Census data for the years 2006, 2011 and 2016 provides the age-distributed composition of the Indigenous population in the states and territories of Australia.

Burden of the Beast

Burden of the Beast

Oral HPV Infection among Indigenous Australians; Incidence, Persistence, and Clearance at 12-Month Follow-up

Abstract Background: Persistent oral human papillomavirus (HPV) infection is a risk factor for oropharyngeal squamous cell carcinoma (OPSCC). Indigenous Australians have a higher rate of OPSCC than non-Indigenous Australians. Risk factors for oral HPV persistence among Indigenous Australians are poorly understood. Methods: Participants provided information on sociodemographic characteristics, health-related behaviors including tobacco and alcohol use, and sexual history. Participants additionally provided saliva samples for microbial genotyping. Negative log binomial regression models were used to evaluate associations of sociodemographic, health behavior, and sexual behavior indicators on incident, persistent, and cleared oral HPV infection at 12-month follow-up. Estimates were quantified as rate ratios (RR). Results: Of the 1,011 participants recruited at baseline, 911 provided saliva samples that were β-globin positive (a DNA integrity check), with 321 (35.3%) testing positive for any oral HPV infection. At 12-month follow up, saliva samples were obtained from 743 of the original 1,011 participants (73.5%). Among the 584 participants who provided β-globin–positive saliva samples at baseline and 12-month follow-up, 24 (42.6%) had no oral HPV infection at both time points, 130 (22.2%) had new (incident) oral HPV infection at 12 months, 130 (22.2%) had persistent oral HPV infection (i.e., present at both baseline and 12 months), and 75 (12.8%) had oral HPV infection clearance from baseline to 12 months. Age of first giving oral sex and unsafe (unprotected) oral sexual behaviors were significantly associated with incidence; rural location of residence and ever received oral sex were significantly associated with persistence; and, rural location of residence and ever received oral sex were significantly associated with clearance of oral HPV infection. Conclusions: The incidence of oral HPV infection at both baseline and 12-month follow-up was high. Factors associated with persistence and clearance of oral HPV infections included location of residence and unsafe oral sexual behaviors. Impact: There are currently no studies available which have assessed oral HPV infection incidence, persistence, and clearance amongst Indigenous populations in Australia or even at a global level. The study has been able to identify risk factors associated with potential malignant changes in the oropharynx among Indigenous Australians.

Health Inequalities and Social Determinants of Indigenous Peoples’ Health in Australia, Canada, and the United States: Causes and Policies Options

The author of the paper investigates the issue of Indigenous health inequalities. The main purpose of the research is to assess the causes of health inequalities among Indigenous people and policy options to reduce the health gaps. Systematization of the literary sources shows that there are health disparities between Indigenous people and non-Indigenous people and approaches for solving the problem come in different forms. The methodological basis of this study is a comparative analysis that used secondary data to capture health inequalities among the Indigenous populations in Australia, Canada, and the United States. These countries have adopted different policy options to reduce these inequalities. The paper presents the results of a comparative analysis that contributes to knowledge by articulating what is not known about Indigenous health inequalities and social determinants of health and policy response. The study contributes to understanding by articulating what is not known about Indigenous health inequalities and social determinants of health and policy response. Aside from the study being useful to policymakers, politicians, development experts and the academic environments, the study provides the opportunity to assess some of the policy interventions. When necessary, it provides ample opportunity if there is a need to reform the social and health policies meant to reduce health inequalities among Indigenous populations. The author found that both grey and academic studies have examined policy options and governance meant to reduce health inequalities among Indigenous people in Australia, Canada, and the U.S. However, there is a lack of quality studies that have evaluated these policy options, limiting the strength to determine achievement associated with such policy options and governance. Further, there is limited information on whether these policy options are suitable for the Indigenous population to enhance their health status. With these limitations, future studies need to assess the effectiveness of these policy options and determine if the policy options are culturally suitable to reduce Indigenous people’s health inequalities.

NMOSD and MS prevalence in the Indigenous populations of Australia and New Zealand.

We studied the prevalence of neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in Indigenous populations of Australia and New Zealand with the aim of assessing potential differences. Cases of possible NMOSD and MS were collected from Australia and New Zealand. Clinical details, MR imaging, and serologic results were used to apply 2015 IPND diagnostic criteria for NMOSD and 2010 McDonald criteria for MS. Frequencies of self-determined ethnic ancestry were calculated for confirmed NMOSD, suspected NMOSD, and MS. Prevalence rates for NMOSD and MS according to ancestry were compared. There were 75 cases with NMOSD, 89 with suspected NMSOD, and 101 with MS. NMOSD cases were more likely to have Asian, Indigenous, or Other ancestry compared to suspected NMOSD or MS. There were no differences in the clinical phenotype of NMOSD seen in Indigenous compared to European ancestry populations. Per 100,000, the prevalence estimate for NMOSD in people with Māori ancestry was 1.50 (95% CI 0.52-2.49) which was similar to those with Asian ancestry 1.57 (95% CI 1.15-1.98). NMOSD prevalence in Australian Aboriginal and Torres Strait Islander populations was 0.38 (95% CI 0.00-0.80) per 100,000. The prevalence of NMOSD in the Māori population is similar to South East Asian countries, reflecting their historical origins. The prevalence of MS in this group is intermediate between those with South East Asian and European ancestry living in New Zealand. Both NMOSD and particularly MS appear to be uncommon in the Indigenous populations of Australia.

Locating the voices of Indigenous young people on identity in Australia: an Indigenist analysis

ABSTRACT The identities of Indigenous young people in Australia have increasingly been recognized in the health and education research literature as being significant. Over half of the Indigenous population in Australia is under the age of 25 years, emphasizing the importance of centering the voices of this cohort. In this paper, two Indigenous scholars undertake an Indigenist analysis of the ways that the voices of Indigenous young people are present within knowledge production about them in relation to their identities. This paper presents a number of themes that emerge from the analysis of how the voices of Indigenous young people in Australia are privileged in the literature, highlighting the significance of closer examination of knowledge paradigms and representations. Creating a deeper understanding of identity and the impact on wellbeing through their lens as Indigenous young people is critical for improving policy and program development as well as future research.

Intellectual Disability in the Australian Aboriginal Population: A Critical Review

Objectives Aboriginal and Torres Strait Islander people are the Indigenous population of Australia. Australian Aboriginal people represent a small percentage of the overall Australian population. However, this population group has a higher rate of Intellectual Disability when compared to the non-Indigenous Australian population. This article aims to review the current literature regarding Intellectual Disability in the Australian Aboriginal Population, build on the current evidence base for Intellectual Disability specific to the Australian Aboriginal population, investigate if any changes to the evidence base have occurred, and identify areas where further research is required. This is in comparison to a literature review completed by Roy and Balaratnasingam in 2014. Methods Literature review. Results The literature review affirms that there exists a disproportionate representation of Intellectual Disability in the Australian Aboriginal population. It highlights the current focus on predisposing risk factors and the resulting risks associated with Intellectual Disability. It also highlights the current lack of evidence-based research around interventions for Intellectual Disability in the Australian Aboriginal population. Conclusions Australian Aboriginal people are disproportionately affected by Intellectual Disability which, as mental health practitioners in Australia, we believe is an area that urgently requires further research and redress. This literature review summarises the current evidence base and identifies potential areas for further research.

Use and uptake of web-based therapeutic interventions amongst Indigenous populations in Australia, New Zealand, the United States of America and Canada: a scoping review

BackgroundBarriers to receiving optimal healthcare exist for Indigenous populations globally for a range of reasons. To overcome such barriers and enable greater access to basic and specialist care, developments in information and communication technologies are being applied. The focus of this scoping review is on web-based therapeutic interventions (WBTI) that aim to provide guidance, support and treatment for health problems.ObjectivesThis review identifies and describes international scientific evidence on WBTI used by Indigenous peoples in Australia, New Zealand, Canada and USA for managing and treating a broad range of health conditions.Eligibility criteriaStudies assessing WBTI designed for Indigenous peoples in Australia, Canada, USA and New Zealand, that were published in English, in peer-reviewed literature, from 2006 to 2018 (inclusive), were considered for inclusion in the review. Studies were considered if more than 50% of participants were Indigenous, or if results were reported separately for Indigenous participants.Sources of evidenceFollowing a four-step search strategy in consultation with a research librarian, 12 databases were searched with a view to finding both published and unpublished studies.Charting methodsData was extracted, synthesised and reported under four main conceptual categories: (1) types of WBTI used, (2) community uptake of WBTI, (3) factors that impact on uptake and (4) conclusions and recommendations for practice.ResultsA total of 31 studies met the inclusion criteria. The WBTI used were interactive websites, screening and assessment tools, management and monitoring tools, gamified avatar-based psychological therapy and decision support tools. Other sources reported the use of mobile apps, multimedia messaging or a mixture of intervention tools. Most sources reported moderate uptake and improved health outcomes for Indigenous people. Suggestions to improve uptake included as follows: tailoring content and presentation formats to be culturally relevant and appropriate, customisable and easy to use.ConclusionsCulturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities. Access to WBTI, alongside appropriate training, allows health care workers to better support their Indigenous clients. Developing WBTI in partnership with Indigenous communities ensures that these interventions are accepted and promoted by the communities.

Applying Community-Based system Dynamics to Address Food Insecurity in Non-Remote Indigenous Populations in Australia

Abstract Objectives There is a growing crisis of hunger and food inequality among Indigenous people in Australia who are increasingly urbanized. They experience substantially higher rates of food insecurity than the general population which impacts on diet-sensitive chronic disease risk and life expectancy. This project aimed to apply systems tools to identify systemic challenges to achieving food security and possible local actions to address the problem in two large Aboriginal communities. Methods A qualitative system dynamics method used group model building (GMB) in two regional and outer urban communities involving participants from Aboriginal Community Controlled Health Services, food relief charities, council, educational groups and some food industry partners in the two local areas. The GMB enabled the participants to consider all the connections between contributing factors, feedback and reinforcing loops to produce a map of food insecurity linked to the local food system. This project was done in collaboration with the Study of Environment of Aboriginal Resilience and Child Health (SEARCH), Australia's largest cohort study into the health of urban Aboriginal children. Results The GMB workshops resulted in causal loop diagrams that mapped the complexities of the food insecurity challenge. The maps highlighted the impact of low incomes and unemployment that influenced the communities’ ability to budget and afford healthy food, thereby leading to a reliance on convenience food outlets. This, in turn, influenced communities’ healthy food preferences, which negatively impacted on food security. Additionally, community education around healthy food choices, meal planning and financial literacy were factors that also directly impacted food security. A distinct loop reflected that a lack of coordination between agencies was leading to duplication and confusion about available food relief services and the ability to access these services. Conclusions These analyses elicited local understanding of the potential levers within the system to address food insecurity in Indigenous people. They are being used to develop community-level workplans to shift the high prevalence of food insecurity and its longer-term impact on preventable chronic disease. Funding Sources This work was funded by the Australian Prevention Partnership Centre and the Sax Institute, Sydney.

Australian Policy Regarding the Indigenous Population (End of the XIXth Century – the First Third of the XXth Century)

An analysis of Australia’s governmental policy towards indigenous peoples has been done. The negative consequences of the colonization of the Australian continent have been revealed, in particular, a significant reduction in the number of aborigines due to the spread of alcohol and epidemics, the seizure of their territories. It is concluded that the colonization of Australia was based on the idea of the hierarchy of human society, the superiority and inferiority of different races and groups of people, and accordingly - the supremacy of European culture and civilization. It is demonstrated in the creation of reservations for aborigines and the adoption of legislation aimed at segregating the country's white and colored populations and assimilating certain indigenous peoples into European society, primarily children from mixed marriages. It has been proven that, considering the aborigines an endangered people and seeking to protect them from themselves, Europeans saw the way to their salvation in miscegenation - interracial marriages and the isolation of aboriginal children from their parents. This policy has been pursued since the end of the XIX century by the 1970s and had disrupted cultural and family ties and destroyed aboriginal communities, although government circles positioned it as a policy of caring for indigenous Australians. As a result, the generation of aborigines taken from their parents and raised in boarding schools or families of white Europeans has been dubbed the “lost generation”. The activity of A.O. Neville who for more than two decades held the position of chief defender of the aborigines in Western Australia and in fact became the ideologist of the aborigines’ assimilation policy has been analyzed. He substantiated the idea of the biological absorption of the indigenous Australian race as a key condition for its preservation and extremely harshly implemented the policy of separating Aboriginal children from their parents. It is concluded that the policy towards the indigenous population of Australia in the late XIX – first third of the XX century was based on the principle of discrimination on racial grounds.

702 Long-Term Survival and Predictors of Outcomes of Indigenous Northern Territorians Undergoing Primary and Re-Do Surgery for Rheumatic Heart Disease in Australia

Rheumatic Heart Disease (RHD) is the leading cause of heart valve dysfunction among the Indigenous population of Australia. Factors that contribute to late postoperative mortality have not been previously studied in Australia. 342 RHD Indigenous patients from the Northern Territory of Australia undergoing their primary surgical procedure between 1997 and 2016 were identified. Pre- and postoperative data was collated using clinical information systems. Multivariable survival analyses were performed using Cox Proportional Hazards model. Early 30-day mortality was 2% (CI 0.5-3.5). Mean follow-up time was 8.2 years (2,784 patient years). 63.5% were female. Mean age of RHD diagnosis was 25 years, mean age at first surgery was 31.6 years. Mean time interval from date of first RHD diagnosis to first surgical intervention was 6.3 years. 22% (n=74) underwent redo surgery, among these 75%, 20% and 5% underwent one, two and three redo surgeries respectively. There was a total of 93 (27.2%) deaths. Actuarial Survival at 5, 10, 15 and 20 years was 89% 70% 58% and 52% respectively. Preoperative Pulmonary Hypertension (ePASP >50mmHg), Chronic Kidney Disease (eGFR <60) and Coronary Heart Disease were independent predictors of mortality regardless of type of surgery and number of valves operated on. Indigenous Australians have poor long-term survival following cardiac surgery for RHD despite their young age. This is at least in part attributed to co-morbid conditions. Significant effort is required to prevent this disease, enable early detection and enhance early access to surgery with close long term follow-up.

Patient survival following renal transplantation in Indigenous populations: A systematic review.

Inequities in health care predispose Indigenous populations to poor health outcomes. The objective of this study was to examine patient survival and other post-transplant outcomes of kidney transplantation among Indigenous patients compared with non-Indigenous populations. A systematic review of MEDLINE, EMBASE, and Google Scholar was undertaken from inception to September 30, 2019, using a computerized search. Publication descriptors and methodological and statistical details were extracted. Articles were assessed using the methodological index for non-randomized studies (MINORS) scale. Twelve studies were included. All studies were retrospective and published between 2004 and 2018. Mean Indigenous patient age was 40 (range: 8-76), while non-Indigenous was 41 (range: 6-74). Mean sample size for Indigenous populations was 398 (range: 24-1459), while for non-Indigenous patients was 1102 (range: 53-7555). Eight studies examined indigenous populations in Australia, two in Canada, one in the United States, and one in New Zealand. All studies were considered of high methodological quality and clinically homogenous. Results indicated that patient survival, graft survival, and delayed graft function were significantly reduced among Indigenous populations compared with non-Indigenous populations. Post-transplant outcomes among various Indigenous populations are significantly worse compared with non-Indigenous populations. The reasons for poor outcomes are likely multifactorial. Improved standardized reporting of transplant outcomes of Indigenous patients is necessary to better inform healthcare services and improve clinical outcomes.

Adaptation of potentially preventable medication-related hospitalisation indicators for Indigenous populations in Australia using a modified Delphi technique

ObjectivesOne of the outcomes of a medication review service is to identify and manage medication-related problems (MRPs). The most serious MRPs may result in hospitalisation, which could be preventable if...

P5354Echocardiographic findings in pregnant indigenous Australians: under utilised?

Abstract Background The Indigenous population of Australia has one of the highest prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) globally. RHD is more common in females and the incidence peaks in the 3rd to 4th decade of life, corresponding with child-bearing age. It is the number one cause of cardiac complications in pregnancy globally. Signs and symptoms of normal pregnancy may overlap with those of cardiac pathology. Significant valvular disease can complicate pregnancy and delivery. Current practice sees pregnant women referred for echocardiography if there are signs or symptoms of possible cardiac pathology or a history of RHD. Aim To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of rheumatic heart disease. Method A retrospective study of all echocardiograms requested for an indication relating to pregnancy over a three-year period were reviewed in the Northern Territory of Australia. Data collected included patient demographics, echocardiography indication, history of RHD, ARF or other cardiac disease, echocardiographic parameters, location of delivery, peri-partum morbidity and mortality. Results The total number of patients reviewed were 257. The 158 Indigenous Australian women had a mean age of 25 years and the 99 non-indigenous women had a mean age of 30 years. The Indigenous women had a higher rate of abnormal echocardiograms, 36.1% compared with 9.1% for non-indigenous women. Table 1 outlines echocardiography indications and outcomes. Indigenous women had extremely high rates of ARF or RHD representing 37% of echocardiography referrals, with 17.1% (27/158) having moderate or severe valve lesions. 5 cases (3.2%) had a history of prior valve surgery. 10 (6.3%) Indigenous patients required transfer to a tertiary centre with valve intervention services available for delivery. There was one maternal death, one post-partum stroke and one foetal death in utero. Echocardiogram indications and outcomes Incidental murmur Cardiac symptoms Other cardiac disease History of RHD and/or ARF Normal study Rheumatic heart disease Congenital heart disease Other heart disease Indigenous (n=158) 60 (38%) 15 (9.4%) 24 (15%) 59 (37.3%) 101 (63.9%) 47 (29.7%) 7 (4.4%) 3 (1.9%) Non-indigenous (n=99) 44 (44.4%) 24 (24.2%) 31 (31.3%) 0 90 (91%) 2 (2%) 3 (3%) 4 (4%) Conclusion In the Top End of Australia, Indigenous patients have a very high rate of abnormal echocardiograms during pregnancy compared with their non-indigenous counterparts, mainly as a result of RHD. Data suggests that pregnant Indigenous women are being under serviced by the current medical model and referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a scoping review protocol.

The objective of this review is to explore and examine the available evidence on mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States. Despite the evidence for the effectiveness of primary health care in improving health outcomes, accessing primary care services is often problematic for Indigenous populations in Australia, Canada, New Zealand and the United States. Improving the accessibility of primary health care services for Indigenous populations is considered essential to alleviating the burden of disease and improving well-being. The review will consider literature that discusses the implementation of a mobile primary health clinic for Indigenous populations. Mobile primary health care clinics targeting Indigenous populations of all ages will be included in this review. Transportable clinics (e.g. van, truck or bus) fitted with health care equipment that deliver health services in a defined geographical area will be included. Only literature published in English from 1 January 2006 will be included. Ovid MEDLINE, CINAHL, Embase, Cochrane Database of Systematic Reviews and SocINDEX will be searched, as well as gray literature sources. The full-text of selected literature will be retrieved and assessed in detail against the inclusion criteria by two independent reviewers. Data will be extracted by two independent reviewers, and a narrative summary will be provided on the objectives, concepts and results of the review question.

Group antenatal care for Aboriginal and Torres Strait Islander women: An acceptability study

BackgroundGood quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AimTo explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. MethodsThis qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FindingsNo overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. ConclusionA foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.