Remote Aboriginal Communities Research Articles

Study protocol for a self-controlled cluster randomised trial of the Alert Program to improve self-regulation and executive function in Australian Aboriginal children with fetal alcohol spectrum disorder

IntroductionWhile research highlights the benefits of early diagnosis and intervention for children with fetal alcohol spectrum disorders (FASD), there are limited data documenting effective interventions for Australian children living in...

Interplay Wellbeing Framework: Community Perspectives on Working Together for Effective Service Delivery in Remote Aboriginal Communities

Access to effective services and programs is necessary to improve wellbeing for Aboriginal and Torres Strait Islander people living in remote Australia. Without genuine participation of Aboriginal community members in the design, governance, and delivery of services, desired service delivery outcomes are rarely achieved. Using a "shared space" model, Aboriginal communities, governments, and scientists came together to design and develop the Interplay Wellbeing Framework. This Framework brings together stories and numbers (or qualitative and quantitative data) to represent community values for the purpose of informing program and policy agendas. This article unpacks what community members saw as making a service work well and why. The domains of empowerment and community functioning are discussed and their relationship to effective service delivery demonstrated.

Thumbs Up: The effective use of music in health and well-being education for Australian Aboriginal youth in remote communities

Abstract The academic literature on Australian Indigenous health and well-being suggests an overwhelming need for education to alleviate ‘lifestyle’ diseases and social dysfunction. Yet, the socio-cultural diversity of Australian Aboriginal communities provides a challenging landscape for efficacious and long-lasting support processes. The ‘Uncle Jimmy Thumbs Up!’ (UJTU) programme is facing these issues from an innovative perspective. ‘Thumbs up’, addresses health and well-being in remote Aboriginal communities from the ground up by engaging in music education programmes with the youth of the community, which subsequently filters through to the broader community. Based on an analysis of the effectiveness of a ‘Thumbs Up’ case study, this article will present preliminary recommendations for working with Australian Indigenous youth and their broader communities through facilitated musical activities. Informal learning frameworks, which incorporate music-making shared between educators and community members, are shown to be a constructive means of engaging the youth and empowering them in the management of their health and well-being.

Cross-Cultural, Aboriginal Language, Discovery Education for Health Literacy and Informed Consent in a Remote Aboriginal Community in the Northern Territory, Australia.

Background: Education for health literacy of Australian Aboriginal people living remotely is challenging as their languages and worldviews are quite different from English language and Western worldviews. Becoming health literate depends on receiving comprehensible information in a culturally acceptable manner. Methods: The study objective was to facilitate oral health literacy through community education about scabies and strongyloidiasis, including their transmission and control, preceding an ivermectin mass drug administration (MDA) for these diseases. A discovery education approach where health concepts are connected to cultural knowledge in the local language was used. Aboriginal and non-Aboriginal educators worked collaboratively to produce an in-depth flip-chart of the relevant stories in the local language and to share them with clan elders and 27% of the population. Results: The community health education was well received. Feedback indicated that the stories were being discussed in the community and that the mode of transmission of strongyloidiasis was understood. Two-thirds of the population participated in the MDA. This study documents the principles and practice of a method of making important Western health knowledge comprehensible to Aboriginal people. This method would be applicable wherever language and culture of the people differ from language and culture of health professionals.

The Barker hypothesis confirmed: association of low birth weight with all-cause natural deaths in young adult life in a remote Australian Aboriginal community.

Barker et al. proposed that low birth weight predisposes to higher death rates in adult life. We previously confirmed this fact in a cohort of young adults who were born in a remote Australian Aboriginal community between 1956 and 1985. We now present data in these same people with four more years of follow-up and a greater number of deaths. The fates of participants were documented from age 15 years until death, start of dialysis, or until the end of 2010 and causes of death were derived from clinic narratives and dialysis records. Rates of natural deaths were compared by birth cohorts and birth weight, and hazard ratios were calculated using Cox proportional hazards methods, by birth weight and adjusted for birth cohort and sex. Over follow-up of 19,661 person-years, 61 people died of natural causes between age 15 and the censor date. Low birth weights (<2.5 kg) were associated with higher rates of natural death, with HR (95% CI) 1.76 (1.1-2.9, P=0.03), after adjustment for year of birth and sex. The effect was particularly prominent for deaths at <41 years of age, and with deaths from respiratory conditions/sepsis and unusual causes. A predisposing effect of low birth weight on adult deaths was confirmed. This phenomenon, occurring in the context of dramatically improved survivals of lower birth weight infants and children since the early 1960s, helps explain the current epidemic of chronic disease in Aboriginal people. Birth weights continue to improve, so excess deaths from this source should progressively be minimized.

Transition to adult care for Aboriginal children with rheumatic fever: a review informed by a focussed ethnography in northern Australia.

Aboriginal children in northern Australia have high rates of rheumatic fever and rheumatic heart disease, which are chronic conditions because of the need for long-term treatment and monitoring. This article critically reviews the literature on transition to adult care for children with chronic conditions and considers applicability to the care of these children. The review was merged with findings from a focussed ethnography conducted in four remote Aboriginal communities with young people who have these conditions. Transition care aims to support adolescents on a healthcare trajectory to facilitate best long-term health and personal outcomes. Characteristics of the two medical conditions, the children and their local health services in northern Australia were generalised and merged with principles from the transition care literature, including policies governing transition clinics in urban locations. In this setting, the challenge is to transition Aboriginal children safely through to adulthood without rheumatic heart damage rather than to a separate health service on reaching adulthood. Recommended tailoring of transition care involves engaging and valuing local navigators who can address language and cultural barriers to provide a sustainable alternative to transition coordinators in mainstream programs. This has potential to improve care without further burdening overstretched clinical resources.

'We can work together, talk together': an Aboriginal Health Care Home.

Objective The aim of this study was to identify an Aboriginal community's aspirations for health service improvement during implementation of the Commonwealth's Health Care Homes (HCH) reform. Methods This study was a qualitative study consisting of Aboriginal-controlled phenomenological enquiry in a large Aboriginal community in north-central Arnhem Land. Results A representative sample of 60 Aboriginal health service users identified shortcomings in their current experience of primary health care, including low cultural security. These shortcomings reduced access to care. Participants described several ways that care could be reorientated to match their needs during HCH implementation. Principally, patients voiced the need for: (1) restructuring care teams to foster culturally secure relationship-based care; and (2) reorientating the Aboriginal Health Practitioner role from acute care to strength-based competencies as the focal point of care continuity: self-management support, care coordination and navigation, health coaching and cultural mentorship for non-Aboriginal staff. Conclusions For HCH to be successful, service providers need to engage with service users to identify and implement patient-centred strategies to improve access, acceptability and patient activation. What is known about the topic? Success of the Commonwealth's HCH reform is contingent on improving care access and patient activation to better manage chronic conditions What does this paper add? This is the first opportunity that this Aboriginal community has had to articulate their aspirations for high quality healthcare. Beyond the strong alignment with the HCH building blocks, their care preferences posit practical and achievable workforce and delivery system reforms that may improve primary health care in other remote Aboriginal communities. What are the implications for practitioners? The long-term success of the HCH reform will require iterative engagement with service users to identify and implement patient-centred strategies to improve access and acceptability of care. Service model alignment with patient care preferences will improve patient activation and is particularly important when working with vulnerable populations.

Mentoring as a tool to engage Aboriginal youth in remote Australian communities: a qualitative investigation of community members, mentees, teachers, and mentors’ perspectives

Sport-based mentoring programs have been used across many contexts to engage young people in education. In this research, we explored the influence that an Aboriginal controlled organisation’s youth mentoring program has on three remote Aboriginal communities in Northern Territory, Australia. We used a composite set of culturally sensitive methods by including artefacts from the community members and mentees, informal interviews with community, and semi-structured conversations with mentors and schoolteachers. The findings demonstrate the positive feelings, many benefits, and relationships that had been established between mentors and mentees, the organisation and community over time. However, participants also suggested that it would be beneficial to engage mentors in activities with students not in the school system, and adults in the broader community. Despite some identified challenges, the mentoring program was perceived to be successful in engaging remote Aboriginal children in school and developing future career aspirations.

Living the Social Determinants of Health: Assemblages in a Remote Aboriginal Community

This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia.

Long-term trends in supply and sustainability of the health workforce in remote Aboriginal communities in the Northern Territory of Australia

BackgroundInternational evidence suggests that a key to improving health and attaining more equitable health outcomes for disadvantaged populations is a health system with a strong primary care sector. Longstanding problems with health workforce supply and turnover in remote Aboriginal communities in the Northern Territory (NT), Australia, jeopardise primary care delivery and the effort to overcome the substantial gaps in health outcomes for this population. This research describes temporal changes in workforce supply in government-operated clinics in remote NT communities through a period in which there has been a substantial increase in health funding.MethodsDescriptive and Markov-switching dynamic regression analysis of NT Government Department of Health payroll and financial data for the resident health workforce in 54 remote clinics, 2004–2015. The workforce included registered Remote Area Nurses and Midwives (nurses), Aboriginal Health Practitioners (AHPs) and staff in administrative and logistic roles. Main outcome measures: total number of unique employees per year; average annual headcounts; average full-time equivalent (FTE) positions; agency employed nurse FTE estimates; high and low supply state estimates.ResultsOverall increases in workforce supply occurred between 2004 and 2015, especially for administrative and logistic positions. Supply of nurses and AHPs increased from an average 2.6 to 3.2 FTE per clinic, although supply of AHPs has declined since 2010. Each year almost twice as many individual NT government-employed nurses or AHPs are required for each FTE position.Following funding increases, some clinics doubled their nursing and AHP workforce and achieved relative stability in supply. However, most clinics increased staffing to a much smaller extent or not at all, typically experiencing a “fading” of supply following an initial increase associated with greater funding, and frequently cycling periods of higher and lower staffing levels.ConclusionsOverall increases in workforce supply in remote NT communities between 2004 and 2015 have been affected by continuing very high turnover of nurses and AHPs, and compounded by recent declines in AHP supply. Despite substantial increases in resourcing, an imperative remains to implement more robust health service models which better support the supply and retention of resident health staff.

Research protocol for the Picture Talk Project: a qualitative study on research and consent with remote Australian Aboriginal communities

IntroductionResearch with Indigenous populations is not always designed with cultural sensitivity. Few publications evaluate or describe in detail seeking consent for research with Indigenous participants. When potential participants are not...

Identifying and understanding the drivers of high water consumption in remote Australian Aboriginal and Torres Strait Island communities

Managing water demand in many remote Indigenous communities is critical yet often poorly implemented due in part to a lack of understanding of the volume and nature of water use. A combination of quantitative and qualitative data has enabled a deeper understanding of water consumption patterns and drivers in three remote Australian communities as part of Stage 1 of the Remote and Isolated Communities Essential Services (RICES) project. Total daily per person use averaged from 270 L/p/d to over 1,500 L/p/d and outdoor water use activities comprised up to 86% of total residential water consumed. Structured interviews with participants identified five main drivers for outdoor water use of which some are traditionally the role of local government service provision (e.g. dust control) and all are closely linked to day to day functioning (e.g. cleaning food, cooling). Traditional demand management strategies such as pricing are not yet appropriate, nor is a reliance on improving local government service provision, due partly to the resource challenges in remote communities. Community-based engagement and education, supported by local government role modelling, has been identified as a more suitable approach and will be tested in later stages of the RICES project.

Poor nutrition from first foods: A cross-sectional study of complementary feeding of infants and young children in six remote Aboriginal communities across northern Australia.

To describe the first foods of Aboriginal and Torres Strait Islander infants and young children who were recruited to a nutrition promotion and anaemia prevention program conducted from 2010 to 2012, in six remote communities across northern Australia. Food records (24-hour diet history, food variety checklist) were completed on recruitment by interview with a parent or carer. Cross-sectional analysis assessed the proportion of participants consuming recommended and not-recommended foods and drinks and meeting recommendations for meal frequency and dietary diversity. Of 245 Aboriginal and Torres Strait Islander participants aged 6-24 months, 227 (92.7%) had a recruitment food record. On the previous day, most (67.4%) had breastmilk, nearly all (98.2%) ate solid food, but only 13% ate fruit, 33% had neither fruit nor vegetables, and 25% had sweet drinks. Children living in smaller households (3-5 people) were more likely to meet the criteria for frequency of meals than those living in larger households of 12-31 people (93% vs 78%, P = 0.012 for trend over household size). Only 30% met the criteria for dietary diversity. Where information was available (n = 91), dietary diversity was adequate more often in 'pay week' compared to 'not pay week' (31.3% vs 9.3%, P = 0.007). Support for current beneficial breast-feeding practices and promotion of nutrient-dense complementary foods, need to be embedded in initiatives for improved family food security. Good nutrition in early life can reduce the disparity in health, education and economic status between Aboriginal and Torres Strait Islander peoples and other Australians.

Everyday watching and learning in an Indigenous Australian community

Abstract In Indigenous communities around the globe, the time and space needed for the learning of language, ways of being, cultural practices and beliefs, and local history have been limited by changes brought on by formal education, modernity and globalisation. However dynamic these factors and processes may be, introduced Western institutional practices, values and expectations have nonetheless eroded the learning that occurs in the everyday environment, and schooling has reduced the time spent acquiring culturally-specific knowledge systems, languages and worldviews. Research has demonstrated that shared cultural practices and beliefs are vital for identity strengthening in Indigenous Australia. However, studies of the process of this learning and teaching remain few. Examined here are three learning events embedded in the everyday social context of a remote Aboriginal community in Australia. Based on an anthropological and art historical research project that investigated the creative, social and cultural world of an Aboriginal community, this paper focuses on community-based learning events in the quotidian environment. Revealed here are the immediate needs and desires of community members and the manner in which local-specific values, practices and knowledge are transmitted intergenerationally. We argue that these events are a key factor in identity strengthening, cultural continuity and cultural renewal.

Soil-Transmitted Helminths in Children in a Remote Aboriginal Community in the Northern Territory: Hookworm is Rare but Strongyloides stercoralis and Trichuris trichiura Persist.

(1) Background: soil-transmitted helminths are a problem worldwide, largely affecting disadvantaged populations. The little data available indicates high rates of infection in some remote Aboriginal communities in Australia. Studies of helminths were carried out in the same remote community in the Northern Territory in 1994–1996 and 2010–2011; (2) Methods: fecal samples were collected from children aged <10 years and examined for helminths by direct smear microscopy. In the 2010–2011 study, some fecal samples were also analyzed by agar plate culture and PCR for Strongyloides stercoralis DNA. Serological analysis of fingerprick dried blood spots using a S. stercoralis NIE antigen was also conducted; (3) Results and Conclusions: a reduction in fecal samples positive for S. stercoralis, hookworm and Trichuris trichiura was seen between the studies in 1994–1996 and 2010–2011, likely reflecting public health measures undertaken in the region to reduce intestinal helminths. Comparison of methods to detect S. stercoralis showed that PCR of fecal samples and serological testing of dried blood spots was at least as sensitive as direct smear microscopy and agar plate culture. These methods have advantages for use in remote field studies.

Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013\u20132015

BackgroundThe geographical maldistribution of the health workforce is a persisting global issue linked to inequitable access to health services and poorer health outcomes for rural and remote populations. In the Northern Territory (NT), anecdotal reports suggest that the primary care workforce in remote Aboriginal communities is characterised by high turnover, low stability and high use of temporary staffing; however, there is a lack of reliable information to guide workforce policy improvements. This study quantifies current turnover and retention in remote NT communities and investigates correlations between turnover and retention metrics and health service/community characteristics.MethodsThis study used the NT Department of Health 2013–2015 payroll and financial datasets for resident health workforce in 53 remote primary care clinics. Main outcome measures include annual turnover rates, annual stability rates, 12-month survival probabilities and median survival.ResultsAt any time point, the clinics had a median of 2.0 nurses, 0.6 Aboriginal health practitioners (AHPs), 2.2 other employees and 0.4 additional agency-employed nurses.Mean annual turnover rates for nurses and AHPs combined were extremely high, irrespective of whether turnover was defined as no longer working in any remote clinic (66%) or no longer working at a specific remote clinic (128%). Stability rates were low, and only 20% of nurses and AHPs remain working at a specific remote clinic 12 months after commencing. Half left within 4 months.Nurse and AHP turnover correlated with other workforce measures. However, there was little correlation between most workforce metrics and health service characteristics.ConclusionsNT Government-funded remote clinics are small, experience very high staff turnover and make considerable use of agency nurses. These staffing patterns, also found in remote settings elsewhere in Australia and globally, not only incur higher direct costs for service provision—and therefore may compromise long-term sustainability—but also are almost certainly contributing to sub-optimal continuity of care, compromised health outcomes and poorer levels of staff safety. To address these deficiencies, it is imperative that investments in implementing, adequately resourcing and evaluating staffing models which stabilise the remote primary care workforce occur as a matter of priority.

“Reframing” relation-based practice in the child protection sector in remote Aboriginal communities of Australia

Australia, like other post-colonial countries, witnesses an over-representation of Indigenous children in the child protection sector and the trend continues to rise. International indigenous scholarship in child protection seeks to problematise relation-based practice to instantiate decolonising standards. However, much of this transformative agenda is situated in psychosocial approaches that focus on inherent power relations and thereby jettison strategies enabling social workers to engage in emotional learning to contain their defences against anxieties. An autoethnography of practice stressors in remote Aboriginal Australian communities is provided and a call for the restoration of relational psychodynamics as the most responsive form to decolonising practice standards.

Transformation of mortality in a remote Australian Aboriginal community: a retrospective observational study

ObjectivesTo describe trends in ages and causes of death in a remote-living Australian Aboriginal group over a recent 50-year period.DesignA retrospective observational study, from 1960 to 2010, of deaths and...

Working together in a good way: Relationships between local Indigenous and fly-in workers delivering a parent–child programme in remote Aboriginal communities

This article considers what successful working relationships between fly-in professionals and Aboriginal community workers involve. Interviews with six Aboriginal workers and the experience of the jointly delivered Let’s Start parent–child programme in remote north Australian Indigenous communities confirm the importance of developing positive relationships within a both-ways learning approach, drawing on each other’s strengths, and the significance of reflection on practice. Working cooperatively enables effective programme implementation, supports incorporation of new learning into practice, and benefits local Aboriginal community members through employment and development opportunities. This model has relevance for health and community programmes delivered in remote Aboriginal communities.

Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia

Objective:To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia. Methods:Availability was assessed through repeated semi‐structured interviews and consumption via a survey. Quantitative data were described and qualitative data classified. Results:Aboriginal and non‐Indigenous key informants (n=30 in 2013; n=19 in 2014) from 20 Northern Territory (NT) communities participated in interviews. Aboriginal primary household shoppers (n=73 in 2014) in five of these communities participated in a survey. Traditional foods were reported to be available year‐round in all 20 communities. Most participants (89%) reported consuming a variety of traditional foods at least fortnightly and 71% at least weekly. Seventy‐six per cent reported being food insecure, with 40% obtaining traditional food during these times. Conclusions:Traditional food is consumed frequently by Aboriginal people living in remote NT. Implications for public health:Quantifying dietary contribution of traditional food would complement estimated population dietary intake. It would contribute evidence of nutrition transition and differences in intakes across age groups and inform dietary, environmental and social interventions and policy. Designing and conducting assessment of traditional food intake in conjunction with Aboriginal leaders warrants consideration.