Remote Australian Communities Research Articles

Global Strategies for Population Management of Domestic Cats (Felis catus): A Systematic Review to Inform Best Practice Management for Remote Indigenous Communities in Australia.

Simple SummaryA systematic review process was used to identify the current global cat population management practices for owned, free-roaming cat populations, particularly those suited to remote Indigenous communities in Australia. Based on this review, a combination of three methods is recommended. The first method, Surgical Sterilisation (SS), requires owners to take their socialised cats to a facility for surgical sterilisation and then take them home. The second method, Trap-Neuter-Release (TNR) traps, neuters (sterilises) and returns healthy owned cats, which are unsocialised to the point where trapping is necessary, to their homes, and the third method, Trap-Remove (TR), traps and removes unwanted social cats via adoption and unhealthy cats via euthanasia. Conducting these three methods together over a long-term period appears to be consistent with current global best practice for humane and ethical management of cat populations in these communities.Pet domestic cat (Felis catus) populations are increasing all around the world, resulting in an increase in contact with humans and wildlife, potentially spreading zoonotic diseases and predating on wildlife. With the recently identified rise in cat populations in remote Indigenous communities in Australia, culturally appropriate cat population management strategies are required. A systematic review process was conducted to review the current global cat population management practices that are suitable for owned, free-roaming cat populations in these communities. Eight articles on in-situ field cat populations and five studies simulating computer modelled cat populations reported results of 66 population management interventions. Surgical Sterilisation (SS) was used in all socialised owned cat articles. The trap–neuter–release (TNR) method was used most frequently on unsocialised cats and gained the best results when the trap–remove (TR) method was used concurrently to adopt out unwanted social cats and euthanise ill or injured cats. The results of this review suggest that long-term TNR/SS programs supplemented with TR provide the current most ethically sound best practice, humane method of managing cat populations in remote Australian Indigenous communities. It is also recognised that no one plan will fit all, and that further research on the micro-level techniques used to deploy both TNR and TR needs to occur, and that culturally appropriate community consultation during all processes is vital in achieving a sustainable management program.

The Rural Pharmacy Practice Landscape: Challenges and Motivators.

BackgroundHealth outcome delivery for rural and remote Australian communities is challenged by the maldistribution of the pharmacy workforce. High staff turnover rates, reduced pharmacist numbers, and reliance on temporary staff have placed great strain on both state health services and rural community pharmacies. However, recent changes to the demographic profile of the rural pharmacist including a lower average age and increased time spent in rural practice highlights a more positive future for the delivery of better health outcomes for rural communities. The aim of this study was to investigate the factors that motivate and challenge pharmacists’ choice to practice rurally.MethodsRural pharmacists were invited to participate in semi-structured interviews using purposive non-probability sampling. Twelve pharmacists were interviewed with early-, middle- and late-career pharmacists represented. Participants described their experiences of working and living in rural and remote locations. Three themes emerged: workforce, practice environment and social factors, which were examined to determine the underlying challenges and motivators impacting rural and remote pharmacy practice.ResultsLack of staff presented a workforce challenge, while motivators included potential for expanded scope of practice and working as part of a multidisciplinary team. While social isolation has often been presented as a challenge, an emerging theme highlighted that this may no longer be true, and that notions of “rural and remote communities as socially isolated was a stigma that needed to be stopped”.ConclusionThis study highlights that despite the challenges rural pharmacists face, there is a shift happening that could deliver better health outcomes for isolated communities. However, for this to gain momentum, it is important to examine both the challenges and motivators of rural pharmacy practice to provide a platform for the development and implementation of appropriate frameworks and programs to better support the rural pharmacy workforce.

Enhancing Social and Emotional Wellbeing of Aboriginal Boarding Students: Evaluation of a Social and Emotional Learning Pilot Program.

Boarding schools can provide quality secondary education for Aboriginal students from remote Aboriginal Australian communities. However, transition into boarding school is commonly challenging for Aboriginal students as they need to negotiate unfamiliar cultural, social and learning environments whilst being separated from family and community support. Accordingly, it is critical for boarding schools to provide programs that enhance the social and emotional skills needed to meet the challenges. This study evaluated a 10-session social and emotional learning (SEL) program for Aboriginal boarders and identified contextual factors influencing its effectiveness. The study combined a pre-post quantitative evaluation using diverse social and emotional wellbeing measures with 28 students between 13–15 years (10 female, 11 male, 7 unidentified) and qualitative post focus groups with 10 students and episodic interviews with four staff delivering the program. Students’ social and emotional skills significantly improved. The qualitative findings revealed improvements in students seeking and giving help, working in groups, managing conflict, being assertive and discussing cultural issues. The focus groups and interviews also identified program elements that worked best and that need improvement. Secure relationships with staff delivering the program and participation in single sex groups stood out as critical enablers. The findings lend evidence to the critical importance of collaborative design, provision and evaluation of SEL programs with Aboriginal peoples.

All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study

ObjectivesTo evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia.DesignRetrospective cohort study using primary care and hospital data...

The case for integrated health and community literacy to achieve transformational community engagement and improved health outcomes: an inclusive approach to addressing rural and remote health inequities and community healthcare expectations.

Despite the substantial investment by Australian health authorities to improve the health of rural and remote communities, rural residents continue to experience health care access challenges and poorer health outcomes. Health literacy and community engagement are both considered critical in addressing these health inequities. However, the current focus on health literacy can place undue burdens of responsibility for healthcare on individuals from disadvantaged communities whilst not taking due account of broader community needs and healthcare expectations. This can also marginalize the influence of community solidarity and mobilization in effecting healthcare improvements. The objective is to present a conceptual framework that describes community literacy, its alignment with health literacy, and its relationship to concepts of community engaged healthcare. Community literacy aims to integrate community knowledge, skills and resources into the design, delivery and adaptation of healthcare policies, and services at regional and local levels, with the provision of primary, secondary, and tertiary healthcare that aligns to individual community contexts. A set of principles is proposed to support the development of community literacy. Three levels of community literacy education for health personnel have been described that align with those applied to health literacy for consumers. It is proposed that community literacy education can facilitate transformational community engagement. Skills acquired by health personnel from senior executives to frontline clinical staff, can also lead to enhanced opportunities to promote health literacy for individuals. The integration of health and community literacy provides a holistic framework that has the potential to effectively respond to the diversity of rural and remote Australian communities and their healthcare needs and expectations. Further research is required to develop, validate, and evaluate the three levels of community literacy education and alignment to health policy, prior to promoting its uptake more widely.

Young Deadly Free: impact evaluation of a sexual health youth peer education program in remote Australian communities.

Young people (n = 128) participated in youth peer educator training to deliver peer education sessions on sexual health topics to other young people in their communities. Pre and post surveys were used to examine changes in STI knowledge, attitudes and behavioural intentions of the young people attending the peer education sessions. GHRANITE software extracted deidentified STI testing data for young people attending 13 community health services. Young people (n = 426) attended peer education sessions delivered by trained youth peer educators. Pre and post surveys were completed by 174 and 172 young people respectively (median age 20 years). Gains were reported in STI knowledge, intentions to test (χ2 = 10.58, d.f. = 4, n = 142, P < 0.001) and number of STI tests (50.8% increase from baseline). Feelings of shame associated with STI testing remained high (39.5% post survey). Peer education can enhance the sexual health literacy of young Aboriginal people residing in remote communities. The extent to which knowledge gains result in behaviours that prevent STI transmission requires further evaluation. Normalising STI testing among Aboriginal young people would help reduce feelings of shame.

Corrigendum to: Young Deadly Free: impact evaluation of a sexual health youth peer education program in remote Australian communities.

Background:Aboriginal and Torres Strait Islander people in remote and very remote communities in Australia experience high rates of sexually transmissible infections (STIs), 4- to 29-fold the rates reported for non-Aboriginal people living in remote areas. Young people aged 16-29 years are particularly vulnerable to STIs. The Young Deadly Free (YDF) sexual health youth peer education program was implemented in 15 remote or very remote communities in four Australian jurisdictions in an effort to address endemic STI rates in these communities. The present study sought to evaluate the effect of YDF for Aboriginal young people. Methods: Young people (n = 128) participated in youth peer educator training to deliver peer education sessions on sexual health topics to other young people in their communities. Pre and post surveys were used to examine changes in STI knowledge, attitudes and behavioural intentions of the young people attending the peer education sessions. GHRANITE software extracted deidentified STI testing data for young people attending 13 community health services. Results: Young people (n = 426) attended peer education sessions delivered by trained youth peer educators. Pre and post surveys were completed by 174 and 172 young people respectively (median age 20 years). Gains were reported in STI knowledge, intentions to test (χ2 = 10.58, d.f. = 4, n = 142, P < 0.001) and number of STI tests (50.8% increase from baseline). Feelings of shame associated with STI testing remained high (39.5% post survey). Conclusions: Peer education can enhance the sexual health literacy of young Aboriginal people residing in remote communities. The extent to which knowledge gains result in behaviours that prevent STI transmission requires further evaluation. Normalising STI testing among Aboriginal young people would help reduce feelings of shame.

Contextual and behavioural risk factors for sexually transmissible infections in young Aboriginal people in central Australia: a qualitative study

Rates of sexually transmissible infections (STIs) in remote central Australian Aboriginal communities have been persistently high for over two decades, yet risk factors for STIs in these communities are not well understood. This qualitative study explored behavioural and contextual risk factors for STIs in young Aboriginal people in central Australia. The study identified that casual relationships between young people are common and that there is a strong association between travel, alcohol and casual sex, highlighting the ongoing need for comprehensive sexual health programs that are tailored to the specific social, cultural and interpersonal circumstances of young people in this setting.

Importance of Land, family and culture for a good life: Remote Aboriginal people with disability and carers

AbstractWorldwide health and social outcomes of Indigenous people are poorer than those of non‐Indigenous. In Australia, the Indigenous population experience disability at more than twice the rate of the non‐Indigenous population, and a quarter live in geographically remote areas. The challenges associated with accessing services and supports in remote communities can impact on a good life for Aboriginal people with disability. Interviews were conducted with Aboriginal people (Anangu) with disability and family carers from remote Central Australian communities and service workers. Thematic data analysis determined factors Anangu viewed as essential to living a good life: connection to their Lands, being with family and engaging in cultural activities. Workers' support for a good life involves “Proper Way” help and an understanding of Anangu culture. Three culturally relevant strengths‐based concepts are important in supporting Anangu with disability to live a good life: being connected to the Lands and family, sharing together and working together.

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia.

Many Indigenous Australians in northern Australia living with chronic hepatitis B are unaware of their diagnosis due to low screening rates. A venous blood point of care test (POCT) or oral fluid laboratory test could improve testing uptake in this region. The purpose of this study was to assess the field performance of venous blood POCT and laboratory performance of an oral fluid hepatitis B surface antigen (HBsAg) test in Indigenous individuals living in remote northern Australian communities. The study was conducted with four very remote communities in the tropical north of Australia's Northern Territory. Community research workers collected venous blood and oral fluid samples. We performed the venous blood POCT for HBsAg in the field. We assessed the venous blood and oral fluid specimens for the presence of HBsAg using standard laboratory assays. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the POCT and oral fluid test, using serum laboratory detection of HBsAg as the gold standard. From 215 enrolled participants, 155 POCT and 197 oral fluid tests had corresponding serum HBsAg results. The POCT had a sensitivity of 91.7% and specificity of 100%. Based on a population prevalence of 6%, the PPV was 100% and NPV was 99.5%. The oral fluid test had a sensitivity of 56.8%, specificity of 98.1%, PPV of 97.3% and NPV of 65.9%. The venous blood POCT has excellent test characteristics and could be used to identify individuals with chronic HBV infection in high prevalence communities with limited access to health care. Oral fluid performance was suboptimal.

Identifying and Overcoming Barriers to Collaborative Sustainable Water Governance in Remote Australian Indigenous Communities

Collaboration between government agencies and communities for sustainable water governance in remote Indigenous communities is espoused as a means to contribute to more equitable, robust, and long-term decision-making and to ensure that water services contribute to broader considerations of physical, social, and economic prosperity. In Australia, the uptake of collaborative water governance in remote Aboriginal and Torres Strait Island contexts has been slow and few examples exist from which to inform policy and practice. This study identifies barriers to uptake of collaborative sustainable water governance, drawing from qualitative interviews with water practitioners working in remote Indigenous Australia and analysis of key project documentation. Thematic analysis revealed discrete barriers across five key categories: (1) governance arrangements, (2) economic and financial, (3) capacity and skills, (4) data and information, and (5) cultural values and norms, with many barriers identified, unique to the remote Indigenous Australian context. The paper provides insights into how to address these barriers strategically to create transformative and sustainable change for Indigenous communities. The results contribute to the greater body of knowledge on sustainable and collaborative water governance, and they are of relevance for broader water management, policy, and research.

Barriers and opportunities for behavior change in managing high water demand in water scarce Indigenous communities: an Australian perspective

Abstract Managing water demand by reducing water consumption and improving water use efficiency has become essential for ensuring water security. This research aimed to identify the primary determinants of household water consumption in an Australian Indigenous community to develop evidence-based water demand management policies and strategies that might be implemented by the water service provider. A behavior change framework was applied to investigate the opportunity, ability, and motivational determinants affecting household water consumption and conservation in an Australian Indigenous community. The lack of water conservation knowledge and skills of high water users could be barriers to saving water. Low water users have positive attitudes towards water conservation and a higher level of awareness about their own water use. While there is a lack of a belief that water shortages will occur, low water users do have concerns of vulnerability to droughts, and that could be a driver for their sense of obligation to engage in water conservation practices. The research recommended communication messages and tools to address identified barriers to enabling positive changes to water use behaviors, which have wider applications in remote Australian Indigenous communities.

MECHANISTIC AND STATISTICAL MODELS OF SKIN DISEASE TRANSMISSION

MECHANISTIC AND STATISTICAL MODELS OF SKIN DISEASE TRANSMISSION

Strategies to improve control of sexually transmissible infections in remote Australian Aboriginal communities: a stepped-wedge, cluster-randomised trial

Remote Australian Aboriginal communities have among the highest diagnosed rates of sexually transmissible infections (STIs) in the world. We did a trial to assess whether continuous improvement strategies related to sexual health could reduce infection rates. In this stepped-wedge, cluster-randomised trial (STIs in remote communities: improved and enhanced primary health care [STRIVE]), we recruited primary health-care centres serving Aboriginal communities in remote areas of Australia. Communities were eligible to participate if they were classified as very remote, had a population predominantly of Aboriginal people, and only had one primary health-care centre serving the population. The health-care centres were grouped into clusters on the basis of geographical proximity to each other, population size, and Aboriginal cultural ties including language connections. Clusters were randomly assigned into three blocks (year 1, year 2, and year 3 clusters) using a computer-generated randomisation algorithm, with minimisation to balance geographical region, population size, and baseline STI testing level. Each year for 3 years, one block of clusters was transitioned into the intervention phase, while those not transitioned continued usual care (control clusters). The intervention phase comprised cycles of reviewing clinical data and modifying systems to support improved STI clinical practice. All investigators and participants were unmasked to the intervention. Primary endpoints were community prevalence and testing coverage in residents aged 16-34 years for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. We used Poisson regression analyses on the final dataset and compared STI prevalences and testing coverage between control and intervention clusters. All analyses were by intention to treat and models were adjusted for time as an independent covariate in overall analyses. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12610000358044. Between April, 2010, and April, 2011, we recruited 68 primary care centres and grouped them into 24 clusters, which were randomly assigned into year 1 clusters (estimated population aged 16-34 years, n=11 286), year 2 clusters (n=10 288), or year 3 clusters (n=13 304). One primary health-care centre withdrew from the study due to restricted capacity to participate. We detected no difference in the relative prevalence of STIs between intervention and control clusters (adjusted relative risk [RR] 0·97, 95% CI 0·84-1·12; p=0·66). However, testing coverage was substantially higher in intervention clusters (22%) than in control clusters (16%; RR 1·38; 95% CI 1·15-1·65; p=0·0006). Our intervention increased STI testing coverage but did not have an effect on prevalence. Additional interventions that will provide increased access to both testing and treatment are required to reduce persistently high prevalences of STIs in remote communities. Australian National Health and Medical Research Council.

Binaural processing and phonological awareness in Australian Indigenous children from the Northern Territory: A community based study

ObjectiveResearch has found that otitis media (OM) is highly prevalent in Australian Indigenous children, and repeated bouts of OM is often associated with minimal-to-moderate hearing loss. However, what is not yet clear is the extent to which OM with hearing loss impacts auditory signal processing specifically, but also binaural listening, listening in noise, and the potential impact on phonological awareness (PA) – an important, emergent literacy skill. The goal of this study was to determine whether auditory abilities, especially binaural processing, were associated with PA in children from populations with a high incidence of OM, living in a remote Australian Indigenous community in the Northern Territory (NT). MethodsForty-seven 5-12-year-olds from a bilingual school participated in the study. All were tested to determine hearing sensitivity (pure tone audiometry and tympanometry), with PA measured on a test specifically developed in the first language of the children. OM often results in a hearing loss that can affect binaural processing: the Dichotic Digit difference Test (DDdT) was used to evaluate the children's dichotic listening and the Listening in Spatialized Noise-sentences test (LiSN-S) was used to evaluate their abilities to listen to speech-in-noise. ResultsSeventeen (36%) and 16 (34%) had compromised middle ear compliance (combined Type-B and –C) in the right and left ear respectively. Six children demonstrated a bilateral mild hearing loss, and another five children demonstrated a unilateral mild hearing loss. Thirty-one children were able to complete the DDdT listening task, whereas only 24 completed the speech in noise task (LiSN-S). Forty-four children (94%) were able to complete the letter identification subtask, comprising part of the PA task. The findings revealed that age was significantly correlated with all tasks such that the older children performed better across the board. Once hearing thresholds were controlled for, PA also correlated significantly with both binaural processing tasks of dichotic listening (r = 0.59, p < 0.001) and listening to speech in noise (r = −0.56, p = 0.005); indicating a potential association between early, emergent literacy and listening skills. ConclusionsThe significant correlations between phonological awareness and dichotic listening as well as phonological awareness with listening to speech-in-noise skills suggests auditory processing, rather than hearing thresholds per se, are associated to phonological awareness abilities of this cohort of children. This suggests that the ability to process the auditory signal is critical.

Jandu Yani U ‘For All Families’ Triple P—positive parenting program in remote Australian Aboriginal communities: a study protocol for a community intervention trial

IntroductionThe population-based (Lililwan) study of fetal alcohol spectrum disorder (FASD) revealed a high prevalence of FASD in the remote communities of the Fitzroy Valley, Western Australia (WA) and confirmed anecdotal...

AN AUSTRALIAN INDIGENOUS ADVANCEMENT AGENDA

Abstract This paper distills arguments by Indigenous public intellectual Noel Pearson in support of an “uplift” agenda for remote Australian Aboriginal communities suffering corrosive disadvantage and intergenerational dysfunction. Pearson draws on Amartya Sen while prioritizing personal responsibility, and attempts a synthesis of liberalism, social democracy, and capabilities building. The present paper also draws on Martha Nussbaum’s and Rutger Claassen’s capabilities approaches, with points of resonance and/or agreement with Pearson’s arguments highlighted. Under a charitable reading, Pearson’s position is defensible against prevailing criticisms, including the criticism that his responsibility emphasis leads him to misunderstand and misapply Sen’s capabilities theory, and that his policies are illiberally perfectionist and paternalistic, ultimately assimilationist, and in breach of Kant’s humanity principle.

Identifying culturally acceptable cognitive tests for use in remote northern Australia

BackgroundA lack of culturally appropriate tests hampers accurate assessment of cognition in remote Australian Aboriginal communities. In Arnhem Land, this study employed a community consultation process to evaluate commonly used Western tests of executive function, memory, attention, and visuospatial function.MethodsAn initial consultation process and a follow-up pilot study resulted in the rejection of some common tests, the development of new tests, and culturally adapted versions of others. In the subsequent 30-person main trial, adult Aboriginal volunteers were examined on nine tests, plus the Kimberly Indigenous Cognitive Assessment screen, and a brief literacy test.ResultsExecutive function, memory, and attention tests were found to group separately after an exploratory principal components analysis. Correlations between new tests and similar Kimberly screen items were not significant, but ceiling effects may be relevant. Six of 13 test scores were found to correlate with the literacy measure.ConclusionsA selection of cognitive tests were identified that Aboriginal people found culturally acceptable and engaging. In particular, Self-Ordered Pointing, Trail-Making, a verbal-switching task, and a new test “Which car?” show promise for further development. This work may contribute to the need for culturally appropriate cognitive testing in Aboriginal communities.

Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community

BackgroundFetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder associated with prenatal alcohol exposure. Early identification can improve functioning for individuals and reduce costs to society. Gold standard methods of diagnosing FASD rely on specialists to deliver intensive, multidisciplinary assessments. While comprehensive, prevalence rates highlight that this assessment model cannot meet demand, nor is it feasible in remote areas where specialist services are lacking. This project aims to expand the capabilities of remote practitioners in north Queensland, Australia, where 23–94% of the community identify as First Nations people. Integrating cultural protocols with the implementation science theories of Knowledge-To-Action, Experience-Based Co-Design, and RE-AIM, remote practitioners with varying levels of experience will be trained in a co-designed, culturally appropriate, tiered neurodevelopmental assessment process that considers FASD as a potential outcome. This innovative assessment process can be shared between primary and tertiary health care settings, improving access to services for children and families. This project aims to demonstrate that neurodevelopmental assessments can be integrated seamlessly with established community practices and sustained through evidence-based workforce development strategies.MethodsThe Yapatjarrathati project (named by the local First Nations community and meaning ‘to get well’) is a mixed-method implementation trial of a tiered assessment process for identifying FASD within a remote Australian community. In collaboration with the community, we co-designed: (a) a culturally sensitive, tiered, neurodevelopmental assessment process for identifying FASD, and (b) training materials that up-skill remote practitioners with varying levels of expertise. Qualitative interviews for primary, secondary and end users will be undertaken to evaluate the implementation strategies. RE-AIM will be used to evaluate the reach, effectiveness, adoption, implementation and maintenance of the assessment and training process.DiscussionCo-designed with the local community, integrated with cultural protocols, and based on implementation science theories, the assessment and training process from this project will have the potential to be scaled-up across other remote locations and trialed in urban settings. The Yapatjarrathati project is an important step towards increasing the availability of neurodevelopmental services across Australia and empowering remote practitioners to contribute to the FASD assessment process.

Detection of classic and cryptic Strongyloides genotypes by deep amplicon sequencing: A preliminary survey of dog and human specimens collected from remote Australian communities.

Strongyloidiasis is caused by the human infective nematodes Strongyloides stercoralis, Strongyloides fuelleborni subsp. fuelleborni and Strongyloides fuelleborni subsp. kellyi. The zoonotic potential of S. stercoralis and the potential role of dogs in the maintenance of strongyloidiasis transmission has been a topic of interest and discussion for many years. In Australia, strongyloidiasis is prevalent in remote socioeconomically disadvantaged communities in the north of the continent. Being an isolated continent that has been separated from other regions for a long geological period, description of diversity of Australian Strongyloides genotypes adds to our understanding of the genetic diversity within the genus. Using PCR and amplicon sequencing (Illumina sequencing technology), we sequenced the Strongyloides SSU rDNA hyper-variable I and hyper-variable IV regions using Strongyloides-specific primers, and a fragment of the mtDNA cox1 gene using primers that are broadly specific for Strongyloides sp. and hookworms. These loci were amplified from DNA extracted from Australian human and dog faeces, and one human sputum sample. Using this approach, we confirm for the first time that potentially zoonotic S. stercoralis populations are present in Australia, suggesting that dogs represent a potential reservoir of human strongyloidiasis in remote Australian communities.