Torres Strait Islander Research Articles

How well are researchers applying ethical principles and practices in Aboriginal and Torres Strait Islander health and medical research? A cross-sectional study.

Describe perceptions of how well researchers conducting Aboriginal and Torres Strait Islander health and medical research apply ethical research practices. Cross-sectional online survey. Researchers who included Aboriginal and Torres Strait Islander people or their data in their projects, and current or past members (previous 5 years) of a human research ethics committee that assessed Aboriginal and Torres Strait Islander research. Researchers' engagement with 15 ethical research practices (on a 5-point Likert scale, poor to excellent). 561 participants (382 researchers [68.1%] and 179 human research ethics committee members [31.9%]) completed the survey. Across all research practices, a rating of excellent was least frequently endorsed, with the highest frequency being for employing Aboriginal and Torres Strait Islander team members (38 participants [6.8%]). A rating of poor was most common for enacting Indigenous data sovereignty and governance principles (156 participants [27.8%]). Aboriginal and Torres Strait Islander respondents had significantly lower odds of perceiving high levels of adherence to ethical principles than non-Aboriginal and Torres Strait Islander respondents for all ethical principles, except employing Aboriginal and Torres Strait Islander team members. In particular, Aboriginal and Torres Strait Islander participants had 65% lower odds of perceiving that researchers have high rates of adhering to disseminating results back to the community (odds ratio [OR], 0.35; 95% CI, 0.22-0.57), 56% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in research implementation (OR, 0.44; 95% CI, 0.27-0.73), and 54% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in developing research questions (OR, 0.46; 95% CI, 0.28-0.75). Researchers are not consistently implementing all ethical practices outlined in guidelines for research involving Aboriginal and Torres Strait Islander people. We call for commitment from researchers, institutions and funding bodies to address shortfalls, embed processes, and hold researchers accountable to Aboriginal and Torres Strait Islander people, communities and the principles and guidelines they have established.

Human research ethics committee processes and practices for approving Aboriginal and Torres Strait Islander health research: a mixed methods study.

To describe human research ethics committee (HREC) members' reports of: HREC membership structures; HREC processes for reviewing Aboriginal and Torres Strait Islander health and medical research; and experiences and perceptions of review operations. Cross-sectional 36-item survey and qualitative interviews with a subsample of survey participants. Current and past members (preceding five years) of HRECs who assessed Aboriginal and Torres Strait Islander research. Survey and interview results related to HREC structures, processes and functioning; challenges in review processes; and what is needed to improve ethical governance. 229 HREC members completed the survey and 13 were interviewed. Half the participants (115 of 221, 52%) reported having an Aboriginal and Torres Strait Islander representative position. Key issues identified related to assessment processes and resourcing, including burden on Aboriginal and Torres Strait Islander members, ability for Aboriginal and Torres Strait Islander HRECs to manage additional applications, lack of clarity around specific assessment criteria for general population studies, lack of cohesion across the application or complaints processes, and lack of resourcing and infrastructure to monitor ethical practice after approval. Aboriginal and Torres Strait Islander people carry an important role and burden in the review of applications and monitoring of health research. However, Aboriginal and Torres Strait Islander people are not presently involved in all aspects of ethical research governance within current HREC structures, including the review and monitoring of approved research. Standardised processes and guidelines that uphold Aboriginal and Torres Strait Islander rights and expert knowledges are required.

Reported processes and practices of researchers applying for human research ethics approval for Aboriginal and Torres Strait Islander health research: a mixed methods study.

To examine self-reported practices for obtaining ethics approval and reflections on ethics application processes among researchers who have conducted Aboriginal and Torres Strait Islander health and medical research. Cross-sectional online survey. Australian-based researchers who conducted research that included Aboriginal and Torres Strait Islander people or their data. Results from a 74-item online survey that participants completed, which included questions on demographics, ethics processes, perceptions of engagement in Aboriginal and Torres Strait Islander research, and barriers to and enablers of conducting Aboriginal and Torres Strait Islander research. Of 553 eligible researchers who commenced the survey, 439 (79.4%) answered all of the questions and were included in the analysis. A total of 327 participants (74.5%) had obtained ethics approval from an Aboriginal human research ethics committee (AHREC), 254 (57.9%) had obtained multistate ethics approvals and 270 (61.5%) had not participated in ethics training specifically for Aboriginal and Torres Strait Islander research. Participants were significantly more likely to report being very or extremely confident in managing the ethics application process if they had ≥ 6 years of research experience, had participated in training, had obtained ethics approval from an AHREC, or dedicated > 50% of their time to Aboriginal and Torres Strait Islander research. Participants acknowledged the importance of ethics approval processes in improving research practices, however they identified time and costs as barriers. Aboriginal and Torres Strait Islander participants identified that ethics processes do not always uphold Indigenous approaches or methodologies. Processes for obtaining ethics approval for Aboriginal and Torres Strait Islander health and medical research do not meet contemporary research needs and would be strengthened by streamlining ethics application processes, reducing time and cost barriers, and enhancing cultural appropriateness. We join calls for the establishment of state-based AHRECs in every jurisdiction, and a national Aboriginal and Torres Strait Islander human research ethics committee to review cross-jurisdictional research.

Researchers' self-reported adherence to ethical principles in Aboriginal and Torres Strait Islander health and medical research and views on improving conduct: a mixed methods study.

To examine researchers' reports of adherence to ethical principles in their most recent research project, including factors associated with higher self-reported adherence, and perceptions of how research conduct could be improved. Online cross-sectional survey. Researchers who had conducted any health or medical research that included Aboriginal and Torres Strait Islander people or their data. Researchers rated their adherence to 15 ethical principles extracted from ethical guidelines in their most recent research project on a 5-point Likert scale (poor to excellent), and reported what they believe is needed to improve the conduct of Aboriginal and Torres Strait Islander health and medical research. 391 researchers completed the survey. Those with > 10 years' experience in the field were significantly more likely to self-report adhering to all 15 key ethical principles compared with those with ≤ 5 years' experience. Compared with those with ≤ 5 years' experience, those with 6-10 years' experience were significantly more likely to self-report adhering to: engaging community in identifying research priorities (odds ratio [OR], 2.05; [95% confidence interval (CI), 1.23-3.40]); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.32-3.55); and engaging community in research implementation (OR, 2.10; 95% CI, 1.25-3.54). Aboriginal and Torres Strait Islander participants were significantly more likely to self-report adhering to the following principles than non-Indigenous participants: engaging community in identifying research priorities (OR, 1.90; 95% CI, 1.16-3.10); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.30-3.61); engaging community in research implementation (OR, 1.92; 95% CI, 1.14-3.20); embedding Aboriginal governance, advisory and decision making on the project (OR, 2.10; 95% CI, 1.26-3.50); embedding opportunities in the research for capacity building for communities (OR, 1.70; 95% CI, 1.04-2.77); and enacting Indigenous data sovereignty and governance principles (OR, 1.67; 95% CI, 1.02-2.70). Open-ended responses indicated research conduct could be improved by recognition of community as experts, genuine partnerships and engagement, and pathways for Aboriginal and Torres Strait Islander researchers and support to strengthen the field. Structural and individual change is required to accommodate community priority setting, governance, consultation, leadership and translation in the conduct of ethical Aboriginal and Torres Strait Islander health and medical research. Such changes should be flexible and responsive to calls made by Aboriginal and Torres Strait Islander researchers and communities.

Beyond ethical guidelines: upholding Aboriginal and Torres Strait Islander ethical governance in health and medical research. A scoping review.

To examine what ethics approvals are being sought for Aboriginal and Torres Strait Islander health and medical research, and to determine what proportion of this research upholds Aboriginal and Torres Strait Islander ethical governance via an Aboriginal and Torres Strait Islander community-controlled human research ethics committee (AHREC) by jurisdiction and funding body type. Scoping review of all original, peer-reviewed health and medical literature published over a 5-year period (January 2018 to December 2022). Extending on a previous review, the search tool LIt.search was used to access all literature relating to Aboriginal and Torres Strait Islander health and medical research. 589 eligible publications were included from the parent review, and a further 1703 publications were identified from the updated search. A total of 945 publications were included. A substantial number of ethics approvals were obtained from government-based ethics committees (394, 41.7%). More than half of the publications reported obtaining institutional ethics approval (514, 54.4%). Less than half (400, 42.3%) reported obtaining AHREC approval. Almost one-third of publications were on research that was conducted in states or territories where there is no AHREC (334, 35.3%). Publications did not always report obtaining AHREC approvals, including in jurisdictions where one operates. We found a concerning lack of Aboriginal and Torres Strait Islander ethical governance reported in health and medical research. Acknowledging that Aboriginal and Torres Strait Islander ethics guidelines and AHRECs were established due to harm caused to communities, these results suggest a high risk, with research not consistently being deemed safe, respectful and beneficial with appropriate AHREC ethics review and approval. We join calls for the establishment of AHRECs in all jurisdictions and nationally. Furthermore, we urge funding bodies and institutions to uphold requirements for Aboriginal and Torres Strait Islander ethical governance in research and funding agreements, as well as institutional policies and procedures.

Aboriginal and Torres Strait Islander community experiences and recommendations for health and medical research: a mixed methods study.

To describe Aboriginal and Torres Strait Islander communities' processes, positioning and experiences of health and medical research and their recommendations. A cross-sectional online and paper-based survey. Representatives from Aboriginal and Torres Strait Islander health services and community-controlled organisations in Australia. Responses to a 33-item mixed methods survey that explored communities' positioning and processes relating to health and medical research and their experiences of health and medical research in the previous 5 years. Recommendations for improving health and medical research were elicited via two open-ended questions. Fifty-one community representatives nationally responded to the survey. Most representatives reported feeling slightly or very positive about research (37, 73%). More than half (33, 65%) reported having formal governance processes, and two-thirds of those without governance processes were interested in establishing such processes (12, 67%). Almost half reported that research has sometimes or never had benefit (25, 49%). Ethical principles that were most often reported as essential included those relating to sharing results back with community (45, 88%), translating research into policy and practice (37, 73%), employing Aboriginal and Torres Strait Islander staff (37, 73%), Indigenous data sovereignty and governance (36, 71%) and research agreements (35, 69%). Community representatives reported being approached frequently and in the later stages of research, with little input during the development and design stages of research. Most representatives reported that their communities had participated in Indigenous-led research (39, 76%). Community representatives highlighted the need for appropriate resourcing and funding to drive and lead their own research agendas. Aboriginal and Torres Strait Islander communities continue to have negative experiences of research despite four decades of advocating for control, ownership and leadership of health and medical research. Researchers, funding bodies and institutions must examine current funding and research structures that reinforce current practices, to ensure transparency and accountability to communities by repositioning and giving power to communities to direct and lead their own health and medical research agendas.

Evaluation of the ED MHAOD Hub at St Vincent's hospital.

In response to the 2021 Royal Commission into Victoria's Mental Health System, the Victorian government established six purpose-built Mental Health Alcohol and Other Drug (MHAOD) emergency department (ED) Hubs. This study evaluates the MHAOD Hub at St Vincent's Hospital Melbourne (SVHM), which opened in March 2022 as metropolitan Melbourne's first multidisciplinary Mental Health and Drug or Alcohol Hub integrated into the St Vincent's Emergency Department. This retrospective analysis covers patient admissions to the MHAOD Hub from March 2022 to June 2024, documenting demographics, clinical characteristics and outcomes. 8553 MHAOD admissions were recorded. The Hub admitted a high proportion of vulnerable populations, including 8.4% Aboriginal and/or Torres Strait Islanders and 36.5% homeless individuals. 76.5% of presentations to the Hub were categorised as Australasian Triage Category (ATS) 1, 2 or 3. The most common discharge diagnosis was alcohol-related diagnosis (18.95%) followed by suicidality (14.71%) and psychosis (5.66%). 17.1% of presentations were admitted to the psychiatric ward. This study highlights the effectiveness of MHAOD Hub care in improving timely access to care and addressing the needs of vulnerable populations. Future research should focus on qualitative assessments to capture the nuanced patient and staff experiences and further evaluate long-term outcomes.

Privileging the spirit, voices, and culture of Aboriginal and Torres Strait Islander peoples in dementia care: education for non-Indigenous health care providers

Privileging the spirit, voices, and culture of Aboriginal and Torres Strait Islander peoples in dementia care: education for non-Indigenous health care providers

Chlamydia and gonorrhoea testing and positivity within an urban Aboriginal and Torres Strait Islander Community Controlled Health Service 2016-2021.

Background This study describes chlamydia and gonorrhoea testing, positivity, treatment, and retesting among individuals aged ≥15years attending an urban Aboriginal Community Controlled Health Service during the period 2016-2021. Method Utilising routinely collected clinical data from the ATLAS program (a national sentinel surveillance network), a retrospective time series analysis was performed. The study assessed testing rates, positivity, treatment efficacy, retesting and trends over time within an urban Aboriginal Community Controlled Health Service. Results Testing rates for chlamydia and gonorrhoea varied between 10 and 30% over the study period, and were higher among clients aged 15-29years and among females. Positivity rates for both infections varied by age, with clients aged 15-24years having higher positivity than older clients. Gonorrhoea positivity rates decreased after 2016. Treatment and retesting practices also showed sex disparities, with men having a slightly higher treatment rate within 7days, whereas females had significantly higher retesting rates within 2-4months, indicating differences in follow-up care between sexes. Conclusion The study emphasises the need for clinical and public health interventions within urban Aboriginal and Torres Strait Islander populations to further reduce chlamydia and gonorrhoea. Prioritising improved access to testing, timely treatment and consistent retesting can significantly contribute to lowering STI prevalence and enhancing sexual health outcomes in these communities.

Improving cardiometabolic risk factors in Aboriginal and Torres Strait Islander people in northeast Arnhem Land: single arm trial of a co-designed dietary and lifestyle program.

To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community. Single arm, pre-post intervention study. Adult residents (18-65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m2 or waist circumferences exceeding 94 cm (men) or 80 cm (women). Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022. Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program. We assessed outcomes for 55 participants who completedweight assessments at both baseline and program end(mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5-2.4 kg), and ten participants (18%; 95% CI, 9-31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was -0.60 kg/m2 (95% CI, -0.93 to -0.27 kg/m2), in waist circumference (53 participants) -3.2 cm (95% CI, -4.7 to -1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) -0.28 mmol/L (95% CI, -0.47 to -0.08 mmol/L); the relative decline in the HbA1c level geometric mean (50 participants) was 11% (95% CI, 6-15%). The intake of breads and cereals (median change, -1.5 [95% CI, -2.0 to -1.0] serves/day) and sugar-sweetened beverages (-0.6 [95% CI, -1.4 to -0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74-136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit. Community appreciation of the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co-designed initiative led by Indigenous people for reducing the prevalence of chronic disease in remote areas. Australian New Zealand Clinical Trials Registry (ACTRN12622000174785; prospective: 2 February 2022).

The Introduction of Extended Out‐of‐Home Care (OOHC) Until 21 Years in Australia: A Mapping of Policy, Legislation and Programs in Each Jurisdiction

ABSTRACTIt is increasingly recognised by global research that extending out‐of‐home care (OOHC) until at least 21 years of age is the policy reform most likely to advance improved outcomes for care leavers. In recent years, all eight Australian jurisdictions (States and Territories) have introduced forms of extended care programs. Yet, major variations remain between these jurisdictions in terms of the placement types covered, the levels of support and funding, and the terms and language used to describe their programs. This paper maps the existing policy developments in each jurisdiction and the level of program supports provided to care leavers aged 18–21 years. For each jurisdiction, we establish extended care eligibility and coverage, funding and adequacy, and the key terminology used. Our discussion of the commonalities and differences between the jurisdictions suggests that some sub‐groups of care leavers may need additional and specialised forms of support. They include most notably those exiting residential care and Aboriginal and Torres Strait Islander care leavers.

A period prevalence study of palliative care need and provision in adult patients attending hospital-based dialysis units.

Advanced chronic kidney disease is a life-limiting disease that is known to benefit from palliative care. Unmet palliative care need in patients with kidney failure is commonly reported but the level of need among patients receiving haemodialysis is unknown. A period prevalence study of adult patients attending two hospital-based dialysis units was conducted. Patient medical records were reviewed using the Gold Standards Framework Proactive Indication Guidance to assess for potential palliative care need. A total of 128 patient medical records were reviewed, 45% (n = 58) of patients could have potentially benefitted from palliative care. Of the patients with indicators for palliative care, 72% (n = 42) had no evidence of receiving or awaiting any form of palliative care. High levels of palliative care need were found in patients who identified as Aboriginal or Torres Strait Islander and non-Indigenous patients. This study found high levels of palliative care need among adult patients attending hospital-based dialysis units. The majority of patients with indicators were not receiving any form of palliative care.

“You’re telling us to go first?!” COVID-19 pandemic and vaccination experiences among Aboriginal adults in Western Australia

Globally, Indigenous populations have been disproportionately impacted by pandemics. In Australia, though national infection rates with COVID-19 infections in Aboriginal and/or Torres Strait Islander people were lower in the first 12 months of the COVID-19 pandemic, there was soon a greater burden in Aboriginal and/or Torres Strait Island people once Omicron was circulating. Uptake of the COVID-19 vaccine was also lower among Aboriginal and/or Torres Strait Islander people. It was imperative to understand the stories of Aboriginal and/or Torres Strait Islander people in WA about their experience of the COVID-19 pandemic and vaccine rollout. Between September 2022 and October 2023, we conducted five face-to-face yarning workshops with Aboriginal and/or Torres Strait Islander people in Noongar Whadjuk Boodja (Perth metropolitan region, Western Australia). Yarns discussed COVID-19 experiences, knowledge and attitudes about COVID-19 and vaccination, reasons for or against COVID-19 vaccination, trusted sources of information, and knowledge of COVID-19 vaccination programmes for Aboriginal and/or Torres Strait Islander people. Data was thematically analysed in an inductive manner on NVivo, followed by a data interpretation forum with study investigators and community members. Across the five yarning workshops, we heard the stories and experiences of 38 Aborginal and/or Torres Strait Islander people. Many described the negative impact that the policies implemented to control COVID-19 had on their ability to connect with their community and practice traditional culture. Very few participants trusted government and any government information due to both historical and contemporary factors. This led participants to be wary of the fact they were among the first to be prioritised for COVID-19 vaccination in Australia. Though most participants (92%) had received at least one COVID-19 vaccine, there were high levels of COVID-19 vaccine hesitancy. The main reason for this was due to COVID-19 vaccine mandates; participants were, in essence, coerced acceptors of what they felt to be an unsafe vaccine that provided little protection against a mild disease. Our yarns identified high levels of COVID-19 vaccine hesitancy and circulation of misinformation amongst Perth-based Aboriginal and/or Torres Strait Islander people. Our findings also demonstrate that there were many unintended consequences of COVID-19 policies on Aboriginal and/or Torres Strait Islander people and culture. Future pandemic policies and vaccine programmes must consider the impact on not only the health of Aboriginal and/or Torres Strait Islander people but also the impact on community and culture.

Sick Day Management Plans for Aboriginal and/or Torres Strait Islander Peoples With Chronic Kidney Disease on the Cape York Peninsula of Australia: Health Workers' Perspectives.

This study aimed to explore the perspectives of healthcare professionals on the utility of sick day management plans for people with chronic kidney disease (CKD) in remote communities and collaboratively design a sick day management plan resource. This qualitative study utilised two phases of data collection: preliminary observational data and semi-structured interviews. The research design and analysis were guided by the normalisation process theory (NPT) framework, tailored for complex interventions in healthcare. Three First Nations communities and one remote mining community in Cape York, Australia. In-person semi-structured interviews were conducted with 23 primary healthcare workers; 40% identified as Aboriginal and/or Torres Strait Islander. The study identified three themes relating to feasibility of implementation: (1) resource coherence and readability, (2) suitability for integration into the care model and (3) safety and risk associated with sick day management plans. Iterative development of resources followed, incorporating feedback from the participants. Recommendations emerged for enhanced readability and coherence, including further co-design with individual communities and consumers, content simplification, incorporation of Aboriginal and/or Torres Strait Islander artwork and language and a flow chart structure. The study underscores the importance of culturally sensitive resource design and the active involvement of Aboriginal and/or Torres Strait Islander communities in healthcare improvement. Future research should explore cost-effective methods for personalised sick day management plans.

Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.

Despite an epidemic of End-Stage Kidney Disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: 1.) Design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment2.) Provide transplant suitability assessments for all patients of the service3.) Describe what temporary contraindications to kidney transplantation should be the focus of health service improvements4.) Explore participant experiences with the suitability assessment process and:5.) Use our findings to inform pre-and post-transplant model of care development within Kimberley Renal Services. Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis, semi-structured interview with thematic analysis. Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and non-medical contraindications, 5/46 had medical contraindications only, and 24/46 had non-medical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46) and high body mass index (BMI) (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation. In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people we achieved substantial catch-up in suitability assessments, and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.

Australian Trachoma Surveillance Report update: 2014-2022.

Australia is the only high-income country where trachoma has been endemic, defined as an overall trachoma prevalence in Aboriginal and Torres Strait Islander children aged 5-9 years of 5% or more. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to collate and analyse trachoma prevalence data and control strategies annually. This report presents data submitted from 2014 to 2022. In 2022, there were 87 remote communities considered at-risk of endemic trachoma, a decline of 51% since 2014 when 177 communities were considered at-risk. World Health Organization grading criteria are used to diagnose trachoma in at-risk populations. Overall prevalence, which includes estimates from all communities ever considered at-risk, fell below 5% endemicity thresholds for the first time in 2022 in Western Australia (2.9%), the Northern Territory (2.1%), New South Wales (0.5%), and in Queensland and South Australia (0.0% each). New cases of trachomatous trichiasis-a severe consequence of trachoma that causes blindness-were detected in eight out of 10,806 persons, aged 15 years and over, screened in 2022. Jurisdictional trichiasis prevalence was 0.2% in Western and South Australia and 0.0% in the Northern Territory. Australia must maintain overall trachoma and trichiasis prevalence below endemicity levels for a further two years before applying for World Health Organization validation of elimination of trachoma as a public health problem.

‘I Don't Think I Would've Survived Without Having a Constant Support System’: Independent Living Skills Acquisition During the Transition From Care in Western Australia

ABSTRACTFor care‐experienced young people, the preparation for leaving out‐of‐home care (OOHC) is vital in support of post‐OOHC outcomes. This research explores the acquisition of Independent Living Skills (ILS) amongst young people in Western Australia and is based on interviews with care‐experienced young people at two time points: while in OOHC and after leaving OOHC. Overall, 72% of participants were female, 45% had a disability and 45% identified as Aboriginal and/or Torres Strait Islander. Total years spent in care ranged from 2 to 16 years. This study adopts two research methods; first, using eight different domains to conceptualise the ILS needed in early adulthood, interview transcript data was cross‐referenced to understand the interconnected nature of ILS. Second, a thematic analysis was conducted of the interview transcripts to highlight participants' experiences. Findings highlight three themes relating to System Impacts, Social and Cultural Capital and Practical Identity and Self‐focus upon acquiring ILS. The findings address this Special Issue's sub‐themes, namely in relation to highlighting (1) examples of good policy and practice in transition planning and/or ongoing gaps in transitions from care policy, practice and implementation for 15–18 year olds/assisting care leavers aged 18–21 years and providing (2) lived experience perspectives.

Wedged between two congeners: will the real Gompholobium nitidum (Fabaceae: Mirbelieae) please stand up?

The most recent review of the genus Gompholobium Sm. (Fabaceae: Mirbelieae), published in 2008, considered Gompholobium nitidum Sol. ex Benth. to exhibit a high degree of variation, ranging from very compact shrubs with linear leaflets, to open shrubs of a taller stature with lanceolate leaflets, through to dense shrubs with oblong leaflets with obtuse-emarginate apices. We use morphological and ddRAD sequencing data to recognise three species from this broad complex, linked with topographic and edaphic complexity in the study area (Laura south to the Atherton Tablelands, north-east Queensland): (1) G. nitidum sens. strict. is a narrowly distributed taxon limited to the white sands of coastal dunes north of Cooktown, with a single disjunct population south of Cooktown; (2) a novel species described here, G. cinctum M.T.Mathieson & C.L.Simmons, has a slightly broader distribution across the skeletal sandy loams of sandstone formations in the Cooktown region; and (3) G. papuanum Merr. & L.M.Perry, previously subsumed into G. nitidum, is reinstated and occurs broadly across north-east Queensland in woodlands from west of Townsville to Cape York, the Torres Strait Islands and into Papua New Guinea.

Characteristics, care and support needs of older Victorians requiring a government-funded Home Care Package: An observational study.

To describe sociodemographic characteristics and comprehensive day-to-day care and support needs of older Victorians requiring government-funded home-based aged-care, and to explore associations between vulnerability factors and complexity indicators in this population. A population-based observational study was conducted using de-identified, routinely collected aged-care assessment data for Victorians approved for a Home Care Package (HCP) between January 2019 and June 2022. The study population (n = 94,975 individuals), approved for one of four HCP levels (Levels 1 (5%), 2 (38%), 3 (34%) or 4 (24%)), was aged 82 years on average (SD 7.6), commonly born outside Australia (48%), with people of higher socio-economic status more likely to be approved for a high-level HCP. Advanced care and support needs such as for showering (53%) and dressing (43%) were common, with higher overall needs when cognitive and behavioural concerns such as short-term memory loss (75%) or agitation (21%) were present. 79% reported at least one vulnerability factor such as being socially isolated, culturally and linguistically diverse, or Aboriginal and Torres Strait Islander peoples, and 49% reported at least one complexity indicator. The three most prevalent complexity indicators were significant cognitive changes (29%), self-neglect (17%) and emotional/mental health issues (11%), which were generally positively associated with vulnerability factors. This population-based study provides evidence of the diverse sociodemographics, and often advanced day-to-day mobility, functional, physical, cognitive, behavioural, psychological and psychosocial care and support needs of people requiring home-based aged-care. It also highlights the multifaceted complexities within this population. Results could inform home care service-delivery models and workforce skill-mix requirements to efficiently and safely meet these needs.

Cultural Adaptation of an Aboriginal and Torres Strait Islanders Maternal and Child mHealth Intervention: Protocol for a Co-Design and Adaptation Research Study.

There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander-specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app's cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. PRR1-10.2196/53748.