Torres Strait Islander Health Services Research Articles

Interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes that modify its management and cardiometabolic risk factors: asystematic review.

To review studies of interventions for reducing the impact of type 2 diabetes in Aboriginal and Torres Strait Islander people. The primary aim was to review and summarise the characteristics and findings of the interventions. The secondary aims were to assess their effects on diabetes and cardiometabolic risk factors, and the proportions of people with type 2 diabetes who achieved therapeutic targets with each intervention. We searched eight electronic databases for publications of studies including Aboriginal or Torres Strait Islander people aged 15 years or older with diagnoses of type 2 diabetes, describing one or more diabetes interventions, and published in English during 1 January 2000 - 31 December 2020. Reference lists in the assessed articles were checked for further relevant publications. MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library, Global Health (EBSCO), Indigenous Collection and Indigenous Australia (Informit), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP). The database searches yielded 1424 unique records; after screening by title and abstract, the full text of 55 potentially relevant articles were screened, of which seventeen met our eligibility criteria: eleven cohort studies (seven retrospective audits and four prospective studies), three randomised controlled trials, and three observational, non-randomised follow-up studies. Twelve publications reported site-based (Aboriginal or Torres Strait Islander health service or diabetes clinic) rather than individual-based diabetes interventions. Interventions with statistically significant effects on mean glycated haemoglobin (HbA1c) levels were laparoscopic adjustable gastric banding, a 5-day diabetes self-management camp, treatment of Strongyloides stercoralis infections, community-based health worker-led management, point-of-care testing, and self-management approaches. Few interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes have been reported in peer-reviewed publications. Improving diabetes care services resulted in larger proportions of people achieving therapeutic HbA1c targets. Outcomes were better when Aboriginal and Torres Strait Islander communities were involved at all levels of an intervention. High quality studies of holistic, culturally safe and accessible interventions should be the focus of research.

Using predictive risk modelling to identify patients with hidden health needs in an Aboriginal and Torres Strait Islander health service.

In partnership with an Aboriginal and Torres Strait Islander community-controlled health service, we explored the use of a machine learning tool to identify high-needs patients for whom services are harder to reach and, hence, who do not engage with primary care. Using deidentified electronic health record data, two predictive risk models (PRMs) were developed to identify patients who were: (1) unlikely to have health checks as an indicator of not engaging with care; and (2) likely to rate their wellbeing as poor, as a measure of high needs. According to the standard metrics, the PRMs were good at predicting health checks but showed low reliability for detecting poor wellbeing. Results and feedback from clinicians were encouraging. With additional refinement, informed by clinic staff feedback, a deployable model should befeasible.

Working to make rural health matter.

Working to make rural health matter.

‘At the grass roots level it’s about sitting down and talking’: exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services

ObjectivesImproving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a...

Smoking among a national sample of Aboriginal and Torres Strait Islander health service staff.

To examine smoking among Aboriginal and Torres Strait Islander staff of Aboriginal community-controlled health services (ACCHSs). The Talking About The Smokes (TATS) project surveyed 374 Aboriginal and Torres Strait Islander staff at a national sample of 31 ACCHSs, from April 2012 to October 2013. We made comparisons with adult participants in the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and with 1643 smokers in a community sample of 2522 Aboriginal and Torres Strait Islander people also surveyed in the TATS project. Smoking status, smoking behaviour at work, quitting behaviour, attitudes and beliefs about smoking and quitting. Aboriginal and Torres Strait Islander ACCHS staff had a lower smoking prevalence than among all Aboriginal and Torres Strait Islander adults surveyed in the NATSISS (38% v 49.8%), but this difference was smaller when compared with only employed adults (38% v 44.8%). Staff smokers had higher odds than smokers in their communities of ever trying to quit (odds ratio [OR], 2.1; 95% CI, 1.1-3.7), of having often noticed anti-smoking advertising (OR, 2.8; 95% CI, 1.4-5.6), and of having used stop-smoking medications (OR, 3.0; 95% CI, 1.6-5.7), often with the support of their ACCHS. There was a significant association (P<0.001) between the smoking status of Aboriginal and Torres Strait Islander staff and their confidence in talking to others about smoking and quitting; ex-smokers were most likely to report being confident. Most Aboriginal and Torres Strait Islander staff who smoked (74%) agreed that being a non-smoker sets a good example to patients at their health service, and most did not smoke with patients or at work where patients could see them. Smoking prevalence among Aboriginal and Torres Strait Islander ACCHS staff is only modestly lower than among other employed Aboriginal and Torres Strait Islander people. Given that ex-smokers feel more confident to help others quit than any other group, smoking cessation in ACCHS staff is a useful contributor to reducing community smoking rates.

Deadly Choices™ community health events: a health promotion initiative for urban Aboriginal and Torres Strait Islander people.

The present study was an evaluation of the effectiveness of Deadly Choices™ community events for improving participants' short-term knowledge of chronic disease and risk factors, and increasing community engagement with local health services. Surveys were completed directly before and after participating in health education activities (pre and post surveys, respectively) assessing knowledge of chronic diseases and risk factors at three Deadly Choices community events and four National Aboriginal and Islander Day Observance Committee (NAIDOC) events in south-east Queensland where Deadly Choices health education activities took place. An audit trail was conducted at two Deadly Choices community events in Brisbane to identify the proportion of participants who undertook a health screen at the event who then followed up for a Medicare-funded health check (MBS item 715) or other appointment at an Aboriginal and Torres Strait Islander clinic in the local area within 2 months. Results were compared with a sample of participants who attended one Deadly Choices community event but did not complete a health screen. There were 472 community members who completed a pre and post survey. All knowledge scores significantly improved between baseline and follow up. Although based on a small sample, the audit trail results suggest individuals who participated in a health screen at the community day were approximately twice as likely to go back to a clinic to receive a full health check or have an alternative appointment compared with attendees who did not participate in a screen. Community events that include opportunities for health education and health screening are an effective strategy to improve chronic disease health literacy skills and appear to have the potential to increase community engagement with local Aboriginal and Torres Strait Islander health services.

A case study in the use of evidence in a changing political context: an Aboriginal and Torres Strait Islander health service re-examines practice models, governance and financing.

This paper examines the response of a regional body, the Institute for Urban Indigenous Health (IUIH), coordinating Aboriginal community controlled health organisations (ACCHOs) in south-east Queensland, to research evidence as they prioritise and plan services in response to internal economic and organisational factors, as well as external policy change. An event-based analysis of a quarterly management meeting of the IUIH allowed an exploration of how the IUIH uses a range of evidence to respond to the challenges faced within the Aboriginal community controlled health sector. The study identified three distinct but interconnected processes: (1) identifying evidence for change; (2) exploring and reframing this evidence; and (3) the application of this evidence at different levels of policy and practice. These processes were evident in each of the three major agendas addressed during the meeting, namely navigating current political change, reforming the ACCHO business model and reframing the available evidence for advocacy. The result has been the emergence of a new service delivery model, in which evidence supports accountability, change management, self-sufficiency and attempts to redefine community control.

The interface of mental and emotional health and pregnancy in urban indigenous women: Research in progress.

Research among indigenous women in Australia has shown that a number of lifestyle factors are associated with poor obstetric outcomes; however, little evidence appears in the literature about the role of social stressors and mental health among indigenous women. The not-for-profit organization beyondblue established a "Depression Initiative" in Australia. As part of this they provided funding to the Townsville Aboriginal and Torres Strait Islander Health Service in the "Mums and Babies" clinic. The aim of this was to establish a project to (a) describe the mental health and level of social stressors among antenatal indigenous women and (b) assess the impact of social stressors and mental health on perinatal outcome. A purposive sample of 92 indigenous women was carried out. Culturally appropriate research instruments were developed through consultations with indigenous women's reference groups. The participants reported a range of psychosocial stressors during the pregnancy or within the last 12 months. Significant, positive correlations emerged between the participants' Edinburgh Postnatal Depression Scale (EPDS; J. Cox, J. Holden, & R. Sagovsky, 1987) score and the mothers' history of child abuse and a history of exposure to domestic violence. A more conservative cutoff point for the EPDS (>9 vs. >12) led to 28 versus 17% of women being identified as "at risk" for depression. Maternal depression and stress during pregnancy and early parenthood are now recognized as having multiple negative sequelae for the fetus and infant, especially in early brain development and self-regulation of stress and emotions. Because of the cumulative cultural losses experienced by Australian indigenous women, there is a reduced buffer to psychosocial stressors during pregnancy; thus, it is important for health professionals to monitor the women's emotional and mental well-being.

Overseas-trained doctors in Aboriginal and Torres Strait Islander health services: many unanswered questions.

Aboriginal and Torres Strait Islander health services are heavily dependent on overseas-trained doctors (OTDs). These OTDs are increasingly from countries with variable English language and educational equivalency compared with locally trained doctors. Aboriginal and Torres Strait Islander health services create particular demands for all doctors, such as negotiating "cultural domains" and acknowledging the contribution of Aboriginal health workers. Little is known about the roles and experience of OTDs in health service provision in Indigenous communities. Barriers to effective research into the experience of OTDs include privacy legislation and a lack of standardised data. Researching the narratives of OTDs in Indigenous health services offers an opportunity to explore the diversity and complexity of the cultural interfaces in health service provision.

The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy

This paper reviews the advocacy role of Aboriginal community controlled health services (ACCHSs) in the development of Aboriginal health policy over the past 30 years, with a specific focus on the recent changes in Commonwealth funding and administrative responsibility - the transfer of Aboriginal health service funding from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the Office of Aboriginal and Torres Strait Islander Health Services (OATSIHS) within the Commonwealth Department of Health and Ageing (DoHA), and the development of policies aimed at Aboriginal health services accessing mainstream (Medical Benefits Scheme [MBS]) funds. The outcomes of this policy change include a significant increase in funding to Aboriginal primary health care (PHC), the inclusion of ACCHSs in collaborative strategic relationships, and the development of new arrangements involving regional planning and access to per capita funds based on MBS equivalents. However, the community sector remains significantly disadvantaged in participating in this collaborative effort, and imposed bureaucratic processes have resulted in serious delays in releasing funds for actual services in communities. Government agencies need to take greater heed of community advocacy, and provide appropriate resourcing to enable community organisations to better direct government effort, especially at the implementation phase. These remain major concerns and should be considered by non-health sectors in the development of new funding and program development mechanisms in the wake of the abolition of ATSIC.