Torres Strait Islander Health Research Articles

Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge

BackgroundProject ECHO® networks at Children’s Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health.Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies.MethodsSocial network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings.ResultsBrokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network.ConclusionsThis study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.

Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey.

To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.

The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

What Resilience (Strength) Means for Australian Aboriginal and Torres Strait Islander Health Professionals and Practitioners: An Exploratory Study

What Resilience (Strength) Means for Australian Aboriginal and Torres Strait Islander Health Professionals and Practitioners: An Exploratory Study

The Utility of Data Collected as Part of Australia's Aboriginal and Torres Strait Islander Health Performance Framework.

Since 2006, the Australian Aboriginal and Torres Strait Islander Health Performance Framework (HPF) reports have provided information about Indigenous Australians' health outcomes. The HPF was designed, in consultation with Indigenous stakeholder groups, to promote accountability and inform policy and research. This paper explores bridging the HPF as a theoretical construct and the publicly available data provided against its measures. A whole-of-framework, whole-of-system monitoring perspective was taken to summarise 289 eligible indicators at the state/territory level, organised by the HPF's tier and group hierarchy. Data accompanying the 2017 and 2020 reports were used to compute improvement over time. Unit change and confidence indicators were developed to create an abstract but interpretable improvement score suitable for aggregation and visualisation at scale. The result is an exploratory methodology that summarises changes over time. An example dashboard visualisation is presented. The use of secondary data inevitably invites acknowledgments of what analysis cannot say, owing to methods of collection, sampling bias, or unobserved variables and the standard mantra regarding correlation not being causation (though no attempt has been made here to infer relationships between indicators, groups, or tiers). The analysis presented questions the utility of the HPF to inform healthcare reform.

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.

Who smokes in Australia? Cross-sectional analysis of Australian Bureau of Statistics survey data, 2017-19.

To assess the socio-demographic and health-related characteristics of people who smoke daily, people who formerly smoked, and people who have never smoked in Australia. Cross-sectional analysis of Australian Bureau of Statistics (ABS) survey data. Adult participants (16 370 people aged 18 years or older) in the ABS 2017-18 National Health Survey (NHS); adult participants in the ABS 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) (6423 people aged 18 years or older). Socio-demographic and health-related characteristics of people who smoke daily, people who formerly smoked, and people who have never smoked, expressed as population-weighted proportions, overall and by Indigeneity. Among adult NHS respondents, an estimated 58.8% of people who smoked daily (95% confidence interval [CI], 56.2-61.4%) were men, 61.3% (95% CI, 58.7-63.9%) were 25-54 years old, 72.5% (95% CI, 70.0-74.8%) were born in Australia, and 65.4% (95% CI, 62.8-67.8%) lived in major cities and 54.3% (95% CI, 51.6-57.0%) in areas in the two socio-economically most disadvantaged quintiles; 75.9% (95% CI, 73.5-78.1%) reported good to excellent health, 73.0% (95% CI, 70.5-75.4%) reported low to moderate psychological distress, 69.0% of those aged 25-64 years (ie, of working age) had completed year 12 (high school), and 68.5% were currently employed. An estimated 2.57 million people smoke daily in Australia: 2.37 million non-Indigenous people (92%) and 195 700 Aboriginal or Torres Strait Islander people (8%). While smoking is more frequent among people living in socio-economically disadvantaged areas and in certain population sub-groups, this first quantitative national profile indicates that most people who smoke daily are in paid employment, are non-Indigenous, are in good physical and mental health, and have completed year 12. Improved comprehensive structural supply- and demand-based tobacco control, informed by the needs of priority groups and the overall profile of people who smoke, is needed to reduce daily smoking prevalence among adults to the 2030 targets of 5% or less for all Australians and 27% or less for Aboriginal and Torres Strait Islander people.

The social determinants of Aboriginal and Torres Strait Islander adults who do not smoke in regional Australia.

Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018-2019. This paper seeks to better understand smoke-free behaviours, and to systematically quantify associations between a range of SDOH and non-smoking/never-smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. To explore the social determinants of health (SDOH) related to non- and never-smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Cross-sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never-smokers and non-smokers (ex- and never-smokers). The social determinants of health exposures related to socioeconomic position, well-being and access to healthcare. Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018-2019. Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). High income was associated with non-smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66-2.57) and never-smoking (PR = 2.02; 1.46-2.79), as was completing year 10 (non-smoking PR = 1.34; 1.12-1.61 and never-smoking PR = 1.56; 1.20-2.03). Better food security was associated with a higher prevalence of never-smoking (PR = 2.42; 1.48-3.98). Lower psychological distress scores were associated with non-smoking (PR = 1.30; 1.10-1.53) and never-smoking (PR = 1.56; 1.21-2.01). Never-smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22-2.06). Having a usual healthcare provider was associated with non-smoking (PR = 1.38; 1.02-1.86). Positive exposure to the SDOH were associated with non- and never-smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non-smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples.

Strong Born-A First of Its Kind National FASD Prevention Campaign in Australia Led by the National Aboriginal Community Controlled Health Organisation (NACCHO) in Collaboration with the Aboriginal Community Controlled Health Organisations (ACCHOs).

The Strong Born Campaign (2022-2025) was launched by the National Aboriginal Community Controlled Health Organisation (NACCHO) in 2023. Strong Born is the first of its kind national Aboriginal and Torres Strait Islander health promotion campaign to address Fetal Alcohol Spectrum Disorder (FASD) within Australia. Strong Born was developed to address a longstanding, significant gap in health promotion and sector knowledge on FASD, a lifelong disability that can result from alcohol use during pregnancy. Utilizing a strengths-based and culturally sound approach, NACCHO worked closely with the Aboriginal Community Controlled Health Organisations (ACCHOs) to develop the campaign through co-design, as described in this paper. Since its inception, the ACCHOs have continually invested in driving change towards improvements in Aboriginal health determinants and health promotion. The Strong Born Campaign developed culturally safe health promotion tool kits designed for the community and health sector staff and also offered communities the opportunity to apply for FASD Communications and Engagement Grants to engage in local campaign promotion. The tool kits have been disseminated to 92 ACCHOs across Australia. This paper describes the development of the Strong Born Campaign and activities following its launch in February 2023 from an Indigenous context within Australia, as described by NACCHO.

Producing knowledge together: a participatory approach to synthesising research across a large-scale collaboration in Aboriginal and Torres Strait Islander health

BackgroundDespite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review.MethodsFirst, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in-depth knowledge of the collaboration’s research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches.ResultsTwelve researchers and 11 service providers/policy partners—8 self-identified as Aboriginal and/or Torres Strait Islander—participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice.ConclusionThe participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.

Aboriginal Health Practitioners obtaining, possessing and administering fluoride varnish: self-determination driven regulation amendment for integrated oral health care for Aboriginal children.

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation - The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children.

The Benefits of Cooperative Inquiry in Health Services Research: Lessons from an Australian Aboriginal and Torres Strait Islander Health Study.

Health services research is underpinned by partnerships between researchers and health services. Partnership-based research is increasingly needed to deal with the uncertainty of global pandemics, climate change induced severe weather events, and other disruptions. To date there is very little data on what has happened to health services research during the COVID-19 pandemic. This paper describes the establishment of an Australian multistate Decolonising Practice research project and charts its adaptation in the face of disruptions. The project used cooperative inquiry method, where partner health services contribute as coresearchers. When the COVID-19 pandemic hit, data collection needed to be immediately paused, and when restrictions started to lift, all research plans had to be renegotiated with services. Adapting the research surfaced health service, university, and staffing considerations. Our experience suggests that cooperative inquiry was invaluable in successfully navigating this uncertainty and negotiating the continuance of the research. Flexible, participatory methods such as cooperative inquiry will continue to be vital for successful health services research predicated on partnerships between researchers and health services into the future. They are also crucial for understanding local context and health services priorities and ways of working, and for decolonising Indigenous health research.

Putting Indigenous Cultures and Indigenous Knowledges Front and Centre to Clinical Practice: Katherine Hospital Case Example.

The inclusion of Indigenous cultures, known as the cultural determinants of health, in healthcare policy and health professional education accreditation and registration requirements, is increasingly being recognised as imperative for improving the appalling health and well-being of Indigenous Australians. These inclusions are a strengths-based response to tackling the inequities in Indigenous Australians' health relative to the general population. However, conceptualising the cultural determinants of health in healthcare practice has its contextual challenges, and gaps in implementation evidence are apparent. In this paper, we provide a case example, namely the Katherine Hospital, of how healthcare services can implement the cultural determinants of health into clinical practice. However, to be effective, health professionals must concede that Australia's Indigenous peoples' knowledges involving cultural ways of being, knowing and doing must co-exist with western and biomedical knowledges of health practice. We use the Katherine Hospital ABC Radio National Background Briefing interview, which was mentioned by two research participants in a 2020 study, as an example of good practice that we can learn from. Additionally, the six Aboriginal and Torres Strait Islander Health actions contained in the 2nd Edition of the Australian National Safety and Quality Health Service Standards provide governance and accountability examples of how to enable Indigenous people's cultures and their knowledges in the provision of services. The role of non-Indigenous clinical allies and accomplices is imperative when embedding and enacting Indigenous Australians' cultures in service systems of health. When Indigenous Peoples access mainstream hospitals, deep self-reflection by allies and accomplices is necessary to enable safe, quality care, and treatment that is culturally safe and free from racism. Doing so can increase cultural responsiveness free of racism, thereby reducing the inherent power imbalances embedded within mainstream health services.

Undertaking One Health Research with Australian Aboriginal and Torres Strait Islander Communities: Implications of a One Health Pilot Study

Abstract This case study presents the research process and learnings from undertaking One Health research within Australian Aboriginal and Torres Strait Islander community settings. One Health is relevant to Australian Aboriginal and Torres Strait Islander communities where people and animals (commonly dogs and cats) live closely together and face health risks due to barriers in accessing animal health care. One Health is an appropriate approach to understanding and addressing health disparities as it aligns with community and cultural contexts that recognise the relationships between the health of people, animals and the shared environment. However, with minimal evidence in this space, the contribution of One Health to Aboriginal and Torres Strait Islander health is not well understood limiting the ability to implement One Health approaches and address the needs of communities, families, animals and the environment. This case study describes the research approach, methodology and implications from a pilot One Health study undertaken with Aboriginal and Torres Strait Islander communities that adopted Indigenous research methodologies within a One Health framework. Information © The Authors 2023

Media coverage of commercial industry activities impacting Aboriginal and Torres Strait Islander health, 2018-2022.

This study aimed to examine the extent and nature of Australian news media coverage of commercial industry activities that explicitly speak to Aboriginal and Torres Strait Islander contexts. We undertook content and framing analysis of Australian newspaper and online media articles published between January 2018 and March 2022 that included terms related to 'Indigenous', 'commercial' and 'health'. Analysis focused on the nature of coverage, framing of responsibility, patterns over time and stakeholder representation. Forty-six media articles were included in the analysis. Half of these articles related to the actions of three companies (Woolworths, WAM Clothing and Rio Tinto). Most articles described negative health and well-being impacts of commercial activity, while four described positive impacts. The most common voice represented in media articles was from industry (n = 25). Aboriginal or Torres Strait Islander voices were represented in 21 articles. This analysis highlights how commercial activities in Australia are reported to negatively influence Aboriginal and Torres Strait Islander health and well-being, and that industry voices are more commonly represented in the media related to these issues.

Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework

BackgroundThe Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance.MethodsClients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program.ResultsFindings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available.ConclusionsThe data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.

Exploring First Nations’ and Cultural Safety Content of Pharmacy Curricula With Academics in Australia

ObjectiveThis study aimed to explore academics’ views on Aboriginal and/or Torres Strait Islander Health and Cultural Safety content in pharmacy school curricula to inform recommendations for future curricula. MethodsAll 18 Australian pharmacy schools were contacted, and interviews were conducted with consenting heads of school and/or their delegate(s). The interviews covered what the school was doing with respect to the First Nations theme in the revised accreditation standards and further ideas for improvement. Audio recordings of interviews were transcribed verbatim via an online transcription service. Transcripts were thematically analyzed and coded according to the framework approach and mapped to the Aboriginal and Torres Strait Islander Health Curriculum Framework. Coding was facilitated using NVivo software. ResultsAll 18 schools consented to participate and a total of 22 interviews were conducted. The pharmacy accreditation standards were well known to most educators, however, the dissemination of the Aboriginal and Torres Strait Islander Health Curriculum Framework, introduced in 2014, appeared to be poor. Many interviewees (n = 14) expressed that the current content regarding Aboriginal health and cultural safety/competence was lacking and cited barriers that have led to a lack of development such as a lack of First Nations staff and expertize. ConclusionWhile cultural safety/competency was taught in all Australian pharmacy schools, it is apparent that pharmacy schools are at various stages in their development of Aboriginal and Torres Strait Islander Health curriculum design and implementation. Future resources should be developed and made available.

Medicine communication between Aboriginal and Torres Strait Islander peoples and health professionals: a scoping review protocol.

This scoping review will describe strategies to support communication between Aboriginal and Torres Strait Islander peoples and health professionals about medicines. Poor communication is a well-established risk factor contributing to adverse medicine events. Communication challenges are exacerbated for Aboriginal and Torres Strait Islander peoples due to their poorer health status, greater use of medicines, a first language that may not be English, cultural bias and systemic racism in health services, and lower health literacy resulting from ongoing colonization. A scoping review will assist in summarizing strategies to support the communication process. The review will consider studies describing strategies related to medicine communication between Aboriginal and Torres Strait Islander peoples and health professionals. The proposed review will follow the JBI methodology for scoping reviews. The review will include all published and unpublished literature in English since 2000, including qualitative, quantitative, and mixed methods study designs, systematic reviews, text and opinion pieces, and gray literature. Databases to be searched will include CINAHL, PsycINFO, Cochrane Library, MEDLINE, Web of Science, Scopus, Web of Science, Informit, Indigenous HealthInfoNet, ProQuest Dissertations and Theses, and Google Scholar. Two researchers will screen titles and abstracts independently and assess the full text of selected citations against inclusion criteria. Extracted data will be presented in a narrative accompanied by tables that reflect the objective of the review.

Demystifying human research ethics committee applications.

The National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research and updated Guidelines for Ethical Conduct inAboriginal and Torres Strait Islander Health Research provide guidance for primary care researchers. This paper describes a step-by-step approach to ethics applications for research projects in primary care for newor inexperienced researchers, orthose new to primary care research. Domains that may enhance ethics applications include increased consumer involvement; comprehensive literature reviews; evidence of researcher training in ethical research and clinical trials; the use of online platforms for participant information, consent processes and surveys; and consideration of the risks ofgenomic research or research in subpopulations. This paper discusses steps required when preparing ethics applications to ensure the community, clinicians and researchers are protected.

Transformation to a patient-centred medical home led and delivered by an urban Aboriginal and Torres Strait Islander community, and association with engagement and quality-of-care: quantitative findings from a pilot study

BackgroundThe patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019–2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here.MethodsDe-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes.ResultsThe number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services’ catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16–17% versus 10–11%). Post-implementation, 41% of clients had continuity-of-care with their assigned care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes.ConclusionsThe increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening.