Sustainability of a successful health and nutrition program in a remote Aboriginal community

OBJECTIVE: To assess the long term effect of a nutrition program in a remote Aboriginal community (Minjilang). DESIGN: Evaluation of nutritional outcomes over the three years before and the three years after a health and nutrition program that ran from June 1989 to June 1990. Turnover of food items at the community store was used as a measure of dietary intake at Minjilang and a comparison community. SETTING: A community of about 150 Aboriginal people live at Minjilang on Croker Island, 240 km north-east of Darwin. A similar community of about 300 people on another island was used as the comparison. RESULTS: The program produced lasting improvements in dietary intake of most target foods (including fruit, vegetables and wholegrain bread) and nutrients (including folate, ascorbic acid and thiamine). Sugar intake fell in both communities before the program, but the additional decrease in sugar consumption during the program at Minjilang "rebounded" in the next year. Dietary improvements in the comparison community were delayed and smaller than at Minjilang. CONCLUSIONS: The success of the program at Minjilang was linked to an ongoing process of social change, which in turn provided a stimulus for dietary improvement in the comparison community. When Aboriginal people themselves control and maintain ownership of community-based intervention programs, nutritional improvements can be initiated and sustained.

Festival of Dangerous Ideas: ‘Are some Aboriginals more Aboriginal than others?’

"White Australia has always had a view on what makes a 'real' Aboriginal person. Andrew Bolt is the merely the latest in a long line of commentators who have put forward their views about 'black' and 'white' Aboriginals. Spread across a continent after 200 years of colonisation, Aboriginal people are diverse in a way that is at odds with media stereotypes of 'traditional' Aboriginal people living in troubled remote communities. At a crucial time for recognition and reconciliation, does 'white' or 'black' matter? Who speaks for Aboriginal people and defines who they are?"--Festivals, Talks & Ideas website

Cultural flows in an Aboriginal school : deterritorializing textual production through a socially mediated Indigenous heritage

Flows of cultural heritage in textual practices are vital to sustaining Indigenous communities. Indigenous heritage, whether passed on by oral tradition or ubiquitous social media, can be seen as a “conversation between the past and the future” (Fairclough, 2012, xv). Indigenous heritage involves appropriating memories within a cultural flow to pass on a spiritual legacy. This presentation reports ethnographic research of social media practices in a small independent Aboriginal school in Southeast Queensland, Australia that is resided over by the Yugambeh elders and an Aboriginal principal. The purpose was to rupture existing notions of white literacies in schools, and to deterritorialize the uses of digital media by dominant cultures in the public sphere. Examples of learning experiences included the following: i. Integrating Indigenous language and knowledge into media text production; ii. Using conversations with Indigenous elders and material artifacts as an entry point for storytelling; iii. Dadirri – spiritual listening in the yarning circle to develop storytelling (Ungunmerr-Baumann, 2002); and iv. Writing and publicly sharing oral histories through digital scrapbooking shared via social media. The program aligned with the Australian National Curriculum English (ACARA, 2012), which mandates the teaching of multimodal text creation. Data sources included a class set of digital scrapbooks collaboratively created in a multi-age primary classroom. The digital scrapbooks combined digitally encoded words, images of material artifacts, and digital music files. A key feature of the writing and digital design task was to retell and digitally display and archive a cultural narrative of significance to the Indigenous Australian community and its memories and material traces of the past for the future. Data analysis of the students’ digital stories involved the application of key themes of negotiated, material, and digitally mediated forms of heritage practice. It drew on Australian Indigenous research by Keddie et al. (2013) to guard against the homogenizing of culture that can arise from a focus on a static view of culture. The interpretation of findings located Indigenous appropriation of social media within broader racialized politics that enables Indigenous literacy to be understood as a dynamic, negotiated, and transgenerational flows of practice. The findings demonstrate that Indigenous children’s use of media production reflects “shifting and negotiated identities” in response to changing media environments that can function to sustain Indigenous cultural heritages (Appadurai, 1696, xv). It demonstrated how the children’s experiences of culture are layered over time, as successive generations inherit, interweave, and hear others’ cultural stories or maps. It also demonstrated how the children’s production of narratives through multimedia can provide a platform for the flow and reconstruction of performative collective memories and “lived traces of a common past” (Giaccardi, 2012). It disrupts notions of cultural reductionism and racial incommensurability that fix and homogenize Indigenous practices within and against a dominant White norm. Recommendations are provided for an approach to appropriating social media in schools that explicitly attends to the dynamic nature of Indigenous practices, negotiated through intercultural constructions and flows, and opening space for a critical anti-racist approach to multimodal text production.

At home on the outstation : barriers to home Internet in remote Indigenous communities

Indigenous Australians living in remote areas have little access to the Internet and make little use of it. This article investigates the various dimensions of Internet take-up in remote Indigenous communities in Australia and considers the implications for broadband policy. It focuses specifically on the circumstances and experiences of three remote Indigenous communities in central Australia. Residents in these communities provided significant insight into the social, economic and cultural aspects of communications access and use. This evidence is used to examine the drivers and barriers to home Internet for remote Indigenous communities and to discuss a complex set of issues, including: the dynamics of remote living, economic priorities, cultural engagement with technology, and the characteristics of domestic life in remote Indigenous communities.

Practices of alternative schools in Queensland in supporting Aboriginal and Torres Strait Islander young people to remain engaged in education

Alternative schools are an emerging model of education offered to young people who have been disenfranchised from conventional schooling opportunities. The body of literature on alternative schools in Australia has not identified how many Indigenous young people are engaged with alternative schools and how alternative schools are supporting Indigenous young people to remain engaged in education. It is well documented that Aboriginal and Torres Strait Islander people experience significant disadvantage including poorer educational outcomes than their non-Indigenous peers. This study seeks to contribute to improving educational outcomes for Aboriginal and Torres Strait Islander young people through exploring Aboriginal and Torres Strait Islander interactions with alternative schools in Queensland and investigating the practices of alternative school leaders in terms of how they are supporting Indigenous young people to remain engaged in education. Critical race theory informed the development of this study. An Aboriginal researcher sought to shift the focus of this study away from Indigenous young people to Principals; to explore their perspective of their own knowledge and practices in supporting Aboriginal and Torres Strait Islander young people at their school. Using survey methodology, a web-based questionnaire was developed to survey Principals’ providing data on alternative schools in Queensland including the demographics of the alternative school; self-reported knowledge of Indigenous cultures and communities and practices that support Aboriginal and Torres Strait Islander young people at their alternative school. There are nine key findings that emerged through the analysis of this study: key finding one is the high percentage of Aboriginal and Torres Strait Islander young people enrolled in schools surveyed; key finding two is there is a high percentage of Aboriginal and Torres Strait Islander staff employed in the schools; key finding three is the majority of the schools are located in low socio-economic areas; key finding four is the strong willingness of Principals’ in this study to engage in self-directed learning in relation to Aboriginal and Torres Strait Islander cultures; key finding five is the limited demonstration of understandings of Aboriginal and Torres Strait Islander cultures and communities; key finding six is the most prevalent practice of Principals’ in this study is the celebration of cultural events and cultural activities; key finding seven is the limited Principal engagement with Aboriginal and Torres Strait Islander young people, their families and the local community; key finding eight is the practice of alternative schools provides limited support and nurturing of Aboriginal and Torres Strait Islander young person’s cultural identity and key finding nine is that Principals’ are relying heavily on informal discussions with staff to know what their staff’s knowledge and skills are in relation to supporting Aboriginal and Torres Strait Islander young people. There are multiple implications that have arisen from this study. The data demonstrated high numbers of Aboriginal and Torre Strait Islander students and staff. The data also revealed that Principal’s demonstration of knowledge in relation to Indigenous cultures and communities was limited, as well as limited Principal engagement with Indigenous young peoples, families and communities. Therefore a major practical implication of this study is the urgent need for quality cultural learning opportunities for leaders of alternative schools to improve practices. Additionally, the implications of this study support an urgent need for further research on the role alternative schools are playing in supporting Indigenous young people to remain engaged in education.

Study Protocol - Alcohol Management Plans (AMPs) in remote indigenous communities in Queensland: their impacts on injury, violence, health and social indicators and their cost-effectiveness

Background In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland’s AMPs. Methods/Design The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland’s Indigenous communities affected by alcohol management plans. Discussion This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the best credible evidence to judge future policy and program requirements for themselves. The project will inform impending alcohol policy and program adjustments in Queensland and other Australian jurisdictions. The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4967 & H5241).

Doing whitefella research in blackfella communities in Australia : decolonizing method in sports related research

There is much for non-Indigenous researchers to consider when researching in Indigenous contexts. This paper is a story of discovery for two researchers working on a project with the Indigenous Sports Program section of the Australian Sports Commission. It documents the slow, meticulous and sometimes clumsy steps taken to gain access to communities and conduct research guided by a social justice ethic. The research was successful in that eventually it was possible to develop the trust of individuals and some of the Indigenous communities more broadly, so that information could be gathered and given within the context of shared understandings and mutual interest. However, it is the turbulent journey, filled as it is, with latent tendencies, privileged assumptions and eventually reflexive readings of the data, which remains the focus of this paper. Tentative recommendations are offered to those wishing to advance this politically and epistemologically challenging approach to culturally based research

Uptake of influenza vaccination in pregnancy amongst Australian Aboriginal and Torres Strait Islander women: A mixed-methods pilot study

Background Influenza infection during pregnancy is associated with significant morbidity and mortality. Immunisation against influenza is recommended during pregnancy in several countries but uptake of vaccine is poor. There are limited data on vaccine uptake, and the determinants of vaccination, in Australian Aboriginal and/or Torres Islander women during pregnancy. This study aimed to establish an appropriate methodology and collect pilot data on vaccine uptake and attitudes towards, and perceptions of, maternal influenza vaccination in that population in order to inform the development of larger studies. Methods A mixed-methods study comprised of a cross-sectional survey and yarning circles (focus groups) amongst Aboriginal and Torres Strait Islander women attending two primary health care services. The women were between 28 weeks gestation and less than 16 weeks post-birth. These data were supplemented by data collected in an ongoing national Australian study of maternal influenza vaccination. Aboriginal research officers collected community data and data from the yarning circles which were based on a narrative enquiry framework. Descriptive statistics were used to analyse quantitative data and thematic analyses were applied to qualitative data. Results Quantitative data were available for 53 women and seven of these women participated in the yarning circles. The proportion of women who reported receipt of an influenza vaccine during their pregnancy was 9/53. Less than half of the participants (21/53) reported they had been offered the vaccine in pregnancy. Forty-three percent reported they would get a vaccine if they became pregnant again. Qualitative data suggested perceived benefits to themselves and their infants were important factors in the decision to be vaccinated but there was insufficient information available to women to make that choice. Conclusions The rates of influenza immunisation may continue to remain low for Aboriginal and/or Torres Strait Islander women during pregnancy. Access to services and recommendations by a health care worker may be factors in the lower rates. Our findings support the need for larger studies directed at monitoring and understanding the determinants of maternal influenza vaccine uptake during pregnancy in Australian Aboriginal and Torres Strait Islander women. This research will best be achieved using methods that account for the social and cultural contexts of Aboriginal and Torres Strait Islander communities in Australia.

Review: Let's talk kinship: Innovating Australian social work education, theory, research and practice through Aboriginal knowledge

Review(s) of: Let's talk kinship: Innovating Australian social work education, theory, research and practice through Aboriginal knowledge, by Christine Fejo-King, published by Christine Fejo-King Consulting, ISBN: 978-0-9922814-0-3.

Runs of homozygosity and a cluster of vulvar cancer in young Australian Aboriginal women

Objective A cluster of vulvar cancer exists in young Aboriginal women living in remote communities in Arnhem Land, Australia. A genetic case–control study was undertaken involving 30 cases of invasive vulvar cancer and its precursor lesion, high-grade vulvar intraepithelial neoplasia (VIN), and 61 controls, matched for age and community of residence. It was hypothesized that this small, isolated population may exhibit increased autozygosity, implicating recessive effects as a possible mechanism for increased susceptibility to vulvar cancer. Methods Genotyping data from saliva samples were used to identify runs of homozygosity (ROH) in order to calculate estimates of genome-wide homozygosity. Results No evidence of an effect of genome-wide homozygosity on vulvar cancer and VIN in East Arnhem women was found, nor was any individual ROH found to be significantly associated with case status. This study found further evidence supporting an association between previous diagnosis of CIN and diagnosis of vulvar cancer or VIN, but found no association with any other medical history variable. Conclusions These findings do not eliminate the possibility of genetic risk factors being involved in this cancer cluster, but rather suggest that alternative analytical strategies and genetic models should be explored.

An investigation into drink driving among aboriginal and Torres strait islander peoples in regional and remote Queensland and the development of the 'Hero to Healing' program

This program of research investigated the factors facilitating drink driving in Indigenous communities in Far North Queensland. Drink driving-related road crashes are a significant health burden for Indigenous people, as they die in road crashes at three times the rate of other Australians and are 30% more likely to be seriously injured. This research provided information to develop and pilot a culturally-specific program, 'Hero to Healing'. The main motivation to drink drive was related to 'kinship pressure; where drivers were pressured by family members to drive after drinking. The underlying responsibility for transporting family members was related to cultural values and involved responding to family needs as a priority. Exposure to older family members drink driving was considered to play a role in normalising the behaviour, leading to imitation into adulthood. The research highlighted the need to treat drink driving as a community issue, rather than an individual phenomenon.

Drink driving among Indigenous Australians in outer regional and remote communities and development of a drink driving program: A summary of findings and recommendations

Drink driving is a leading cause of criminal justice system contact for Indigenous Australians. National and state strategies recommend Indigenous road safety initiatives are warranted. However, there is sparse evidence to inform drink driving-related preventive and treatment measures. Using quantitative and qualitative methods, the study examines the profile of Queensland’s Indigenous drink drivers using court convictions and identifies the contributing psycho-social, cultural and contextual factors through qualitative interviews.

A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial

Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications.

'Hero to healing' drink driving program for Indigenous communities in Far North Queensland

Issue addressed: Alcohol-related road crashes are a leading cause of the injury burden experienced by Indigenous Australians. Existing drink driving programs are primarily designed for the mainstream population. The ‘Hero to Healing’ program was specifically developed with Indigenous communities and is underpinned by the Community Reinforcement Approach (CRA). This paper reports on the formative evaluation of the program from delivery in two Far North Queensland communities. Methods: Focus groups and semistructured interviews were conducted with drink driver participants (n = 17) and other Elders and community members (n = 8) after each program. Qualitative content analysis was used to categorise the transcripts. Results: The CRA appealed to participants because of its flexible nature and encouragement of rearranging lifestyle factors, without specific focus on alcohol use. Participants readily identified with the social and peer-related risk and protective factors discussed. Cofacilitation of the program with Elders was identified as a key aspect of the program. More in-depth discussion about cannabis and driving, anger management skills and relationship issues are recommended. Conclusions: Participants’ recognition of content reinforced earlier project results, particularly the use of kinship pressure to motivate younger family members to drink drive. Study findings suggest that the principles of the CRA are useful; however, some amendments to the CRA components and program content were necessary. So what?: Treating drink driving in regional and remote Indigenous Australian communities as a community and social issue, rather than an individual phenomenon, is likely to lead to a reduction in the number of road-related injuries Indigenous people experience.

Youth programs in remote Indigenous communities: Context matters

A diversity of programs oriented to young people seek to develop their capacities and their connection to the communities in which they live. Some focus on ameliorating a particular issue or ‘deficit’ whilst others, such as sporting, recreation and youth groups are more grounded in the community. This article reports a qualitative study undertaken in three remote Indigenous communities in Central Australia. Sixty interviews were conducted with a range of stakeholders involved in a diversity of youth programs. A range of critical challenges for and characteristics of remote Indigenous youth programs are identified if such programs are to be ‘fit for context’. ‘Youth centred-context specific’ provides a positive frame for the delivery of youth programs in remote Central Australia, encouraging an explicit focus on program logic; program content and processes; and relational, temporal, and, spatial aspects of the practice context. These provide lenses with which youth program planning and delivery may be enhanced in remote communities. Culturally safe service planning and delivery suggests locally determined processes for decision-making and community ownership. In some cases, this may mean a community preference for all ages to access the service to engage in culturally relevant activities. Where activities are targeted at young people, yet open to and inclusive of all ages, they provide a medium for cross-generational interaction that requires a high degree of flexibility on the part of staff and funding programs. Although the findings are focused in Central Australia, they may be relevant to similar contexts elsewhere.