Stores healthy options project in remote indigenous communities (SHOP@RIC): a protocol of a randomised trial promoting healthy food and beverage purchases through price discounts and in-store nutrition education

Background
Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts – much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions.

This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities.

Methods/Design
We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed.

Discussion
This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting.

The sociological imaginary and disability enquiry in late modernity

Mills’s idea of the sociological imagination has captured many generations of scholars interested in the difficult social issues that people grapple with in their lives. Yet, sociology has traditionally had a poor record of linking disabled people’s ‘private’ accounts of their difficulties to ‘public’ issues. We contend that disability is still marginal to the sociological imaginary, despite attempts by disability studies and subdisciplines within sociology to make the concept relevant to the larger discipline. There is a range of conceptual tensions in sociology such as public/private and normal/abnormal that can be better illuminated by focusing on disability. We argue that critical disability studies, with its reimagining of disability within late modernity, may be better positioned to make more effectively the case for disability’s significance to the sociological imaginary. Facilitating dialogue with sociology on the concept of disability, however, may require disability scholars to develop more explicit strategies of engagement.

Orphan DNA: Indigenous samples, ethical biovalue and postcolonial science in Australia

Thousands of blood samples taken from Australia’s indigenous people lie in institutional freezers of the global North, the legacy of a half-century of scientific research. Since those collections were assembled, standards of ethical research practice have changed dramatically, leaving some samples in a state of dormancy. While some European and American collections are still actively used for genetic research, this practice is viewed as unethical by most Australian genetic researchers, who have closer relationships with indigenous Australians and postcolonial politics. For collections to be used ethically, they require a ‘guardian’ who has an ongoing and documented relationship with the donors, so that consent to further studies on samples can be negotiated. This affective and bureaucratic network generates ‘ethical biovalue’ such that a research project can satisfy Australian ethical review. I propose in this article that without ethical biovalue, collections become ‘orphan’ DNA, divorced from a guardian and often difficult to trace to their sources. Such samples are both orphaned and functionally sterile, unable to produce data, scientific articles, knowledge or prestige. This article draws on an ethnographic study of genetic researchers who are working in indigenous communities across Australia. I present tales of researchers’ efforts to generate ethical biovalue and their fears for succession; fears that extend to threats to destroy samples rather than see them orphaned, or worse, fall into the wrong hands. Within these material and affective  networks, indigenous DNA morphs from biological sample to sacred object to political time bomb. 

Genetic research in Aboriginal and Torres Strait Islander communities : continuing the conversation

Genetics is at the forefront of medical research, but it is rarely used in Indigenous health research projects. This discussion paper is the outcome of the first ever national discussion of the conduct of genetic research in Indigenous communities in Australia convened by the Lowitja Institute in 2010. It reviews the ethical issues relevant to genetic research in an Australian Indigenous context; existing guidelines for genetic research in indigenous communities internationally; and literature on genetic literacy in Indigenous contexts. Finally, the discussion paper presents a summary of the productive and challenging conversations at the round table.

Indigenous students' persistence in higher education in Australia: contextualising models of change from psychology to understand and aid students' practices at a cultural interface

The need to address the substantial inequities that exist between Indigenous and non-Indigenous Australians in higher education is widely recognised. Those factors that affect the performance of Indigenous students in tertiary education have been reasonably well documented across different institutions, disciplines, and programme levels but there has, to date, been less consideration of the processes by which Indigenous students either persist or desist in higher education. This paper aims to present a conceptual understanding of academic persistence that can inform the delivery of tailored academic support interventions to Indigenous students who are at high risk of leaving higher education.

Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities

To examine experiences of racism in health settings and their impact on mental health among Aboriginal Australians.

Supporting healthy communities through sports and recreation programs

There is some evidence, in the form of critical descriptions of programs and systematic reviews, on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and crime reduction.Although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect. For example, using these programs to reduce juvenile antisocial behaviour largely work through diversion, providing alternative safe opportunities to risk taking, maintenance of social status, as wellas opportunities to build healthy relationships with Elders and links with culture.Although Indigenous Australians have lower rates of participation in sport than non-Indigenous people, surveys suggest that around one-third of Indigenous people participate in some sporting activity (ABS 2010). That makes sports a potentially powerful vehicle for encouraging Indigenous communities to look at challenging personal and community issues.Within Indigenous communities, a strong component of sport and recreation is the link with traditional culture. Cultural activities such as hunting are generally more accepted as a form of sport and recreation than traditional dance. Therefore sport and recreation are integral in understanding ‘culture’ within Indigenous communities, as well as highlighting the culture within which sport and recreation operate.

Changing listening frequency to minimise white noise and hear indigenous voices

Listening… can involve the listener in an intense, efficacious, and complex set of communicative acts in which one is not speaking, discussing, or disclosing, but sitting quietly, watching, and feeling-the-place, through all the senses…. In the process, one becomes a part of the scene, hearing and feeling with it (Carbaugh 1999: 259).To listen this way involves much more than providing a chance for words to be spoken; it includes tuning in and getting the listening frequency clear. As a non-Indigenous person seeking to conduct qualitative research that listens to Aboriginal people, I need to ask how I can tune into the “active attentiveness” described by Carbaugh (1999) in order to listen in a manner that is appropriate, respectful and minimises my inherent white privilege. In addressing this question I draw on the work of Indigenous authors and academics, critical whiteness studies and my own experiences learning from Aboriginal people in a number of contexts over the past ten to fifteen years.History in Australia since colonization has created a situation where Aboriginal voices are white noise to the ears of many non-Indigenous people. This paper proposes that white privilege and the resulting white noise can be minimised and greater clarity given to Aboriginal voices by privileging Indigenous knowledge and ways of working when addressing Indigenous issues. To minimise the interference of white noise, non-Indigenous people would do well to adopt a position that recognises, acknowledges and utilises some of the strengths that can be learned from Aboriginal culture and Indigenous authors.This paper outlines a model of apprentice, allied listening for non-Indigenous researchers to adopt when preparing to conduct research alongside Indigenous people. Such an approach involves Re-learning of history, Reviewing of the researcher’s beliefs and placing Relating at the centre of the listening approach. Each of these aspects of listening is based on privileging of Indigenous voices.

Patient participation in nursing care on medical wards: An integrative review

BACKGROUND: Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care. OBJECTIVES: To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards. DESIGN: Integrative review. DATA SOURCES: Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed. REVIEW METHODS: After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis. RESULTS: Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates. CONCLUSIONS: On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.

Children's play in the Australian Indigenous context: the need for a contemporary view

Despite an extensive search, very little literature was found on Australian Indigenous children’s play, and more specifically pretend play. Most of the literature found was written in the period from 1840 to the 1950s and was primarily descriptive. We argue that the literature found on Australian Indigenous children’s play could be interpreted through the prominent classical theories of the day. These theories emphasized the value of play in preparing children for adulthood. The literature is silent in regard to the value and significance of play in Indigenous Australian culture and on the contribution of play to children’s developmental skills such as language, cognition, problem-solving, literacy and learning. This paper presents a review of the available literature and argues for an analysis of contemporary Australian Indigenous children’s play which values play in the development of the child and interprets play behavior within an Indigenous cultural framework.

Science, research and social change in Indigenous health – evolving ways of knowing

History tells us of the overwhelming destructive influence of exotic culture, politics and knowledge forms upon the worldview and wellbeing of Indigenous Australians. The power of dominant culture to oppress, control and dominate traditional Indigenous ways of knowing and being has been identified as a being a crucial influence on the health status, future hopes and aspirations of Indigenous Australians. Fundamental to this assertion is that the alienating effect of the belief in and application of the scientific method in relation to learning and knowing is a phenomenon that is incompatible with the law and cultural ways of traditional Indigenous people. The establishment of the Centre of Clinical Research Excellence (CCRE) is predicated upon and responds to a deep need in our community today to synthesise the ideological and epistemological premises of an increasing range of cultures and world views. It recognises that clinical research, for example, is important to the health of Aboriginal and Torres Strait Islander peoples, but also that the way such research is designed and carried out is also crucial to its potential to effect change in and improve the state of Indigenous health in Australia. This paper examines knowledge principles and processes associated with research in Indigenous communities, explores emerging research trends in science and proposes an epistemological framework for synthesis of traditional approaches with those of the scientific paradigm.

Planning for country: empowering built environment students with Indigenous protocols and knowledge

Increasingly, Built Environment (BE) professionals, including planner, architect and landscape architect practitioners, are becoming involved in the planning and design of projects for, and in direct consultation with Indigenous communities and their proponents. These projects range from inserting Indigenous cultural landscape analysis into planning schemes, including Indigenous protocols and aspirations in policy statements; designing cultural centres, information centres and housing; drafting cultural tourism strategies and devising cross-cultural land management plans. This entails working with Indigenous communities or their nominated representatives as stakeholders in community engagement, consultation, and planning processes. Critically, BE professionals must be able to plan and design with regard to Indigenous community’s cultural protocols, issues and values. Yet many (domestic and or international) students graduate with little or no comprehension of Indigenous knowledge systems or the protocols for engagement with the communities in which they are required to work, whether they be Australian or international Indigenous communities. Contextually, both PIA and the planning academe have struggled with coming to terms with this realm over the last 10 years. This paper will report on a recently completed Australian Government Office of Learning & Teaching (OLT) funded research project that has sought to improve opportunities to improve the knowledge and skills of tertiary students in the BE professions through the enhancement of their competency, appreciation and respect for Indigenous protocols and processes that also implicates the professional accreditation systems that these courses are accountable. It has proposed strategies and processes to expose students in the BE professions to Australian Indigenous knowledge and cultural systems and the protocols for engaging with Indigenous Australians about their rights, interests, needs and aspirations. Included in these findings is the provision of a tool that enables and offers guidance to BE tertiary students and academics how to enhance comprehension, exposure to, and knowledge and cultural systems of, Indigenous Australians. While the scope of this report is cross-BE, this paper will focus upon the planning practice, policy and academe realms.