Having a yarn about smoking : using action research to develop a 'no smoking' policy within an Aboriginal health organisation

Objectives: This article reports on a culturally appropriate process of development of a smoke-free workplace policy within the peak Aboriginal Controlled Community Health Organisation in Victoria, Australia. Smoking is acknowledged as being responsible for at least 20% of all deaths in Aboriginal communities in Australia, and many Aboriginal health workers smoke. Methods: The smoke-free workplace policy was developed using the iterative, discursive and experience-based methodology of Participatory Action Research, combined with the culturally embedded concept of ‘having a yarn’. Results: Staff members initially identified smoking as a topic to be avoided within workplace discussions. This was due, in part, to grief (everyone had suffered a smoking related bereavement). Further, there was anxiety that discussing smoking would result in culturally difficult conflict. The use of yarning opened up a safe space for discussion and debate,enabling development of a policy that was accepted across the organisation. Conclusions: Within Aboriginal organisations, it is not sufficient to focus on the outcomes of policy development. Rather, due attention must be paid to the process employed in development of policy, particularly when that policy is directly related to an emotionally and communally weighted topic such as smoking.

Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers

Objective: In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. Method: A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. Results: The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Conclusion: Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy. Keywords: case management, caseload, stress

Engaging the practice of yarning in Action Research

This paper discusses the technique of ‘yarning’ as an action research process relevant for policy development work with Aboriginal peoples. Through a case study of an Aboriginal community-based smoking project in the Australian State of Victoria, the paper demonstrates how the Aboriginal concept of ‘yarning’ can be used to empower people to create policy change that not only impacts on their own health, but also impacts on the health of others and the Aboriginal organisation for which they work. The paper presents yarning within the context of models of empowerment and a methodological approach of participatory action research. The method is based on respect and inclusivity, with the final policy developed by staff for staff. Yarning is likely to be successful for action researchers working within a variety of Indigenous contexts.

Enhancing resilience in indigenous people: The integration of individual, family and community interventions

This paper describes a number of interventions being developed to address the emotional, social and behavioural problems experienced by Aboriginal people in Australia. These are: the We-Al-Li program to help people deal with the impact of transgenerational trauma; and the RAP Indigenous Parenting Program. It is argued that the emotional well being of indigenous people will be enhanced through the integration of interventions targeting the individual, family and community.

Disobedient Citizens : Press Depictions of Striking School Teachers in NSW and Anti-Vietnam War Demonstrators in NSW and Victoria in 1968

Across Australia in 1968, students demonstrating against the Vietnam War engaged in confrontational behaviour. The metropolitan daily newspapers,the most important source of news for most people, enthusiastically reported the scenes. The demonstrations were exciting. Sensational headlines and photographs captured the interest of readers and influenced their opinions. But radical opposition to government policies at the time was not limited to university students opposing the Vietnam War. Teachers had become increasingly critical of conditions in schools, with Victorian secondary school teachers having stopped work on a number of occasions since 1965. In October 1968, both primary and secondary school teachers in New South Wales participated in eastern Australia’s first state-wide teachers’ strike. As Sydney’s Sun commented on 1 October 1968, “The teachers’ strike threw the ... education system into chaos ... A huge proportion of the State’s 2764 schools were silent and empty.” Similarities with the anti-war demonstrations were obvious. Although not as confrontational, the New South Wales teachers’ strike was a publicity-seeking action. This examination of the teachers’ more restrained, but more effective, approach to challenging government policies provides a new voice and vision to our understandings of the diverse nature of radicalism in Australia in the 1960s.

A limb lost every 3 hours: can Australia reduce amputations in people with diabetes?

Recommendations to improve national diabetes-related foot disease (DRFD) care • National data collection on incidence and outcomes of DRFD. • Improved access to care, through the Medicare Benefits Schedule, for people with diabetes who have a current or past foot complication. • Standardised national model for interdisciplinary DRFD care. • National accreditation of interdisciplinary foot clinics and staff. • Subsidies for evidence-based treatments for DRFD, including medical-grade footwear and pressure off-loading devices. • Holistic diabetes care initiatives to “close the gap” on inequities in health outcomes for Aboriginal and Torres Strait Islander peoples.

A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

Background: Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population. Methods: Hospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status. Results: When compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups. Conclusion: Contrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma.

Hospital utilisation among people born in refugee-source countries : an analysis of hospital admissions, Victoria, 1998–2004

Objective: To investigate whether hospital utilisation and health outcomes in Victoria differ between people born in refugee-source countries and those born in Australia. Design and setting: Analysis of a statewide hospital discharge dataset for the 6 financial years from 1 July 1998 to 30 June 2004. Hospital admissions of people born in eight countries for which the majority of entrants to Australia arrived as refugees were included in the analysis. Main outcome measures: Age-standardised rates and rate ratios for: total hospital admissions; emergency admissions; surgical admissions; total days in hospital; discharge at own risk; hospital deaths; admissions due to infectious and parasitic diseases; and admissions due to mental and behavioural disorders. Results: In 2003–04, compared with the Australia-born Victorian population, people born in refugee-source countries had lower rates of surgical admission (rate ratio [RR], 0.85; 95% CI, 0.81–0.88), total days in hospital (RR, 0.74; 95% CI, 0.73–0.75), and admission due to mental and behavioural disorders (RR, 0.70; 95% CI, 0.65–0.76). Over the 6-year period, rates of total days in hospital and rates of admission due to mental and behavioural disorders for people born in refugee-source countries increased towards Australian-born averages, while rates of total admissions, emergency admissions, and admissions due to infectious and parasitic diseases increased above the Australian-born averages. Conclusions: Use of hospital services among people born in refugee-source countries is not higher than that of the Australian-born population and shows a trend towards Australian-born averages. Our findings indicate that the Refugee and Humanitarian Program does not currently place a burden on the Australian hospital system.

‘My people right here…’ Indigenous young people, alienation and paint sniffing in inner Brisbane

This paper describes and explains the social worlds of a group of young Murris who are engaged in chroming (paint sniffing) and who sleep rough in inner Brisbane. In particular, the paper considers the ways young Indigenous drug users describe their marginalisation from wider society and its structures of opportunity, but it also includes some reflections from their youth worker and a young man who frequents the young people’s squat. The paper demonstrates the centrality of racism and material disadvantage to the experience of a group of young Aboriginal and Torres Strait Islander sniffers, a perspective largely unreflected in the literature on Indigenous volatile substance misuse. Further, the young people’s ways of interacting with the broader society are described to explain the ways their rejection of mainstream norms form a significant political response to their marginality and reflect, at least in part, the wider Indigenous historical experience. The work draws on theories of alienation and subculture to analyse the young people’s descriptions of their social estrangement and the formation of the ‘paint sniffer group’. It is concluded that paint sniffing among urban Indigenous youth is, at least in part, an obnoxious and encoded distillation of a wider Indigenous rebuttal of broader societal norms, and that the dominant — normalising — modes of treatment risk further alienating an already oppositional group of young people.

Growing existing aboriginal designs to guide a cross-cultural design project

Designing across cultures requires considerable attention to inter-relational design methods that facilitate mutual exploration, learning and trust. Many Western design practices have been borne of a different model, utilizing approaches for the design team to rapidly gain insight into “users” in order to deliver concepts and prototypes, with little attention paid to different cultural understandings about being, knowledge, participation and life beyond the design project. This paper describes a project that intends to create and grow a sustainable set of technology assisted communication practices for the Warnindilyakwa people of Groote Eylandt in the form of digital noticeboards. Rather than academic practices of workshops, interviews, probes or theoretical discourses that emphasize an outside-in perspective, we emphasize building upon the local designs and practices. Our team combines bilingual members from the local Land Council in collaboration with academics from a remote urban university two thousand kilometers away. We contribute an approach of growing existing local practices and materials digitally in order to explore viable, innovative and sustainable technical solutions from this perspective.

Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations : a protocol for a cohort linkage study

Background: Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander people* in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for both women and their infants. Women diagnosed with GDM have an eightfold risk of developing T2DM after pregnancy, compared with women who have not had GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM can lead to heart disease, stroke, renal disease, kidney failure, amputations and blindness. A GDM diagnosis offers a ‘window of opportunity’ for diabetes health interventions and it is vital that acceptable and effective prevention, treatment, and post-pregnancy care are provided. Low rates of post-pregnancy screening for T2DM are reported among non-Aboriginal women in Australia and among Indigenous women in other countries, however data for Aboriginal women are scarce. Breastfeeding, a healthy diet, and exercise can also help to prevent T2DM, and together with T2DM screening are recommended elements of ‘post-pregnancy care’ for women with GDM, This paper describes methods for a data linkage study to investigate rates of post-pregnancy care among women with GDM. Methods/Design: This retrospective cohort includes all women who gave birth at Cairns Base Hospital in Far North Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Base Hospital Clinical Coding system. Data linkage is being conducted with the Queensland Perinatal Data Collection, and three laboratories. Hospital medical records are being reviewed to validate the accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Multiple logistic regression is being used to compare post-pregnancy care between Aboriginal and non-Aboriginal women, while adjusting for other factors may impact on post-pregnancy care. Survival analysis is being used to estimate the rates of progression from GDM to T2DM. Discussion: There are challenges to collecting post-pregnancy data for women with GDM. However, research is urgently needed to ensure adequate post-pregnancy care is provided for women with GDM in Australia.

Aboriginal and Torres Strait Islander cookbooks : promoting Indigenous foodways or reinforcing Western traditions?

This article examines the recent emergence of cookbooks written for Aboriginal and Torres Strait Islander people in Australia. The cookbooks are health promotion initiatives, developed through a desire to improve the health status of Indigenous Australians. They focus on nutritious, family meals that can be cooked on a low budget. In this article, the authors argue that the cookbooks designed for Aboriginal and Torres Strait Islander people are developed within a Western paradigm of health and nutrition that subtly reinforces Western approaches to food and disregards traditional diets. While the authors recognize the value of the cookbooks as health promotion tools, they suggest that cookbooks centred around Indigenous foodways – with a focus on traditional ingredients and traditional cooking methods – may be more appropriate for improving the health of Indigenous people and helping Indigenous cultures to thrive. They advocate for a decolonizing approach to food and nutrition, that specifically promotes Indigenous traditions and culture, and incorporates traditional foodways into modern recipes.

Submission to expert panel on constitutional recognition of Indigenous people

Submission recommended addition of a new 'self-enacting' preamble and enacting words to the Commownealth Constitution, and replacement of the 'race power' by a series of more specific powers relating to the recognition of native title and laws of the indigenous people.

Homocysteine concentrations lowered following dietary intervention in an aboriginal community

Low circulating folate concentrations lead to elevations of plasma homocysteine. Even mild elevations of plasma homocysteine are associated with significantly increased risk of cardiovascular disease (CVD). Available evidence suggests that poor nutrition contributes to excessive premature CVD mortality in Australian Aboriginal people. The aim of the present study was to examine the effect of a nutrition intervention program conducted in an Aboriginal community on plasma homocysteine concentrations in a community-based cohort. From 1989, a health and nutrition project was developed, implemented and evaluated with the people of a remote Aboriginal community. Plasma homocysteine concentrations were measured in a community-based cohort of 14 men and 21 women screened at baseline, 6 months and 12 months. From baseline to 6 months there was a fall in mean plasma homocysteine of over 2|mol/L (P = 0.006) but no further change thereafter (P = 0.433). These changes were associated with a significant increase in red cell folate concentration from baseline to 6 months (P < 0.001) and a further increase from 6 to 12 months (P < 0.001). In multiple regression analysis, change in homocysteine concentration from baseline to 6 months was predicted by change in red cell folate (P = 0.002) and baseline homocysteine (P < 0.001) concentrations, but not by age, gender or baseline red cell folate concentration. We conclude that modest improvements in dietary quality among populations with poor nutrition (and limited disposable income) can lead to reductions in CVD risk.

Australian Diabetes Foot Network : practical guideline on the provision of footwear for people with diabetes

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system.