Talkin' up sport and gender : Three Australian Aboriginal women speak

This paper presents the perspectives from three Aboriginal women on body image, sport and physical activity within Australian contemporary society. It draws on a range of literature along with artworks from visual artist Pamela Croft.

Establishing Aboriginal health research priorities in Victoria

The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) conducted a research project to find out the impact of social determinants such as education, employment, income, racism and housing on the health and wellbeing of Aboriginal peoples. Forums and workshops were conducted to establish future research outcomes and priorities. The project will help in developing localised and community-oriented solutions to Aboriginal health issues.

Establishing Aboriginal health research priorities in Victoria

Short overview of the VACCHO Social Determinants Research Forum (2010).

Revitalizing health for all : international Indigenous representative group. Learning from the experience of comprehensive primary health care in Aboriginal Australia — A commentary on three projects

This paper presents a regional commentary (hereafter ‘the commentary’) on the three Australian projects of the Teasdale-Corti Global Health Research Partnership Program. The three Australian projects are: Victorian Aboriginal Health Service Ltd (VAHS), Melbourne, Victoria—Forty Years of Comprehensive Primary Health Care; Central Australian Aboriginal Congress Inc. (Congress), Alice Springs, Northern Territory—Ingkintja, Male Health Program; and Urapuntja Health Service (UHS), Utopia, Northern Territory—Outstation Health Care. It highlights common themes and lessons in respect to the Revitalising Health for All project in the context of Aboriginal and Torres Strait Islander health in Australia.

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.

Contextualising the teaching and learning of measurement in Torres Strait Islander schools

This paper reports on a mathematics project conducted with six Torres Strait Islander schools and communities by the research team at the YuMi Deadly Centre at QUT. Data collected is from a small focus group of six teachers and two teacher aides. We investigated how measurement is taught and learned by students, their teachers and teacher aides in the community schools. A key focus of the project was that the teaching and learning of measurement be contextualised to the students’ culture, community and home languages. A significant finding from the project was that the teachers had differing levels of knowledge and understanding about how to contextualise measurement to support student learning. For example, an Indigenous teacher identified that mathematics and the environment are relational, that is, they are not discrete and in isolation from one another, rather they mesh together, thus affording the articulation and interchange among and between mathematics and Torres Strait Islander culture.

Mathematics funds of knowledge : sotmaute and sermaute fish in a Torres Strait Islander community

The purpose of this article is to describe a project with one Torres Strait Islander Community. It provides some insights into parents’ funds of knowledge that are mathematical in nature, such as sorting shells and giving fish. The idea of funds of knowledge is based on the premise that people are competent and have knowledge that has been historically and culturally accumulated into a body of knowledge and skills essential for their functioning and well-being. This knowledge is then practised throughout their lives and passed onto the next generation of children. Through adopting a community research approach, funds of knowledge that can be used to validate the community’s identities as knowledgeable people, can also be used as foundations for future learnings for teachers, parents and children in the early years of school. They can be the bridge that joins a community’s funds of knowledge with schools validating that knowledge.

Development and testing of an iPad application for teaching self-management to heart failure patients. (Nursing/Allied Health Professional Investigator Award)- Abstract

Purpose: Heart failure (HF) is the leading cause of hospitalization and significant burden to the health care system in Australia. To reduce hospitalizations, multidisciplinary approaches and enhance self-management programs have been strongly advocated for HF patients globally. HF patients who can effectively manage their symptoms and adhere to complex medicine regimes will experience fewer hospitalizations. Research indicates that information technologies (IT) have a significant role in providing support to promote patients' self-management skills. The iPad utilizes user-friendly interfaces and to date an application for HF patient education has not been developed. This project aimed to develop the HF iPad teaching application in the way that would be engaging, interactive and simple to follow and usable for patients' carers and health care workers within both the hospital and community setting. Methods: The design for the development and evaluation of the application consisted of two action research cycles. Each cycle included 3 phases of testing and feedback from three groups comprising IT team, HF experts and patients. All patient education materials of the application were derived from national and international evidence based practice guidelines and patient self-care recommendations. Results: The iPad application has animated anatomy and physiology that simply and clearly teaches the concepts of the normal heart and the heart in failure. Patient Avatars throughout the application can be changed to reflect the sex and culture of the patient. There is voice-over presenting a script developed by the heart failure expert panel. Additional engagement processes included points of interaction throughout the application with touch screen responses and the ability of the patient to enter their weight and this data is secured and transferred to the clinic nurse and/or research data set. The application has been used independently, for instance, at home or using headphones in a clinic waiting room or most commonly to aid a nurse-led HF consultation. Conclusion: This project utilized iPad as an educational tool to standardize HF education from nurses who are not always heart failure specialists. Furthermore, study is currently ongoing to evaluate of the effectiveness of this tool on patient outcomes and to develop several specifically designed cultural adaptations [Hispanic (USA), Aboriginal (Australia), and Maori (New Zealand)].

Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian Aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was 1,210 dollars more per person per year than status quo care, and dialyses avoided gave net savings of 1.0 million dollars at 3 years and 3.4 million dollars at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided.

Validating a screening tool for mental health and substance use risk in an Indigenous prison population

Introduction and Aims: The Indigenous Risk Impact Screen (IRIS) is a validated culturally appropriate and widely used tool in the community for assessing substance use and mental disorder. This research aimed to assess the utility of this tool in an Indigenous prison population. Design and Methods: The study used data collected from a cross-sectional study of mental health among indigenous inmates in Queensland custodial centres (n=395, 84% male). Participants were administered a modified version of the IRIS, and ICD-10 diagnoses of substance use, depressive and anxiety disorders obtained using the Composite International Diagnostic Interview (CIDI). The concurrent validity of the modified IRIS was assessed against those of the CIDI. Results: 312 people screened as high risk for a substance use disorder and 179 were high risk for mental problems. 73% of males and 88% of females were diagnosed with a mental disorder. The IRIS was an effective screener for substance use disorders, with high sensitivity (Se) of 94% and low specificity (Sp) of 33%. The screener was less effective in identifying depression (Se 82%, Sp 59%) and anxiety (Se 68%, Sp 60%). Discussion: The IRIS is the first culturally appropriate screening instrument to be validated for the risk of drug and alcohol and mental disorder among Indigenous adults in custody. Conclusions: This study demonstrated that the IRIS is a valid tool for screening of alcohol and drug use risk among an incarcerated Indigenous population. The IRIS could offer an opportunity to improve the identification, treatment and health outcomes for incarcerated Indigenous adults.

Indigenous health: Embracing and enacting the spirit of change. Opening keynote address

In speaking at the Cardiac Society this morning, I am conscious of this year’s 60th Anniversary. It is 60 years since motivated and impassioned people travelled to form the organisation that became the Cardiac Society. They started an organisation and a movement of sorts which was joined by many others over the years and which brings us to this room on this morning. This started in 1952. What were you doing in 1952? Where you just born and for some of you were? Others here were not born and may be your parents hadn’t even met yet. I want you to gain a sense of this time, of 60 years ago.

Study protocol : establishing good relationships between patients and health care providers while providing cardiac care. Exploring how patient-clinician engagement contributes to health disparities between indigenous and non-indigenous Australians in South Australia

Abstract Background: Studies that compare Indigenous Australian and non-Indigenous patients who experience a cardiac event or chest pain are inconclusive about the reasons for the differences in-hospital and survival rates. The advances in diagnostic accuracy, medication and specialised workforce has contributed to a lower case fatality and lengthen survival rates however this is not evident in the Indigenous Australian population. A possible driver contributing to this disparity may be the impact of patient-clinician interface during key interactions during the health care process. Methods/Design: This study will apply an Indigenous framework to describe the interaction between Indigenous patients and clinicians during the continuum of cardiac health care, i.e. from acute admission, secondary and rehabilitative care. Adopting an Indigenous framework is more aligned with Indigenous realities, knowledge, intellects, histories and experiences. A triple layered designed focus group will be employed to discuss patient-clinician engagement. Focus groups will be arranged by geographic clusters i.e. metropolitan and a regional centre. Patient informants will be identified by Indigenous status (i.e. Indigenous and non-Indigenous) and the focus groups will be convened separately. The health care provider focus groups will be convened on an organisational basis i.e. state health providers and Aboriginal Community Controlled Health Services. Yarning will be used as a research method to facilitate discussion. Yarning is in congruence with the oral traditions that are still a reality in day-to-day Indigenous lives. Discussion: This study is nestled in a larger research program that explores the drivers to the disparity of care and health outcomes for Indigenous and non-Indigenous Australians who experience an acute cardiac admission. A focus on health status, risk factors and clinical interventions may camouflage critical issues within a patient-clinician exchange. This approach may provide a way forward to reduce the appalling health disadvantage experienced within the Indigenous Australian communities. Keywords: Patient-clinician engagement, Qualitative, Cardiovascular disease, Focus groups, Indigenous

‘We’ve always cooked kangaroo. We still cook kangaroo. Although sometimes we use cookbooks now’ : Aboriginal Australians and cookbooks

Aboriginal Australians have a long history of eating native animals and plants. Food preparation techniques were handed down through the generations, without any need for cookbooks. But colonisation changed the diets of Aboriginal Australians, introducing us to a processed diet high in salt, sugar and fat, and causing a wide range of diet-related health problems. Over the years, many Aboriginal Australians lost their connections to traditional food preparation practices. In this paper, the authors provide a brief overview of Aboriginal food history and describe a newly-emerging focus on reintroducing native foods. They describe the work of an Aboriginal chef, Dale Chapman, who is actively promoting native foods and creating a native-Western food fusion. Chapman has developed native food recipes and a cookbook, in an effort to make native foods accessible to all Australians. She promotes a future when native foods are part of the identity of all Australians – both Aboriginal and non-Aboriginal.

Aboriginal dietary intake and a successful nutrition intervention project in a Northern Territory community

This paper summarises the development and testing of the 'store-turnover' method, a non-invasive dietary survey methodology for quantitative measurement of food and nutrient intake in remote, centralised Aboriginal communities. It then describes the use of the method in planning, implementation and evaluation of a community-based nutrition intervention project in a small Aboriginal community in the Northern Territory. During this project marked improvements in both the dietary intake of the community and biological indicators of nutritional health (including vitamin status and the degree and prevalence of several risk factors for non-communicable disease) were measured in the community over a 12-month period following the development of intervention strategies with the community. Although these specific strategies are presented, emphasis is directed towards the process involved, particularly the evaluation procedures used to monitor all stages of the project with the community.