Lowitja Publishing

Starting to Smoke: Experiences of Indigenous Youth

This report sets out the background, research design, findings and conclusions of the ‘Starting to Smoke’ project. The aim of the project was to explore the determinants of smoking among Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group. This project was undertaken in the Northern Territory and involved two sites: one in Darwin and one in a remote community in Arnhem Land. 

A summary report is also available.

The History of Indigenous Identification in Victorian Health Datasets, 1980–2011: Initiatives and Policies Reported by Key Informants

This report is a component of the Victorian Aboriginal Child Mortality Study (VACMS) – a total population, data linkage, child mortality study currently underway at Onemda VicHealth Koori Health Unit at the University of Melbourne, in conjunction with the Victorian Aboriginal Community Controlled Health Organisation. It is funded by the Australian Research Council, the Victorian Department of Health and the Lowitja Institute. The overall aim of the VACMS is to measure accurately the patterns and trends of Aboriginal infant, child and youth mortality and the disparities between Aboriginal and non-Aboriginal populations in Victoria for births occurring in the 20 years from 1988 to 2008 inclusive.

A summary report for this component of the project is also available.

Managing Two Worlds Together: City Hospital Care for Country Aboriginal People—Community Summary

The Managing Two Worlds Together project aims to add to existing knowledge of what works well and what needs improvement in the system of care for Aboriginal patients from rural and remote areas of South Australia (and parts of the Northern Territory). It explores their complex patient journeys and what happens when they come to Adelaide for hospital care. The project is taking place in two stages, with stage 1 focusing on the problems and stage 2 (taking place during 2012) focusing on the solutions. This four-page summary report provides an overview of stage 1.

Researching Indigenous Health: A practical guide for researchers

Price for students and community

Genetic Research in Aboriginal and Torres Strait Islander Communities: Continuing the Conversation

Genetics is a rapidly developing and controversial research tool that is beginning to contribute to Indigenous health research internationally. This Discussion Paper has emerged out of the 2nd Lowitja Institute National Roundtable on Genetic Research in Aboriginal and Torres Strait Islander Communities that was held at the University of Melbourne in 2011. This publication, which gives an overview of the presentations and discussion at the Roundtable, aims to encourage many more conversations around the country about the potential that genetic research has to contribute to Aboriginal and Torres Strait Islander health research efforts. More importantly, it explores the mechanisms that need to be in place to ensure that Aboriginal and Torres Strait Islander communities are empowered to make informed decisions about participating in genetic research.

Genetic Research in Aboriginal and Torres Strait Islander Communities: Beginning 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 roundtable.

Managing Two Worlds Together: City Hospital Care for Country Aboriginal People—Project Report

The Managing Two Worlds Together project aims to add to existing knowledge of what works well and what needs improvement in the system of care for Aboriginal patients from rural and remote areas of South Australia (and parts of the Northern Territory). It explores their complex patient journeys and what happens when they come to Adelaide for hospital care. The project is taking place in two stages, with stage 1 focusing on the problems and stage 2 (taking place during 2012) focusing on the solutions. This project report provides a detailed description of the entirety of stage 1.

Managing Two Worlds Together: Study 2—Staff Perspectives on Care for Country Aboriginal Patients

The Managing Two Worlds Together project aims to add to existing knowledge of what works well and what needs improvement in the system of care for Aboriginal patients from rural and remote areas of South Australia (and parts of the Northern Territory). Stage 1 of the project comprised four separate studies and this report of Study 2 describes the views of staff who provide care for country Aboriginal patients in city and country hospitals and health services.

This paper is not available in hard copy.

Managing Two Worlds Together: Study 4—Complex Country Aboriginal Patient Journeys

The Managing Two Worlds Together project aims to add to existing knowledge of what works well and what needs improvement in the system of care for Aboriginal patients from rural and remote areas of South Australia (and parts of the Northern Territory). Stage 1 of the project comprised four separate studies and this report of Study 4 maps four journey case studies, and analyses gaps and breakpoints in those care journeys.

This paper is not available in hard copy.

Taking Care of Business: Corporate Services for Indigenous Primary Health Care Services—Case Studies

This report focuses specifically on existing models for sharing corporate services and highlights the different ways those working in the sector have developed strategies for addressing their specific needs. Four case studies of organised support structures are documented. These are:

• Queensland Aboriginal and Islander Health Council,
• Bila Muuji Health Services Incorporated,
• Katherine West Health Board, and
• Central Australian Aboriginal Congress.

There is an overview report and a summary report for this project. Also, a web tool was developed to help Aboriginal Community Controlled Health Organisations (ACCHOs) decide their best strategy or model for getting support for their corporate functions.

The Overburden Report: Contracting for Indigenous Health Services

In Australia, Aboriginal and Torres Strait Islander community health organisations play a significant role as providers of essential primary health care (PHC) in rural, remote and urban settings. Australian governments have developed policies and funding programs to support this growing health sector. But the current arrangements for funding are much criticised.

Our examination of the current practices and policies of health authorities has identified characteristics of the funding relationship that are important barriers to good practice, as well as some enabling factors. Governments are committed to the development of a robust comprehensive PHC sector, but the classical contracting model is not adequate to support the achievement of this goal. We suggest that implementation of government policy commitments will require a different way of thinking about the relationship between government and the sector, with implications for both sides.

This paper is not available in paper copy. A summary report is also available in PDF format.

Audit and Best Practice for Chronic Disease Extension Project, 2005–2009: Final Report

The Audit and Best Practice for Chronic Disease (ABCD) Extension project was an action research project designed to improve the quality of services for the prevention and management of chronic disease among Aboriginal and Torres Strait Islander people across Australia. This report draws on analyses of data from use of the quality improvement tools in health centres from 2005 to 2009; data from community survey tools; report templates; and purposively structured dialogue and in-depth interviews with implementers and other key informants. It aims to synthesise lessons that have been learned from these diverse data sources about the factors that are important for effective implementation of the ABCD approach and to identify areas for further research.

Aboriginal Spirituality: Aboriginal Philosophy, The Basis of Aboriginal Social and Emotional Wellbeing

This is the ninth in the CRC for Aboriginal Health's Discussion Paper Series. Although this discussion paper has been developed for people working within health practice, as it explains, the wholistic philosophical basis of Aboriginal and Torres Strait Islander culture that encompasses wellbeing has applications in every area of engagement with Indigenous Australian people. This literature review draws on a diverse range of sources including history, anthropology, sociology, literature, biography and autobiography, government reports, websites, and the writings of health and social and emotional wellbeing practitioners, describing their approaches to the implementation of programs.

This paper is not available in hard copy.

Improving the Patient Journey: Achieving positive outcomes for remote Aboriginal cardiac patients

Aboriginal patients from remote areas have special needs when interacting with health systems, and these needs must be met for safe care practices and optimal health outcomes to be achieved. A growing body of evidence suggests that relatively small modifications to existing systems and practices can lead to substantial improvements in health outcomes for these Aboriginal people.

This quality improvement, action research project aimed to establish if Aboriginal people living in remote areas who need to travel to a major metropolitan hospital for life-saving cardiac surgery benefit from improved arrangements around their journey to and from the hospital. Results from the research project demonstrated that improved cultural competency in a clinical setting led to improved clinical/cultural liaison; increased cultural respect for remote area Aboriginal patients; improved patient care; enhanced patient safety; reduced travel costs; less disruption in the hospital system; and improved hospital efficiencies.

New South Wales Aboriginal Mental Health Worker Training Program: Implementation Review

To address the high rate of mental health and social and emotional wellbeing problems in Aboriginal communities across New South Wales, from 2006 the NSW Government funded a new community-based approach that included the training and employment of Aboriginal Mental Health Workers. This evaluation of the first full year of the training program was intended to inform the future implementation of the training program as it expands. The reviewers identify many positive aspects within the training program and recommend a number of activities and projects to strengthen the training program’s future outcomes.

Research Dancing: Reflections on the Relationships between University-based Researchers and Community-based Researchers at Gurriny Yealamucka Health Services Aboriginal Corporation, Yarrabah

This paper examines and reflects upon the research relationships between university-based researchers and community-based researchers working in social health and empowerment programs with the Indigenous community of Yarrabah in northern Queensland. Such relationships have undergone significant reappraisal and change in the past decade, and, in the case of Yarrabah, are undergoing significant expansion. At Yarrabah, this has been a process whereby the community has set the research agenda and university researchers have facilitated the development of appropriate programs and the capacity of the community to administer and run these programs.

This paper emphasises that implementation of community research partnerships is a process requiring time, trust and commitment from all involved. An important aspect of the programs that has facilitated these experiences is the inclusion of supportive and reflexive processes within the research framework for both ongoing orientation and evaluation. It is a process that can be personally rewarding for professional researchers and that allows community members wider social engagement.

Success Stories: Environmental, Social, Emotional and Spiritual Health of Aboriginal and Torres Strait Islanders. Report of the Indigenous Health Workshop

In July 2008 in Brisbane, Australia, an Indigenous Health Workshop was conducted in conjunction with the Population Health Congress. A collaboration of four partner organisations— Australian Health Promotion Association, International Union for Health Promotion and Education, Cooperative Research Centre for Aboriginal Health, and Queensland Aboriginal and Islander Health Council—the workshop aimed to consolidate recent success stories and innovations undertaken in Indigenous health by identifying critical success factors to inform future health service delivery and policy.

This report contains detailed case studies and brief reports that were presented, discussed and documented at the workshop. Additionally, the carefully planned workshop process is documented as an example of successful quality health promotion practice. Respecting individuals and communities for the assets they bring to improve health was an underpinning principle of the workshop. Key processes identified included: capacity building through personal relationships that facilitate dialogue about cultural protocols; community experiences and expectations (including formal introductions and endorsement between partners, Elders and community members); collaborative ongoing support for activities between partners and project staff; authentic engagement; and a focus on strategies to maximise sustainability for creating and embedding new practice in settings.

What Do Aboriginal Women Think Is Good Antenatal Care? Consultation Report

The major research question that the consultation addressed was: What is good antenatal care? There were three parts to this question:

• What elements of antenatal care are identified as being important by Aboriginal women in the Central region?
• What are the features or dimensions of these identified elements?; and
• Which of these features or elements are the most important to Aboriginal women in the Central region?

The features of antenatal care identified and discussed by the women incorporated many social and economic aspects, as well as bio-medical and health service-related factors. For example, the need to feel and be safe from violence, the role of their families and partners, the importance of transport and the nature of their relationship with a health provider. It is essential and of the utmost importance that health services are flexible, adaptive and responsive to these preferences so that young Aboriginal women are provided with a range of options for their care and the opportunity and support to exercise their own choices.

This paper is not available in hard copy from the Lowitja Institute. Paper copies may be available from the Central Australian Aboriginal Congress.

Health Care Access for Aboriginal and Torres Strait Islander People Living in Urban Areas, and Related Research Issues: A Review of the Literature

Although it is well recognised that the health of Aboriginal and Torres Strait Islander peoples is substantially worse than the rest of the Australian population, historically there has been a paucity of information about the health status and health needs of those people living in urban areas. This literature review describes the current status of research in urban areas and provides an information base for the development of targeted research to fill identified knowledge gaps. It also identifies population sampling techniques that may overcome some of the difficulties inherent in researching the health of ‘hidden’—and frequently mobile—Aboriginal and Torres Strait Islander populations in urban areas.

Research Priorities in Aboriginal Prisoner Health: Recommendations and Outcomes from the CRCAH Aboriginal Prisoner Health Industry Roundtable

The CRCAH held a Roundtable in November 2007 to discuss issues around the physical and emotional health of Aboriginal prisoners in partnership with the Public Health Association of Australia and the Australian Institute of Aboriginal and Torres Strait Islander Affairs. The Roundtable was prompted by the stubbornly high rates of Aboriginal incarceration in jails around Australia, and the effect this has not only on the health of individual prisoners but also on their families and communities. This paper provides an overview of the Roundtable discussion and the five research priorities that emerged from the discussion, as well as identifying policy levers that could act as tools for change.

Aboriginal Holistic Health: A Critical Review

This is the second in the CRC for Aboriginal Health's Discussion Paper Series. The concept of Aboriginal holistic health occupies a central position in Aboriginal health policy discourse. This review seeks to establish a definition, and to understand how the concept affects policy, programs and strategy. One hundred and fifty-three publications of the health professional literature that made explicit reference Aboriginal holistic health were reviewed, and a content and thematic analysis was undertaken.

This is the first time that such a critical analysis has been conducted. No definitive written source was found—there are confounding discourses attached to the concept, with no operating framework and with shifting constituent elements. As such, there is an inability to judge health system performance using the concept. This is in part due to many barriers to effective textual and oral transfer into the policy context of Aboriginal concepts. The most significant finding lies in the unfounded perception of holism as immutably Aboriginal. The review also demonstrates how the validity of such concepts can be undermined by poor definition, operationalisation, and conflicting and confounding discourse, and is an important tool for policy makers to gain foundational understanding of the issue.

Beyond Bandaids: Exploring the Underlying Social Determinants of Aboriginal Health. Papers from the Social Determinants of Aboriginal Health Workshop, Adelaide, July 2004

Beyond Bandaids is a collection of sixteen papers from the CRCAH Social Determinants of Aboriginal Health Workshop held in Adelaide in July 2004.

The monograph presents a perspective on how social and economic factors affect Indigenous Australians’ health and coincides with a growing interest in the topic, as embodied in the establishment of the Commission on the Social Determinants of Health (CSDH) in 2005 by the World Health Organization. Beyond Bandaids suggests fruitful directions for further inquiry into how these factors can be made more health promoting. Authors (individuals and/or groups) reviewed the literature on particular factors and made recommendations for the evolving CRCAH Social Determinants of Indigenous Health research program, discussed in the conclusion of this monograph. Chapters cover a range of topics, including Koori perspectives of the social determinants of health; education and its impact on health; material social determinants of income, poverty, employment and the physical environment; the less visible, but vital, aspects of social and emotional wellbeing, community development, effective means of governance, and the value of social capital; law and justice, including an overview of constitutional rights issues for Indigenous peoples and a case study of the Koori Court in Victoria; also aspects of culture as it impacts the health of Indigenous Australians.

This paper is not available in paper copy, but is available in CD format.

Learning From Action: Management of Aboriginal and Torres Strait Islander Health Services

This is the full report about a combined learning and research project that explored the challenges facing managers of Aboriginal and Torres Strait Islander Health Services. The project was based on the idea that health service managers are the ones who know their own practice best, and that their stories can tell us a lot about what works and what needs to work better. A summary report is also available.

Management of Aboriginal and Torres Strait Islander Health Services is vested in community-controlled organisations that occupy contested ground in the health system. This study aimed to document the challenges faced by managers in this context, and the strengths and strategies they use to address them, while also meeting the ethical obligation of providing a direct substantive benefit to participants and communities. In partnership with the Queensland Aboriginal and Islander Health Council, we worked with a group of senior managers in community-controlled organisations in Queensland. The project used an integrated action learning and research method, in which participants were engaged as co-researchers with a small project team. They participated in a year-long learning program (with an option for academic credit) and presented current management challenges using learning set method. Documentation of the management challenges in the form of stories (and the participants' reporting back at subsequent workshops on action taken and results) constitute the data. Data gathered from a concurrent mainstream learning set are used for comparison. Workforce and people management issues, along with managing the roles of communities and boards and limits on organisational capacity were the most widespread challenges. There was much in common with the mainstream learning set, but the Aboriginal managers seem to have faced additional challenges (and drawn additional resources) from the closeness of their relationships with boards and communities.

There is a summary report for this project (PDF 4pp).

Making all our Families Well, Summary Report November 2006

This report provides a summary of the development and activities of the Western Desert Nganampa Walytja Palyantjaku Tjutaku, an Aboriginal organisation representing Yanangu people on dialysis in the remote Western Desert spanning the Northern Territory/Western Australia border. Yanangu living in this area experience some of the highest rates of kidney failure in Australia and until recently all dialysis treatment took place in the far away desert centre of Alice Springs. Making extensive use of photographs and quotes from community members, the report shows how the Yanangu implemented a series of initiatives between 2000 and 2005 to ensure a smoother and more culturally appropriate treatment regime while at the same time minimising disruption to families and communities.

Sharing the True Stories: Evaluating strategies to improve communication between health staff and Aboriginal patients, Stage 2 report

This report covers Stage 2 of a two-stage project to identify strategies to improve communication between health staff and Aboriginal patients, a key determinant in improving health outcomes for Aboriginal people. Stage 2 of the project focused on developing and evaluating strategies and resources to bring about constructive change in health service delivery to Aboriginal client and community groups. It was conducted with renal staff and patients in the Top End of the Northern Territory and focused on a discrete group of Aboriginal people (Yolngu speakers from north-east Arnhem Land) suffering from renal disease. The Stage 2 report found that patients and their families benefited from the effective use of interpreters, the provision of appropriate health educational resources to both staff and patients and the participation of patients and their families in strategies to improve communication.

The report for Stage 1 is also available.