This Study Report summarises the activities, findings and challenges of the Improving Aboriginal Patient Journeys (IAPJ) study, which is Stage 3 of the Managing Two Worlds Together project. The aim of the IAPJ study was to develop, refine and evaluate a set of Aboriginal patient journey mapping tools for use in quality improvement and education. A collaborative approach to knowledge exchange was used, with the research team working with staff and managers from a range of health settings in South Australia and the Northern Territory. Together they explored how the tools could be adapted and used to make real improvements in communication, coordination and collaboration within and across a diverse range of patient journeys.
Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Rural and Remote Sites Case StudiesJ. Kelly, J. Wiseman, S. Mazzone, D. Miller, J. Newham, B. Ryan, K. Thomas & L. Martinez 2015
This report on Rural and Remote Sites Case Studies is complemented by reports on four others: Renal, Cardiac, Maternity, and City Sites. It is published as part of the Improving Aboriginal Patient Journeys study, Stage 3 of the Managing Two Worlds Together project.
Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Cardiac Case StudiesJ. Kelly, M. Ramage, D. Perry, J. Tinsley, H. Auckram, W. Corkhill, S. Wyatt, N. McCabe 2015
This report on Cardiac Case Studies is complemented by four others: Renal, Maternity, Rural and Remote Sites, and City Sites. It is published as part of the Improving Aboriginal Patient Journeys Study, Stage 3 of the Managing Two Worlds Together project.
Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – City Sites Case StudiesJ. Kelly, N. McCabe, W. McInnes, M. Kirkbride, A. Graham, D. Rigney & A. Nori 2015
This report on City Sites Case Studies is complemented by reports on four others: Renal, Cardiac, Maternity, and Rural and Remote Sites. It is published as part of the Improving Aboriginal Patient Journeys study, Stage 3 of the Managing Two Worlds Together project.
Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Maternity Case StudiesJ. Kelly, P. Medway, D. Miller, L. Catt & M. Lawrence 2015
This report on Maternity Case Studies is complemented by reports on four others: Renal, Cardiac, Rural and Remote Sites, and City Sites. It is published as part of the Improving Aboriginal Patient Journeys study, Stage 3 of the Managing Two Worlds Together project.
This report on Renal Case Studies is complemented by reports on four others: Cardiac, Maternity, Rural and Remote Sites, and City Sites. It is published as part of the Improving Aboriginal Patient Journeys study, Stage 3 of the Managing Two Worlds Together project.
The tools contained in this Workbook are an outcome of the Improving Aboriginal Patient Journeys (IAPJ) study, Stage 3 of the Managing Two Worlds Together project. Many Aboriginal care journeys are complex, challenging and overwhelming – not only for the person experiencing the journey but also for their family and the staff members supporting them within and across various health and support services. Thus, the aim of the IAPJ study was to develop, refine and evaluate a set of Aboriginal patient journey mapping tools for use in quality improvement and education.
Alarming over-representation of Aboriginal and Torres Strait Islander people in Australian prisons, combined with high recidivism rates and poor health and social outcomes among those released from prison, has led many to claim that incarceration is a social policy failure.
An important obstacle to a reform agenda in the criminal justice area is public opinion. The public are often perceived to hold punitive attitudes towards offenders, a situation often exploited by politicians to perpetuate punitive penal policies at the expense of developing decarceration initiatives.
However, alternatives to public opinion surveys/polls are needed. Citizens Juries offer an alternative method to assess the public’s views, views that are critically informed and thus better aid policy development.
The Lowitja Institute has published the report that explores, through Citizens Juries, the views of a better informed public towards how we, as a community, should address offenders in terms of incarceration and incarceration alternatives. The research focused on a range of incarceration alternatives including Justice Reinvestment.
Watering the Garden of Family Wellbeing: Empowering Aboriginal and Torres Strait Islander people to bloom and growL. Monson-Wilbraham 2015
Recommendations and outcomes from the national roundtable Empowering Aboriginal and Torres Strait Islander people through the Family Wellbeing program, Adelaide, March 2014.
Family Wellbeing (FWB) is an effective social and emotional wellbeing program originally developed and delivered by and for Aboriginal and Torres Strait Islander people. The central objective of FWB is to develop people’s skills and capacity to move from a position of disempowerment to empowerment; to empower people with a way to control and change their lives.
In March 2014, the Lowitja Institute convened a national roundtable in Adelaide to consider the impact of FWB and opportunities for future development. Roundtable participants from across community, training and delivery, research and policy sectors, shared their experiences of FWB and focused on finding strategies to support the delivery, research and uptake of the FWB program.
Roundtable discussions underlined how the program’s empowerment model builds the evidence base that social and emotional wellbeing programs effectively improve people’s lives and provide a promising and practical way to help bridge the gap between Australia’s First Peoples and the non-Indigenous population.
Shifting Gears in Career: Identifying Drivers of Career Development for Aboriginal and Torres Strait Islander Workers in the Health SectorT. Bretherton 2014
This paper explores how the Australian health sector might improve opportunities for career development for Aboriginal and Torres Strait Islander workers. It considers the current evidence surrounding career development in the health sector, along with Aboriginal and Torres Strait Islander worker experiences, to develop a usable conceptual framework for change.
A policy brief is also available.
The Shape of Things to Come: Visions for the future of Aboriginal and Torres Strait Islander health researchJ. Brands 2014
In late 2012, the Lowitja Institute embarked on a project using ‘futures thinking’ to consider how research might best contribute to Aboriginal and Torres Strait Islander health and wellbeing in the year 2030. The project was motivated by a desire to ‘get ahead of the game’: to anticipate and prepare for the potential research demands of the future. In particular, there was a desire to ‘close the gap’ between the point at which important research needs are identified by policy makers or service providers, and when research findings can be delivered.
Download the 2030: A Vision for Aboriginal and Torres Strait Islander Health brochure
Victorian Aboriginal Child Mortality Study: Patterns, Trends and Disparities in Mortality between Aboriginal and Non-Aboriginal Infants and Children, 1999–2008J. Freemantle, R. Ritte, K. Smith, D. Iskandar, T. Cutler, B. Heffernan, G. Zhong, F. Mensah, A. Read 2014
– uses linked population birth information collected by the Consultative Council on Obstetric & Paediatric Mortality and Morbidity (Victorian Perinatal Data Collection) with the birth registration information collected by the Registrar of Births Deaths and Marriages, 1988–2008 inclusive, to construct mortality rates for Victorian-born Aboriginal infants and children
– reports the cause-specific and age-specific Aboriginal infant (neonatal and postneonatal) and child mortality rates for the birth years 1999–2008 inclusive
– illustrates the patterns and trends in deaths for Aboriginal compared with non-Aboriginal infants and children born 1999–2008 inclusive
– describes the mortality outcomes according to metropolitan and regional birth and death locations
– provides a baseline from which to measure the effectiveness of Close the Gap initiatives introduced from 2009
– has the potential to provide the Victorian baseline data that will contribute to measuring the Australian Government’s specific aim ‘to halve the gap in mortality rates for Indigenous children under five
– provides empirical evidence to inform the more strategic direction of policy and initiatives aimed at improving Aboriginal infant and child outcomes
– gives clear key messages and recommendations for future initiatives.
A summary report is also available
This report is based on research from the project ‘Understanding and addressing racism against Aboriginal and Torres Strait Islander Australians through the LEAD (Localities Embracing and Accepting Diversity) program’ funded by the Lowitja Institute. The LEAD program is funded by the Victorian Health Promotion Foundation (VicHealth), the Department of Immigration and Citizenship (DIAC) through its Diverse Australia program and beyondblue, Australia’s peak body for mental health issues. The Experiences of Racism survey was carried out as part of these two interrelated projects. The report authors are part of the University of Melbourne LEAD evaluation team.
A summary report is also available.
National Appraisal of Continuous Quality Improvement Initiatives in Aboriginal and Torres Strait Islander Primary Health CareM. Wise, S. Angus, E. Harris & S. Parker 2013
There has been a substantial increase in interest in continuous quality improvement (CQI) efforts in the Australian primary health care arena over the past several years, including in the Indigenous primary health care sector. This interest has promoted increased financial incentives (e.g. to achieve accreditation and/or complete specific services such as health checks), attention to developing performance indicators, and moves to rationalise reporting requirements using web-based information technology.
This publication reports on project activity, including
- review of current efforts and directions in light of recent and emerging national, regional and local CQI initiatives and major strategic directions relevant to Indigenous primary health care, and
- identification of potential actions to progress further development of CQI initiatives over the next decade, taking into account strengths, weaknesses, opportunities and priorities.
A summary report is also available.
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 Use of Incentives to Stop Smoking in Pregnancy among Aboriginal and Torres Strait Islander WomenM. Hefler & D. Thomas 2013
This discussion paper describes a Roundtable which brought together invited participants from the Aboriginal community controlled health service sector, government, research organisations, antenatal care services and tobacco control. The Roundtable provided an opportunity to raise issues and canvass different perspectives on the use of incentives to reduce smoking in pregnancy among Aboriginal and Torres Strait Islander women.
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.
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.
Stage 2 focuses on solutions and consists of a small set of action research projects. The patient journey mapping tools are the first output of Stage 2. This project has focused on the specific needs and journeys of country Aboriginal patients in South Australia.
This paper is not available in hard copy.
The History of Indigenous Identification in Victorian Health Datasets, 1980–2011: Initiatives and Policies Reported by Key InformantsB. Heffernan, D. Iskandar & J. Freemantle 2012
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.
This report presents findings from an analysis of the funding received by 28 Aboriginal Community Controlled Health Services (ACCHSs) in the 2007/2008 financial year and the reporting requirements attached to that funding. This study’s aim was to contribute to efforts – on the part of both governments and the ACCHS sector – to streamline and simplify funding and accountability arrangements.
We undertook this survey as a follow-up to The Overburden Report (2009). Our aim was to update the information from the first study with data from a larger sample and a more recent financial year.
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.
Legally Invisible – How Australian Laws Impede Stewardship and Governance for Aboriginal and Torres Strait Islander HealthG. Howse 2011
This paper explains the options available for Australian governments to articulate and allocate responsibilities for the health and health care of Aboriginal and Torres Strait Islander people in an enduring, reliable form. It was commissioned by the Lowitja Institute – Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research in response to widespread recognition of problems in the policy and administrative arrangements for health and health care for Australia’s First Peoples, including lack of clarity about the responsibilities of governments at various levels.
For more information, please visit the Legally Invisible – Options for enduring government responsibility for Aboriginal health project page.
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.
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.
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 1 analyses the patterns of admission and length of stay of country Aboriginal patients in city public hospitals.
This paper is not available in hard copy.
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.
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 3 provides a first-hand report of rural Aboriginal patients and their carers.
This paper is not available in hard copy.
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.
Indigenous health research needs to be driven by priorities set by Indigenous people, to be of practical use to the Indigenous health sector and to develop research capacity within the Indigenous community. The Lowitja Institute and its predecessor the CRC for Aboriginal Health, have developed resources in response to a growing need for resources in this area.
The Guide includes the history, context, values and change priorities of Indigenous health research in Australia and the planning and management of Indigenous health research projects. It offers practical information, advice, strategies and success stories in Indigenous health research.
For more information, please visit our Resources for Researchers page.
A companion volume, Supporting Indigenous Researchers: A practical guide for supervisors, by the same authors, was published in 2009.
Price for students and community
Revitalizing Health for All: International Indigenous Representative Group. Learning from the Experience of Comprehensive Primary Health Care in Aboriginal Australia—A Commentary on Three ProjectsB. Fredericks & D. Legge 2011
This paper presents a regional 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.
This paper is not available in hard copy.
Taking Care of Business: Corporate Services for Indigenous Primary Health Care Services—Case StudiesK. Silburn, A. Thorpe & I. Anderson 2011
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.
Taking Care of Business: Corporate services for Indigenous primary health care services – Overview ReportK. Silburn, A. Thorpe & I. Anderson 2011
This is an overview of the Support Systems Project, which focused on corporate support for Aboriginal Community Controlled Health Services (ACCHSs). The aim of the project was to contribute to improving the viability and sustainability of ACCHSs as corporate entities through examining the corporate support needs of ACCHSs, the issues associated with obtaining appropriate support and existing support structures.
The report highlights the capacity of the ACCHS sector to develop innovative solutions to difficult issues while working in a quickly changing environment. Additional resources are likely to enable further innovation. Such work should contribute to stronger and more viable health services for Aboriginal communities.
There is a summary report for this project and 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. Four case studies are also available.
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.
The research described in this report focuses on the interaction between access to safe transport and the health and wellbeing of Aboriginal people in several distinct South Australian Aboriginal communities (urban, regional and remote). It draws on the fragmented literature and, through interviews and focus groups with Aboriginal people and their service providers, starts to develop a coherent view of the issues and possible responses.
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.
Improving the Identification of Aboriginal and Torres Strait Islander People in Mainstream General PracticeM. Kelaher, A. Parry, S. Day, Y. Paradies, J. Lawlor & L.Solomon 2010
Better identification of Indigenous patients in general practices would improve their access to Medicare benefits such as health checks that could help ‘Close the Gap’, yet many GPs don’t consider ethnicity to be relevant to quality of care. This study reviewed the effectiveness of strategies that aim to improve the identification of Indigenous people.
National data and research evidence indicate that less than one third of general practices routinely collect information on the Indigenous status of patients. Improved identification of Aboriginal and Torres Strait Islander patients would support new ‘Closing the Gap’ initiatives to extend the delivery of routine health checks and chronic disease management services.
Aboriginal Spirituality: Aboriginal Philosophy, The Basis of Aboriginal Social and Emotional WellbeingV. Grieves 2009
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.
Skin infections such as scabies, skin sores and tinea affect many Aboriginal people living in remote regions of Australia, with particular prevalence among children, and can lead to serious conditions such as rheumatic heart fever and rheumatic heart disease. This report details the outcomes of a three-year project in the Northern Territory’s East Arnhem region to build community-based solutions to skin infections, including the development of educational resources and accredited training programs for Aboriginal community workers. The project had particular success in reducing the incidence of skins sores among children aged less than 15 years, and resulted in 11 Aboriginal community workers graduating with recognised primary health care qualifications.
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.
Living on the Edge: Social and Emotional Wellbeing Risk and Protective Factors for Serious Psychological Distress among Aboriginal and Torres Strait Islander PeopleK. Kelly, P. Dudgen, G. Gee & B. Glaskin 2009
This is the tenth in the CRC for Aboriginal Health's Discussion Paper Series. This paper has been prepared by the Australian Indigenous Psychologists Association (AIPA) to generate discussionaround the determinants of Indigenous social and emotional wellbeing (SEWB), and to provide a range of recommendations for addressing the current gap in social and emotional wellbeing between Indigenous and non-Indigenous Australians.
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.
This full-colour flipchart is specifically targeted at an Aboriginal and Torres Strait Islander audience for whom English is not a first language. It uses photographs and easy-to-understand descriptions to show and explain the different kinds of skin conditions likely to affect Aboriginal and Torres Strait Islander people, and how best to treat them. It is designed for use by health professionals working in remote locations but, due to the confronting nature of the images, it is not suited for broad dissemination.
This flipchart is not available in hard copy.
Research Dancing: Reflections on the Relationships between University-based Researchers and Community-based Researchers at Gurriny Yealamucka Health Services Aboriginal Corporation, YarrabahK. Mayo, K. Tsey & Empowerment Research Team 2009
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.
The link between Aboriginal spirituality and Aboriginal peoples’ social and emotional wellbeing is a little researched area but one which has significant implications for individual and community health, in particular its role in building resilience within colonised populations. This review emerged out of a 2006 CRCAH Roundtable to identify priorities around Aboriginal social and emotional wellbeing, and looks at both the broad differences between Aboriginal and non-Aboriginal spiritual concepts and the ways in which the two concepts have intermingled over time. It also examines the way ceremony, art and song have helped build resistance to the colonisation of Aboriginal spirituality. Chapter Five includes an annotated bibliography of relevant literature spanning the years 1973 to 2008.
Success Stories: Environmental, Social, Emotional and Spiritual Health of Aboriginal and Torres Strait Islanders. Report of the Indigenous Health WorkshopR. Erben, J. Judd, J. Ritchie & L. Rowling (eds) 2009
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.
The CRC for Aboriginal Health developed this guide to help researchers and research supervisors who are working in Aboriginal and Torres Strait Islander settings. The publication is intended to support training and be a hands-on resource in the field. It offers practical information, advice, strategies and success stories in Aboriginal and Torres Strait Islander health research. It is an easy-to-use manual in plain English that supports:
- setting up a workplace with the capacity to employ, support and train a developing researcher
- research processes and issues (a practical overview)
- doing research work in and with Aboriginal and Torres Strait Islander communities.
For more information about this work, please visit our Resources for Researchers page.
A companion volume, Researching Indigenous Health: A practical guide for researchers, by the same authors, was published in 2011.
The Role of Spirituality in Social and Emotional Wellbeing Initiatives: The Family Wellbeing Program at YarrabahA. McEwan, K. Tsey & Empowerment Research Team 2009
This is the seventh in the CRC for Aboriginal Health's Discussion Paper Series. The relationship between spirituality, religion and health is an emerging area of research worldwide. Although the available evidence generally supports a positive association between religious beliefs, spirituality and health, the reasons underlying this association are not well understood.
This paper explores the role that spirituality plays in social and emotional wellbeing for one group of Indigenous Australians by considering the outcomes of the Family Wellbeing (FWB) empowerment program, as reported by participants from Yarrabah, an Indigenous community located in far north Queensland. Analysis of 38 semi-structured evaluation interviews conducted with FWB participants in 2003 and 2005 demonstrated that the program outcomes, including improved relationships with family, increased empathy, a sense of calm and peace and a sense of healing, resonated very strongly with contemporary concepts of spirituality. The feelings, attitudes and behaviours reported by participants are also closely linked to ‘the control factor’ – recognised as an important psychological variable in epidemiological patterns of disease – and several personal and social factors that have been identified as protective against suicide and other self-destructive behaviours. The findings of this study will contribute to greater understanding of the role of spirituality in SEWB and to a more holistic approach to health care and community-based SEWB programs.
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.
Sort of Like Reading a Map – A community report on the survival of south-east Australian Aboriginal art since 1834F. Edmonds & M. Clarke 2009
In this report we explore the reasons behind the ‘hidden history’ of Aboriginal art in south-east Australia. We look at the continuing practice of art among Aboriginal people, mainly in Victoria, and the changes and adaptations to art practices that were often made in response to the colonising process. The recent practice of reclaiming or reinvigorating art styles fromthe past and developing these within contemporary artworks is also signifi cant in continuing the story of Aboriginal art in the region. The stories included here, told by Aboriginal artists and curators, also explore the signifi cance of art practices in maintaining south-east Australian Aboriginal culture, identity and wellbeing.
Health Care Access for Aboriginal and Torres Strait Islander People Living in Urban Areas, and Related Research Issues: A Review of the LiteratureM. Scrimgeour & D. Scrimgeour 2008
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.
One of the signature achievements of the CRCAH was to implement a new way of developing and appraising research grant proposals, a methodology that came to be known as the Facilitated Development Approach (FDA). This paper describes how the FDA model emerged as a result of dissatisfaction within the Aboriginal health sector with the earlier, researcher-driven competitive tendering model. It describes how the FDA’s more collaborative approach, with an emphasis on involving Aboriginal communities and organisations from the earliest stages of a research proposal, yields research with greater relevance to Aboriginal people’s health and a greater likelihood of uptake by the health sector.
Research Priorities in Aboriginal Prisoner Health: Recommendations and Outcomes from the CRCAH Aboriginal Prisoner Health Industry RoundtableDavis, Scott R. & Brands, Jenny 2008
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.
This is the fourth in the CRC for Aboriginal Health's Discussion Paper Series. This report summarises findings from a symposium held at the University of Melbourne in November 2007 that brought together key experts on racism and Indigenous health from Australia and Aotearoa (New Zealand). The report presents clear evidence that racism has a detrimental impact on the health of Indigenous peoples and endorses a cohesive research agenda to advance our understanding of the extent and nature of racism, and to improve our ability to combat racism as a threat to Indigenous health in Australia and Aotearoa.
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.
The Indigenous populations of Australia, New Zealand, Canada and the United States share the similarity of living in First World nations where they suffer a disproportionate health burden compared with their non-Indigenous fellow citizens. The implementation of programs and policies to reverse this health imbalance are often complicated by the lack of reliable health statistics. This report considers peer-reviewed and government accounts of health outcomes for Indigenous peoples in all four jurisdictions over a 10-year period, and includes case studies that outline initiatives that have had a positive impact on the health and wellbeing of the respective Indigenous populations. The conclusion focuses on data collection in Australia, and how improved statistical information could help inform better health interventions for Aboriginal and Torres Strait Islander peoples.
Beyond Bandaids: Exploring the Underlying Social Determinants of Aboriginal Health. Papers from the Social Determinants of Aboriginal Health Workshop, Adelaide, July 2004I. Anderson, F. Baum & M. Bentley (eds) 2007
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 publication is available in CD format on request to e: firstname.lastname@example.org
Communities Working for Health and Wellbeing: Success stories from the Aboriginal community controlled health sector in Victoria (VACCHO)S. Fletcher 2007
This publication outlines ten stories of successful health initiatives to celebrate ten years of activities by the Aboriginal Community-controlled health service movement in Victoria (VACCHO). These stories highlight the commitment and hard work of ACCHOs to create services and programs that reflect the values and needs of Aboriginal people, and address the wider social issues that determine health and wellbeing. The stories include birthing services and sexual health initiatives, well person’s health checks and specific youth health services, family violence programs, home ownership and financial counselling initiatives, maternal and child health services and playgroups, smoking cessation programs, appropriate care and respite care for Elders, training programs for Health Workers, and research into young people’s health and wellbeing. All these activities enhance Aboriginal health and wellbeing at service-delivery level, and, most importantly, build capacity in the Community.
This report is not available in hard copy.
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).
A Longitudinal Data Resource on Key Influences on Health in the Northern Territory: Opportunities and ObstaclesF. Siciliano, M. Stevens, J. Condon & R. Bailie 2006
This is the first in the CRC for Aboriginal Health's Discussion Paper Series. The purpose of this study is to increase understanding among researchers, health professionals, and government policy makers of the social and environmental determinants of health. Determinants include income, employment, education, housing, community infrastructure, social disruption, crime and violence. This paper summarises the benefits and feasibility of a longitudinal database of socio-economic, environmental and health indicators at the regional and community level within the Northern Territory (NT): a Longitudinal Indicators Database (LID). It reviews literature as well as statistical initiatives currently underway, and involved a series of consultations with stakeholders. A statistical resource such as LID would facilitate both the monitoring of trends over time, as well as provide access to data to support applied research and inform policy makers and service providers. The LID envisaged in this paper focuses on health, reflecting the work of the Menzies School of Health Research and the Cooperative Research Centre for Aboriginal Health. The study recommends that such a resource be seen in the context of a broader integrated information system of environmental, economic and social indicators, and encourages increased research–government collaborations in a number of sectors.
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.
Relevance of an Accredited Australian Diabetes Educators Association Course to Aboriginal Health Workers, Supervisors and Aboriginal People in South AustraliaM. N. King 2006
From 1997 onwards, Flinders University allowed Aboriginal Health Workers (AHWs) to enrol as students in the university’s accredited Australian Diabetes Educators Association course. This report details the outcomes of an evaluation to determine whether the course was meeting the needs of Aboriginal participants. Among the main findings was that, while the course was difficult for AHWs, those that did pass the academic requirements found the course highly relevant to their needs and were more prepared to assume responsibility for initiating diabetes health promotional activities.
Sharing the True Stories: Evaluating strategies to improve communication between health staff and Aboriginal patients, Stage 2 reportK. Coulehan, I. Brown, M. Christie, G. Gorham, A. Lowell, B. Marrnganyin & B. Patel 2005
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.
This paper focuses on the health and social impact of housing and home management services in Indigenous communities. While the authors found considerable community support for Home Management Programs, they also found significant gaps in the knowledge of how best to optimise programs. This was due to insufficient research, problems with defining Home Management Programs, the peripheral status of programs and insufficient or non-existent evaluation of programs. This project was conducted by the CRCATH at the request of the Family and Childrens Services (FACS) branch of the Department of Health and Community Services (DHCS).
This paper is not available in hard copy.
Sharing the True Stories: Improving communication between health staff and Aboriginal patients, Stage 1 reportA. Lowell, I. Brown,B. Marrnganyin, M. Flack, M. Christie, P. Snelling & A. Cass 2001
This report covers Stage 1 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 1 of the project was primarily an exploratory phase to inform decisions about actions to be undertaken in Stage 2. 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.