Published Research

Australian Institute of Aboriginal and Torres Strait Islander Studies & The Lowitja Institute 2017, Changing the Narrative in Aboriginal and Torres Strait Islander Health Research: Four Cooperative Research Centres and the Lowitja Institute: The story so far, The Lowitja Institute, Melbourne. - Link - Details - Abstract


Changing the Narrative
 outlines the journey and the successes of the Lowitja Institute and the four associated Cooperative Research Centres (CRCs) over our 20-year history.

The publication showcases how the cumulative efforts of the CRCs and the Institute have pioneered a new way of conducting health research in Aboriginal and Torres Strait Islander communities. It’s an approach driven by Aboriginal and Torres Strait Islander priorities – an approach developed by the CRCs, and embodied in the Institute.

The Lowitja Institute commissioned the Australian Institute of Aboriginal and Torres Strait Islander Studies to write a brief history of our organisation – including audiovisual recordings that highlight the vision of influential individuals. In addition, the writing, editorial and production work of the Lowitja Institute team has created the hard copy Changing the Narrative publication, and a companion e-book.

Hard copies of Changing the Narrative can be purchased for $75, or $50 for Aboriginal and Torres Strait Islander community organisations.

An e-book with video and audio content is available.


Thorpe, A., Arabena, K., Sullivan, P., Silburn, K. & Rowley, K. 2016, Engaging First Peoples: A Review of Government Engagement Methods for Developing Health Policy, The Lowitja Institute, Melbourne. - Download [1,509 KB] - Link - Abstract

This second discussion paper commissioned by the Lowitja Institute follows on from the successful paper Legally Invisible – How Australian Laws Impede Stewardship and Governance for Aboriginal and Torres Strait Islander Health (Howse 2011). Researchers from the Universities of Melbourne, La Trobe and Notre Dame conducted an analysis of national, State and regionally constructed engagement policies and strategies in Aboriginal and Torres Strait Islander health and wellbeing to identify best practice examples and lessons learned. These learnings aim to support those working on the challenges of effective implementation of policies and programs within the Aboriginal and Torres Strait Islander health arena, and Indigenous affairs more generally. They have particular relevance for practitioners concerned with the difficulties of contributing to the achievement of equity in health and wellbeing for First Peoples in increasingly complex policy and community contexts. 


Fischer, K., High School Outreach in Remote Northwest Queensland, The Lowitja Institute, Melbourne, 2016. - Details - Abstract

The QIMR Berghofer’s Science and Young Minds project aimed to inspire the scientists and medical professionals of tomorrow by relaying the importance of medical research and health-related professions in an integrated school education and capacity building program. Focussing on skin health, the project included the development and delivery of science workshops to senior high school students in remote areas of northwest Queensland during 2014 and 2015. In addition, selected students and teachers participated in a laboratory work experience program at the QIMR Berghofer in Brisbane.


Silburn, K., Thorpe, A., Carey, L., Frank-Gray, Y., Fletcher, G., McPhail, K. and Rumbalara Aboriginal Co-operative 2016, Is Funder Reporting Undermining Service Delivery? Compliance reporting requirements of Aboriginal Community Controlled Health Organisations in Victoria, The Lowitja Institute, Melbourne - Link - Details - Abstract

This paper describes a case study of the compliance and reporting requirements of a large Aboriginal Community Controlled Health Organisation (ACCHO) in Victoria—Rumbalara Aboriginal Co-operative. It demonstrates that on top of the reporting overburden, incredible complexity is introduced when single organisations work across a range of health and community service sectors and consequently have to report in different ways, on different performance criteria, using different databases, for funding from different government programs. The irony is that while ACCHOs aim to build their service delivery capability in order to implement holistic responses to individual and community need, reporting to funders appears to work against this.


Silburn, K., Reich, H. & Anderson, I. (eds) 2016, A Global Snapshot of Indigenous and Tribal Peoples’ Health, The Lancet-Lowitja Institute Collaboration, The Lowitja Institute, Melbourne. - Link - Details - Abstract

The purpose of this report is to provide a more detailed understanding of the context of each population included in a paper published by The Lancet in April 2016, 'Indigenous and Tribal Peoples Health (The Lancet–Lowitja Institute Collaboration): A population study' by I. Anderson, B. Robson, M. Connolly et al. 

Contributors have endeavoured to provide a summary of the history, culture, legal and political status as well as socio-demographic factors of each Indigenous or Tribal group. Unfortunately the political situation in some countries has meant that in some cases authors have not been able to include important facts pertaining to their Indigenous peoples.

The Lancet-Lowitja Institute Global Collaboration


Elliott, A., McIlwaine, F., Stone, N. & Proctor, K. 2015, The Bouverie Centre’s Aboriginal Family Therapy Training Program: Impact Analysis Report, The Lowitja Institute, Melbourne - Details - Abstract

This report presents findings from a three-phase Impact Analysis Evaluation of the Bouverie Centre’s Aboriginal Family Therapy Training Program delivered by staff of the Indigenous Program, The Bouverie Centre, La Trobe University.

Phase 1 involved analysing transcripts of a major student assessment task – their Spoken Essays in which students were required to articulate what they learned from their participation in the Aboriginal Family Therapy Training Program.

The first part of Phase 2 was based on conducting and analysing interviews with graduates and other stakeholders, and the second part of Phase 2 saw the development, administration and analysis of an online survey of all graduates.

Phase 3 integrated earlier phases into a Project Management Brief and related recommendations for the future of the program.

Findings from all three phases were consistent in delivering important messages. Graduates and other stakeholders agreed that the program is broadly achieving its objectives. Specifically, they confirmed that the program has led to substantial gains in the specialised knowledge, skills and motivation required to support effective family therapy practice in Aboriginal and Torres Strait Islander communities. The effects are, for many graduates, transformational in expanding their awareness, perspectives and competencies related to sophisticated conceptual and practical frameworks.

An evidence brief is also available.


D'Aprano, A., Silburn, S., Johnston, V., Oberklaid, F., Tayler, C., 2015, Culturally Appropriate Training for Remote Australian Aboriginal Health Workers: Evaluation of an Early Child Development Training Intervention, Journal of Developmental and Behavioral Pediatrics, 36(7):503-11. doi: 10.1097/DBP.0000000000000200 - Link - Abstract

Objective

This study aimed to design, implement, and evaluate training in early childhood development (ECD) and in the use of a culturally adapted developmental screening tool, for remote Australian Aboriginal Health Workers (AHWs) and other remote health practitioners.

Method

A case-study evaluation framework was adopted. Two remote Australian Aboriginal health services were selected as case-study sites. Materials review, semistructured interviews, posttraining feedback surveys, and workplace observations contributed to the evaluation, guided by Guskey's 5-level education evaluation model.

Results

Remote health practitioners (including AHWs and Remote Area Nurses) and early childhood staff from the sites participated in a customized 2½ day training workshop focusing on the principles of ECD and the use of the culturally adapted Ages and Stages Questionnaire, third edition. Consistent with adult learning theories and recommendations from the literature regarding culturally appropriate professional development methods in this context, the workshop comprised interactive classroom training, role-plays, and practice coaching in the workplace, including booster training. The qualitative findings demonstrated that mode of delivery was effective and valued by participants. The workshop improved practitioners' skills, knowledge, competence, and confidence to identify and manage developmental difficulties and promote child development, evidenced on self-report and workplace clinical observation.

Conclusion

The findings suggest that the practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners. This is an important finding that has implications in other Indigenous contexts, as effective training is a critical component of any practice improvement intervention. Further research examining factors influencing practice change is required.


Tilton, R., Martini, A., Brown, C. & Strout, K. 2015, Towards a History of Apunipima Cape York Health Council, 1994–2006, The Lowitja Institute, Melbourne. - Link - Details - Abstract

This publication is one of five that report on the work of the Funding, Accountability and Results (FAR) project, all published by the Lowitja
Institute in 2015.

FAR is a study of reforms in primary health care for Aboriginal and Torres Strait Islander communities in the Northern Territory (between 2009 and 2014) and Cape York, Queensland (between 2006 and 2014).

This review tracks the development of Apunipima Cape York Health Council (Apunipima or ACYHC), an Aboriginal community controlled health service for Cape York, Queensland. It covers the period from 1994—when Apunipima was established by Aboriginal community representatives to advocate for the health of all communities of Cape York—until 2006, when transition to community control of primary health care services was endorsed by all key players in Cape York.


Kinchin, I., Jacubs, S., Tsey, K. & Lines, K., 2015, An empowerment intervention for Indigenous communities: an outcome assessment, BMC Psychology, 3:29. - Link - Abstract

Background

Empowerment programs have been shown to contribute to increased empowerment of individuals and build capacity within the community or workplace. To-date, the impact of empowerment programs has yet to be quantified in the published literature in this field. This study assessed the Indigenous-developed Family Wellbeing (FWB) program as an empowerment intervention for a child safety workforce in remote Indigenous communities by measuring effect sizes. The study also assessed the value of measurement tools for future impact evaluations.

Methods

A three-day FWB workshop designed to promote empowerment and workplace engagement among child protection staff was held across five remote north Queensland Indigenous communities. The FWB assessment tool comprised a set of validated surveys including the Growth and Empowerment Measure (GEM), Australian Unity Wellbeing Index, Kessler psychological distress scale (K10) and Workforce engagement survey. The assessment was conducted pre-intervention and three months post-intervention.

Results

The analysis of pre-and post-surveys revealed that the GEM appeared to be the most tangible measure for detecting positive changes in communication, conflict resolution, decision making and life skill development. The GEM indicated a 17 % positive change compared to 9 % for the Australian Unity Wellbeing Index, 5 % for the workforce engagement survey and less than 1 % for K10.

Conclusions

This study extended qualitative research and identified the best measurement tool for detecting the outcomes of empowerment programs. The GEM was found the most sensitive and the most tangible measure that captures improvements in communication, conflict resolution, decision making and life skill development. The GEM and Australian Unity Wellbeing Index could be recommended as routine measures for empowerment programs assessment among similar remote area workforce.


Devitt, J., Dwyer, J., Martini, A. & Tilton, E. 2015, Northern Territory Aboriginal Health Forum: A historical review, The Lowitja Institute, Melbourne. - Link - Details - Abstract

This publication is one of five that report on the work of the Funding, Accountability and Results (FAR) project, all published by the Lowitja Institute in 2015.

FAR is a study of reforms in primary health care for Aboriginal and Torres Strait Islander communities in the Northern Territory (between 2009 and 2014) and Cape York, Queensland (between 2006 and 2014).

This report examines the history of the Northern Territory Aboriginal Health Forum (NTAHF) and its contribution to policy making and to system development for Aboriginal health in the Northern Territory – from its founding in 1998 until 2009 with the commencement of work to implement the newly completed Pathways to Community Control framework. Subsequent events are covered in the NTAHF case study that forms part of our main report of this project (Dwyer et al. 2015).


Myott, P., Martini, A. & Dwyer, J. 2015 Miwatj and East Arnhem: Case study, The Lowitja Institute, Melbourne. - Link - Details - Abstract

This publication is one of five that report on the work of the Funding, Accountability and Results (FAR) project, all published by the Lowitja Institute in 2015.

FAR is a study of reforms in primary health care for Aboriginal and Torres Strait Islander communities in the Northern Territory (between 2009 and 2014) and Cape York, Queensland (between 2006 and 2014).

This case study documents the engagement of the Miwatj Health Aboriginal Corporation (Miwatj) and the communities and leaders of the East Arnhem Region in the planning and implementation of the Pathways regionalisation program led by the Northern Territory Aboriginal Health Forum (NTAHF) from 2009 to 2014. The study is based on interviews with 20 people—14 Aboriginal Community Controlled Health Organisations (ACCHOs) staff (including three people who also served in community representative roles), five current and former government staff and one community representative—and on analysis of 98 publicly available or internal NTAHF and Miwatj documents.


Dwyer, J., Martini, A., Brown, C., Tilton, E., Devitt, J., Myott, P. & Pekarsky, B. 2015, The Road Is Made by Walking: Towards a better primary health care system for Australia’s First Peoples – Report, The Lowitja Institute, Melbourne. - Link - Details - Abstract

This publication is one of five that report on the work of the Funding, Accountability and Results (FAR) project, all published by the Lowitja Institute in 2015.

The research reported here is a study of planned reforms in primary health care for Aboriginal and Torres Strait Islander communities in the Northern Territory (between 2009 and 2014) and Cape York, Queensland (between 2006 and 2014). In both places the intention of the reforms was twofold: to establish a regional system of PHC provision with reliable access to care for all Aboriginal communities in the regions and to increase community control of health care by transferring some or all of the responsibility for providing PHC from government health authorities to regional Aboriginal Community Controlled Health Organisations. These were bold plans, with long histories in both jurisdictions.

Download policy brief.


Dwyer, J., Martini, A., Brown, C., Tilton, E., Devitt, J., Myott, P. & Pekarsky, B. 2015, The Road Is Made by Walking: Towards a better primary health care system for Australia’s First Peoples – Summary Report, The Lowitja Institute, Melbourne. - Link - Details - Abstract

This publication is one of five that report on the work of the Funding, Accountability and Results (FAR) project, all published by the Lowitja Institute in 2015.

The research reported here, in summary form, is a study of reforms in primary health care for Aboriginal and Torres Strait Islander communities in the Northern Territory (between 2009 and 2014) and Cape York, Queensland (between 2006 and 2014). In both places, the intention of the reforms was twofold: to establish a regional system of PHC provision with reliable access to care for all Aboriginal and Torres Strait Islander communities in the regions, and to increase community control of health care by transferring some or most of the responsibility for providing PHC from government health authorities to regional Aboriginal Community Controlled Health Organisations (ACCHOs). These were bold plans with long histories of development in both jurisdictions.

Download policy brief


Kelly, J., Dwyer, J., Pekarsky, B., Mackean, T., Willis, E., de Crespigny, C., Perkins, S., O’Donnell, K., King, R., Mackean, L., Brown, A., Lawrence, M. & Dixon, K. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Study Report, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Kelly, J., Dwyer, J., Pekarsky, B., Mackean, T., McCabe, N., Wiseman, J., de Crespigny, C. & O’Donnell, K. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Workbook (Version 1), The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.

Download an interactive version of this workbook


Kelly, J., Ramage, M., Perry, D., Tinsley, J., Auckram, H., Corkhill, W., Wyatt, S. & McCabe, N. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Rural and Remote Sites Case Studies, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Kelly, J., Herman, K., Martin, G., Wilden, C., East, T., Russell, C. & Brown, S. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Renal Case Studies, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Kelly, J., Ramage, M., Perry, D., Tinsley, J., Auckram, H., Corkhill, W., Wyatt, S. & McCabe, N. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Cardiac Case Studies, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Kelly, J., McCabe, N., McInnes, W., Kirkbride, M., Graham, A., Rigney, D. & Nori, A. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – City Sites Case Studies, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Kelly, J., Medway, P., Miller, D., Catt, L. & Lawrence, M. 2015, Managing Two Worlds Together (Stage 3): Improving Aboriginal Patient Journeys – Maternity Case Studies, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Emerson, L., Fox, S. & Smith, C. 2015, Good Beginnings: Getting it right in the early years, The Lowitja Institute, Melbourne. - Link - Details - Abstract

This publication is a compendium of three papers commissioned as part of the Stewardship Dialogues for Aboriginal and Torres Strait Islander Health, a project of the Lowitja Institute.

The first two were written to inform the discussion during the Stewardship Dialogues and the third was written after the Dialogues to address an identified need for decision makers to have access to a more systematic review of the evidence about the effectiveness of different interventions. These papers review the evidence on the importance of a healthy start to life and on interventions to promote good beginnings.

The Stewardship Dialogues for Aboriginal and Torres Strait Islander Health were established to test if an open exploration of underlying barriers to better progress in Aboriginal and Torres Strait Islander health policy and programs can  generate new ways to approach some of the ‘wicked problems’ of policy and implementation. Dialogue participants identified that education and early years interventions, implemented in collaboration with Aboriginal and Torres Strait Islander communities and properly adapted to their settings, held the potential to produce significant long-term effects on health and wellbeing.


Monson-Wibraham, L., 2015, Watering the Garden of Family Wellbeing: Empowering Aboriginal and Torres Strait Islander people to bloom and grow, The Lowitja Institute, Melbourne. - Details - Abstract

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.

Policy brief

Family Wellbeing project page with additional resources.


Kelaher, M., Sabanovic, H. La Brooy, C., Lock, M., Uddin, S. & Brown L. 2015, Planning, Implementation and Effectiveness in Indigenous Health Reform, The Lowitja Institute, Melbourne. - Details - Abstract

The Planning, Implementation and Effectiveness in Indigenous Health Reform (PIE) project, funded by the Lowitja Institute and the Australian Research Council, carried out by the University of Melbourne, arose from concerns by Aboriginal and Torres Strait Islander people that despite the importance of participation and investment in collaborative governance, little research focused on capturing current practice and identifying best practice is being done. The advent of the National Indigenous Reform Agreement (NIRA) and the Indigenous Health National Partnership Agreements (IHNPAs) has led to further development/application of collaborative approaches to governance through committees and forums at national, State and regional levels. The activities associated with these committees and forums are referred to throughout this report as collaborative governance.

This report focuses on building the evidence base around best practice based on case studies of collaborative governance in relation to the NIRA.

A policy brief highlighting the policy recommendations of this report is also available.


Simpson, P., Guthrie, J., Lovell, M., Walsh, C. & Butler, T., 2014, Views on Alternatives to Imprisonment: A Citizens Jury approach, The Lowitja Institute, Melbourne. - Details - Abstract

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.


Sullivan, P. 2015, A Reciprocal Relationship: Accountability for public value in the Aboriginal community sector, The Lowitja Institute, Melbourne. - Link - Details - Abstract

The Aboriginal community controlled health sector is a major provider of primary and preventative health care services to Aboriginal people outside Australia’s major cities and towns. It is important that it functions well. There are many aspects to good service delivery. This paper contributes to one of them—good management—both in the community health services themselves and in the public sector agencies that fund them.

The paper begins by outlining the changing ‘grand narratives’ of public administration over the past century or so among English-speaking countries. It is relevant because they are never completely superseded; some elements of old approaches always survive nested in the trappings of the new. This background also helps our understanding of how things got the way they are, why we do what we do, and how we may be able to do some things better. While this is important for any kind of service delivery, it is particularly so for implementing improvements in Aboriginal health.

The paper then narrows to a discussion of Aboriginal service delivery and how this has evolved through the early years of post-colonial self-determination policy, being taken up by the Aboriginal and Torres Strait Islander Commission (ATSIC), and then the current post-ATSIC environment of contestable service functions.


Guthridge, S., Li, L., Silburn, S., Li, SQ., McKenzie, J. & Lynch, J. 2015, Impact of perinatal health and socio-demographic factors on school education outcomes: A population study of Indigenous and non-Indigenous children in the Northern Territory, Journal of Paediatrics and Child Health, vol 15, no 1 (January 2015 – March 2015). DOI: 10.1111/jpc.12852 - Link - Abstract

Aim

This study investigated the association between early-life risk factors and school education outcomes.

Methods

This is an historical cohort study of 7601 children (61% were Indigenous) born in the Northern Territory between 1999 and 2004. Information was linked, for each child on: perinatal health, student enrolment and National Assessment Program – Literacy and Numeracy (NAPLAN) Year 3 results. Logistic regression was used to estimate the association between selected risk factors and a NAPLAN result ‘below’ the national minimum standard (NMS) in reading and numeracy.

Results

Indigenous children had much higher odds, than non-Indigenous children, of a result below the NMS for both reading (odds ratio (OR): 8.58, 95% confidence interval (CI): 7.55–9.74) and numeracy (OR: 11.52, 95% CI: 9.94–13.35). When adjusted for all other variables, the increased odds were attenuated for both reading (OR: 2.89, 95% CI: 2.46–3.40) and numeracy (OR: 3.19, 95% CI: 2.65–3.84). Common risk factors for Indigenous and non-Indigenous children included higher birth order, maternal smoking in pregnancy and being a boy. There were gradients of decreasing risk with increasing education level of primary care giver and increasing maternal age. Among Indigenous children only, risks increased when living in remote areas, with younger age (8 years) and low birthweight.

Conclusions

The study highlights that many of the risk factors associated with poor education outcomes among Indigenous children are shared with the general population. The results inform a targeted, cross-agency response to address modifiable early-life risk factors for educational disadvantage. Data linkage, using existing administrative datasets, provides a useful addition to methods that identify priority areas for prevention and early intervention.


Ireland, S., Narjic, C.W., Belton, S., Saggers, S. & McGrath, A., 2015, Jumping around: exploring young women's behaviour and knowledge in relation to sexual health in a remote Aboriginal Australian community, Culture, Health & Sexuality, 17 (1), 1-16 - Link - Abstract

Sexual health indicators for young remote-living Aboriginal women are the worst of all of Australian women. This study aimed to describe and explore young women's behaviour and knowledge in relation to sexual health, as well as to provide health professionals with cross-cultural insights to assist with health practice. A descriptive ethnographic study was conducted, which included: extended ethnographic field work in one remote community over a six-year period; community observation and participation; field notes; semi-structured interviews; group reproductive ethno-physiology drawing and language sessions; focus-group sessions; training and employment of Aboriginal research assistants; and consultation and advice from a local reference group and a Cultural Mentor. Findings reveal that young women in this remote community have a very poor biomedical understanding of sexually transmitted infections and contraception. This is further compounded by not speaking English as a first language, low literacy levels and different beliefs in relation to body functions. In their sexual relationships, young women often report experiences involving multiple casual partners, marijuana use and violence. Together, the findings contribute to a better understanding of the factors underlying sexual health inequity among young Aboriginal women in Australia.


Brands, J. 2014, 'The Shape of Things to Come: Visions for the future of Aboriginal and Torres Strait Islander health research', The Lowitja Institute, Melbourne. - Details - Abstract

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


Freemantle, J., Ritte, R., Smith, K., Iskandar, D., Cutler, T., Heffernan, B., Zhong, G., Mensah, F., Read, A. 2014, Victorian Aboriginal Child Mortality Study: Patterns, Trends and Disparities in Mortality between Aboriginal and Non- Aboriginal Infants and Children, 1999–2008, The Lowitja Institute, Melbourne - Details - Abstract

This report:
– 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


Jongen, C., McCalman, J., Bainbridge, R. & Tsey, K. 2014, Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings, BMC Pregnancy and Childbirth, 14:251 - Link - Abstract

Background
Persistent disparities in pregnancy and birth outcomes between Aboriginal and Torres Strait Islander and other Australians evidence a need to prioritise responsive practice in Maternal Child Health (MCH). This study reviewed the existing knowledge output on Aboriginal and Torres Strait Islander MCH programs and services with the objective to advance understanding of the current evidence base and inform MCH service development, including the identification of new research priorities.

Methods
A systematic search of the electronic databases Informit, Proquest, PubMed, Scopus, Wiley, and Cinahl, and 9 relevant websites was undertaken for the period 1993–2012. The reference lists of MCH program reviews were hand-searched for additional relevant studies which met the eligibility criteria. The study designs of included publications were classified and the characteristics extracted and categorized. Evaluation quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Program (CASP) tool for qualitative studies.

Results
Twenty-three search results were identified for inclusion, with the majority published in 2003–2012. Fifty two percent of publications reported on programs and services operating out of Aboriginal Community Controlled Health Organisations, with antenatal and postnatal care the main intervention type/s, and health promotion/education and advice/support the most common intervention component. Outcomes such as increased antenatal attendance and higher infant birth weights were reported in some intervention studies, however methodological quality varied considerably with quantitative studies typically rated weak.

Conclusion
The prevalence of community controlled and/or community-based programs is significant given the health and wellbeing implications of self-determination. While the literature highlights the promise of many intervention models and program components used there are some significant gaps in the documentation and implementation of important MCH interventions. Similarly, while positive health outcomes were reported there are issues with key measures used and study quality. This review highlights the need to improve the quality of evaluations of MCH programs for Aboriginal and Torres Strait Islander women and to address the key evidence gaps in responding to their health and wellbeing needs.


Kelaher, M.,Sabanovic, H., La Brooy, C., Lock, M., Lusher, D., Brown, L. 2014, Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia, Social Science & Medicine, DOI: 10.1016/j.socscimed.2014.07.032 - Link - Abstract

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments.

The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations.

The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity.


McCalman,J., Tsey, K., Bainbridge, R., Rowley, K., Percival, N., O’Donoghue, L., Brands, J., Whiteside, M., Judd, J., 2014. The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search, doi:10.1186/1471-2458-14-712 - Link - Abstract

Background
Health promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools.

Methods
Indigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors’ knowledge (n = 1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively.

Results
The review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies.

Conclusions
The small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation.


Swe, P. & Fischer, K. 2014, A Scabies Mite Serpin Interferes with Complement-Mediated Neutrophil Functions and Promotes Staphylococcal Growth, PLOS Neglected Tropical Diseases, vol 8, no 6, DOI: 10.1371/journal.pntd.0002928 - Link - Abstract

Scabies is an infectious skin disease caused by the mite Sarcoptes scabiei and has been classified as one of the six most prevalent epidermal parasitic skin diseases infecting populations living in poverty by the World Health Organisation. The role of the complement system, a pivotal component of human innate immunity, as an important defence against invading pathogens has been well documented and many parasites have an arsenal of anti-complement defences. We previously reported on a family of scabies mite proteolytically inactive serine protease paralogues (SMIPP-Ss) thought to be implicated in host defence evasion. We have since shown that two family members, SMIPP-S D1 and I1 have the ability to bind the human complement components C1q, mannose binding lectin (MBL) and properdin and are capable of inhibiting all three human complement pathways. This investigation focused on inhibition of the lectin pathway of complement activation as it is likely to be the primary pathway affecting scabies mites. Activation of the lectin pathway relies on the activation of MBL, and as SMIPP-S D1 and I1 have previously been shown to bind MBL, the nature of this interaction was examined using binding and mutagenesis studies. SMIPP-S D1 bound MBL in complex with MBL-associated serine proteases (MASPs) and released the MASP-2 enzyme from the complex. SMIPP-S I1 was also able to bind MBL in complex with MASPs, but MASP-1 and MASP-2 remained in the complex. Despite these differences in mechanism, both molecules inhibited activation of complement components downstream of MBL. Mutagenesis studies revealed that both SMIPP-Ss used an alternative site of the molecule from the residual active site region to inhibit the lectin pathway. We propose that SMIPP-Ss are potent lectin pathway inhibitors and that this mechanism represents an important tool in the immune evasion repertoire of the parasitic mite and a potential target for therapeutics.


Reynolds, L., Pike, R., Mika A., Blom, A., Hofmann, A., Wijeyewickrema, L., Kempand, D. & Fischer, K., 2014, Scabies Mite Inactive Serine Proteases Are Potent Inhibitors of the Human Complement Lectin Pathway, PLOS Neglected Tropical Diseases, vol 8, no 5, DOI: 10.1371/journal.pntd.0002872 - Link - Abstract

Scabies is an infectious skin disease caused by the mite Sarcoptes scabiei and has been classified as one of the six most prevalent epidermal parasitic skin diseases infecting populations living in poverty by the World Health Organisation. The role of the complement system, a pivotal component of human innate immunity, as an important defence against invading pathogens has been well documented and many parasites have an arsenal of anti-complement defences. We previously reported on a family of scabies mite proteolytically inactive serine protease paralogues (SMIPP-Ss) thought to be implicated in host defence evasion. We have since shown that two family members, SMIPP-S D1 and I1 have the ability to bind the human complement components C1q, mannose binding lectin (MBL) and properdin and are capable of inhibiting all three human complement pathways. This investigation focused on inhibition of the lectin pathway of complement activation as it is likely to be the primary pathway affecting scabies mites. Activation of the lectin pathway relies on the activation of MBL, and as SMIPP-S D1 and I1 have previously been shown to bind MBL, the nature of this interaction was examined using binding and mutagenesis studies. SMIPP-S D1 bound MBL in complex with MBL-associated serine proteases (MASPs) and released the MASP-2 enzyme from the complex. SMIPP-S I1 was also able to bind MBL in complex with MASPs, but MASP-1 and MASP-2 remained in the complex. Despite these differences in mechanism, both molecules inhibited activation of complement components downstream of MBL. Mutagenesis studies revealed that both SMIPP-Ss used an alternative site of the molecule from the residual active site region to inhibit the lectin pathway. We propose that SMIPP-Ss are potent lectin pathway inhibitors and that this mechanism represents an important tool in the immune evasion repertoire of the parasitic mite and a potential target for therapeutics.


Swe, P. & Fischer, K., 2014 A scabies mite serpin interferes with complement-mediated neutrophil functions and promotes staphylococcal growth, Accepted for publication in PLOS Neglected Tropical Diseases, San Francisco
Bretherton T. 2014, Shifting Gears: Identifying drivers of career development for Aboriginal and Torres Strait Islander workers in the health sector, The Lowitja Institute, Melbourne. - Download [570 KB] - Abstract

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.


Tieman, J., Lawrence, M., Damarell, R., Sladek, R., Nikolof, A. 2014, LIt.search: fast tracking access to Aboriginal and Torres Strait Islander health literature, Australian Health Review, http://dx.doi.org/10.1071/AH14019 - Link - Abstract

Objective
To develop and validate a PubMed search filter, LIt.search, that automatically retrieves Aboriginal and Torres Strait Islander health literature and to make it publicly accessible through the Lowitja Institute website.

Methods
Search filter development phases included: (1) scoping of the publication characteristics of Aboriginal and Torres Start Islander literature; (2) advisory group input and review; (3) systematic identification and testing of MeSHand text word terms; (4) relevance assessment of the search filter’s retrieved items; and (5) translation for use in PubMed through
the web.

Results
Scoping study analyses demonstrated complexity in the nature and use of possible search terms and publication characteristics. The search filter achieved a recall rate of 84.8% in the full gold standard test set. To determine real-world performance, post-hoc assessment of items retrieved by the search filter in PubMed was undertaken with 87.2% of articles deemed as relevant. The search filter was constructed as a series of URL hyperlinks to enable one-click searching.

Conclusion
LIt.search is a search tool that facilitates research into practice for improving outcomes in Aboriginal and Torres Strait Islander health and is publicly available on the Lowitja Institute website.


Whiteside, M., Tsey, K., Cadet-James, Y. and McCalman, J. (2014). Promoting Aboriginal Health: The Family Wellbeing Empowerment approach. SpringerBriefs in Public Health. Cham Heidelberg New York Dordrecht London: Springer. - Link - Abstract

"Those of us who have worked on the frontline of Aboriginal health for any length of time know that beneath the surface reality of Aboriginal people's poor health outcomes sits a deeper truth. It is about the importance of social and emotional wellbeing, and how this flows from a sense of control over one's own life. Where this is lacking, as it is in so many Aboriginal families and communities, there is instead indifference and despair and a descent into poor lifestyle choices and self-destructive behaviours. Our medical professionals do a great job of prescribing medicines and devising treatment programs but, to fix the root causes of ill-health, we need something more. As Aboriginal people we need to have a sense of agency in our lives, that we are not stray leaves blowing about in the wind. In a word, we need empowerment".

Ms Pat Anderson, Chairperson, the Lowitja Institute, Australia's National Institute for Aboriginal and Torres Strait Islander Health Research.  


Ferdinand, A., Paradies, Y. & Kelaher, M. 2013, Mental Health Impacts of Racial Discrimination in Victorian Aboriginal Communities, The Lowitja Institute, Melbourne. - Link - Details - Abstract

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.


Ahmad Fuaad, A. A., Jia, Z., Hartas, J., Ziora, Z. M., Lin, I. C., Moyle, P. M., Batzloff, M. R., Good, M. F., Monteiro, M. J., Skwarczynski, M. & Toth, I. 2013, Polymer-peptide Hybrids as a Highly Immunogenic Single-dose Nanovaccine, Nanomedicine, April 2013 - Link - Abstract

Aim: To explore four-arm star poly(t-butyl)acrylate (PtBA)-peptide and linear PtBA-peptide conjugates as a vaccine-delivery system against Group A Streptococcus. Materials & methods: PtBA nanoparticles bearing J14 peptide epitopes were prepared via alkyne-azide 1,3-dipolar cycloaddition 'click' reaction. The conjugated products were self-assembled into small or large nanoparticles. These nanoparticle vaccine candidates were evaluated in vivo and J14-specific antibody titers were assessed. Results & discussion: Mice vaccinated with the nanoparticles were able to produce J14-specific IgG antibodies without the use of an external adjuvant after a single immunization. We have demonstrated for the first time that the immune responses against self-assembled PtBA nanoparticles are stronger for the smaller sized (∼20 nm) nanoparticles compared with the larger (∼500nm) PtBA nanoparticles. Conclusion: PtBA analogs have the potential to be developed as potent carrier systems for single-dose synthetic vaccines. Original submitted 29 August 2012; Revised submitted 6 December 2012.


Beetson, J., Ah Chee, D., Boughton, B. & Leblanch, J. C. 2013, ‘An Aboriginal Adult Literacy Campaign in Australia Using Yes I Can’, Paper presented at the Pedagogia 2013 Conference, Havana, Cuba, 4–8 February - Link - Abstract

In 2012, the remote Aboriginal community of Wilcannia in western NSW hosted the first Australian pilot of a Cuban mass adult literacy campaign model known as Yes I Can. The aim was to investigate the appropriateness of this model in Aboriginal Australia. Building on an intensive community development process of ‘socialisation and mobilisation’, sixteen community members with very low literacy graduated from the basic literacy course, with the majority continuing on into post-literacy activities, further training and/or employment. The pilot was initiated by the National Aboriginal Adult Literacy Campaign Steering Committee (NAALCSC) consisting of Aboriginal leaders from the education and health sectors, and managed by the University of New England (UNE), working in partnership with the Wilcannia Local Aboriginal Land Council as the local lead agency. The pilot was supported by a Cuban academic who came to Australia for this purpose, and included a Participatory Action Research (PAR) evaluation led by the UNE Project Manager. In this paper, members of the project team and the NAALCSC describe the pilot and reflect on its outcomes.


Boughton, B., Chee, D.A., Beetson, J., Durnan, D. & Leblanch, J. C. 2013, An Aboriginal Adult Literacy Campaign Pilot Study in Australia Using Yes I Can, Literacy and Numeracy Studies, vol. 21, no. 1 (n.p.) - Link - Abstract

In 2012, the remote Aboriginal community of Wilcannia in western NSW hosted the first Australian pilot of a Cuban mass adult literacy campaign model known as Yes I Can. The aim was to investigate the appropriateness of this model in Aboriginal Australia. Building on an intensive community development process of ‘socialisation and mobilisation’, sixteen community members with very low literacy graduated from the basic literacy course, with the majority continuing on into post-literacy activities, further training and/or employment. The pilot was initiated by the National Aboriginal Adult Literacy Campaign Steering Committee (NAALCSC) consisting of Aboriginal leaders from the education and health sectors, and managed by the University of New England (UNE), working in partnership with the Wilcannia Local Aboriginal Land Council as the local lead agency. The pilot was supported by a Cuban academic who came to Australia for this purpose, and included a Participatory Action Research (PAR) evaluation led by the UNE Project Manager. In this paper, members of the project team and the NAALCSC describe the pilot and reflect on its outcomes.


Good, M. F., Batzloff, M. R. & Pandey, M. 2013, Strategies in the Development of Vaccines to Prevent Infections with Group A Streptococcus, Human Vaccines & Immunotherapeutics, vol. 9, no. 11 - Link - Abstract

There has long been interest and demand for the development of a vaccine to prevent infections caused by the Gram-positive organism group A streptococcus. Despite numerous efforts utilizing advanced approaches such as genomics, proteomics and bio-informatics, there is currently no vaccine. Here we review various strategies employed to achieve this goal. We also discuss the approach that we have pursued, a non-host reactive, conformationally constrained minimal B cell epitope from within the C-repeat region of M-protein, and the potential limitations in moving forward.


Doyle J., Firebrace F., Reilly R., Crumpen T. & Rowley K., 2013, What makes us different? The role of Rumbalara Football & Netball Club in promoting Indigenous wellbeing, Australian Community Psychologist. 25 (2), 7-21. - Link - Abstract

The Rumbalara Football and Netball Club has competed in regional football and netball leagues since 1997, continuing a tradition that began with the Cummergunja football teams of the 1890s. The Club is an important contributor to cultural identity for Aboriginal people in the Goulburn-Murray Rivers region of northern Victoria. It is a place where Aboriginal people can (re)connect with community, language, and stories of culture and history. It is also a vehicle for building relationships with mainstream Australia. Through competing in regional football and netball leagues, the Club brings Aboriginal community into mainstream society, working to wards and demanding recognition, equality, and respect for Aboriginal people. The Club’s hosting of visiting players and supporters enables mainstream visitors to accept reciprocity from the Aboriginal community. These characteristics of participation make up part of ‘being healthy’ for Aboriginal people. Because they drive engagement of Aboriginal people with the Club, they are foundational to the Club’s programs and activities that fit with a more conventional definition of ‘health promotion’, including programs to increase physical activity and improve diet, promote engagement of young people in education, and facilitate employment opportunities. The Club also engages in research which seeks to describe the breadth, strategies, and effectiveness of this health promotion activity.

Johnston, L., Doyle, J., Morgan, B., Atkinson-Briggs, S., Firebrace, B., Marika, M., Reilly, R., Cargo, M., Riley, T. & Rowley, K. 2013, A Review of Programs that Targeted Environmental Factors for Improving Aboriginal and Torres Strait Islander Health, International Journal of Environmental Research & Public Health, vol. 10, pp. 3518–42 - Link - Abstract

Objective

Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health.

Methods and results

We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller's Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective.

Conclusions

Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.


Johnston, L., Doyle, J., Morgan, B., Atkinson-Briggs, S., Firebrace. B., Marika, M., Reilly, R., Cargo, M., Riley, T., Rowley, K., 2013, A review of programs that targeted environmental factors for improving Aboriginal and Torres Strait Islander health, International Journal of Environmental Research & Public Health, 10(8), 3518-3542. - Link - Abstract

Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.


Hefler, M. & Thomas, D. 2013, The Use of Incentives to Stop Smoking in Pregnancy among Aboriginal and Torres Strait Islander Women, The Lowitja Institute, Melbourne - Details - Abstract

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.

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Wise, M., Angus, S., Harris, E. & Parker, S. 2013, National Appraisal of Continuous Quality Improvement Initiatives in Aboriginal and Torres Strait Islander Primary Health Care, The Lowitja Institute, Melbourne. - Details - Abstract

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.


Wise, M., Angus, S., Harris, E. & Parker, S., 2013, 'National Appraisal of Continuous Quality Improvement Initiatives in Aboriginal and Torres Strait Islander Primary Health Care, The Lowitja Institute, Melbourne. - Download [2,190 KB] - Link - Abstract

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 project

  • reviewed 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
  • identified potential actions to progress further development of CQI initiatives over the next decade, taking into account strengths, weaknesses, opportunities and priorities.

McCalman, J., Tsey, K., Bainbridge, R. G., Shakeshaft, A., Singleton, M. & Doran, C. M. 2013, Tailoring a Response to Youth Binge Drinking in an Aboriginal Australian Community: A grounded theory study, BMC Public Health, vol. 13. pp. 1–9 - Link - Abstract

Background

While Aboriginal Australian health providers prioritise identification of local community health needs and strategies, they do not always have the opportunity to access or interpret evidence-based literature to inform health improvement innovations. Research partnerships are therefore important when designing or modifying Aboriginal Australian health improvement initiatives and their evaluation. However, there are few models that outline the pragmatic steps by which research partners negotiate to develop, implement and evaluate community-based initiatives. The objective of this paper is to provide a theoretical model of the tailoring of health improvement initiatives by Aboriginal community-based service providers and partner university researchers. It draws from the case of the Beat da Binge community-initiated youth binge drinking harm reduction project in Yarrabah.

Methods

A theoretical model was developed using the constructivist grounded theory methods of concurrent sampling, data collection and analysis. Data was obtained from the recordings of reflective Community-Based Participatory Research (CBPR) processes with Aboriginal community partners and young people, and university researchers. CBPR data was supplemented with interviews with theoretically sampled project participants. The transcripts of CBPR recordings and interviews were imported into NVIVO and coded to identify categories and theoretical constructs. The identified categories were then developed into higher order concepts and the relationships between concepts identified until the central purpose of those involved in the project and the core process that facilitated that purpose were identified.

Results

The tailored alcohol harm reduction project resulted in clarification of the underlying local determinants of binge drinking, and a shift in the project design from a social marketing awareness campaign (based on short-term events) to a more robust advocacy for youth mentoring into education, employment and training. The community-based process undertaken by the research partnership to tailor the design, implementation and evaluation of the project was theorised as a model incorporating four overlapping stages of negotiating knowledges and meanings to tailor a community response.

Conclusions

The theoretical model can be applied in spaces where local Aboriginal and scientific knowledges meet to support the tailored design, implementation and evaluation of other health improvement projects, particularly those that originate from Aboriginal communities themselves.


The Lowitja Institute and its projects produce a variety of publications and resources, listed below. Scroll down to browse or use the search fields to find what you are looking for.

Our publications include material from the Lowitja Institute, the CRCATSIH and our predecessors the Cooperative Research Centre for Aboriginal Health (CRCAH: 2003–2009) and the Cooperative Research Centre for Aboriginal and Tropical Health (CRCATH: 1997–2003).

If you have problems finding publications, please contact publications@lowitja.org.au.