First Nations Health and Wellbeing - The Lowitja Journal最新文献

Purpose

To explore community and workforce perspectives on how the Home Care Package (HCP) program supports the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander peoples.

Methods

This qualitative design study included semi-structured interviews and a focus group with Aboriginal and Torres Strait Islander peoples receiving an HCP (n = 15) and aged care workers providing service coordination to Aboriginal and Torres Strait Islander peoples (n = 7) across metropolitan, rural and remote areas of South Australia. Semi-structured interviews and the focus group took place between March 2022 and February 2023. Data were analysed using thematic analysis.

Main findings

Twenty-two participants were involved in this study. Seven themes representing how the HCP program supports, or could better support, the SEWB of clients were identified: 1) maintaining independence, 2) supporting grief and loss, 3) facilitating social connections, 4) promoting choice and control, 5) assessment and funding, 6) cross-sectoral support and 7) strengthening the workforce.

Principal conclusions

The findings contribute to a deeper understanding of the unique SEWB needs of Aboriginal and Torres Strait Islander peoples accessing home-based aged care services and have significant implications for current and future aged care reforms in Australia.

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Purpose

Scant attention has been paid to the experiences of researchers engaged in cohort studies of minority populations such as Indigenous children and their families. This qualitative study aimed to explore the practical challenges, strategies and solutions used by researchers representing 10 prospective cohort studies of Australian Aboriginal and Torres Strait Islander children and young people.

Methods

Eighteen researchers, 44.5% of whom identified as Aboriginal, were interviewed. Reflexive thematic analysis was conducted.

Main findings

Four overarching themes were generated from the dataset: (1) getting things just right; (2) build and nurture connections with community and staff; (3) ‘sit and yarn with them’: approaches to recruitment and retention; and (4) great responsibility. These themes underline the importance of developing early community partnerships to guide the scope and direction of the research, building a solid team of local Aboriginal researchers with community connections, and prioritising two-way learning and feedback loops from the beginning.

Principal conclusions

It is imperative to take a flexible and pragmatic approach to longitudinal studies involving Aboriginal children and their families that minimises participant burden while respecting local needs and priorities. Lessons learnt will be useful to new researchers undertaking, or planning to undertake, longitudinal research with First Nations populations.

Purpose

Chronic pain/mamae is a major public health problem worldwide, and disproportionately affects Indigenous populations impacted by colonisation. In Aotearoa New Zealand, Indigenous Māori experience a greater burden of chronic pain than non-Māori. However, pain services based on Western models are unlikely to adequately meet the needs of Indigenous peoples. Little is published about traditional Māori views of, or approaches to, managing mamae/pain, knowledge that is traditionally held by Kaumātua/Elders. Therefore, this study aimed to understand Kaumātua (Māori Elder) views on the effects of pain, traditional pain management practices and mātauranga Māori (Māori knowledge) relating to managing pain.

Methods

Fourteen Kaumātua participated in individual interviews or a hui/focus group. Methods honoured tikanga (Māori protocol) and centralised whanaungatanga (relationships). Interviews and the hui/focus group were transcribed, and reflexive thematic analysis was conducted.

Main findings

Three themes were developed: 1. The multidimensional aspects of pain. Pain stretched beyond the physical and encompassed emotional and mental trauma, wairua/spiritual pain, grief from the loss of loved ones, contamination of the environment or breaches of tikanga/protocol. Some mamae/pain was described as everlasting, passing between people or generations. 2.Whakawhanaungatanga/relationships: Healing through connection. Healing of pain was seen to occur through strengthening connections with people, the spiritual realm, the natural world and with papakāinga (one’s ancestral homeland). 3.Tino Rangatiratanga/self-determination: Strength to self-manage pain. Self-reliance to manage pain and self-determination to make health decisions were critical, and a stoical approach to pain was described. Stoicism was noted to avoid perceptions of weakness and burdening whānau/family, but may inhibit emotional expression, connection and healing.

Principal conclusions

Mātauranga Māori/Māori knowledge emphasises that pain and its healing should be considered multidimensional, incorporating physical, mental and relational components, existing in the spiritual realm and incorporating links between people, places, the past and future. Individuals may approach pain with a stoical approach, which has both positive and negative features. Pain services may wish to incorporate this knowledge of the spiritual, social and psychological aspects of pain and pain management to provide more meaningful care for people with pain.

Purpose

In 2021, during the height of the COVID-19 pandemic, researchers from the University of Queensland sought greater understanding of how responses to the pandemic impacted the spread or mitigation of virus in Indigenous communities in southeast Queensland, Australia. This article used a systems thinking methodology to critically unpack the strengths and challenges associated with pandemic responses during COVID-19 in urban Brisbane, Australia.

Methods

The findings from three Indigenous-led workshops held in 2020 with Indigenous and non-Indigenous stakeholders from the urban health sector were documented. By visually mapping the dynamics that influence the outcomes of health responses, this study found that holistic understandings of complex problems such as COVID-19 can be gained, and more effective policy implemented. Drawing on the insights provided by stakeholders from state, federal and community representative bodies, it discussed how infection rates, socioeconomic conditions, age-specific responses, Indigenous participation and treatment in the workforce, media and communications, and vaccinations are key determinants that shape positive or adverse outcomes during pandemics.

Main findings

This research found by addressing issues relating to mobility; incentivising protective behaviours; engaging in coordinated responses; improving cultural literacy; and limiting overcrowding that preparedness and responses to COVID-19 and future pandemics may improve.

Principal conclusion

This study, led by Indigenous scholars at the University of Queensland, examines the health and social outcomes of Indigenous peoples and health workers during pandemics in urban settings. The study incorporates systems thinking, emphasising new approaches to complex problems. The research highlighted systemic challenges in pandemic responses, emphasising the need for policy reform, particularly in areas like housing. However, applying these insights into practice remains challenging, and further investigation into the practical application of systems thinking in Indigenous health is needed.

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Purpose

Indigenous peoples from high income countries experience health disparities attributable to the ongoing legacy of colonisation and racism, including higher rates of diabetes and associated complications, including diabetes foot disease, in comparison to the relevant resident population. Providing culturally safe care through well-organised diabetes foot interventions can improve outcomes. This scoping review describes the range of publications detailing diabetes foot interventions that incorporated Indigenous peoples.

Methods

This scoping review followed the PRISMA-Scoping Review guide. Indigenous Māori perspectives were included in all stages of the review. Eligible publications described diabetes foot interventions that included Indigenous peoples from high-income countries. Key study characteristics included country, Indigenous population, intervention description, foot-related outcomes, and alignment with the CONSIDER statement domains for reporting on Indigenous involvement in health research.

Main findings

A total of 32 publications met the eligibility criteria, with publications from Australia (n = 14), Canada (n = 6), USA (n = 6), New Zealand (n = 2), Greenland (n = 2) and Nauru (n = 2). Primary prevention interventions were predominant (n=20) with a focus on increasing foot screening rates (n=16). Other interventions included health promotion and education (n=4), comprehensive foot interventions (n=5), foot care services embedded in undergraduate podiatry education, a diabetic foot ulcer management protocol, and a service brokerage model. Only 2 studies of the 29 evaluated reported all the CONSIDER statement domains.

Principal conclusions

Few publications described improved outcomes for Indigenous peoples and most interventions for diabetes-related foot disease overlooked Indigenous perspectives and health beliefs concerning feet. The CONSIDER statement provides useful guidance for all stages of research with Indigenous peoples and our findings suggest reporting Indigenous engagement could be strengthened.

First Nations scholars and practitioners have increasingly called for anti-racist healthcare to address disparate health outcomes between First Nations and non-First Nations Australians. However, these arguments largely miss the significant negative impact that colonial heterosexism and cisgenderism (i.e. discrimination and marginalisation of queer and transgender peoples) have on LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex, queer/questioning) First Nations peoples’ wellbeing. To address this gap, survey data from 63 First Nations LGBTIQ+ adults in Western Australia were utilised to illustrate the impact of racism, heterosexism and cisgenderism in healthcare settings on First Nations LGBTIQ+ peoples’ wellbeing. This study examined relations between participant wellbeing and 1) their comfort in being asked about their LGBTIQ+ and First Nations identity by a health provider, and 2) their experiences of race-based and LGBTIQ+-based discrimination (microaggressions) in broader community settings. Higher comfort in being asked about LGBTIQ+ identity was associated with higher wellbeing, whereas experiencing LGBTIQ+-based microaggressions within First Nations communities was associated with lower wellbeing. These findings add to the literature by showing that First Nations LGBTIQ+ patients experience additional discrimination. This paper also discusses findings with reference to settler-colonial racism (i.e. the racism enacted against First Nations LGBTIQ+ peoples to maintain settler norms and control) and offers suggestions for updating anti-racist healthcare.