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

Purpose

Pregnancy care guidelines in many countries recommend that alcohol consumption is addressed for all women as part of routine antenatal care. Considerations should be given to providing culturally appropriate care for First Nations women. Limited studies have explored the perceptions of Aboriginal and Torres Strait Islander women in Australia regarding such care. This study aimed to explore Aboriginal and Torres Strait Islander women’s experiences and acceptance of receiving antenatal care addressing alcohol consumption from maternity services, as well as their suggestions for culturally appropriate strategies for positive care experiences.

Methods

Nine yarning groups were conducted across a large local health district in New South Wales, Australia, between November 2017 and October 2018. Aboriginal and Torres Strait Islander women who had attended a maternity service within the last two years were purposively recruited through existing networks. An Aboriginal-led Indigenist and community-based participatory action research approach and yarning were used to explore the women’s experiences and suggestions for culturally appropriate care. Three Aboriginal researchers facilitated the yarning groups. Yarning groups were transcribed and analysed using thematic analysis.

Main findings

Thirty-nine Aboriginal and Torres Strait Islander women participated in the yarning groups. The women reported mixed experiences of antenatal care regarding alcohol consumption during pregnancy; however, they were largely accepting of receiving such care from their antenatal providers. Two main themes that centred around empowerment and safety were identified. The women suggested that these could be addressed with the following approaches: i) all pregnant women should be asked and informed about the risks of alcohol; ii) continuity of care models should be used; iii) holistic approaches should be used; and iv) support should be given without judgement and fear of reporting.

Principal conclusions

Aboriginal and Torres Strait Islander women want and expect to receive antenatal care around alcohol consumption during pregnancy. To inform their receipt of culturally appropriate care, Aboriginal and Torres Strait Islander women need to be engaged in decision-making about the implementation of pregnancy guidelines in maternity services.

Purpose

Methods

Main findings

Principal conclusions

Purpose

Methods

Main findings

Principal conclusions

Background

Perinatal inequities experienced by Aboriginal and Torres Strait Islander (First Nations) women and newborns are impacted by colonisation. As a redress, government health policies recommend the implementation of evidence-based, co-designed models of care. Maternity services that are committed to meeting the needs of First Nations communities must centre the voices of First Nations women in program planning, implementation, and evaluation. The purpose of the study was to explore the views and experiences of First Nations women who gave birth at one of the health services where new models had been implemented.

Methods

The study design was developed with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), the partner sites, staff from their respective Aboriginal Health Units and the project Aboriginal Advisory Committee. Using an overall framework underpinned by Critical Race Theory and Indigenous methodologies, a descriptive qualitative design integrated with ‘yarning’ was used. Women were interviewed by a First Nations researcher and data analysed thematically.

Main findings

Ten women participated in an interview. Overall, women reported having very positive experiences of the culturally tailored caseload midwifery models. Key contributing factors were ‘relationships’ (continuity and accessibility of their known midwife), ‘trust’ (with their midwife and the program) and ‘culture’ (acknowledging identity and a safe space). These elements were considered as essential for culturally safe maternity care. Women reported challenges within the broader maternity system if trust, relationships or culture were missing. Women also reported that support and care from First Nations staff was important.

Principal conclusions

Women in this study endorsed the implementation of culturally tailored continuity of midwife models of care. Trust, relationships and culture were the trifecta for a safe and positive maternity care experience.

Purpose

Knowledge translation (KT) has always been an essential part of Indigenous lives and cultures. Indigenous communities worldwide develop, share, translate and apply knowledge for community benefit. As a result of settler-colonial structures, KT processes in academia are predominately informed by Euro-Western ways of thinking that are inappropriate for Indigenous communities and undermine Indigenous ways of knowing, being and doing.

Methods

A scoping review of KT literature in Aboriginal and Torres Strait Islander research contexts in Australia was conducted to lay the groundwork for developing KT methods and tools for this context. Items were eligible if they purposefully recruited Aboriginal and/or Torres Strait Islander participants, were in English and described ongoing or completed KT processes. Item screening and charting was iteratively conducted by Aboriginal and Torres Strait Islander peoples.

Main findings

Forty-seven items were found. Of these, eight were considered examples of KT and aligned with cultural ways of translating knowledge. There was limited information on KT in the included items: 35 did not state a theory, 19 did not define KT, 26 did not state Indigeneity of authors and 23 did not disclose any Aboriginal and/or Torres Strait Islander governance or partnership.

Principal conclusions

Knowledge translation has always been a core component of Indigenous cultures and there is opportunity to leverage this strong base to incorporate Indigenous KT in research. The meaningful application of Indigenous KT will ensure that research agendas and priorities are identified and driven by Aboriginal and Torres Strait Islander peoples, and that knowledge is appropriately translated to ensure long-term benefit for these communities.

Purpose

Aboriginal and Torres Strait Islander peoples’ culture is integral to health and wellbeing; this includes access to traditional Country, maintenance of kinship relationships, to speak traditional language and participate in cultural practices. Most clients commencing dialysis in remote Australia, including the Northern Australia region, identify as Aboriginal and/or Torres Strait Islander peoples. Aboriginal people who need kidney replacement therapy and are physically fit to access home dialysis report additional health and cultural benefits beyond achieved dialysis adequacy. This study aimed, within the setting of local COVID-19 pandemic preparations and response phases, to design and pilot a physical frailty assessment tool to inform the support needs of physically frail adults in the Northern Territory of Australia after starting haemodialysis.

Methods

Informed by a literature review and patient advisors, the tool incorporated patient-important domains of dyspnoea, strength, mobility and fitness using the Medical Research Council dyspnoea scale, hand grip strength, de Morton Mobility Index and 1-minute sit-to-stand test. During April to September 2021, frailty measures were recorded at baseline and 16 weeks at one outpatient location, alongside optional restorative care and individualised physical function goal setting. Data were presented as median (IQR) and percentage.

Main findings

Twenty adults completed the baseline assessment: median age was 51 (47, 67) years, 80% were Aboriginal and/or Torres Strait Islander peoples, 80% were utilising haemodialysis and 53 (35, 74) days after incident dialysis. All study participants identified physical function goals, including walking improvement. Baseline measures for the dyspnoea scale and de Morton Mobility Index were 3 (1, 4) and 74 (67, 96); hand grip strength was 21.1 (21.1, 27.4) kg, and 1-minute sit-to-stand repetitions was 16.0 (3.3, 21.0), respectively. Ten patients returned for follow-up measures, with a 70% goal achievement and statistically significantly improved measures for hand grip strength (P = 0.03), de Morton Mobility Index (P = 0.04) and 1-minute sit-to-stand (P = 0.02).

Principal conclusions

Baseline physical frailty and subsequent personal physical goal attainment were associated with improvements in strength, fitness and mobility in adults after starting dialysis.

Purpose

Wellbeing is eroded when Indigenous children are forcefully removed from families and communities. This study explored how intergenerational child apprehension shapes human immunodeficiency virus (HIV) health and wellness among young Indigenous peoples who have used drugs and are living with HIV.

Methods

This exploratory sequential mixed-methods study took place within the Cedar Project cohort and involved young Indigenous peoples who have used drugs in British Columbia, Canada. In-depth interviews addressing HIV cascade of care experiences involved 12 participants living with HIV in 2016. Interpretive description identified themes. Based on qualitative findings, longitudinal generalised linear mixed effects models involving 52 participants investigated relationships between intergenerational child apprehension and HIV viral suppression using data collected between 2011–14.

Main findings

Family connections, child apprehension and parenting concerns were identified as central to HIV health and wellness. Themes highlighting intersections included: (1) impact of removal from families on long-term health and wellbeing; (2) (re)connecting with family; (3) intersections of substance use, child apprehension and HIV; (4) fear, stress and demands of maintaining/regaining custody of children; and (5) traditional wellness practices being valued but complicated. Having been apprehended as a child (aOR 0.23; 95% CI 0.06–0.82) and having had a child apprehended (aOR 0.24; 95% CI 0.07–0.77) were associated with reduced odds of HIV viral suppression.

Principal conclusions

Young Indigenous peoples who have used drugs were >75% less likely to be virally suppressed if they had been apprehended from their parents as children, or their own children had been apprehended. It is believed that this is the first study to demonstrate statistical links between intergenerational child apprehensions and negative HIV outcomes among Indigenous people with HIV. Respecting Indigenous rights to self-determination over child welfare processes is urgent. HIV care for young Indigenous peoples who have used drugs must acknowledge and address ongoing impacts of intergenerational child apprehensions. Supporting parenting and family connections is essential to culturally-safe, healing-centred HIV care.

Purpose

During March 2021 to February 2022, within a local pandemic preparation and response phase in the Northern Territory (Australia), the New Start Dialysis Transition Programme (NSDTP) extended usual services by designing and implementing three activities aimed to support patients with kidney failure to Live Strong after starting dialysis: a) incorporation of COVID-safe education at group health education sessions, b) Frailty to Fit restorative physiotherapy and c) a COVID and culturally-safe, frailty-enabled transport service. This qualitative study evaluated these initiatives within the broader socio-environmental context.

Methods

The study was guided by an evolved Grounded Theory approach. Feedback was gained from 61 participants, involving Aboriginal and Torres Strait Islander people with lived experience of dialysis care, their family caregivers, health professionals and Indigenous Patient Reference Group members.

Main findings

Multiple data sources and a related comprehensive thematic analysis generated six key themes: 1) COVID-safe education delivery enabled family learning, was culturally respectful and strengths-based; 2) physiotherapy was personalised and patients experienced enjoyment; and 3) the transport service accommodated frailty needs and supported COVID safety needs. Participants also reported that within the broader socio-environmental context Live Strong meant: 4) living with purpose and dignity; and 5) living for the family, culture and the Country. Thus, participants recommended that 6) health systems could enable patients to ‘Live Strong’ by providing cultural understanding and patient safety across all healthcare settings they used.

Principal conclusions

Participants confirmed acceptability and recommended sustainability of three innovative services. These were designed, delivered and incorporated within usual care during the local COVID pandemic preparation and response. Success was credited to service flexibility that prioritised patient needs, family-inclusive care, and empathetic and respectful staff who had good cultural understanding of kidney care and strong team collaboration. Participants also recommended health systems to support the transferability of those success attributes to other healthcare settings.