Using photovoice to generate solutions to improve food security among families living in remote Aboriginal and/or Torres Strait Islander communities in Australia.

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.

Exposure to the Family Wellbeing program and associations with empowerment, health, family and cultural wellbeing outcomes for Aboriginal and Torres Strait Islander peoples: a cross-sectional analysis.

BACKGROUND: Empowerment is an internationally recognised concept commonly incorporated in First Nations and in this instance Aboriginal and Torres Strait Islander health and wellbeing programs. The Family Wellbeing Program is an empowerment program developed in partnership with Aboriginal and Torres Strait Islander peoples that has been widely delivered to Aboriginal and Torres Strait Islander communities across Australia for close to 30 years. To date, there has been limited quantitative analysis of how this program is linked to health and empowerment outcomes. METHODS: Cross sectional analysis of Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, baseline data (n = 9,843) recruited using multi-mode random sampling including mail out survey and in community convenience sampling. Logistic regression models were performed to calculate Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) to examine the association between personal control, life satisfaction, general health, family wellbeing and cultural wellbeing outcomes for Family Wellbeing participants (n = 718) versus non-participants (n = 9,125). RESULTS: Compared with non-FWB participants, FWB participants are more likely to be female (67.1% versus 58.4%), be aged 35-54 (41.8% versus 32.0%) and live in a remote area (17.7% versus 10.4%) and have educational attainment at the Year 12 level or above (57.8% versus 53.2%). Family Wellbeing participation was associated with a 13% higher reporting of family functioning, a 74% higher reporting of cultural participation and a 21% in higher reporting of local decision making in the local community compared to non-FWB participants. There were significant associations between FWB exposure compared to non-FWB exposure including reporting lower levels of health risk factors including quitting alcohol (26.4% versus 20.4%), regular exercise (67.7% versus 66.3%), quitting smoking (33.4% versus 31.9%). and e. FWB participants who had experienced both prison and youth detention were nearly double that of Non-FWB (3.5% versus 1.4%) and more reported being removed from their families as children (Stolen) (7.0% versus 4.1% Non-FWB). CONCLUSION: There are significant associations between Family Wellbeing exposure and organisation and community level empowerment outcomes, but only for some individual level empowerment outcomes. There is a lower reporting health risk factors including increased physical exercise, reduced alcohol use and smoking; and educational attainment among FWB participants compared to non-FWB participants. The results suggest individual, community and organisational empowerment needs to be explored further with more robust study designs that can attribute causality and direction of association.

"We are not stray leaves blowing about in the wind": exploring the impact of Family Wellbeing empowerment research, 1998-2021.

BACKGROUND: An Aboriginal-developed empowerment and social and emotional wellbeing program, known as Family Wellbeing (FWB), has been found to strengthen the protective factors that help Indigenous Australians to deal with the legacy of colonisation and intergenerational trauma. This article reviews the research that has accompanied the implementation of the program, over a 23 year period. The aim is to assess the long-term impact of FWB research and identify the key enablers of research impact and the limitations of the impact assessment exercise. This will inform more comprehensive monitoring of research impact into the future. METHODS: To assess impact, the study took an implementation science approach, incorporating theory of change and service utilisation frameworks, to create a logic model underpinned by Indigenous research principles. A research impact narrative was developed based on mixed methods analysis of publicly available data on: 1) FWB program participation; 2) research program funding; 3) program outcome evaluation (nine studies); and 4) accounts of research utilisation (seven studies). RESULTS: Starting from a need for research on empowerment identified by research users, an investment of $2.3 million in research activities over 23 years produced a range of research outputs that evidenced social and emotional wellbeing benefits arising from participation in the FWB program. Accounts of research utilisation confirmed the role of research outputs in educating participants about the program, and thus, facilitating more demand (and funding acquisition) for FWB. Overall research contributed to 5,405 recorded participants accessing the intervention. The key enablers of research impact were; 1) the research was user- and community-driven; 2) a long-term mutually beneficial partnership between research users and researchers; 3) the creation of a body of knowledge that demonstrated the impact of the FWB intervention via different research methods; 4) the universality of the FWB approach which led to widespread application. CONCLUSIONS: The FWB research impact exercise reinforced the view that assessing research impact is best approached as a "wicked problem" for which there are no easy fixes. It requires flexible, open-ended, collaborative learning-by-doing approaches to build the evidence base over time. Steps and approaches that research groups might take to build the research impact knowledge base within their disciplines are discussed.

Stillbirth risks and rates for Aboriginal and Torres Strait Islander women and their babies in North Queensland.

BACKGROUND: The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants remains higher than non-Indigenous rates. Risks for stillbirth include maternal factors such as ethnicity, age, geographic location, and physical health. Fetal risk factors include gestational age, birthweight and congenital anomalies. The total stillbirth rate for all babies born at the Townsville University Hospital during the study period was 11 per 1000 births. AIMS: To identify Aboriginal and Torres Strait Islander stillbirth rates, risk factors and causes in North Queensland. MATERIALS AND METHODS: A retrospective chart audit was conducted to identify Indigenous women who had experienced stillbirth in the Townsville University Hospital between January 2005 and December 2014. RESULTS: Thirty-two charts were available for audit. The stillbirth rate for non-Indigenous infants was 10.3 per 1000 births. The stillbirth rate for Indigenous infants was 11.7 per 1000 births. Almost half of the women lived in rural, remote or very remote areas. Maternal risk factors included poorer physical health, such as obesity, diabetes, hypertension, and smoking, fertility issues and lack of antenatal care. Fetal risk factors included congenital anomalies, including cardiac and skeletal abnormalities, placental disorders, and preterm birth. CONCLUSIONS: Stillbirth risk remains higher for Aboriginal and Torres Strait Islander women and their babies. Supporting women to enhance their health is paramount, particularly during pregnancy. Further, increasing awareness of stillbirth risk factors through education for both women and healthcare professionals will support culturally responsive care for women and their families to mitigate stillbirth risk and enhance pregnancy outcomes in non-urban Queensland.

Major amputation rates and outcomes for Aboriginal and Torres Strait Islander and non-Indigenous people in North Queensland Australia between 2000 and 2015.

BACKGROUND: This study estimated the incidence of major amputation for people in North Queensland, Australia, examined changes in amputation rates over time and investigated survival after major amputation. METHODS: This was a retrospective study of patients who underwent a major amputation above the ankle between 2000 and 2015. Major amputation rates and incidence rate ratios (IRR) were calculated using census data to define the at-risk population. Associations between risk factors and calendar year with major amputation were assessed using quasipoisson regression. Kaplan-Meier survival and Cox-proportional hazard analyses estimated the incidence of and risk factors for all-cause mortality. RESULTS: The annual incidence of major amputation was estimated to be greater in Aboriginal and Torres Strait Islanders than non-Indigenous people (IRR 2.75, 95 % CI 1.92 to 3.84). After adjusting for population growth, the annual incidence of major amputations did not change significantly over time for either groups. Aboriginal and Torres Strait Islander people were at greater risk of all-cause mortality after major amputation compared to non-Indigenous people, although this association was not significant after adjusting for other risk factors (hazard ratio 1.24, 95 % CI 0.82 to 1.90). CONCLUSIONS: The incidence of major amputation in North Queensland has not reduced over time, indicating the need for better preventative treatments, particularly in Aboriginal and Torres Strait Islander people.

Decisions to consent for autopsy after stillbirth: Aboriginal and Torres Strait Islander women's experiences.

BACKGROUND: The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants is twice that for non-Indigenous infants. Autopsy is the gold standard for fetal investigation; however, parental consent is often not given. There is little research investigating the drivers of parents' decision-making for autopsy after stillbirth. AIMS: The current study explored the reasons why Aboriginal and Torres Strait Islander women did or did not give permission to autopsy after stillbirth. MATERIALS AND METHODS: Five Aboriginal and/or Torres Strait Islander women participated in semi-structured interviews. Thematic analysis was conducted within a phenomenological framework. RESULTS: Five themes were identified as reasons for giving permission - to find out why the baby died; to confirm diagnosis; to understand future risk; to help others; and doubt about maternal causes. Four themes were identified as reasons for declining permission - not asked in a sensitive manner; not enough time to think; distress about the autopsy procedure; and unwilling to agree. There was a lack of acceptability of the lengthy timeframe for the availability of autopsy results as families usually wait between three and nine months. This lengthy waiting period negatively impacted upon families' health and wellbeing. CONCLUSIONS: It is important for health professionals to understand the factors that parents consider when giving permission for autopsy after stillbirth. It is hoped that an increase in autopsy rate will enhance the understanding of the causes of stillbirth and ultimately decrease the stillbirth rate for Aboriginal and Torres Strait Islander families.

Study protocol: a clinical trial for improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children using the Kimberley Mum's Mood Scale.

BACKGROUND: Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum's Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the 'real world' validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. METHODS: The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach's alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. DISCUSSION: This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. TRIAL REGISTRATION: The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).

Presentation and outcomes of indigenous Australians with peripheral artery disease.

BACKGROUND: The risk factors for peripheral artery disease (PAD) are more common in Indigenous than non-Indigenous Australians, however the presentation and outcome of PAD in Indigenous Australians has not been previously investigated. The aim of this prospective cohort study was to compare the presenting characteristics and clinical outcome of Indigenous and non-Indigenous Australians with PAD. METHODS: PAD patients were prospectively recruited and followed-up since 2003 from an outpatient vascular clinic in Townsville, Australia. Presenting symptoms and risk factors in Indigenous and non-Indigenous patients were compared using Pearson's χ2 test and Mann Whitney U test. Kaplan Meier survival analysis and Cox proportional hazard analysis were used to compare the incidence of myocardial infarction (MI), stroke or death (major cardiovascular events) among Indigenous and non-Indigenous patients. RESULTS: Four hundred and one PAD patients were recruited, of which 16 were Indigenous and 385 were non-Indigenous Australians. Indigenous Australians were younger at entry (median age 63.3 [54.7-67.8] vs 69.6 [63.3-75.4]), more commonly current smokers (56.3% vs 31.4%), and more frequently had insulin-treated diabetes (18.8% vs 5.2%). During a median follow-up of 2.5 years, five and 45 major cardiovascular events were recorded amongst Indigenous and non-Indigenous Australians, respectively. Indigenous Australians were at ~ 5-fold greater risk of major cardiovascular events (adjusted hazard ratio 4.72 [95% confidence intervals 1.41-15.78], p = 0.012) compared to non-Indigenous Australians. CONCLUSIONS: These findings suggest that Indigenous Australians with PAD present at a younger age, have higher rates of smoking and insulin-treated diabetes, and poorer clinical outcomes compared to non-Indigenous Australians.

Cultural challenges when developing anti-tobacco messages for Indigenous Australians.

Recently, many programs have been funded to tackle Indigenous Australian smoking. This study assessed what challenges and unexpected responses could occur when developing anti-tobacco messages for Indigenous communities. A cross-sectional telephone survey of organizations involved in making anti-tobacco messages for the target population was conducted in 2012-2013. Open-ended questions explored cultural challenges to message development and unexpected outcomes. Responses were noted and these qualitative data were independently coded by two researchers using an inductive analysis. Non-parametric tests explored associations between organization orientation, whether target group feedback about messages was sought (pre-tests) and the presence of the above factors. The 47 organizations represented included: 22 Aboriginal Medical Services (AMS), 13 government organizations (GO), eight non-government organizations (NGO) and four universities. The response rate was 83%. Cultural challenges were reported equally by organizations oriented towards Aboriginal communities and those oriented towards the general population. Organizations conducting target group pre-tests of the messages were more likely to report cultural challenges (p = 0.002). Four main themes were revealed: the diversity of Aboriginal and Torres Strait Islander cultures; the selection of role models; conflicts and delays; and unexpected outcomes. Nearly 60% of organizations reported better-than-expected outcomes e.g. community appreciation and pride. A further 40% reported negative responses, e.g. messages being misunderstood or confronting. Cultural challenges and unexpected outcomes are reported by Australian organizations when developing anti-tobacco messages for Indigenous Australians warranting attention to improve the salience of anti-tobacco messages for Indigenous peoples.NB. In this paper, Indigenous Australians is a term used to refer to Aboriginal and Torres Strait Islander peoples, the first inhabitants of Australia. No offence is intended. The authors acknowledge and respect that Aboriginal and Torres Strait Islander people are diverse populations with different language and cultural groups.

Getting over the shock: taking action on Indigenous maternal smoking.

Smoking rates are slow to decline among pregnant Indigenous women. One in two pregnant Indigenous Australian women is a tobacco smoker compared with one in eight in the non-Indigenous population. The National Close the Gap strategy ambitiously aims to reduce Indigenous smoking prevalence to half by 2018, but this goal is unlikely to be achieved. Evidence is growing to better inform targeted strategies for Indigenous pregnant women based on national and international studies. It is proposed to be an appropriate time to refine translational approaches for anti-tobacco messages and cessation support in this population, rather than waiting for further empirical research before making these essential changes. Systemic barriers to Indigenous pregnant women receiving equitable primary health care have been identified, are remediable, and urgently require addressing. These barriers include: (1) lack of subsidised access to suitable oral forms of nicotine replacement therapy; (2) lack of clinician training in the complex area of management of maternal Indigenous smoking; and (3) lack of targeted health promotion programs addressing the psychosocial challenges that Indigenous women face. In the interim, translational strategies to target tobacco control and cessation in pregnant Indigenous women need to be based on current evidence.

Systematic review of youth mental health service integration research.

Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998-2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12-25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.

No one's discussing the elephant in the room: contemplating questions of research impact and benefit in Aboriginal and Torres Strait Islander Australian health research.

BACKGROUND: There remains a concern that Indigenous Australians have been over-researched without corresponding improvements in their health; this trend is applicable to most Indigenous populations globally. This debate article has a dual purpose: 1) to open a frank conversation about the value of research to Indigenous Australian populations; and 2) to stimulate ways of thinking about potential resolutions to the lack of progress made in the Indigenous research benefit debate. DISCUSSION: Capturing the meaning of research benefit takes the form of ethical value-oriented methodological considerations in the decision-making processes of Indigenous research endeavours. Because research practices come from Western knowledge bases, attaining such positions in research means reconciling both Indigenous and Western knowledge systems to produce new methodologies that guide planning, evaluating and monitoring of research practices as necessary. Increasingly, more sophisticated performance measures have been implemented to ensure academic impact and benefits are captured. Assessing societal and other non-academic impacts and benefits however, has not been accorded corresponding attention. Research reform has only focussed on research translation in more recent years. The research impact debate must take account of the various standards of accountability (to whom), impact priorities (for whom), positive and negative impacts, and biases that operate in describing impact and measuring benefit. SUMMARY: A perennial question in Indigenous research discourse is whether the abundance of research conducted; purportedly to improve health, is justified and benefits Indigenous people in ways that are meaningful and valued by them. Different research stakeholders have different conceptions of the value and nature of research, its conduct, what it should achieve and the kinds of benefits expected. We need to work collaboratively and listen more closely to the voice of Indigenous Australians to better understand, demonstrate and measure health research benefits. The authors conclude that as an imperative, a systematic benefit assessment strategy that includes identification of research priorities and planning, monitoring and evaluation components needs to be developed and implemented across research projects. In Indigenous health research, this will often mean adopting a benefit-led approach by changing the way research is done and preferencing alternative research methodologies. As a point of departure to improving impact and reaching mutually beneficial outcomes for researchers and partners in Indigenous health research, we need to routinise the assessment of benefit from outset of research as one of the standards toward which we work.

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community.

BACKGROUND: The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. METHODS/DESIGN: The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. DISCUSSION: There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.

Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey.

BACKGROUND: Smoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations. METHODS: Telephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships. RESULTS: Among organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n=24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p<0.005) and advised smokers to quit (p<0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p<0.05) and government organisations (p<0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p<0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as "cultural understanding" (bottom-up, community-based approaches, deep structures) and "rigour" (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data. CONCLUSION: Message features, associated with successful campaigns in other populations, are starting to be used for Aboriginal and Torres Strait Islander peoples. A model is proposed to facilitate the development of targeted anti-tobacco messages for Aboriginal and Torres Strait Islander peoples. Organisations could consider incorporating both components of cultural understanding-rigour to enable the growth of evidence-based practice.

What Matters to Aboriginal and Torres Strait Islander Youth (WM2Y): a study protocol to develop a national youth well-being measure.

INTRODUCTION: Adolescents face challenges associated with unprecedented environmental, social and technological changes. The impacts of colonisation, intergenerational trauma, racism and socioeconomic disadvantage intensify these challenges for many Aboriginal and Torres Strait Islander adolescents. However, Aboriginal and Torres Strait Islander adolescents also have cultural, spiritual, family and community capital that fosters their well-being.To date, little research has focused on understanding and appropriately measuring the well-being of Aboriginal and Torres Strait Islander adolescents, a pivotal factor in informing and guiding programmes and interventions that support them. This study will identify the domains of well-being and develop a new preference-based well-being measure based on the values and preferences of Aboriginal and Torres Strait Islander youth (aged 12-17 years). METHODS AND ANALYSIS: This project will be conducted across three research phases: (1) qualitative exploration of well-being using PhotoYarning and yarns with adult mentors to develop candidate items; (2) Think Aloud study, quantitative survey, psychometric analysis, validity testing of candidate items and finalisation of the descriptive system; and (3) scoring development using a quantitative preference-based approach. A multinomial (conditional) logit framework will be used to analyse responses and generate a scoring algorithm for the new preference-based well-being measure. ETHICS AND DISSEMINATION: Ethics approvals have been obtained from: the Human Research Ethics Committees for each state and territory where data are being collected, the institutions where the research is being conducted and from the relevant Departments of Education. The new well-being measure will have wide applicability and can be used in assessing the effectiveness of programmes and services. This new national measure will ensure benefit and positive impact through the ability to identify and measure the aspects of well-being important to and valued by Aboriginal and Torres Strait Islander youth. Results will be published in international peer-reviewed journals and presented at conferences, and summaries will be provided to the study partner organisations and other relevant organisations.

Coming to an ethics of research practice in a remote Aboriginal Australian community.

BACKGROUND: This paper identifies the latent opportunities and challenges inherent in the formative stages of a project that was resumed after partial completion by other on-the-ground research teams. METHODS: Grounded theory methods were used to analyse project documentation from previous research teams and to generate new process-oriented data. RESULTS: The intention of all research teams was moving towards Engaging in Community-Based Participatory Research; this was conceptually identified as the core category. The social process involved in achieving community engagement practice was named Coming to an Ethics of Practice. Four different facets comprised the core category: Developing meaningful relationships; being reflective; recognising difference; and making research relevant. CONCLUSIONS: To achieve mutually beneficial outcomes, researchers conducting community-based research with Aboriginal people must implement strengths-based approaches to realise ethically sound research; prioritise the relevance of the research to the daily lives, needs and aspirations of those with whom they work; and in doing so, remain cognisant of their own philosophical position and context in which the research is located.

Counting what counts: a systematic scoping review of instruments used in primary healthcare services to measure the wellbeing of Indigenous children and youth.

BACKGROUND: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. METHODS: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. RESULTS: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. CONCLUSION: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth.

Communities Setting the Direction for Their Right to Nutritious, Affordable Food: Co-Design of the Remote Food Security Project in Australian Indigenous Communities.

Despite long histories of traditional food security, Indigenous peoples globally are disproportionately exposed to food insecurity. Addressing this imbalance must be a partnership led by Indigenous peoples in accordance with the UN Declaration of the Rights of Indigenous Peoples. We report the co-design process and resulting design of a food security research project in remote Australia and examine how the co-design process considered Indigenous peoples' ways of knowing, being, and doing using the CREATE Tool. Informed by the Research for Impact Tool, together Aboriginal Community Controlled Health Organisation staff, Indigenous and non-Indigenous public health researchers designed the project from 2018-2019, over a series of workshops and through the establishment of research advisory groups. The resulting Remote Food Security Project includes two phases. Phase 1 determines the impact of a healthy food price discount strategy on the diet quality of women and children, and the experience of food (in)security in remote communities in Australia. In Phase 2, community members propose solutions to improve food security and develop a translation plan. Examination with the CREATE Tool showed that employing a co-design process guided by a best practice tool has resulted in a research design that responds to calls for food security in remote Indigenous communities in Australia. The design takes a strengths-based approach consistent with a human rights, social justice, and broader empowerment agenda. Trial registration: The trial included in Phase 1 of this project has been registered with Australian New Zealand Clinical Trials Registry: ACTRN12621000640808.

A Silver Fluoride Intervention to Improve Oral Health Trajectories of Young Indigenous Australians: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Indigenous Australian children and adolescents experience profound levels of preventable dental disease. The application of silver fluoride (AgF) to active dental caries is a noninvasive alternative to traditional dental treatment approaches. There is particular utility among Indigenous children and young people with dental fear, who may not have access to timely or culturally safe dental service provisions. OBJECTIVE: The aims of this study are to: (1) assess levels of active dental caries among Indigenous children and young people in 6 Australian states and territories; (2) determine if an AgF intervention reduces levels of active disease over 12-24 months; (3) measure the impact of improved oral health on social and emotional well-being (SEWB) and oral health-related quality of life; and (4) calculate the cost-effectiveness of implementing such an initiative. METHODS: The study will use a 2-arm, parallel cluster randomized controlled trial design. Approximately 1140 Indigenous children and youth aged between 2 and 18 years will be recruited. Each state or territory will have 2 clusters. The intervention group will receive the AgF intervention at the start of the study, with the delayed intervention group receiving the AgF intervention 12 months after study commencement. The primary outcome will be the arrest of active carious lesions, with arrested caries defined as nonpenetration by a dental probe. Secondary outcomes will include SEWB, oral health-related quality of life, and dental anxiety, with covariates including dental behaviors (brushing and dental visits). Effectiveness measures for the economic evaluation will include the number of children and young people managed in primary oral health care without the need for specialist referral, changes in SEWB, the numbers and types of treatments provided, and caries increments. RESULTS: Participant recruitment will commence in May 2023. The first results are expected to be submitted for publication 1 year after a 24-month follow-up. CONCLUSIONS: Our findings have the potential to change the way in which active dental disease among Indigenous children and young people can be managed through the inclusion of specifically tailored AgF applications to improve dental health and SEWB delivered by Indigenous health care workers. Desired impacts include cost savings on expensive dental treatments; improved SEWB, nutrition, social, and learning outcomes; and improved quality of life for both children and young people and their caregivers and the broader Indigenous community. The AgF application could be easily implemented into the training program of Indigenous health workers and yield critical information in the management armamentarium of health and well-being recommendations for Australia's First Peoples. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48558.