Artificial intelligence and prediction of cardiometabolic disease: Systematic review of model performance and potential benefits in indigenous populations.

BACKGROUND: Indigenous peoples often have higher rates of morbidity and mortality associated with cardiometabolic disease (CMD) than non-Indigenous people and this may be even more so in urban areas. The use of electronic health records and expansion of computing power has led to mainstream use of artificial intelligence (AI) to predict the onset of disease in primary health care (PHC) settings. However, it is unknown if AI and in particular machine learning is used for risk prediction of CMD in Indigenous peoples. METHODS: We searched peer-reviewed literature using terms associated with AI machine learning, PHC, CMD, and Indigenous peoples. RESULTS: We identified 13 suitable studies for inclusion in this review. Median total number of participants was 19,270 (range 911-2,994,837). The most common algorithms used in machine learning in this setting were support vector machine, random forest, and decision tree learning. Twelve studies used the area under the receiver operating characteristic curve (AUC) to measure performance. Two studies reported an AUC of >0.9. Six studies had an AUC score between 0.9 and 0.8, 4 studies had an AUC score between 0.8 and 0.7. 1 study reported an AUC score between 0.7 and 0.6. Risk of bias was observed in 10 (77 %) studies. CONCLUSION: AI machine learning and risk prediction models show moderate to excellent discriminatory ability over traditional statistical models in predicting CMD. This technology could help address the needs of urban Indigenous peoples by predicting CMD early and more rapidly than conventional methods.

Education of the public health workforce and the Sustainable Development Goals: An analysis of existing competency sets.

Objectives: This paper describes a project designed to quantify the extent to which existing competency frameworks used for educating the public health workforce contribute to achieving the Sustainable Development Goals (SDGs) directly relevant to public health. Study design: This was a qualitative study involving a content and thematic analysis and mapping of nine available public health competency sets against the World Federation of Public Health Association's Global Charter for the Public's Health and the SDGs. Methods: First, the SDG targets directly relevant to public health were selected, then mapped against the elements of the Global Charter to illustrate their alignment with aspects of public health practice. Next, competencies from each respective framework were mapped against the SDG targets, and the results quantified as to the coverage of the SDG targets by each of the frameworks. Results: Overall, very few competencies directly or fully covered the SDG targets in question, however, there were more competencies partially covering the targets. Except for one framework, many issues found in the SDG targets were not explicitly addressed by the competencies in most of the frameworks, namely, migration, human rights, violence, and food and water scarcity. Conclusions: Overall, urgent action is required to ensure public health competency frameworks are more in line with the SDGs and include public health issues that disproportionally affect low- and middle-income countries.

Study protocol: primary healthcare transformation through patient-centred medical homes-improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study.

INTRODUCTION: For over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with the ACCHS sector-relational care responsive to patient identified healthcare priorities. Evidence is lacking on the implementation and effectiveness of the PCMH model of care governed by, and delivered for, Aboriginal and Torres Strait Islander populations in large urban settings. METHOD AND ANALYSIS: Our multiphased mixed-methods prospective cohort study will compare standard care provided by a network of ACCHS to an adapted PCMH model of care. Phase 1 using qualitative interviews with staff and patients and quantitative analysis of routine primary care health record data will examine the implementation, feasibility and acceptability of the PCMH. Phase 2 using linked survey, primary care and hospitalisation data will examine the impact of our adapted PCMH on access to care, relational and quality of care, health and wellbeing outcomes and economic costs. Phase 3 will synthesise evidence on mechanisms for change and discuss their implications for sustainability and transferability of PCMHs to the broader primary healthcare system ETHICS AND DISSEMINATION: This study has received approval from the University of Queensland Human Research Ethics Committee (2021/HE00529). This research represents an Aboriginal led and governed partnership in response to identified community priorities. The findings will contribute new knowledge on how key mechanisms underpinning the success and implementation of the model can be introduced into policy and practice. Study findings will be disseminated to service providers, researchers, policymakers and, most importantly, the communities themselves.

Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions.

BACKGROUND: Reproductive coercion and abuse (RCA) interferes with a person's reproductive autonomy and can be classified into behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion). However, prevalence data are lacking, and little is known about whether particular forms of RCA are more or less common. The aims of our study were to explore how frequently people seeking pregnancy counselling reported RCA, the proportions reporting the different forms of RCA, and whether there were different trends based on a range of demographic factors. METHODS: Data were collected from 5107 clients seeking counselling support for their pregnancy between January 2018 and December 2020 from two leading providers of pregnancy counselling and sexual and reproductive health services in Australia, Marie Stopes Australia and Children by Choice. Counsellors identified and recorded the presence of RCA and whether the behaviour was pregnancy promoting and/or pregnancy preventing. Demographic factors included age, and whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person. RESULTS: RCA was identified in 15.4% of clients, with similar proportions disclosing RCA towards pregnancy (6%) and towards pregnancy prevention or abortion (7.5%), and 1.9% experiencing RCA towards pregnancy and abortion concurrently. There were no differences based on age or whether the person identified as being from a migrant or refugee background, though people who identified as Aboriginal and/or Torres Strait Islander experienced RCA that was significantly more likely to be pregnancy promoting. CONCLUSIONS: RCA is commonly disclosed by people seeking support in a pregnancy counselling context, and coercion and abuse is equally likely to be towards pregnancy promotion or pregnancy prevention/abortion. Given the prevalence and negative impacts of RCA, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be embedded in healthcare, health education, and health research.

Reproductive coercion and abuse (RCA) is behaviour that interferes with a person's decision to become pregnant or to continue a pregnancy. We classified RCA into behaviours that attempt to promote pregnancy or to prevent/end a pregnancy. Drawing on data collected from 5107 people seeking counselling support for their pregnancy from two Australian services, this research explored how common the different types of RCA are. The research also looked at whether a person's age or whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person made any difference to the type of RCA they experienced. We found that 15.4% of people reported RCA, with similar proportions reporting behaviours attempting to promote pregnancy and prevent/end pregnancy. Around 2% reported experiencing both forms of RCA. We found that there were no differences in frequency of RCA based on age or whether the person identified as being from a migrant or refugee background, although we found that people who identified as Aboriginal and/or Torres Strait Islander were proportionally more likely to experience RCA that was pregnancy promoting. Given how common RCA is, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be included in any conversations around sexual and reproductive health care and education.

Mapping competency frameworks: implications for public health curricula design.

OBJECTIVES: We discuss the implications stemming from a recent competency mapping project on public health workforce education and training programs. METHODS: In line with professional practice, we reflected on the results of a major mapping exercise which examined public health competency frameworks against the Global Charter, particularly with respect to the implications for curriculum design. RESULTS: Our reflections identified five key challenges (diversity of frameworks, interpretation challenges, levels of competence, integration in curricula and knowledge vs skills-based competences) for developing internationally consistent credentialling standards. CONCLUSIONS: While the Charter provides an international benchmark for public health curricula, we argue that applying an international competency framework is challenging. Anyone working in public health should be trained in all foundation areas of public health to support public health practice and initiatives into the future and they may then choose to specialise in sub-disciplines of public health. IMPLICATIONS FOR PUBLIC HEALTH: Both theoretical and practical content must be fully integrated across public health programs to operationalise competencies. Utilising the Charter can ensure alignment with the sector needs, and curriculum mapping should be an integral part of a continual and ongoing review process.

Practical competencies for public health education: a global analysis.

OBJECTIVES: We quantified the contents of existing public health competency frameworks against the elements of the World Federation of Public Health Associations' Global Charter for the Public's Health. METHODS: We conducted a desktop analysis of eight public health competency frameworks publicly available on the internet. Using a pre-formed template, competency statements from each framework were mapped against the elements of the Global Charter-core public health services (Protection, Promotion and Prevention) and overarching enabling functions (Information, Governance, Capacity, and Advocacy). We then quantified coverage of the Charter's elements in each of the frameworks. RESULTS: We found that although the public health competency frameworks vary considerably in terms of coverage and focus, they all cover every element contained in the Global Charter. However, there were a number of areas of competency identified in some frameworks not explicitly referred to in the Charter including cultural safety, human rights and systems thinking. CONCLUSIONS: The Global Charter provides a mechanism for comparing competency sets, checking public health curricula content, informing competency framework and curricula (re)design, and planning and monitoring workforce needs.

Educating for Indigenous public health competence - how do we stack up in Australia?

OBJECTIVE: Internationally, work is underway to develop or revise public health graduate competencies, of which Indigenous public health competencies are a subset in Australia. This paper outlines the summative results from a review of Master of Public Health (MPH) programs undertaken to determine the level of coverage of Indigenous health in core content and to explore factors that influence the extent of integration. METHODS: Of the 22 Australian universities offering an MPH program at the commencement of this study, seven were eventually reviewed using a mixed methods approach. RESULTS: Results showed varying levels of relevant content in both core and elective subjects. Not all reviewed universities taught all the competencies in their core curriculum and some universities did not cover all the competencies in either the core or elective subjects. CONCLUSION: These findings highlight the need for inclusion of the Indigenous public health competencies to be made obligatory in MPH programs. Implications for public health: Significant gaps remain in public health curricula enabling students to develop competencies that enable them to become judgement safe practitioners when working with Indigenous peoples and communities. A revised curriculum framework document provides a range of useful strategies and resources to remedy these omissions.

Aboriginal and Torres Strait Islander Public Health: Online and Integrated into Core Master of Public Health Subjects.

The Master of Public Health (MPH) is an internationally recognised post-graduate qualification for building the public health workforce. In Australia, MPH graduate attributes include six Indigenous public health (IPH) competencies. The University of Melbourne MPH program includes five core subjects and ten specialisation streams, of which one is Indigenous health. Unless students complete this specialisation or electives in Indigenous health, it is possible for students to graduate without attaining the IPH competencies. To address this issue in a crowded and competitive curriculum an innovative approach to integrating the IPH competencies in core MPH subjects was developed. Five online modules that corresponded with the learning outcomes of the core public health subjects were developed, implemented and evaluated in 2015. This brief report outlines the conceptualisation, development, and description of the curriculum content; it also provides preliminary student evaluation and staff feedback on the integration project. Significance for public healthThis approach to a comprehensive, online, integrated Indigenous public health (IPH) curriculum is significant, as it ensures that all University of Melbourne Master of Public Health (MPH) graduates will have the competencies to positively contribute to Indigenous health status. A workforce that is attuned not only to the challenges of IPH, but also to the principles of self-determination, Indigenous agency and collaboration is better equipped to be comprised of ethical and judgment-safe practitioners. Additionally, the outlined approach of utilizing IPH content and examples into core MPH subjects ensures both the Australian relevance for an Australian-based health professional course and international appeal through the modules inclusion of International Indigenous case-studies and content. Furthermore, approaches learned in a challenging Indigenous Australian context are transferable and applicable to other IPH challenges in a local, national and global context.

Community-governed health services in Cape York: does the evidence point to a model of service delivery?

Health service delivery model reforms are currently underway in Cape York in an effort to improve health outcomes for the Aboriginal and Torres Strait Islander communities. These reforms include the transition of the Apunipima Cape York Health Council from an advocacy agency to a community-controlled health service provider. This paper investigates the literature on existing community governance models and community-controlled health service delivery models, to guide the choice of the most appropriate model for the Cape York health reforms. The evidence collected suggests a new innovative health service delivery model is emerging that will not only improve Indigenous health status, but may also present a more appropriate model for the health care sector than the existing mainstream health service delivery model provided for other sections of the collective Australian population.

The challenges of change management in Aboriginal community-controlled health organisations. Are there learnings for Cape York health reform?

The health status of Aboriginal and Torres Strait Islander peoples continues to be significantly poorer than Australia's general population. Clearly there is a need for change, hence the renewed interest in transitioning to a community control model for health services as a health intervention. Yet this requires a significant change management process, which is a process developed using Western business philosophies, and may not be applicable for community-controlled services that need to operate within the Aboriginal cultural domain. This paper examines the literature on organisational change management processes, and features of Aboriginal community-controlled health organisations and Aboriginal management styles. It identifies challenges and synergies that can be used to inform more effective transition processes to a community-control model for health services. The findings also highlight the need for a fundamental systems change approach to achieve such major reform agendas through the creation of a "collective responsibility" to achieve the vision for change, utilising participatory change management processes both internally and externally.