Looking after bubba for all our mob: Aboriginal and Torres Strait Islander community experiences and perceptions of stillbirth.

The stillbirth rate among Aboriginal and Torres Strait Islander women and communities in Australia is around double that of non-Indigenous women. While the development of effective prevention strategies during pregnancy and improving care following stillbirth for women and families in communities has become a national priority, there has been limited progress in stillbirth disparities. With community permission, this study aimed to gain a better understanding of community experiences, perceptions, and priorities around stillbirth. We undertook an Indigenous researcher-led, qualitative study, with community consultations guided by a cultural protection protocol and within an unstructured research framework. A total of 18 communities were consulted face-to-face through yarning interviews, focus groups and workshops. This included 54 community member and 159 health professional participants across remote, regional, and urban areas of Queensland, Western Australia, Victoria, South Australia, and Northern Territory. Thematic analysis of consultation data identified common themes across five focus/priority areas to address stillbirth: Stillbirth or Sorry Business Baby care needs to be family-centered; using Indigenous "ways of knowing, being, and doing" to ensure cultural safety; application of Birthing on Country principles to maternal and perinatal care; and yarning approaches to improve communication and learning or education. The results underscore the critical need to co-design evidence-based, culturally appropriate, and community-acceptable resources to help reduce existing disparities in stillbirth rates.

'Nih Waangkiny Kaadatjiny': 'Listening, learning and knowing': Stakeholders' perspectives about barriers and enablers to delivering a successful physical activity program for older Aboriginal people.

There is limited evidence about how physical activity (PA) programs should be provided for older Aboriginal and Torres Strait Islander peoples. Recently two groups of Aboriginal Elders on Noongar Boodja (Country) in Western Australia participated in the Ironbark PA program. ISSUE ADDRESSED: The objective of this study was to explore the views of key stakeholders about the barriers and enablers to delivering a successful PA program and provide feedback for future program delivery. METHODS: The research took a 'Nih (listening), Waangkiny (learning), Kaadatjiny (knowing)' approach. The lead researcher, a Noongar Wadjuk woman, conducted semi-structured interviews (n = 17) with key stakeholders: Aboriginal and non-Aboriginal workers who assisted to deliver the program, and family and local members of the communities. Data were also collected through weekly program notes and researcher diary entries. Data were analysed thematically. RESULTS: The overarching theme highlighted that stakeholders felt a sense of building a PA program that was culturally appropriate. They reflected that the program attracted older Aboriginal people because it was designed to make them feel welcomed with a sense of belonging. Five major themes were identified: Relationships, Belonging, Program structure, Benefits of the program and Future planning. Positive changes observed in Elders' health and well-being were a source of inspiration for team workers. CONCLUSIONS: Key enablers to delivering a PA program for older Aboriginal people are building a culturally strong program that creates a sense of belonging for the participants. SO WHAT?: Practitioners who are planning PA programs for older Aboriginal people should prioritise the development of cultural safety and security.

Tolerability and efficacy of sodium-glucose co-transporter-2 inhibitors in Australian Aboriginal and Torres Strait Islanders with type 2 diabetes mellitus: an observational study.

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have renal and cardiovascular benefits in addition to their glucose-lowering potential. Data on the efficacy and safety of SGLT2i in Australian Aboriginal and Torres-Strait Islanders are lacking. We conducted a single-centre retrospective study assessing the safety and effects on glycaemic control and albuminuria of SGLT2i in Aboriginal and Torres Strait Islander patients with type 2 diabetes mellitus.

Incidence and epidemiology of aneurysmal subarachnoid haemorrhage in Australian Aboriginal and Torres Strait Islanders; a ten-year population study.

Health disparity between Aboriginal and Torres Strait Islander (ATSI) Australians and non ATSI Australians is well established. Incidence and epidemiology of aneurysmal subarachnoid haemorrhage (aSAH) in the ATSI population is less well described. An observational, cross-sectional study was conducted to identify all acute spontaneous subarachnoid haemorrhage in the Hunter New England and Mid North Coast population of New South Wales, Australia. Population and baseline information was obtained from the Australian Consens data. The size of the population was 1.1 million. Over the 9.8 year period, 959 admissions for subarachnoid haemorrhage were identified, of which, 531 were due to aneurysm rupture. The ATSI population represented 6 % of the study population and had a higher incidence of aSAH (11.5 per 100,000 person years' vs 5.8 per 100,000 person years). The mean age at presentation was 8.6 years younger than the non-ATSI group (48.8 years vs 57.4 years). The ATSI population had higher rates of smoking and family history of aneurysms, but lower rates of premorbid hypertension. The overall rate of hospitalization for aneurysmal subarachnoid haemorrhage was higher in the indigenous Australian group, especially in younger patients. Higher smoking rates could be a contributing factor.

Risk Factors for Hospital Re-admission for Diabetes Related Foot Disease: A Prospective Cohort Study.

OBJECTIVE: Diabetes related foot disease (DFD) is a common reason for admission to hospital, but the predictive factors for repeat admission are poorly defined. The primary aim of this study was to identify rates and predictive factors for DFD related hospital re-admission. METHODS: Patients admitted to hospital for treatment of DFD at a single regional centre were recruited prospectively between January 2020 and December 2020. Participants were followed for 12 months to evaluate the primary outcome of hospital re-admission. The relationship between predictive factors and re-admission were examined using non-parametric statistical tests and Cox proportional hazard analyses. RESULTS: The median age of the 190 participants was 64.9 (standard deviation 13.3) years and 68.4% were male. Forty-one participants (21.6%) identified themselves as Aboriginal or Torres Strait Islander people. One hundred participants (52.6%) were re-admitted to hospital at least once over 12 months. The commonest reason for re-admission was for treatment of foot infection (84.0% of first re-admission). Absent pedal pulses (unadjusted hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26 - 2.85), loss of protective sensation (LOPS) (unadjusted HR 1.98; 95% CI 1.08 - 3.62), and male sex (unadjusted HR 1.62; 95% CI 1.03 - 2.54) increased the risk of re-admission. After risk adjustment, only absence of pedal pulses (HR 1.92, 95% CI 1.27 - 2.91) and LOPS (HR 2.02, 95% CI 1.09 - 3.74) significantly increased the risk of re-admission. CONCLUSION: Over 50% of patients admitted to hospital for treatment of DFD are re-admitted within one year. Patients with absent pedal pulses and those with LOPS are twice as likely to be re-admitted.

Trusting relationships and learning together: A rapid review of Indigenous reference groups in Australian Indigenous health research.

OBJECTIVE: This rapid review aims to identify how Indigenous research governance is conceptualised, implemented and documented within Australian Indigenous health research studies. METHODS: We searched for peer-reviewed English-language articles in two databases and for web-based grey literature published from database inception to November 2021. Reference lists were searched to identify additional articles. Data relating to research governance were extracted and analysed thematically. RESULTS: A total of 1120 records were screened, and 27 articles were included. Most articles providing detailed description of Indigenous research governance activities were qualitative studies (n=15, 55.6%). Key themes included members are experts; respectful relationships; flexibility; and key logistic considerations (nuts 'n' bolts). CONCLUSIONS: Although Indigenous research governance is recognised as an essential part of ethical research, activities and contributions made by Indigenous reference group (IRG) members are underreported. This important work needs greater visibility in the published literature to share best practice in Indigenous research governance that foregrounds Indigenous expert knowledge, perspectives, and experiences. IMPLICATIONS FOR PUBLIC HEALTH: The study provides a synthesis of factors to consider when establishing and facilitating an IRG for research with Indigenous communities. This has implications for researchers who can adapt and apply the findings to their practice.

Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities.

This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.

Community co-selection of measures to evaluate the health and wellbeing impact of Aboriginal and Torres Strait Islander community running groups.

ISSUE ADDRESSED: Physical activity participation can improve the physical health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. The evaluation of physical activity programmes can elicit a clearer understanding of where these impacts occur and to what extent. We describe applying a collaborative approach to the selection of a set of measures that can be used to examine health and wellbeing impacts of Indigenous community running groups. METHODS: Physical activity, health and wellbeing measurement tools previously used with Aboriginal and Torres Strait Islander peoples were collated. Participants in the collaborative process were nine female running group members aged 30+ years from a regional New South Wales (NSW) town. The Indigenous research method, Yarning, explored views of participating in the group on health and wellbeing and how these could be measured using those collated measurement tools. RESULTS: Runners described participating for holistic physical, mental and social reasons and stated the importance of the group participating together and providing social support to each other. There was broad support for the identified physical activity, lifestyle, physical health, and social and emotional wellbeing measures, with social networks and sports injuries identified as additionally relevant. CONCLUSIONS: Co-selecting measures to evaluate a physical activity programme for Aboriginal and Torres Strait Islander participants can better inform the development of relevant future healthy lifestyle programme evaluation, revealing factors that may be missed as relevant by researchers. SO WHAT?: This process presents an example of determining evaluation measures with Aboriginal and Torres Strait Islander participants that could be applied more broadly to evaluation design.

What's data got to do with it? A scoping review of data used as evidence in policies promoting the health of Aboriginal and Torres Strait Islander children in the Northern Territory, Australia.

ISSUE ADDRESSED: Accurate data on the health of Australia's First Nations peoples is critical in determining appropriate public health programs and establishing a baseline against which to measure progress. The effective translation of evidence into practice continues to be a challenge for Australian health departments and policymakers. The objective of this scoping review was to (i) determine the extent and range of policies relevant to the health and well-being of Aboriginal and Torres Strait Islander children in the Northern Territory (NT); to (ii) identify what data is reported to be used as evidence to reconcile policy goals with outcomes, (iii) to describe issues acknowledged by policy makers relating to data availability and/or limitations, and to (iv) examine how principles of Indigenous inclusion and self-determination are included in these policies. METHODS: A search for current policy documents, strategic plans/initiatives or frameworks was conducted across Ovid Medline, PubMed, Informit, Scopus, in addition to a web-based search for grey literature. Current policy documents for the period 2010-2021 were included providing at least one of the goals or objectives were relevant to the health and well-being of Australian Aboriginal and Torres Strait Islander children from the NT. RESULTS: The search located 2610 unique citations. Full-text screening was conducted on 85 documents, a total of 49 policy documents or strategic plans/frameworks were included in the final synthesis. The source of data being used as evidence was unclear or absent in 10 of the 49 (20.4%) identified policy documents. Limitations of the available data were mentioned to some extent, but detailed information on quality and completeness was largely absent. In mapping the key principles of working in Aboriginal and Torres Strait Islander health contexts, only two policies articulated the need for information sharing and data governance. CONCLUSIONS: This review underscores the importance of providing clear information about which data is being used to inform policy decisions so that they may be evaluated and critiqued in meaningful ways that ensure decision makers are accountable. SO WHAT?: Specific data items and/or indicators should be explicitly referenced as evidence used in the development of policies promoting the health of Aboriginal and Torres Strait Islander children and their communities from the outset so that evaluation is clear and policy makers are held accountable.

Dementia ECHO: Evaluation of a telementoring programme to increase dementia knowledge and skills in First Nations-led health services.

INTRODUCTION: High rates of dementia among Australian First Nations' peoples have resulted in an increased demand for dementia knowledge and skills among the primary health care professionals in these communities. The Dementia Extension for Community Healthcare Outcomes (ECHO) program aims to be a culturally safe way of increasing local health workforce capacity by facilitating dementia knowledge, skills and confidence among primary care professionals in First Nations community settings. Dementia ECHO is based on the international evidence-based telementoring programme, Project Extension for Community Healthcare Outcomes. Every Dementia ECHO session is delivered by videoconference and comprises a specialist-led presentation and a case discussion from a primary care health service participant. The aims of this study were to assess the uptake and reach of Dementia ECHO; examine the perceived importance of dementia care and dementia education among Aboriginal and Torres Strait Islander Community Controlled Health Service staff; and evaluate the potential impact of Dementia ECHO on health service staff pertaining to dementia knowledge, confidence to provide dementia care and professional isolation. METHOD: Dementia ECHO service activity data maintained by the programme providers was reviewed to determine uptake and reach. A pre-implementation survey examined Aboriginal and Torres Strait Islander Community Controlled Health Service staff perspectives on the importance of dementia education and the priority of a range of health issues. After each Dementia ECHO session, a brief online survey gathered quantitative and qualitative data regarding the potential impact of the session. RESULTS: Of 30 completed pre-implementation surveys, all staff rated dementia education as either very important or important. Salient themes highlighting why it is important are presented. When asked to rank six different health priorities, dementia (n = 10) and chronic disease (n = 10) were placed as the top priority. The brief post-session feedback provided 44 complete survey responses demonstrating: perceived improvement in dementia knowledge and skills (88.4%); increased confidence to provide dementia care (83%); and a reduction in professional isolation (88%). CONCLUSION: Dementia ECHO addresses a gap in dementia education that is much needed in health professionals with increasing numbers of First Nations people living with dementia. This current study shows that attending an evidence-based telementoring programme, such as Dementia ECHO, can increase dementia knowledge and confidence to care for someone living with dementia and their families.

Built Environment Features and Cardiometabolic Mortality and Morbidity in Remote Indigenous Communities in the Northern Territory, Australia.

Indigenous Australians experience poorer health than non-Indigenous Australians, with cardiometabolic diseases (CMD) being the leading causes of morbidity and mortality. Built environmental (BE) features are known to shape cardiometabolic health in urban contexts, yet little research has assessed such relationships for remote-dwelling Indigenous Australians. This study assessed associations between BE features and CMD-related morbidity and mortality in a large sample of remote Indigenous Australian communities in the Northern Territory (NT). CMD-related morbidity and mortality data were extracted from NT government health databases for 120 remote Indigenous Australian communities for the period 1 January 2010 to 31 December 2015. BE features were extracted from Serviced Land Availability Programme (SLAP) maps. Associations were estimated using negative binomial regression analysis. Univariable analysis revealed protective effects on all-cause mortality for the BE features of Education, Health, Disused Buildings, and Oval, and on CMD-related emergency department admissions for the BE feature Accommodation. Incidence rate ratios (IRR's) were greater, however, for the BE features Infrastructure Transport and Infrastructure Shelter. Geographic Isolation was associated with elevated mortality-related IRR's. Multivariable regression did not yield consistent associations between BE features and CMD outcomes, other than negative relationships for Indigenous Location-level median age and Geographic Isolation. This study indicates that relationships between BE features and health outcomes in urban populations do not extend to remote Indigenous Australian communities. This may reflect an overwhelming impact of broader social inequity, limited correspondence of BE measures with remote-dwelling Indigenous contexts, or a 'tipping point' of collective BE influences affecting health more than singular BE features.

Cardiac rehabilitation in rural and remote areas of North Queensland: How well are we doing?

OBJECTIVE: To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). (2) propose changes to improve access to CR in R&R areas of NQ. SETTING: Four focus communities in R&R areas of NQ. PARTICIPANTS: Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling). DESIGN: A qualitative descriptive case study, with data collection via semi-structured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities. RESULTS: Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post-discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community-based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre-based CR services; lack of awareness, or acceptance of telephone support services. CONCLUSION: To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in-service education, is required to developing a model of care that focuses on self-management and education: Heart: Road to Health.

Characterising health promotion in Aboriginal and Torres Strait Islander languages: A content analysis of COVID-19 and maternal health resources.

ISSUE ADDRESSED: Health promotion resources in Aboriginal and Torres Strait Islander (Indigenous) languages are being widely translated and disseminated at the community, health service and government level. In addition to outlining the relevant Australian policy context and evidence base, this study sought to describe the availability and characteristics of COVID-19 and maternal health promotion resources incorporating Indigenous languages. METHODS: Health promotion resources published online between June 2005 and June 2020 were identified by a desktop scan and screened against quality inclusion criteria. A content analysis by resource type, health topic, purpose, use of language and source was conducted. RESULTS: A total of 215 resources was eligible for inclusion, incorporating 50 different Indigenous languages and representing a varied approach to language use and health promotion. Almost 7 times as many COVID-19 resources were identified than maternal health materials. CONCLUSIONS: In contrast to maternal health, COVID-19 has seen a sharp rise in the number of health promotion resources produced in language, especially in formats capable of streamlined replication in multiple languages. Strong use of narrative, storytelling and alternative primary aims such as language education suggests potential for greater collaboration between health promotion organisations and other community groups and services. Bilingual resources may have applications for communities where traditional language knowledge is being reawakened. SO WHAT?: Emerging capacity to efficiently produce health promotion resources in multiple Indigenous languages could be capitalised for health topics beyond COVID-19. However, further research in determining best practice and user perspectives is essential in guiding the development of these resources.

Scoping review - What do we know about Aboriginal peoples' use of dose administration aids?

ISSUE ADDRESSED: This paper aims to report findings of a scoping review which mapped and summarised available literature regarding Aboriginal peoples' use of Dose Administration Aids (DAAs) for improved medication management. Aboriginal and Torres Strait Islander peoples have higher rates of chronic disease than other Australians. This leads to increased numbers of prescribed medications and complex medication taking regimens. The Australian Government and Pharmacy Bodies provide programs for Aboriginal peoples with chronic conditions, including programs supporting access to DAAs to improve medication adherence. METHODS: The search strings used included three key concepts: Indigeneity; DAAs and outcomes. PubMed, Medline via Ovid and the grey literature were searched. RESULTS: After removal of duplicates, 426 papers were screened by title and abstract for inclusion. A further 407 papers were then excluded leaving a total of nineteen papers included in the review. Only three of these papers included all three concepts in the search criteria, and none of these were empirical studies. CONCLUSION: The lack of studies found in this review support the requirement for empirical research regarding the effects of DAAs on medication taking behaviours of Aboriginal people, and the programs that provide them. SO WHAT?: The Australian Government funds programs that provides access to DAAs as a method of improving medication taking behaviours. But what do we really know about DAAs and if or how they assist in this goal? This review scopes out what is known, in order to direct studies that will answer this question.

Developing culturally appropriate food literacy resources for Aboriginal children with Foodbank WA's Superhero Foods®.

ISSUE ADDRESSED: In Australia, food sovereignty of traditional landowners has been marginalised by the globalisation of food systems and resulted in limited opportunities for children to experience familiar bush tucker foods as healthy choices, particularly in a school environment. Superhero Foods® themed teaching resources focus on the development of nutrition education materials that included traditional Aboriginal foods together with contemporary foods readily available in regional/remote communities. METHODS: Consultation with an Aboriginal expert and Aboriginal artist; local, regional/remote teachers and stakeholders informed the development of tailored resources including food cartoon characters, school lesson plans and a storybook. The latter was guided by a resource development model. Users of the resources were surveyed to ascertain the useability, alignment with the Australian Dietary Guidelines, cross-curricular learnings and cultural relevance. RESULTS: Respondents across regional/remote and urban locations completed a lesson plan and food character (clipart) survey (N = 51) and storybook survey (N = 14). Respondents advised the resources were relevant, enjoyable, engaging and culturally appropriate for all students regardless of Aboriginality. The resources provided learning opportunities for all children to enhance knowledge about Aboriginal culture and bush foods. Independent evaluation has further indicated the translation of messaging into student's knowledge and learning. CONCLUSIONS: Key enablers to the success of the resource included; free online access, the highly engaging nature of the resources and adaptability to be implemented across a number of Aboriginal language groups in WA. Ensuring visual representation of healthy choices was fundamental to reinforcing nutrition messaging. Superhero Foods resources are a positive and important inclusion in the health promotion toolbox for Aboriginal children. SO WHAT?: Superhero Foods are novel nutrition education resources depicting Aboriginal foods and Aboriginal children. These food literacy resources will engage children's understanding of Aboriginal culture, improve food literacy and strengthen equitable access for regional and remote communities.

Ironbark: Developing a healthy community program for older Aboriginal people.

ISSUE ADDRESSED: Programs by, with and for Aboriginal older people must be culturally safe and relevant. Successful elements include being Aboriginal specific and group based. Co-design with Aboriginal people and stakeholders is essential. We describe the co-design process of developing the Ironbark: Healthy Community program. METHODS: Aboriginal ways of knowing, being and doing and yarning conversational methods guided the development process, during 2018. A desktop review provided details of current group characteristics and key community stakeholders. Stakeholder engagement regarding views about group operations, participants and benefits also occurred. Aboriginal Elders views of their groups were gathered through yarning circles in New South Wales (NSW). Grounded theory approach was used to ascertain key themes. RESULTS: Initial engagement occurred with 13 different community stakeholders and organisations in three Australian states (NSW, South Australia (SA), Western Australia (WA)). Three yarning circles occurred with Elders from urban (N = 10), regional coastal (N = 10) and regional country (N = 4) groups. Six key themes were organised in three groups according to an Aboriginal ontology. 1. Knowing: groups provide opportunities to share knowledge and connect socially. Adequate program resourcing and sustainability are valued. 2. Being: groups strengthen culture, providing important social, emotional and other forms of support to age well. 3. Doing: previous program experiences inform perceptions for new program operations. Group venues and operational aspects should be culturally safe, acknowledging diversity among Elders, their preferences and community control. Themes were used to develop the program and its resource manual that were finalised with stakeholders, including steering committee approval. CONCLUSIONS: Stakeholder feedback at multiple stages and Aboriginal Elders' perspectives resulted in a new co-designed community program involving weekly yarning circles and social activities. So what?: Co-design, guided by Aboriginal ways of knowing, being and doing, can develop programs relevant for Aboriginal people.

Understanding culturally safe aged care from the perspectives of older Aboriginal Australians in rural and remote communities.

ISSUE ADDRESSED: Aboriginal and Torres Strait Islander peoples face challenges in accessing aged care and are less likely to use some services than their non-Indigenous counterparts. Culturally safe care is increasingly recognised as an enabler to improve access and quality of care. This study explored older Aboriginal peoples' perceptions and experience of culturally safe aged care. METHODS: We conducted semi-structured interviews with sixty-three older Aboriginal people, purposively sampled from three rural and remote geographic locations in South Australia, between April and October 2018, with participants who were both receiving and not receiving aged care services. We asked participants how organisations do or could meet their aged care needs. We analysed interview data inductively into themes. These themes were incorporated into six principles of culturally safe aged care which were subsequently endorsed by participants and study stakeholders. RESULTS: Participants described culturally safe aged care services as those which facilitated or maintained connection to participants' culture, traditional lands and community. Five themes were identified: maintaining cultural identity, culturally informed service delivery, culturally competent workforce, culturally supportive environments and partnerships and collaboration within the aged care service system. CONCLUSION: Addressing cultural safety in aged care will require organisations to adapt their policies, service delivery, environments and work practices to meet the needs of older Aboriginal peoples. SO WHAT? Identifying culturally safe aged care from the perspectives of older Aboriginal and Torres Strait Islander peoples provides timely insight to how services may be better designed and implemented to promote quality of life.

Tuberculosis care designed with barramarrany (family): Participatory action research that prioritised partnership, healthy housing and nutrition.

ISSUE ADDRESSED: Ongoing tuberculosis (TB) transmission in Aboriginal communities in Australia is unfair and unacceptable. Redressing the inequity in TB affecting Aboriginal peoples is a priority in Australia's Strategic Plan for Tuberculosis Control. Improving TB care needs not to just identify barriers but do something about them. Privileging the voices of Aboriginal people affected by TB is essential to identify effective and enabling strategies. METHODS: A barramarrany (Aboriginal family) affected by recurring TB partnered with TB and Environmental Health teams using a participatory action research (PAR) methodology to improve housing health hardware and nutrition alongside biomedical TB prevention and care. A combination of the Ottawa Charter for Health Promotion; the International "End TB" Strategy; and Aboriginal barramarrany leadership, worldviews and traditional values guided actions to reduce TB transmission. RESULTS: Together the partners improved housing hardware and access to nutritious food, so the barramarrany could create a setting for good health and wellbeing. These actions supported the barramarrany to regain the physical, social and emotional wellbeing to deal with day-to-day challenges and stresses. The barramarrany were able to better sustain supportive relationships; grow, prepare and eat healthy food; and participate in health care activities. The barramarrany could better engage with medical approaches for TB and four barramarrany members completed TB treatment. The PAR action-project enabled and supported early TB diagnosis, treatment and prevention. CONCLUSION: Amplifying the voices of Aboriginal people and shared ownership of TB diagnosis, treatment and prevention by the barramarrany, was underpinned with principles of self-determination, capacity building and social justice. This PAR action-project provides further evidence that improving housing and nutrition can assist in Ending TB while improving wellbeing. SO WHAT?: Our action-research project undertaken within a PAR framework demonstrates the implementation of End TB Strategies by utilising the Ottawa Charter's five actions to promote health, by understanding and centralising the social determinants of health.

Neonatal death is a major concern for Indigenous women with asthma during pregnancy and could be prevented with better models of care.

Asthma is the most common respiratory illness in Aboriginal and Torres Strait Islander Australians. From the Mater Mothers routinely collected perinatal data in Brisbane we have identified that 24% of Indigenous and 17% of non-Indigenous women have pregnancies complicated by asthma. Indigenous women with asthma are more likely to have poorer birth outcomes when compared to non-Indigenous women with asthma, with neonatal death being doubled in asthmatic Indigenous women. These data indicate that asthma management during pregnancy is an unmet need for Indigenous women and essential if we are to avoid these devastating outcomes for Indigenous families.

A Pathway to Precision Medicine for Aboriginal Australians: A Study Protocol.

(1) Background: Genomic precision medicine (PM) utilises people's genomic data to inform the delivery of preventive and therapeutic health care. PM has not been well-established for use with people of Aboriginal and Torres Strait Islander ancestry due to the paucity of genomic data from these communities. We report the development of a new protocol using co-design methods to enhance the potential use of PM for Aboriginal Australians. (2) Methods: This iterative qualitative study consists of five main phases. Phase-I will ensure appropriate governance of the project and establishment of a Project Advisory Committee. Following an initial consultation with the Aboriginal community, Phase-II will invite community members to participate in co-design workshops. In Phase-III, the Chief Investigators will participate in co-design workshops and document generated ideas. The notes shall be analysed thematically in Phase-IV with Aboriginal community representatives, and the summary will be disseminated to the communities. In Phase-V, we will evaluate the co-design process and adapt our protocol for the use in partnership with other communities. (3) Discussion: This study protocol represents a crucial first step to ensure that PM research is relevant and acceptable to Aboriginal Australians. Without fair access to PM, the gap in health outcome between Aboriginal and non-Aboriginal Australians will continue to widen.