Exploring perspectives and insights of experienced voyagers on human health and Polynesian oceanic voyaging: A qualitative study.

BACKGROUND: The Worldwide Voyage (WWV) was a 3-year (2014-2017) open-ocean voyage to circumnavigate the world using Indigenous knowledge and navigational skills aboard Hokule'a, a traditionally designed Native Hawaiian (NH) voyaging canoe (wa'a kaulua). Each WWV segment included experienced crew and leadership who were recognized by their voyaging peers as highly experienced in Polynesian oceanic voyaging. This study explored the perceptions and insights of WWV-experienced ocean voyagers on the interconnection between human health and oceanic voyaging. METHODOLOGY: A constructivist approach with a storytelling-based moderator guide was used to conduct focus groups and informant interviews of experienced crew and voyaging leadership. Participants were interviewed and recorded transcripts were analyzed using content analysis. Triangulation of analysis included secondary thematic review by two independent NH cultural practitioners and participant member checking. Purposive sampling was used to enroll 34 of 66 eligible highly experienced voyagers (leadership n = 6; crew n = 28) in 5 focus groups and 4 informant interviews. RESULTS: Six themes emerged: 1) Indigenous context (spiritual and natural environment); 2) Importance of relationships and community; 3) Description of life on the canoe; 4) Holistic health; 5) Mindfulness, stress reduction and emotional health; and 6) Opportunities for intervention. Themes 1-5 were inductive and intricately interrelated, and theme 6 was deductive in that it directly resulted from a moderator guide question. Theme 6 offers strategies to improve the impact of voyaging and health well beyond the physical voyage with recommendations for improved transition back to land and developing a wa'a community context, which reflects a traditional voyaging experience. CONCLUSIONS: Polynesian oceanic voyaging is strongly perceived as a positive and transformative holistic-health-promoting experience. SIGNIFICANCE: Recommendations to promote generalizable health benefits of a voyaging lifestyle offers a promising and culturally grounded approach warranting future studies to understand mechanism and potential impact for improving health inequities.

The Mauli Ola Study: A Unique Academic-Community Partnership With MA'O Organic Farms to Understand and Address Health Inequities Among Native Hawaiians and Other Pacific Islanders in Hawai'i.

Indigenous peoples, including Native Hawaiians and Pacific Islanders (NHPIs), experience significant cardiometabolic health disparities arising in large part from rapid changes to their diets and food systems. Innovative food sovereignty initiatives led by NHPIs are needed to address these disparities. This article describes a community-based participatory research study that incorporates social and biological measures to examine the impact of an Indigenous-led land-based food sovereignty youth leadership program on health disparities among NHPI youth in Hawai'i. Grounded in the Indigenous knowledge that holistic health and wellbeing of people is inseparable from that of the environment and to counter rampant food insecurity in their community of Wai'anae, O'ahu, MA'O Organic Farms developed a Youth Leadership Training (YLT) program that offers education, nutrition, physical activity, and access to health care. The program also engages YLT interns and their social networks in health education and research in the ongoing Mauli Ola study. Preliminary data from this study affirm the need to address the disproportionately high rates of obesity, type 2 diabetes mellitus (T2D), and poor mental health conditions among young NHPIs in the Wai'anae community, and how the YLT program may provide an effective approach to address this need. Our unique academic-community partnership underscores the importance of social and biomedical research to understand health disparities in the NHPI population, which present novel avenues to enable disease prevention. The outcomes of the Mauli Ola study may serve as a valuable model for health disparities research while leveraging ongoing social programs that support Indigenous food sovereignty.

A Qualitative Study on Preventing Gestational Diabetes in Native Hawaiian and Pacific Islander Adolescent Females: Perspectives from an Expert Panel of Health Care Providers.

The authors examined perspectives of health care providers (HCPs) who serve Native Hawaiian and Pacific Islander (NH/PI) adolescents to inform the adaption of an existing American Indian and Alaska Native-specific gestational diabetes mellitus (GDM) risk reduction and preconception counseling program entitled Stopping GDM, for NH/PI adolescents. Hawai'i-based HCPs (n=14) who care for NH/PI adolescent females volunteered for this expert panel focus group study. These HCP participants served as an expert panel specific to their experiences in providing primary care and reproductive health care/family planning, and their perspectives regarding GDM risk reduction for NH adolescents. Several key themes emerged from these expert panel focus groups: (1) importance of multi-generational family involvement and support; (2) need to address the social determinants of health; (3) strengths-based strategies and recommendations to engage adolescents in a preconception counseling and GDM risk-reduction education program. Findings will inform the adaptation of Stopping GDM into a more holistic, multi-level, strengths-based, culturally tailored GDM risk reduction intervention that fosters empowerment and builds on the resilience of NH/PI communities.

Key features of a trauma-informed public health emergency approach: A rapid review.

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a "trauma-informed lens," which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or "lens" to minimize compounding trauma for First Nations communities.

Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death in women around the world. Aboriginal and Torres Strait Islander women (Australian Indigenous women) have a high burden of CVD, occurring on average 10-20 years earlier than non-Indigenous women. Traditional risk prediction tools (eg, Framingham) underpredict CVD risk in women and Indigenous people and do not consider female-specific 'risk-enhancers' such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM) and premature menopause. A CT coronary artery calcium score ('CT-calcium score') can detect calcified atherosclerotic plaque well before the onset of symptoms, being the single best predictor for future cardiac events. A CT-calcium score may therefore help physicians intensify medical therapy in women with risk-enhancing factors. METHODS AND ANALYSIS: This multisite, single-blind randomised (1:1) controlled trial of 700 women will assess the effectiveness of a CT-calcium score-guided approach on cardiovascular risk factor control and healthy lifestyle adherence, compared with standard care. Women without CVD aged 40-65 (35-65 for Aboriginal and Torres Strait Islander women) at low-intermediate risk on standard risk calculators and with at least one risk-enhancing factor (eg, HDP, GDM, premature menopause) will be recruited. Aboriginal and Torres Strait Islander women will be actively recruited, aiming for ~10% of the sample size. The 6-month coprimary outcomes will be low-density lipoprotein cholesterol and systolic blood pressure. Barriers and enablers will be assessed, and a health economic analysis performed. ETHICS AND DISSEMINATION: Western Sydney Local Health District Research Ethics Committee (HREC 2021/ETH11250) provided ethics approval. Written informed consent will be obtained before randomisation. Consent will be sought for access to individual participant Medicare Benefits Schedule, Pharmaceutical Benefits Scheme claims usage through Medicare Australia and linked Admitted Patient Data Collection. Study results will be disseminated via peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: ACTRN12621001738819p.

A call for culture-centred care: exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia.

BACKGROUND: Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants' second birthday. It explores health workers' perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health. METHODS: Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed. RESULTS: Three key themes emerged: the system takes priority, culture is not central in approaches to care, and 'we've got to be allowed to do it in a different way'. CONCLUSIONS: This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants' first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.

A Culturally Responsive Trauma-Informed Public Health Emergency Framework for Aboriginal and Torres Strait Islander Communities in Australia, Developed during COVID-19.

The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples' livelihoods and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia continue to experience intergenerational trauma associated with colonization and may experience trauma-related distress in response to government responses to public health emergencies. We aimed to develop a culturally responsive trauma-informed public health emergency response framework for Aboriginal and Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led study involved: (i) a review of trauma-informed public health emergency responses to develop a draft framework (ii) interviews with 110 Aboriginal and Torres Strait Islander parents about how COVID-19 impacted their lives, and (iii) a workshop with 36 stakeholders about pandemic experiences using framework analysis to refine a culturally responsive trauma-informed framework. The framework included: an overarching philosophy (cultural humility, safety and responsiveness); key enablers (local leadership and Eldership); supporting strategies (provision of basic needs and resources, well-functioning social systems, human rights, dignity, choice, justice and ethics, mutuality and collective responsibility, and strengthening of existing systems); interdependent core concepts (safety, transparency, and empowerment, holistic support, connectedness and collaboration, and compassion, protection and caring); and central goals (a sense of security, resilience, wellbeing, self- and collective-efficacy, hope, trust, resilience, and healing from grief and loss).

Parent wellbeing, family screen time and socioeconomic status during early childhood predict physical activity of Aboriginal and Torres Strait Islander children at ages 8-13.

OBJECTIVES: Physical activity is holistically linked to culture and wellbeing among Aboriginal and Torres Strait Islander peoples, the First Nation Peoples of Australia. Socioecological correlates of high physical activity among Indigenous children include living in a remote area and low screen time but little is known about early life determinants of physical activity. This paper examines sociodemographic, family, community, cultural, parent social and emotional wellbeing determinants of physical activity among Aboriginal and Torres Strait Islander children. DESIGN: Longitudinal cohort study. METHODS: The Longitudinal Study of Indigenous Children, the largest First Nations child cohort study in the world, primarily collects data through parental report. Multiple logistic regression analyses examined Wave 1 (age 0-5 years) predictors of achieving ≥1 h/day of physical activity at Wave 9 (aged 8-13 years). RESULTS: Of the 1181 children, 596 (50.5 %) achieved ≥1 h of physical activity every day. Achieving ≥1 h/day of physical activity at Wave 9 was associated with the following Wave 1 determinants: high parent social and emotional wellbeing (resilience; adjusted odds ratio 1.87 (95 % confidence interval: 1.32-2.65)), living in remote (odds ratio 3.66 (2.42-5.54)), regional (odds ratio 2.98 (2.13-4.18)) or low socioeconomic areas (odds ratio 1.85 (1.08-3.17)), main source of family income not wages/salaries (odds ratio 0.66 (0.46-0.97)), and if families played electronic games (odds ratio 0.72 (0.55-0.94)). CONCLUSIONS: To achieve high physical activity levels among Aboriginal and Torres Strait Islander children, high parental culture specific social and emotional wellbeing and low family screen time in early life may compensate for apparently low socio-economic circumstances, including living in remote areas.

Sexuality and Gender Identity Inequities in Substance Use Disorder and Its Treatment among American Indian, Alaska Native, and Native Hawaiian College Students.

BACKGROUND: The aim of this study was to investigate inequities in substance use disorder (SUD) diagnosis, opioid misuse, marijuana misuse, SUD treatment utilization, and utilization of university mental health services among sexual and gender minority (SGM) American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students. METHODS: Data consisting of 8,103 AI/AN/NH students' responses to the American College Health Association's National College Health Assessment survey from fall 2015 through spring 2019 were utilized for this study. Multivariable logistic regression models were used to compare the odds of SUD diagnosis, opioid misuse, and marijuana misuse in SGM AI/AN/NH students to cisgender, heterosexual peers. Unadjusted odds of SUD treatment utilization and utilization of university mental health services were also evaluated. RESULTS: Compared to cisgender females, transgender (aOR = 4.43, 95% CI = 2.67-7.34) and gender diverse (aOR = 2.86, 95% CI = 1.61-5.07) students had significantly higher odds of SUD diagnosis. Similarly, significantly higher odds of SUD diagnosis were observed among sexual minorities, including gay/lesbian (aOR = 2.95, 95% CI = 1.71-5.09) and bisexual (aOR = 1.97, 95% CI = 1.30-2.99) students compared to heterosexual peers. Sexual minority students had significantly higher odds of utilizing university mental health services (uOR = 2.43, 95% CI = 1.22-4.84) than heterosexual peers. Odds of opioid misuse and marijuana misuse were also significantly increased among sexual minority students. CONCLUSIONS: AI/AN/NH college students who identify as SGM have higher odds of SUD diagnosis, opioid misuse, and marijuana misuse than their cisgender, heterosexual peers. These findings highlight the need to consider tailored programming for SGM AI/AN/NH students in substance use prevention and intervention efforts in U.S. college settings.

Much being Written about Us, not much being Written with Us: Examining how alcohol and other drug use by indigenous Australians is portrayed in Australian Government policies and strategies: A discourse analysis.

BACKGROUND: Using critical discourse analysis, this study examined the portrayal of Aboriginal and Torres Strait Islander people in Australian Government policies regarding alcohol and other drug (AOD) use. METHODS: We used critical discourse analysis, informed by an Indigenous Research Paradigm, to analyse texts and contexts of six key Australian Government AOD drug policies; two Aboriginal AOD data documents, two reporting documents and two AOD strategy documents. RESULTS: The social practice analysis found issues of power imbalance relating to the socio-political situation the documents were created in. Textual analysis identified: culture being performative or functional in documents; cultural unsafety in construction of targets and outcomes, and; the decentring of Aboriginal peoples in the framing of the documents. The discourse analysis identified that the documents often wrote about Aboriginal peoples rather than writing documents with or by Aboriginal peoples. This typically: absented complexities of consultation occurring within a complex power imbalanced cultural interface; did not support an Aboriginal paradigm; centred Gubba people in power and; promoted a paternalistic view of 'helping' Aboriginal people. CONCLUSIONS: There is an urgent need to move from policy relating to Aboriginal affairs that relies on a deficit discourse, to more effective AOD policy that improves power balance in policy development, is written with or by Aboriginal people, is inclusive of Aboriginal epistemologies and ontologies, and represents a paradigm-shift to a strength-based approach.

Native Hawaiian/Pacific Islander alcohol, tobacco and other drug use, mental health and treatment need in the United States during COVID-19.

INTRODUCTION: Before COVID-19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID-19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID-19. METHODS: Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large-scale investigation of NH/PI ATOD use, mental health and treatment need during COVID-19. Between April and November 2021, NH/PI-heritage research staff from our community partners collected data involving 306 NH/PI adults using several community-based recruitment methods (e-mail, telephone, in-person) and two survey approaches: online and paper-and-pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment. RESULTS: During COVID-19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One-third of participants reported past-year treatment need with lifetime illicit substance use, COVID-19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment. CONCLUSIONS: NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID-19. Targeted research and treatment services may be warranted to mitigate COVID-19's negative behavioural health impact on NH/PI communities.

Exploring the lived experiences of Indigenous Australians within the context of alcohol and other drugs treatment services: A scoping review.

ISSUES: Substance use among Indigenous peoples has been extensively researched in the Australian context. However, syntheses of existing research focused on Indigenous Australian peoples' experiences of alcohol and other drug (AOD) treatment are limited. This review sought to fill this gap. APPROACH: A scoping review using three databases, and the Google search engine, examined empirical and grey literature relating to Indigenous Australian peoples' lived experiences of accessing and undergoing AOD treatment. The review was not restricted to intervention type, treatment setting, substance, or individual characteristics (e.g., age or gender). The experiences of staff of Indigenous Australian service providers were excluded. KEY FINDINGS: Twenty-seven articles were reviewed, with most research (n = 12) conducted in New South Wales. Our secondary analysis of existing research found three themes: the role of culture, the value of holistic strength-based services, and the influence of organisational components for Indigenous Australian service users in AOD treatment settings. IMPLICATIONS AND CONCLUSION: Despite diversity of experiences, our review highlights the importance of integrating culture and facilitating holistic strength-based approaches to AOD treatment for Indigenous Australian peoples. While our review is limited by the findings and biases contained within the literature reviewed, the paucity of literature relating to the experiences of Indigenous Australian peoples within AOD treatment settings warrants further attention.

Aboriginal Community Controlled Health Services: An Act of Resistance against Australia's Neoliberal Ideologies.

The individualistic and colonial foundations of neoliberal socio-political ideologies are embedded throughout Australian health systems, services, and discourses. Not only does neoliberalism undermine Aboriginal and Torres Strait Islander collectivist values by emphasizing personal autonomy, but it has significant implications for Aboriginal and Torres Strait Islander health. Aboriginal Community Controlled Health Services (ACCHS) operate within Community-oriented holistic understandings of well-being that contradict neoliberal values that Western health services operate within. Therefore, this paper aims to explore the role of ACCHS in resisting the pervasive nature of neoliberalism through the prioritization of self-determination for Aboriginal and Torres Strait Islander Peoples. Utilizing a critical evaluative commentary, we reflect on Aboriginal political leadership and advocacy during the 1970s and 1980s and the development of neoliberalism in Australia in the context of ACCHS. Community controlled primary health services across Australia are the only remaining government-funded and Aboriginal-controlled organizations. Not only do ACCHS models resist neoliberal ideologies of reduced public expenditure and dominant individualistic models of care, but they also incontrovertibly strengthen individual and Community health. ACCHS remain the gold standard model by ensuring Aboriginal and Torres Strait Islander rights to the self-determination of health in accordance with the United Nations Declaration of the Rights of Indigenous Peoples.

"Don't let anybody ever put you down culturally . it's not good ": Creating spaces for Blak women's healing.

Research has highlighted the importance of Indigenous knowledge and cultural practice in healing from ongoing histories of trauma, dispossession, and displacement for Indigenous peoples in Australia and elsewhere. Connection with culture, Country, and kinship has been identified as protective factors for Aboriginal social and emotional well-being and as facilitating cultural healing. This paper draws on stories mediated through cultural practice specifically, Wayapa and bush-dyeing workshops, to explore how women resignified experiences and engaged in "healing work." Our collaborative analysis of the stories shared resulted in three main themes that capture dialogs about the need for culturally safe spaces, vulnerability and identity, and culture, Country, and place. Centering Aboriginal knowledge, our analysis shows the meanings of Country, spirituality, and the coconstitution of people, culture, and the natural environment. Through Indigenous cultural practice, the women "grew strength in relationship" as they engaged in the psychosocial processes of deconstruction, reclamation, and renarrating personal and cultural identities.

"Ko Au te Whenua, Ko te Whenua Ko Au: I Am the Land, and the Land Is Me": Healer/Patient Views on the Role of Rongoa Maori (Traditional Maori Healing) in Healing the Land.

In Rongoa Maori (traditional Maori healing), the connection with the land stems from seeing Papatuanuku/Mother Earth as a part of our identity/whakapapa (genealogy), our culture, and our wellbeing. This qualitative study aimed to explore the holistic nature and meaning of Rongoa Maori. There were 49 practitioner and patient participants who participated in semi-structured interviews and focus groups across Aotearoa/New Zealand. The findings showed four themes: land as an intrinsic part of identity; land as a site and source of healing; reciprocity of the healing relationship; and the importance of kaitiakitanga/conservation to Rongoa Maori. Participants shared narratives of connections between the people and the land that showed that when the land is well, the people are well. Implications of these themes for Indigenous wellbeing and the conservation and protection of our natural environments led to three recommendations to reconnect with the land, support Rongoa Maori healing, and to participate in the conservation and preservation of local land and waterways. It is hoped that in learning more about the connection between the land and Rongoa Maori healing, we begin to place greater value on the need to conserve and preserve both the land and our connections to her through traditional healing practices.

Healing journeys: experiences of young Aboriginal people in an urban Australian therapeutic community drug and alcohol program.

Disproportionately high numbers of Aboriginal young people access residential alcohol and other drug programs in Australia. While demand is high, these programs often have low numbers of Aboriginal staff. Residential programs, however, generally offer supports that reflect features of Aboriginal health care - holistic, group-based, connected to local communities, and addressing determinants of health. The qualitative research outlined in this paper was a collaboration between a mainstream residential therapeutic community program and two Aboriginal community-controlled organisations, and Aboriginal young people and researchers, with Aboriginal research leadership. It used an Aboriginal healing framework to understand the experiences of 12 young Aboriginal people in the program, triangulated with 19 key informant interviews. This provided an opportunity to understand how Indigenous knowledge about healing related to mainstream programs and the experiences of Aboriginal young people. This moves beyond individualist and deficit-focused conceptions of youth alcohol and drug use and centres Aboriginal cultures as healing. Findings point to the need for critically self-reflective mainstream organisations, a larger Aboriginal workforce with leadership roles, partnerships with Aboriginal Elders and organisations, and an investment in Aboriginal community-controlled alcohol and other drug services.

The stay strong app as a self-management tool for first nations people with chronic kidney disease: a qualitative study.

BACKGROUND: The high burden of chronic kidney disease in First Nations peoples requires urgent attention. Empowering people to self-manage their own condition is key, along with promotion of traditional knowledge and empowerment of First Nations communities. This study explores the potential of a culturally responsive tool, already found to have high acceptability and feasibility among First Nations people, to support self-management for First Nations people with kidney failure. The Stay Strong app is a holistic wellbeing intervention. This study explores the suitability of the Stay Strong app to support self-management as shown by the readiness of participants to engage in goal setting. Data were collected during a clinical trial which followed adaption of research tools and procedures through collaboration between content and language experts, and community members with lived experience of kidney failure. METHODS: First Nations (i.e., Aboriginal and Torres Strait Islander) participants receiving haemodialysis in the Northern Territory (n = 156) entered a three-arm, waitlist, single-blind randomised controlled trial which provided collaborative goal setting using the Stay Strong app at baseline or at 3 months. Qualitative data gathered during delivery of the intervention were examined using both content and thematic analysis. RESULTS: Almost all participants (147, 94%) received a Stay Strong session: of these, 135 (92%) attended at least two sessions, and 83 (56%) set more than one wellbeing goal. Using a deductive approach to manifest content, 13 categories of goals were identified. The three most common were to: 'connect with family or other people', 'go bush/be outdoors' and 'go home/be on country'. Analysis of latent content identified three themes throughout the goals: 'social and emotional wellbeing', 'physical health' and 'cultural connection'. CONCLUSION: This study provides evidence of the suitability of the Stay Strong app for use as a chronic condition self-management tool. Participants set goals that addressed physical as well as social and emotional wellbeing needs, prioritising family, country, and cultural identity. The intervention aligns directly with self-management approaches that are holistic and prioritise individual empowerment. Implementation of self-management strategies into routine care remains a key challenge and further research is needed to establish drivers of success.

The Current Use of Sakau (Kava) in Pohnpei Island, Federated States of Micronesia.

In Pohnpei Island, sakau (kava) is a symbol of the traditional culture. Although the use of sakau was once limited to people of high rank and used only during ceremonial occasions, it is now consumed in bars and sold in bottles around the island. Recently, negative medical and environmental effects correlated with the increase sale of sakau have attracted scholarly attention. However, the current use of sakau is not fully understood. This study aims to describe the current use of sakau and consider by whom, on what occasions, and for what purpose sakau is consumed, and whether it continues to play a traditional role. Fieldwork was conducted from July to September 2019 in Kolonia (where people of Pohnpeian ethnicity live) and Mand (where non-Pohnpeians live). The latter was included to investigate whether sakau was consumed by people of ethnic groups that have never used it traditionally. Data were collected via interviews using a questionnaire, direct observation, and casual conversations. A total of 89 people (41 in Kolonia; 48 in Mand) participated in the study. Most (71% of those in Kolonia and 58% of those in Mand) reported they drank sakau at some point in their lives. Although the frequency of sakau consumption was significantly lower in Mand (P=.027), it was consumed regardless of their original culture. Commonly reported reasons for drinking sakau included treating anxiety and socializing. The use of sakau in Pohnpeian society continues in traditional contexts, such as feasts, marriage proposals, and forgiveness. Additionally, increased consumption has been profitable for people engaged in businesses related to sakau.

Aspiring toward Pae Ora: Values and strengths-based child safety messaging in Aotearoa/New Zealand.

On-going inequities in rates of fatal and non-fatal injury between tamariki Maori (Indigenous children) and non-Maori children in Aotearoa (New Zealand) are unacceptable and highlight breaches by the Crown in their obligations to Maori, outlined in Te Tiriti o Waitangi (The Treaty of Waitangi). Safekids Aotearoa, a national organisation tasked with reducing unintentional injuries to children (0-14 years), is shifting the focus of its programmes and resources to better align with Te Tiriti o Waitangi and to honour Maori knowledge, ideas and principles to eliminate inequity and support the pursuit of Pae Ora: Maori health aspirations for flourishing whanau (families) and tamariki. We provide an overview of Te Tiriti o Waitangi and its relevance to child injury prevention and the Te Tiriti-led response by Safekids Aotearoa, particularly around approaches to developing values and strengths-based safety messages. In doing so, we challenge and counter pervasive barriers to achieving equity and Pae Ora and describe how identifying and incorporating shared Maori values in a Te Tiriti-led agenda supports the work, ethos, programmes and relationships of Safekids Aotearoa in its journey toward equitable outcomes and Pae Ora for all. We highlight the importance of embedding prevention efforts and advocacy within a holistic framework of tamariki and whanau well-being embracing capability and strengths-based approaches.

"The world is so white": improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease.

OBJECTIVE: To examine the views of senior health system knowledge holders, including Aboriginal experts, regarding the spaces where elimination strategies for rheumatic heart disease take place: Aboriginal and Torres Strait Islander ways of knowing, being and doing; and biomedical healthcare models. We aimed to support the implementation of the RHD Endgame Strategy by providing some of the 'how'. METHODS: In-depth interviews were undertaken with 23 participants. The design of the interview questions and analysis of the data used strengths-based approaches as directed by Aboriginal researchers. RESULTS: Given the dominance of the biomedical worldview, and the complex trajectory of RHD, there is significant tension in the intersection of worldviews. Tensions that limit productive dialogue are juxtaposed with suggestions on how to reduce tension through reflexivity, power shifting and endorsing Aboriginal leadership and governance. Evidence supported cultural safety for RHD care, prevention and elimination as the key action. CONCLUSIONS: Recommendations include addressing power imbalances between dominant and minority populations throughout the health system; reform that both supports and is supported by Non-Indigenous and Aboriginal and Torres Strait Islander leadership. IMPLICATIONS FOR PUBLIC HEALTH: Increased understanding of and support for Indigenous leadership and cultural safety will enable implementation of the new RHD strategy.