Exploration of barriers and enablers to diabetes care for Aboriginal people on rural Ngarrindjeri Country.

ISSUES ADDRESSED: Addressing the disproportionate burden of type 2 diabetes prevalence in Aboriginal communities is critical. Current literature on diabetes care for Aboriginal people is primarily focused on remote demographics and overwhelmingly dominated by Western biomedical models and deficit paradigms. This qualitative research project adopted a strengths-based approach to explore the barriers and enablers to diabetes care for Aboriginal people on Ngarrindjeri Country in rural South Australia. METHODS: Knowledge Interface methodology guided the research as Aboriginal and Western research methods were drawn upon. Data collection occurred using three yarning sessions held on Ngarrindjeri Country. Yarns were transcribed and deidentified before a qualitative thematic analysis was conducted, guided by Dadirri and a constructivist approach to grounded theory. RESULTS: A total of 15 participants attended the yarns. Major barriers identified by participants were underscored by the ongoing impacts of colonisation. This was combated by a current of survival as participants identified enablers to diabetes care, namely a history of healthy community, working at the knowledge interface, motivators for action, and an abundance of community skills and leadership. CONCLUSIONS: Despite the raft of barriers detailed by participants throughout the diabetes care journey, Aboriginal people on Ngarrindjeri Country were found to be uniquely positioned to address diabetes prevalence and management. SO WHAT?: Health promotion efforts with Aboriginal people on Ngarrindjeri Country must acknowledge the sustained impacts of colonisation, while building on the abundance of community enablers, skills and strengths. Opportunities present to do so by adopting holistic, community-led initiatives that shift away from the dominant biomedical approach to diabetes care.

Scoring thermal limits in small insects using open-source, computer-assisted motion detection.

Scoring thermal tolerance traits live or with recorded video can be time consuming and susceptible to observer bias, and as with many physiological measurements, there can be trade-offs between accuracy and throughput. Recent studies show that automated particle tracking is a viable alternative to manually scoring videos, although some of the software options are proprietary and costly. In this study, we present a novel strategy for automated scoring of thermal tolerance videos by inferring motor activity with motion detection using an open-source Python command line application called DIME (detector of insect motion endpoint). We apply our strategy to both dynamic and static thermal tolerance assays, and our results indicate that DIME can accurately measure thermal acclimation responses, generally agrees with visual estimates of thermal limits, and can significantly increase throughput over manual methods.

Understanding how healthcare providers build consumer trust in the Australian food system: A qualitative study.

AIM: This study aimed to identify how dietitians and other healthcare providers work to build trust in food systems in the course of providing dietary education. METHODS: Qualitative semi-structured interviews were conducted with 15 purposefully sampled dietitians (n = 5), general practitioners (n = 5), and complementary and alternative medicine practitioners (n = 5) within metropolitan South Australia. Interview data were then interpreted using an inductive thematic analysis approach, involving the construction of themes representing trust-enhancing roles around which beliefs about professional roles, the 'patient', and food and health were clustered. RESULTS: Healthcare providers communicate beliefs regarding (dis)trust in food systems through: (i) responding to patient queries and concerns following a food incident or scare; (ii) helping patients to identify (un)trustworthy elements of food supply systems; and (iii) encouraging consumption of locally produced and minimally processed food. Importantly, the expression of these roles differed according to participant beliefs about food and health (medico-scientific versus alternative medicine) and their adoption of professional projects that sought to promote medico-scientific ways of thinking about health and diet or manage the failures of Western medicine. CONCLUSION: The development and consolidation of trust-enhancing roles amongst healthcare providers likely requires disciplinary reflection on professional values and the processes by which practitioners apply these values to understanding food systems.

A realist evaluation of a community of practice for dietitians and nutritionists working in Aboriginal and Torres Strait Islander health.

BACKGROUND: Communities of practice have been proposed as a workforce development strategy for developing dietitians, yet little is known about how they work and for whom, as well as under what circumstances. We aimed to understand the mechanisms by which dietitians working in Aboriginal and Torres Strait Islander health benefit from communities of practice. METHODS: A realist evaluation of 29 interviews with non-Indigenous dietitians and nutritionists was employed, which was conducted over the course of two communities of practice (2013 and 2014) and follow-up interviews in 2019. Programme theory was developed from analysis of initial interviews and used to recode all interviews and test theory. The identification of patterns refined the programme theory. RESULTS: Six refined theories were identified: (1) a community of practice fosters the relationships that support navigation of the many tasks required to become more responsive health professionals; (2) committed and open participants feel supported and guided to be reflexive; (3) sharing, reflexivity, feedback and support shift awareness to one's own practice to be able to manoeuvre in intercultural spaces; (4) through sharing, feedback, support and collaboration, participants feel assured and affirmed; (5) connection through feelings of understanding and being understood contributes to commitment to remain working in the area; and (6) through sharing, feedback, support and collaboration, participants with varied experience and roles see the value of and gain confidence in new perspectives, skills and practices. CONCLUSIONS: Further research is required to test this model on a much larger scale, with communities of practice inclusive of Aboriginal and non-Aboriginal health professionals together, and across a diverse group of dietitians.

Improving cultural competence of healthcare workers in First Nations communities: a narrative review of implemented educational interventions in 2015-20.

BACKGROUND: Cultural competency is often promoted as a strategy to address health inequities; however, there is little evidence linking cultural competency with improved patient outcomes. This article describes the characteristics of recent educational interventions designed to improve cultural competency in healthcare workers for First Nations peoples of Australia, New Zealand, Canada and the USA. METHODS: In total, 13 electronic databases and 14 websites for the period from January 2015 to May 2021 were searched. Information on the characteristics and methodological quality of included studies was extracted using standardised assessment tools. RESULTS: Thirteen published evaluations were identified; 10 for Australian Aboriginal and Torres Strait Islander peoples. The main positive outcomes reported were improvements in health professionals' attitudes and knowledge, and improved confidence in working with First Nations patients. The methodological quality of evaluations and the reporting of methodological criteria were moderate. CONCLUSIONS: Cultural competency education programs can improve knowledge, attitudes and confidence of healthcare workers to improve the health of First Nations peoples. Providing culturally safe health care should be routine practice, particularly in places where there are concentrations of First Nations peoples, yet there is relatively little research in this area. There remains limited evidence of the effectiveness of cultural education programs alone on community or patient outcomes.

Testing delay in an environment of low COVID-19 prevalence: A qualitative study of testing behaviour amongst symptomatic South Australians.

Introduction: South Australia has to date (October 2021) been highly successful in maintaining an aggressive suppression strategy for the management of the COVID-19 pandemic. However, continued success of this strategy is dependent on ongoing testing by people with symptoms of COVID-19 to identify, trace and quarantine emergent cases as soon as possible. This study sought to explore community members' decisions about having COVID-19 testing in an environment of low prevalence, specifically exploring their decision-making related to symptoms. Materials and methods: This study drew on a qualitative case study design, involving five focus groups, conducted in May 2021, with 29 individuals who had experienced COVID-19-like symptoms since the commencement of testing in South Australia. Participants detailed their last COVID-19-like illness episode and described their decision-making regarding testing. Data collection methods and analysis were theoretically informed by the capability, opportunity, and motivation behaviour (COM-B) model. Findings: Participants' belief that COVID-19 symptoms would be 'unusual', severe, and persistent caused them to either reject or delay testing. Participants generally employed 'watch and wait' and social distancing behaviour rather than timely presentation to testing. Concern about economic loss associated with isolating after testing, and the potential for illness transmission at testing centres further prevented testing for some participants. Conclusions: In a low COVID-19 prevalence environment, individuals rely on pre-existing strategies for interpreting and managing personal illness (such as delaying help seeking if symptoms are mild), which generally conflict with public health management advice about COVID-19. In low prevalence environments therefore public health authorities must give the public a reason to test beyond considerations of personal risk, and clearly communicate the need for ongoing COVID-19 surveillance despite the low prevalence environment.

Long-Term Outcomes of a Community of Practice for Dietitians Working in Aboriginal and Torres Strait Islander Health: A Multimethod, Follow-up Study.

INTRODUCTION: Dietitians are in an important position to work alongside Aboriginal and Torres Strait Islander peoples to improve their health and may play a role in reducing the burden of disease experienced by Aboriginal and Torres Strait Islander peoples. Many dietitians do not feel confident to practice effectively in these settings and require improved workforce development opportunities. Communities of Practice can improve dietitians' confidence and practice in Aboriginal and Torres Strait Islander health; however, evidence for long-term impacts is limited. This study aims to determine if a Community of Practice can have long-term impacts on dietitians working in Aboriginal and Torres Strait Islander health. METHODS: Data were collected through semistructured interviews and a cultural awareness self-assessment tool. Analysis was through a multimethod approach and combined qualitative inductive thematic analysis, social network analysis, and descriptive statistics. RESULTS: Three main areas of long-term impact were identified including development of a social and professional network, career progression and retention, and a fundamental change in thinking and practice. All participants experienced feelings of support and increased confidence. DISCUSSION: Communities of practice may be a feasible, low-cost workforce development strategy that can reduce dietitians' feelings of professional isolation when working in Aboriginal and Torres Strait Islander health. Further research is required to identify the mechanisms underlying sustained impacts. Social network analysis, combined with realist evaluation may be an appropriate research design, to answer future and more in-depth questions about the effectiveness of communities of practice.

The health implications of distrust in the food system: findings from the dimensions of trust in food systems scale (DOTIFS scale).

BACKGROUND: Consumer trust in food systems is essential for consumers, food industry, policy makers and regulators. Yet no comprehensive tool for measuring consumer trust in food systems exists. Similarly, the impact that trust in the food system has on health-related food behaviours is yet to be empirically examined. The aim of this research was to develop a comprehensive instrument to measure trust in the food system (the Dimensions of Trust in Food Systems Scale (DOTIFS scale) and use it to explore whether trust in the food system impacts consumers' health-related behaviours. METHODS: The DOTIFS scale was developed using sociological theories of trust and pre-existing instruments measuring aspects of trust. It was pilot tested and content validity was assessed with 85 participants. A mixed-methods exploration of the health-related behaviours of 18 conveniently sampled Australian consumers with differing trust scores determined by the DOTIFS scale was then conducted. During March-July 2019 shopping- and home-observations were used to assess participants' food safety practices and exposure to public health fortification programs, while the CSIRO Healthy Diet Score determined their adherence to national dietary guidelines. RESULTS: The DOTIFS scale was found to have high comprehension, ease of use and content validity. Statistical analysis showed scale scores significantly trended as predicted by participants' stated level of trust. Differences were found in the way individuals with more or less trust in the food system comply with national dietary guidelines, are exposed to public health fortification programs, and adhere to recommended food safety practices. CONCLUSIONS: The DOTIFS scale is a comprehensive, sociologically- and empirically- informed assessment of consumer trust in food systems that can be self-administered online to large populations and used to measure changes in consumer trust over time. The differences in health-related behaviours between individuals with varying levels of trust warrant further investigation.

Assessing cultural safety in Aboriginal and Torres Strait Islander Health.

OBJECTIVE: The aim of this study was to explore how nurses and midwives (trained at Flinders University in Adelaide) from rural, remote and urban locations view the impact of cultural safety training on their practice and the extent to which they incorporated cultural safety principles into their practice. DESIGN: qualitative research study. SETTING: rural, remote and urban locations across Australia. PARTICIPANTS: Nurses and midwives who had undertaken cultural safety training at Flinders University as part of their undergraduate degree. METHODS: Participants were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Transcripts were coded independently by members of the research team. MAIN OUTCOME MEASURES: The use of cultural safety principles in participants' practice, and the extent to which they were applied, was determined. Barriers and enablers to enacting cultural safety in the workplace were also identified. RESULTS: 10 individuals participated in an interview (7 nurses and 3 midwives). The Modified Monash Model was used to classify participant location with the following observed: MM1, six; MM2, two; MM5, one; MM6, one. 3 participants were from the Northern Territory and 7 from South Australia. Participants were at varying stages in their journey of cultural safety, ranging from early stages to those able to embody the Cultural Safety Principles and negotiate barriers to provide culturally safe care. Educational strategies for participants to progress their cultural safety journey were also identified. CONCLUSION: The extent to which cultural safety principles are applied in practice is diverse amongst the nurses and midwives that participated in this study, demonstrating that cultural safety is a journey and ongoing support is needed.

How the Media Places Responsibility for the COVID-19 Pandemic-An Australian Media Analysis.

Global pandemics are likely to increase in frequency and severity, and media communication of key messages represents an important mediator of the behavior of individuals in response to public health countermeasures. Where the media places responsibility during a pandemic is therefore important to study as blame is commonly used as a tool to influence public behavior but can also lead to the subjective persecution of groups. The aim of this paper is to investigate where the media places responsibility for COVID-19 in Australia. Specifically, we identify the key themes and frames that are present and observe how they changed over the course of the COVID-19 pandemic in relation to government actions and progression of the pandemic. Understanding media representations of the COVID-19 pandemic will provide insights into ways in which responsibility is framed in relation to health action. Newspaper articles from the Australian and the Sydney Morning Herald were sampled between January 20 and March 31 2020 on every second Monday. Factiva was used to identify and download newspaper articles using the following search criteria: "COVID-19" OR coronavirus OR "Wuhan virus" OR "corona virus" OR "Hebei virus" OR "wet market" OR (Wuhan AND virus) OR (market AND Wuhan and virus) or (China AND Virus) or (Novel AND Virus). Articles were imported into Nvivo and thematic and framing analyses were used. The results show that framing of the pandemic was largely based on societal issues with the theme of economic disruption prevalent throughout the study time period. Moral evaluations of the pandemic were infrequent initially but increased co-incident with the first signs of "flattening of the curve." Explicit examples of blame were very rare but were commonly implied based on the causal origin of the virus. The Australian printed media were slow to report on the COVID-19 pandemic, in addition they were reluctant to apportion blame until the end of the study period, after confirmed case rates had begun to slow. This is interpreted as being due to an evaluation of the pandemic risks as low by the media and therefore the tools of othering and blame were not used until after the study period when the actual risks had begun to abate, more consistent with an inquiry than a mediating mechanism.

Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares?

Trust in public health officials and the information they provide is essential for the public uptake of preventative strategies to reduce the transmission of COVID-19. This paper discusses how a model for developing and maintaining trust in public health officials during food safety incidents and scandals might be applied to pandemic management. The model identifies ten strategies to be considered, including: transparency; development of protocols and procedures; credibility; proactivity; putting the public first; collaborating with stakeholders; consistency; education of stakeholders and the public; building your reputation; and keeping your promises. While pandemic management differs insofar as the responsibility lies with the public rather than identifiable regulatory bodies, and governments must weigh competing risks in creating policy, we conclude that many of the strategies identified in our trust model can be successfully applied to the maintenance of trust in public health officials prior to, during, and after pandemics.

Working together in Aboriginal health: a framework to guide health professional practice.

BACKGROUND: Working effectively with Aboriginal and Torres Strait Islander people is important for maximising the effectiveness of a health care interaction between and Aboriginal and Torres Strait Islander patients and a health professional. This paper presents a framework to guide health professional practice in Aboriginal and Torres Strait Islander health. METHODS: This qualitative study was based in a social constructionist epistemology and was guided by a critical social research methodology. Two methods were employed: interviews with Aboriginal health workers and allied health professionals about their experiences of working together in Aboriginal health, and an auto-ethnography conducted by the researcher, a non-Aboriginal dietitian and researcher who worked closely with two Aboriginal communities while undertaking this research. RESULTS: Interviews were conducted with 44 allied health professionals and Aboriginal health workers in 2010. Critical Social research, which involves the deconstruction and reconstruction of data, was used to analyse data and guided the evolution of themes. Strategies that were identified as important to guide practice when working respectfully in Aboriginal health included: Aboriginal and non-Aboriginal people working with Aboriginal health workers, using appropriate processes, demonstrating commitment to building relationships, relinquishing control, having an awareness of Aboriginal history, communication, commitment, flexibility, humility, honesty, and persistence. Reciprocity and reflection/reflexivity were found to be cornerstone strategies from which many other strategies naturally followed. Strategies were grouped into three categories: approach, skills and personal attributes which led to development of the Framework. CONCLUSIONS: The approach, skills and personal attributes of health professionals are important when working in Aboriginal health. The strategies identified in each category provide a Framework for all health professionals to use when working with Aboriginal and Torres Strait Islander people.

Resetting the Narrative in Australian Aboriginal and Torres Strait Islander Nutrition Research.

As the oldest continuous living civilizations in the world, Aboriginal and Torres Strait Islander peoples have strength, tenacity, and resilience. Initial colonization of the landscape included violent dispossession and removal of people from Country to expand European land tenure and production systems, loss of knowledge holders through frontier violence, and formal government policies of segregation and assimilation designed to destroy ontological relationships with Country and kin. The ongoing manifestations of colonialism continue to affect food systems and food knowledges of Aboriginal peoples, and have led to severe health inequities and disproportionate rates of nutrition-related health conditions. There is an urgent need to collaborate with Aboriginal and Torres Strait Islander peoples to address nutrition and its underlying determinants in a way that integrates Aboriginal and Torres Strait Islander peoples' understandings of food and food systems, health, healing, and well-being. We use the existing literature to discuss current ways that Australian Aboriginal and Torres Strait Islander peoples are portrayed in the literature in relation to nutrition, identify knowledge gaps that require further research, and propose a new way forward.

Role of Aboriginal Health Workers and Liaison Officers in quality care in the Australian acute care setting: a systematic review.

Objective The aim of this study was to identify the contribution of Aboriginal Health Workers and Liaison Officers (AHWLOs) to quality of care in the acute health care setting in Australia. Methods A systematic review of peer-reviewed literature focused on the role of AHWLOs and quality processed and quality outcomes. Authors undertook study selection based on inclusion criteria and performed quality assessment using critical appraisal tools from the Joanna Briggs Institute. Results The search revealed limited literature that met the inclusion criteria, namely four quantitative studies and one mixed-methods study. The settings of the included studies were mental health and cardiac care units within various hospitals. The studies indicated that AHWLOs may have a positive effect on communication between healthcare professionals and patients, rates of discharge against medical advice and continuity of care. Methodological constraints among the included studies made it difficult to establish specific contributions of AHWLOs to quality care markers across acute care units. Conclusions The role of AHWLOs in providing quality care in the acute care setting has received minimal research. The limited existing research highlights the importance of the AHWLO role. For example, AHWLOs may influence patient communication, discharge against medical advice and continuity of care within mental health and cardiac care units. Further, because of methodological constraints among the limited studies, research into the role of AHWLOs in these and other acute care settings is needed to assess effects on a range of specific clinical quality markers. What is known about the topic? Aboriginal and Torres Strait Islander people experience unacceptable health inequities. AHWLOs are a unique workforce introduced to increase access to culturally safe care and, ultimately, help to address these inequities. What does this paper add? This review explores the current evidence for the contribution of AHWLOs to quality care in the acute care setting. The findings suggest that these professionals may improve communication between patients and medical staff, improve continuity of care and reduce patient discharge against medical advice. However, these findings highlight that the use of quality care markers across acute care settings is needed to generate tangible evidence to help establish the legitimacy of these health professionals. What are the implications for practitioners? AHWLOs have a place in the acute care team. Although further research is required to expand the preliminary evidence base of their effect on quality acute care, this workforce should be supported at the individual, organisational and policy levels to enhance the health and well-being of one the most vulnerable communities in Australia.

Cross-country comparison of strategies for building consumer trust in food.

Consumer trust in the modern food system is essential given its complexity. Contexts vary across countries with regard to food incidents, regulation and systems. It is therefore of interest to compare how key actors in different countries might approach (re)building consumer trust in the food system; and particularly relevant to understanding how food systems in different regions might learn from one another. The purpose of this paper is to explore differences between strategies for (re)building trust in food systems, as identified in two separate empirical studies, one conducted in Australia, New Zealand and the UK (Study 1) and another on the Island of Ireland (Study 2). Interviews were conducted with media, food industry and food regulatory actors across the two studies (n = 105 Study 1; n = 50 Study 2). Data were coded into strategy statements, strategies describing actions to (re)build consumer trust. Strategy statements were compared between Studies 1 and 2 and similarities and differences were noted. The strategy statements identified in Study 1 to (re)build consumer trust in the food system were shown to be applicable in Study 2, however, there were notable differences in the contextual factors that shaped the means by which strategies were implemented. As such, the transfer of such approaches across regions is not an appropriate means to addressing breaches in consumer trust. Notwithstanding, our data suggest that there is still capacity to learn between countries when considering strategies for (re)building trust in the food system but caution must be exercised in the transfer of approaches.

Role of Community and Professional Engagement in Allied Health Higher Education: The Academic Perspective.

Community and professional engagement describes a collaborative model of interaction between institutions of higher education and the communities in which they operate. This qualitative study aimed to examine how professional and community engagement is understood and incorporated into the role of staff members within the School of Health Sciences of one university. Twenty-one academic and professional staff were interviewed. Participants identified a range of definitions for both 'community' and 'professional' engagement, as well as the benefits and limitations of such engagement. Ability to conduct engagement was limited by time capacity when competing with other role requirements. Integration of community engagement with research and teaching requires development of a framework that addresses both the common barriers and facilitators to engagement.

Supporting dietitians to work in Aboriginal health: Qualitative evaluation of a Community of Practice mentoring circle.

AIM: This paper explores the experience of dietitians participating in a Community of Practice designed to support their work with Aboriginal communities. METHODS: The Community of Practice for dietitians working with Aboriginal communities ran for 12 months, starting in May 2014. Six-weekly mentoring sessions were held using Skype, with conversation aided by a facilitator. In-depth, semi-structured interviews were held with all participants at the conclusion of the Community of Practice. Data were analysed using thematic analysis. RESULTS: Thirteen dietitians participated in the Community of Practice and an in-depth, semi-structured interview. Four key themes were identified: (i) Aboriginal health practice requires a different way of 'knowing', 'being' and 'working'; (ii) Community of Practice is a safe place to discuss, debrief and explore ideas that are not safe elsewhere; (iii) participation in Community of Practice contributed to workforce retention in the Aboriginal health sector; and (iv) participation in Community of Practice contributed to dietitians changing their practice and feeling confident to do so. CONCLUSIONS: By increasing confidence and opportunities for safe discussion, Community of Practice appears to be a useful model of Continuing Professional Development to support dietitians working in Aboriginal health.