Making Big Business Everybody's Business: Aboriginal leaders' perspectives on commercial activities influencing aboriginal health in Victoria, Australia.

BACKGROUND: The commercial determinants of health is a rapidly expanding field of research; however Indigenous perspectives remain notably underrepresented. For Indigenous peoples the intersection of globalisation, colonialism and capitalism may amplify commercially-driven health inequities. This study aimed to explore the perspectives of Aboriginal leaders regarding the influence of commercial activities on Aboriginal health and wellbeing in Victoria, Australia. METHODS: Semi-structured interviews with 23 Aboriginal leaders from across five sectors (n = 15 urban, n = 8 rural/regional) were analysed through reflexive thematic analysis. RESULTS: Three overarching themes were identified encompassing (i) harmful commercial practices and processes, (ii) improving corporate engagement and (iii) opportunities for self-determination through business. Participants expressed concern over aggressive marketing by the gambling industry, commercial exploitation of Aboriginal culture, the privatisation of public services, and lack of oversignt of corporate social responsibility strategies. Simultaneously, Aboriginal-led businesses were viewed as opportunities for cultural connection, and financial empowerment and self-determination. CONCLUSION: Numerous commercial entities and activities are perceived to influence Aboriginal health and wellbeing. This study highlights the need for stronger policy and regulation to mitigate harmful industry practices while incentivising the potential positive impacts of the commercial activities on Aboriginal health and wellbeing.

Differences in weight status among Australian children and adolescents from priority populations: a longitudinal study.

BACKGROUND AND SIGNIFICANCE: Australia has a high level of cultural and linguistic diversity, including Aboriginal and Torres Strait Islander peoples. Children from specific cultural and ethnic groups may be at greater risk of overweight and obesity and may bear the additional risk of socioeconomic disadvantage. Our aim was to identify differences in body-mass index z-score (zBMI) by: (1) Cultural and ethnic groups and; (2) Socioeconomic position (SEP), during childhood and adolescence. SUBJECTS/METHODS: We used data from the Longitudinal Study of Australian children (n = 9417) aged 2-19 years with 50870 longitudinal measurements of zBMI. Children were classified into 9 cultural and ethnic groups, based on parent and child's country of birth and language spoken at home. These were: (1) English-speaking countries; (2) Middle East & North Africa; (3) East & South-East Asia; (4) South & Central Asia; (5) Europe; (6) Sub-Saharan Africa; (7) Americas; (8) Oceania. A further group (9) was defined as Aboriginal and Torres Strait Islander from self-reported demographic information. Longitudinal cohort analyses in which exposures were cultural and ethnic group and family socioeconomic position, and the outcome was zBMI estimated using multilevel mixed linear regression models. We stratified our analyses over three periods of child development: early childhood (2-5 years); middle childhood (6-11 years); and adolescence (12-19 years). RESULTS: Across all three periods of child development, children from the Middle East and North Africa, the Americas and Oceania were associated with higher zBMI and children from the two Asian groups were associated with lower zBMI, when compared to the referent group (English). zBMI was socioeconomically patterned, with increasingly higher zBMI associated with more socioeconomic disadvantage. CONCLUSIONS: Our findings identified key population groups at higher risk of overweight and obesity in childhood and adolescence. Prevention efforts should prioritize these groups to avoid exacerbating inequalities in healthy weight in childhood.

Pathways between foodways and wellbeing for first nations Australians.

BACKGROUND: Supporting the health and wellbeing of Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as First Nations peoples) is a national priority for Australia. Despite immense losses of land, language, and governance caused by the continuing impact of colonisation, First Nations peoples have maintained strong connections with traditional food culture, while also creating new beliefs, preferences, and traditions around food, which together are termed foodways. While foodways are known to support holistic health and wellbeing for First Nations peoples, the pathways via which this occurs have received limited attention. METHODS: Secondary data analysis was conducted on two national qualitative datasets exploring wellbeing, which together included the views of 531 First Nations peoples (aged 12-92). Thematic analysis, guided by an Indigenist research methodology, was conducted to identify the pathways through which foodways impact on and support wellbeing for First Nations peoples. RESULTS AND CONCLUSIONS: Five pathways through which wellbeing is supported via foodways for First Nations peoples were identified as: connecting with others through food; accessing traditional foods; experiencing joy in making and sharing food; sharing information about food and nutrition; and strategies for improving food security. These findings offer constructive, nationally relevant evidence to guide and inform health and nutrition programs and services to harness the strengths and preferences of First Nations peoples to support the health and wellbeing of First Nations peoples more effectively.

Ear health and hearing in urban Aboriginal children.

OBJECTIVE: Evaluate ear health and hearing among urban Aboriginal children and quantify relationships with child, family and social factors. METHODS: Baseline questionnaire and ear health examinations from 1430 children with diagnoses (0.5-18 years) attending Aboriginal Health Services enrolled in SEARCH. Ear health outcomes were Otitis Media (OM), and hearing loss (three-frequency average hearing loss >20dB) diagnosed using pneumatic otoscopy, tympanometry, and audiometry. RESULTS: Half the children 0.5-3 years had OM (51.5%, 136/264). One third 0.5-18 years (30.4%; 435/1430) had OM, including 1.8% (26/1430) with perforation (0.8% chronic suppurative OM, 0.6% dry perforation and 0.4% acute OM with perforation). One quarter 0.5-18 years (25.7%; 279/1087) had hearing loss; 12.4% unilateral, 13.2% bilateral (70.6% with bilateral loss had concurrent OM). OM was associated with: younger age (0.5-<3 years versus 6-18 years) age-sex-site; adjusted prevalence ratio (aPR)=2.64, 95%, 2.18-3.19); attending childcare/preschool (aPR=1.24, 95%CI, 1.04-1.49); foster care (aPR=1.40, 95%CI, 1.10-1.79); previous ear infection/s (aPR=1.68, 95%CI, 1.42-1.98); and ≥2 people/bedroom (aPR=1.66, 95%CI, 1.24-2.21). Hearing impairment was associated with younger age (0.5-<6 years vs. ≥6 years aPR=1.89, 95%CI, 1.40-2.55) and previous ear infection (aPR=1.87, 95%CI, 1.31-2.68). CONCLUSIONS: Half the urban Aboriginal children in this cohort had OM and two-thirds with hearing impairment had OM. IMPLICATIONS FOR PUBLIC HEALTH: Findings highlight importance of early detection and support for ear health, particularly in pre-school-aged children with risk factors.

Don't Follow the Smoke-Listening to the Tobacco Experiences and Attitudes of Urban Aboriginal Adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

Preventing smoking among young Aboriginal people is important for reducing health inequities. Multiple factors were associated with adolescent smoking in the SEARCH baseline survey (2009-12) and discussed in a follow-up qualitative study that aimed to inform prevention programs. Twelve yarning circles were facilitated by Aboriginal research staff at two NSW sites in 2019 with 32 existing SEARCH participants aged 12-28 (17 female, 15 male). Open discussion around tobacco was followed by a card sorting activity, prioritising risk and protective factors and program ideas. The age of initiation varied by generation. Older participants had established smoking in their early adolescence, whereas the current younger teens had little exposure. Some smoking commenced around high school (from Year 7), and social smoking increased at age 18. Mental and physical health, smoke-free spaces and strong connections to family, community and culture promoted non-smoking. The key themes were (1) drawing strength from culture and community; (2) how the smoking environment shapes attitudes and intentions; (3) non-smoking as a sign of good physical, social and emotional wellbeing; and (4) the importance of individual empowerment and engagement for being smoke-free. Programs promoting good mental health and strengthening cultural and community connections were identified as a priority for prevention.

Aboriginal Young People's Experiences of Accessibility in Mental Health Services in Two Regions of New South Wales, Australia.

This article assesses the accessibility of mainstream mental health services (MMHSs) in two regions of New South Wales (NSW), Australia, based on experiences and perspectives of Aboriginal young people aged 16-25. Semi-structured yarning interviews were conducted with thirteen Aboriginal young people in two regions of NSW. Thematic analysis was undertaken by all research team members to identify major themes from the data and conceptual connections between them. The identified themes from individual analysis and coding were triangulated during several analysis meetings to finalise the key themes and findings. Aboriginal young people had no experience of engaging with early-intervention MMHSs. MMHSs were identified as inaccessible, with most participants unaware that MMHSs existed in each region. Due to MMHSs being inaccessible, many Aboriginal young people presented to emergency departments (EDs) during a crisis. Aboriginal Community Controlled Health Services (ACCHSs) were identified as key providers of accessible, culturally meaningful, and effective social and emotional wellbeing (SEWB) service support for Aboriginal young people in NSW. If health and wellbeing outcomes are to improve for Aboriginal young people in NSW, MMHSs must increase accessibility for Aboriginal young people requiring SEWB support.

Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning.

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.

Murradambirra Dhangaang (make food secure): Aboriginal community and stakeholder perspectives on food insecurity in urban and regional Australia.

BACKGROUND: It is widely acknowledged that the invasion by colonial powers of the Australian continent had profound and detrimental impacts on Aboriginal Communities, including food security. Policies of successive governments since European arrival have since further exacerbated the situation, with food insecurity now affecting 20-25% of Aboriginal and Torres Strait Islander people. Food insecurity contributes to long-term impacts on health, in particular diet-sensitive chronic diseases. This study aimed to describe Aboriginal community and stakeholder perspectives on food insecurity to get a better understanding of the key contributing factors and recommendations for potential strategies to address this issue in Aboriginal communities in urban and regional Australia. METHODS: Semi-structured interviews were conducted with 44 participants who were purposively selected. This included Aboriginal people in two communities and both Aboriginal and non-Aboriginal stakeholders from local food relief agencies, food suppliers, schools, and government in an urban and regional location in NSW. A conceptual framework was developed from literature on food security, and sensitizing concepts of availability, affordability, accessibility and acceptability or the lack thereof of healthy food were used to elicit responses from the participants. Interview transcripts were analysed thematically. RESULTS: All participants felt strongly that food insecurity was a major problem experienced in their local Aboriginal communities. Five core areas impacting on food security were identified: trapped in financial disadvantage; gaps in the local food system; limitations of non-Aboriginal food relief services; on-going impacts of colonization; and maintaining family, cultural and community commitments and responsibilities. Participants suggested a number of actions that could help ease food insecurity and emphasized that Aboriginal values and culture must be strongly embedded in potential programs. CONCLUSIONS: This study found Aboriginal families in urban and regional Australia are experiencing food insecurity on a regular basis, which is impacted by a range of socio-economic, environmental, systemic and cultural factors, as reported by the participants. Study findings highlight the need to address system level changes in the food environment and acknowledge Aboriginal history, culture and food preferences when considering the development of programs to alleviate food insecurity among Aboriginal people.

Markers of chronic disease risk in a cohort of Aboriginal children: findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

OBJECTIVE: This study investigated chronic disease risk markers among a cohort of Aboriginal children in New South Wales. METHODS: Distributions of body mass index (BMI), blood lipids and haemoglobin A1c (HbA1c) among Aboriginal children aged 5-<19 years were investigated. Prevalence ratios (PR) were calculated for borderline/high total cholesterol, low-density lipoprotein (LDL) cholesterol and HbA1c, and low high-density lipoprotein (HDL) cholesterol, by age group, sex and BMI. RESULTS: Almost half (46.8%) of the cohort, had a normal BMI and 53.3% had overweight or obesity. Prevalence of chronic disease risk markers was low, with no individuals having high total cholesterol (0.0%) and few having high LDL (3.0%) or borderline/high HbA1c (2.6%); 85.5% of the cohort had normal HDL. There was no significant variation in the prevalence of chronic disease risk markers by age group or sex. The prevalence of borderline total cholesterol was 28% higher (PR 1.28, 95%CI 1.06-1.54), and the prevalence of low HDL was double (2.00, 1.19-3.35) for participants with obesity versus normal BMI. CONCLUSIONS: Dyslipidaemia and elevated HbA1c prevalence was low in the cohort, increasing with high BMI. Overweight and obesity were common, which increase the risk of developing chronic disease later in life. Implications for public health: Findings indicate few Aboriginal children have dyslipidaemia and hyperglycaemia, supporting screening for chronic disease risk factors from 18 years of age. Opportunities to reduce overweight and obesity among children should be considered to decrease the future risk of chronic disease.

Systems thinking for Aboriginal Health: Understanding the value and acceptability of group model building approaches.

Systems thinking is increasingly applied to understand and address systemic drivers of complex health problems. In Australia, group model building, a participatory method from systems science, has been applied in various locations to engage communities in systems-based health promotion projects. To date there is limited evidence regarding GMB use with Australian Aboriginal communities. This study aimed to determine the value and acceptability of group model building (GMB) as a methodological approach in research with Aboriginal communities and identify any adaptations required to optimise its utility. Semi-structured interviews were undertaken with 18 Aboriginal health and university staff who had prior experience with a GMB research project. Interview transcripts were inductively analysed using thematic analysis and key themes were organised using an Indigenous research framework. Participants reported that GMB methods generally aligned well with Aboriginal ways of knowing, being, and doing. Participants valued the holistic, visual and collaborative nature of the method and its emphasis on sharing stories and collective decision-making. Group model building was viewed as a useful tool for identifying Aboriginal-led actions to address priority issues and advancing self-determination. Our findings suggest that by bringing together Aboriginal and non-Aboriginal knowledge, GMB is a promising tool, which Aboriginal communities could utilise to explore and address complex problems in a manner that is consistent with their worldviews. In adapting group model building methods, non-Aboriginal researchers should aspire to move beyond co-design processes and enable Aboriginal health research to be entirely led by Aboriginal people.

Staying smoke-free: Factors associated with nonsmoking among urban Aboriginal adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

ISSUE ADDRESSED: To examine the factors associated with preventing regular smoking among Aboriginal adolescents. METHODS: Cross-sectional analysis of data from 106 Aboriginal adolescents aged 12-17 years, and their caregivers, from four Aboriginal Community Controlled Health Services in urban New South Wales, 2008-2012. The relation of individual, social, environmental and cultural factors to having 'never' smoked tobacco regularly was examined using Poisson regression. RESULTS: Overall, 83% of adolescents had never smoked regularly; 13 reported current and five past smoking. Most lived in smoke-free homes (60%) despite 75% reporting at least one current smoker caregiver. Participants were significantly more likely to have never smoked regularly if they had good mental health (PR = 1.4, 95% CI: 1.1-1.9), their mother as their primary caregiver (1.3, 1.0-1.6), good family relationships (1.2, 1.0-1.5), stable housing (1.3, 1.1-1.7), had never used alcohol (1.8, 1.3-2.4), were not sexually active (3.1, 1.3- 7.2) and had no criminal justice interactions (1.8, 1.2-2.8). CONCLUSIONS: Most participants lived in smoke-free homes and the vast majority had never smoked regularly. Promoting good mental health and strengthening social connections may be protective against smoking as those experiencing less social disruption were more likely to have never smoked regularly. Smoking may be an indicator of psychosocial conditions and a prompt for screening and simultaneous treatment. SO WHAT?: Organisations should be resourced to deliver holistic adolescent health promotion programs. Programs and policies should support positive family relationships and stable housing as this may protect against the uptake of regular smoking.

Asthma in urban Aboriginal children: A cross-sectional study of socio-demographic patterns and associations with pre-natal and current carer smoking.

AIM: To describe socio-demographic patterns of asthma prevalence in urban Aboriginal children and quantify associations between asthma prevalence and pre-natal maternal and current carer smoking. METHODS: Analyses used carer-reported survey data for 1290 urban Aboriginal children aged 2-17 years from the Study of Environment on Aboriginal Resilience and Child Health. Multilevel log-binomial regression was used to estimate asthma prevalence ratios (PRs) for child- and family-level socio-demographic factors, pre-natal maternal smoking and current carer smoking. Smoking-related PRs were compared with general-population estimates derived from meta-analyses of published cross-sectional data. RESULTS: Overall, 33.9% of children had ever had asthma, and 12.9% had received treatment for asthma in the past month. Prevalence estimates declined with increasing household income and increasing household size (posterior probabilities of decreasing trend >0.98), while children exposed to pre-natal maternal smoking had a higher risk of asthma ever than unexposed children (PR 1.18 (95% credible interval 1.00-1.40)). Recently treated asthma prevalence was not significantly associated with pre-natal maternal (0.98 (0.71-1.41)) or current carer smoking (0.97 (0.68-1.37)); however, there was substantial uncertainty in our PR estimates, and 95% credible intervals contained general-population estimates derived from the meta-analyses (1.37 (1.17-1.65) for pre-natal smoking, 1.28 (1.15-1.44) for current parental or household smoking). CONCLUSION: Among urban Aboriginal children in the Study of Environment on Aboriginal Resilience and Child Health cohort, asthma prevalence declines as household income and household size increase, while children exposed to pre-natal maternal smoking are at increased risk of ever having asthma. Our results emphasise the importance of reducing smoking in Aboriginal communities, particularly among pregnant women.

Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

BACKGROUND: Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers' concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. METHODS: Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents' Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. RESULTS: Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62-3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21-6.54), prior history of ear infection (1.95, 1.21-3.15), having lived in 4 or more houses versus one house (4.13, 2.04-8.35), foster care versus living with a parent (5.45, 2.32-12.78), and having a caregiver with psychological distress (2.40, 1.37-4.20). CONCLUSION: In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.

Aboriginal childhood overweight and obesity: the need for Aboriginal designed and led initiatives.

Childhood obesity poses an urgent and serious public health challenge in Australia. Aboriginal children are more profoundly affected than non-Aboriginal children, with the gap in weight status between the two groups widening, indicating an increased risk of metabolic disorders earlier in life. Obesity is the second biggest contributor (16%) to the gap in health status between Aboriginal and non-Aboriginal people. The bulk of this gap is attributable to people living in non-remote settings who make up 81% of the total Aboriginal population in Australia. The complex interplay of socio-environmental factors that contribute to obesity are well known and include prolonged financial stress associated with food insecurity, urbanisation, substandard and overcrowded housing, and lack of adequate access to health services. In addition, Aboriginal people, specifically, contend with the loss of traditional lands, and poor dietary behaviours due to the transition from traditional to Western diets as a result of colonisation. There are very few national policies and guidelines for obesity prevention and treatment for Australian children. This is especially the case for Aboriginal children. Most Australian states and territories have a suite of programs targeting obesity in childhood through healthy eating and active living strategies but with the exception of a few programs, the reach and effectiveness among Aboriginal children is either not known or has not been adequately assessed. Where programs have assessed Aboriginal participation, completion rates have generally been lower compared with the general population. The problem cannot be addressed without proper Aboriginal governance and leadership, and collaborative program development for Aboriginal-specific obesity interventions. Meaningful engagement and empowering Aboriginal communities to have control over programs that affect their health and wellbeing are more likely to result in positive health outcomes. Importantly, appropriate funding and support is essential to simultaneously facilitate the building of an Aboriginal health workforce to develop, coordinate, deliver and evaluate programs.

Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study.

OBJECTIVES: To explore the perceptions of Aboriginal Community Controlled Health Service (ACCHS) staff involved in providing mental healthcare to Aboriginal young people of the current and ideal pathways to mental healthcare for urban Aboriginal young people attending ACCHSs, and to identify what additional supports staff may need to provide optimal mental healthcare to Aboriginal young people. DESIGN: Qualitative interview study conducted during May 2016-2017. SETTING: Primary care, at two ACCHSs participating in the Study of Environment on Aboriginal Resilience and Child Health in New South Wales. PARTICIPANTS: Purposive sampling of staff involved in mental healthcare pathways of Aboriginal young people, including general practitioners (GPs), nurses and Aboriginal Health Workers (AHWs). RESULTS: All individuals approached for interview (n=21) participated in the study. Four overarching themes and seven sub-themes were identified: availability and use of tools in practice (valuing training and desire for tools and established pathways), targeting the ideal care pathway (initiating care and guiding young people through care), influencing the care pathway (adversities affecting access to care and adapting the care pathway) and assessing future need (appraising service availability). CONCLUSIONS: Participants desired screening tools, flexible guidelines and training for healthcare providers to support pathways to mental healthcare for Aboriginal young people. Both GPs and AHWs were considered key in identifying children at risk and putting young people onto a pathway to receive appropriate mental healthcare. AHWs were deemed important in keeping young people on the care pathway, and participants felt care pathways could be improved with the addition of dedicated child and adolescent AHWs. The ACCHSs were highlighted as essential to providing culturally appropriate care for Aboriginal young people experiencing mental health problems, and funding for mental health specialists to be based at the ACCHSs was considered a priority.

Perspectives on childhood resilience among the Aboriginal community: an interview study.

OBJECTIVE: To describe Aboriginal community members' perspectives on the outcomes and origins of resilience among Aboriginal children. METHODS: Face-to-face interviews were conducted with 36 Aboriginal adults (15 health service professionals, 8 youth workers and 13 community members) at two urban and one regional Aboriginal Community Controlled Health Service in New South Wales. Interviews were transcribed and analysed thematically. RESULTS: We identified six themes: withstanding risk (displaying normative development, possessing inner fortitude); adapting to adversity (necessary endurance, masking inner vulnerabilities); positive social influences (secure family environments, role modelling healthy behaviours and relationships); instilling cultural identity (investing in Aboriginal knowledge, building a strong cultural self-concept); community safeguards (offering strategic sustainable services, holistic support, shared responsibility, providing enriching opportunities); and personal empowerment (awareness of positive pathways, developing self-respect, fostering positive decision making). CONCLUSIONS: Community members believed that resilient Aboriginal children possessed knowledge and self-belief that encouraged positive decision making despite challenging circumstances. A strong sense of cultural identity and safe, stable and supportive family environments were thought to promote resilient behaviours. Implications for public health: Many Aboriginal children continue to face significant adversity. More sustainable, Aboriginal-led programs are needed to augment positive family dynamics, identify at-risk children and provide safeguards during periods of familial adversity.

Health professional and community perspectives on reducing barriers to accessing specialist health care in metropolitan Aboriginal communities: A semi-structured interview study.

AIM: To describe the perspectives of health professionals and communities on an innovative health service delivery project, Hearing EAr health and Language Services (HEALS). HEALS was a government funded initiative to improve access to specialist ear, nose and throat and speech pathology services for Aboriginal families living in metropolitan areas. METHODS: Semi-structured interviews were conducted with 21 health-care professionals (clinicians, health service managers and Aboriginal health workers) and 16 care givers of children who participated in HEALS. Interviews took place at four Aboriginal Community Controlled Health Services in metropolitan Australia or by telephone. Interview transcripts were analysed thematically. RESULTS: We identified five major themes: leveraging partnerships (building on collaborative research, integrating and expanding existing networks, engaging the Aboriginal community), intrinsic and extrinsic motivation (seizing opportunities for altruism, empowered by collegiality, taking pride in achievements), removing common barriers (circumventing waiting times and cost, providing culturally appropriate services, raising awareness), strategic service delivery (proactive service delivery, encouraging flexibility and innovation, offering convenience and support), and service shortfall (pressured timeframes, desire for more sustainable services). CONCLUSION: HEALS facilitated improved health-care access by providing prompt, no-cost services that were strategically targeted to address multiple barriers. HEALS' model of care was built upon strong pre-existing research partnerships, the knowledge and support of five Aboriginal Community Controlled Health Services, and the willingness and motivation of local health-care professionals to help Close the Gap. HEALS highlights the importance of tailoring health services to the needs of Aboriginal families, and provides a framework for other health service delivery initiatives.

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing, EAr health and Language Services (HEALS) project.

OBJECTIVE: To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. METHODS: A case-study involving a mixed-methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi-structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. RESULTS: To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech-language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. CONCLUSIONS: HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health: HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the 'no research without service' philosophy.

Building better research partnerships by understanding how Aboriginal health communities perceive and use data: a semistructured interview study.

OBJECTIVE: To describe the attitudes and beliefs of health professionals working in Aboriginal Community Controlled Health Services (ACCHS) towards the access, usage and potential value of routinely obtained clinical and research data. DESIGN, SETTING AND PARTICIPANTS: Face-to-face, semistructured interviews were conducted with 35 health professionals from 2 urban and 1 regional ACCHS in New South Wales. The interviews were transcribed and themes were identified using an adapted grounded theory approach. RESULTS: Six major themes were identified: occupational engagement (day-to-day relevance, contingent on professional capacity, emphasising clinical relevance), trust and assurance (protecting ownership, confidence in narratives, valuing local sources), motivation and empowerment (engaging the community, influencing morale, reassuring and encouraging clients), building research capacity (using cultural knowledge, promoting research aptitude, prioritising specific data), optimising service provision (necessity for sustainable services, guiding and improving services, supporting best practice), and enhancing usability (ensuring ease of comprehension, improving efficiency of data management, valuing accuracy and accessibility). CONCLUSIONS: Participants were willing to learn data handling procedures that could further enhance health service delivery and enable more ACCHS-led research, but busy workloads restrict these opportunities. Staff held concerns regarding the translation of research data into beneficial services, and believed that the outcome and purpose of data collection could be communicated more clearly. Promoting research partnerships, ensuring greater awareness of positive health data and the purposes of data collection, and communicating data in a user-friendly format are likely to encourage greater data use, build research capacity and improve health services within the Aboriginal community.