Relationships between social determinants of health and healthy body composition among Aboriginal and Torres Strait Islander youth in the Next Generation: Youth Well-being study.

ISSUE ADDRESSED: Little is currently known about the relationships between body composition and the social determinants of health among Aboriginal and Torres Strait Islander youth in Australia, which could help inform policy responses to address health inequities. METHODS: This study aimed to explore the relationship between various social factors and healthy body mass index (BMI) and waist/height ratio (WHtR) among Aboriginal and Torres Strait Islander youth aged 16-24 years. Baseline survey data from 531 participants of the 'Next Generation: Youth Well-being study' were used. Robust Poisson regression quantified associations between healthy body composition and self-reported individual social factors (education, employment and income, government income support, food insecurity, home environment, relationship status, racism), family factors (caregiver education and employment) and area-level factors (remoteness, socioeconomic status). RESULTS: Healthy body composition was less common among those living in a crowded home (healthy WHtR aPR 0.67 [0.47-0.96]) and those receiving government income support (healthy BMI aPR 0.74 [0.57-0.95]). It was more common among those with tertiary educated caregivers (healthy BMI aPR 1.84 [1.30-2.61]; healthy WHtR aPR 1.41 [1.05-1.91]) and those in a serious relationship (healthy BMI aPR 1.33 [1.02-1.75]). CONCLUSIONS: Social factors at the individual and family level are associated with healthy body composition among Aboriginal and Torres Strait Islander youth. SO WHAT?: The findings of this study highlight the potential for health benefits for youth from policies and programs that address social inequities experienced by Aboriginal and Torres Strait Islander people in Australia.

"They feel shame sometime, but that is why we need to talk to them we need to tell them how important it is not to feel shame": Hepatitis B related shame and improving hepatitis B care in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory, according to the Aboriginal health workforce.

BACKGROUND: The Aboriginal health workforce has unique insights given their healthcare experience and interactions with their communities. The aims of this project were to explore their perceptions of hepatitis B related shame and ways to improve hepatitis B care in Aboriginal and Torres Strait Islander communities of Northern Territory's Top End, Australia. METHODS: We conducted a qualitative study with guidance from the Menzies School of Health Research Infectious Diseases Indigenous Reference Group. The Aboriginal health workforce was asked to participate in semi-structured interviews exploring hepatitis B related shame and ways to improve hepatitis B care. Qualitative data were evaluated using reflexive thematic analysis. RESULTS: There were fifteen semi-structured interviews with participants representing eight different communities. The experience of shame was reported by the Aboriginal health workforce to be common for individuals diagnosed with hepatitis B and comprised feelings of fear related to transmitting the virus, to being isolated, and to being at fault. Shame was mediated by poor health literacy, communication, the lack of culturally safe spaces and was perpetuated by intersecting stereotypes. Improvements in care can be achieved by utilising the Aboriginal health workforce more effectively, improving communication and the availability of culturally safe spaces, emphasising community connection, and reframing hepatitis B as a chronic condition. CONCLUSIONS: Hepatitis B related shame was an important issue and impactful in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory. There were many facets to shame in these communities and it was mediated by several factors. The Aboriginal health workforce has emphasised several pathways to improve care and diminish the impact of shame, such as improving communication and the availability of culturally safe spaces.

Reckoning with rights: the Voice Referendum.

OBJECTIVE: Many Aboriginal and Torres Strait Islander Australians are dismayed by the rejection of the 2023 Voice Referendum and its amplification of social divisions. This article considers a recent article in Australasian Psychiatry in which matters of motivation, process and outcome are raised that provides the scaffolding to explore these issues. CONCLUSIONS: The breakdown of bipartisan political support and subsequent politicisation of the Referendum process resulted in claims regarding the reasons for and consequences of the Referendum that were not consistent with the process leading to the Uluru Statement. The outcome has been socially divisive and a cause of significant distress for many Aboriginal and Torres Strait Islander Australians, the majority of whom voted in support of the Voice.

Looking out across the front yard: aboriginal peoples' views of frailty in the community - A qualitative study.

OBJECTIVE: Frailty is one of the most significant challenges to healthy ageing. Aboriginal Australians experience some of the highest levels of frailty worldwide, and despite this, no studies have explored frailty from an Aboriginal perspective. This is important because Aboriginal understandings and priorities in frailty may differ from Western/mainstream frailty frameworks. Furthermore, this lack of research severely hampers healthcare planning and service delivery. As a starting point, this study aims to understand the experiences, attitudes, and perceptions that Aboriginal older adults hold regarding frailty. DESIGN: A qualitative study that utilized the Indigenous research method of Yarning for data collection as a culturally appropriate process for engaging Aboriginal peoples. Yarning circles and one-on-one yarns with 22 Aboriginal adults aged 45+ years living in one Australian capital city took place online and over the phone to explore the views that Aboriginal adults hold around frailty. Data were analysed thematically by Aboriginal researchers. RESULTS: Seven key thematic areas were identified: (1) Keep in with culture; (2) Physical markers of frailty; (3) Frailty throughout the life course; (4) Social, cultural, and psychological understandings of frailty; (5) We want information about frailty; (6) Appropriate and positive wording; (7) Frailty assessment. CONCLUSIONS: There was interest and engagement in the concept of frailty by Aboriginal older adults and approaches to frailty that extend beyond the physical to address cognitive, psychosocial, cultural and spiritual domains are likely to be more acceptable to this population. Culture and community connectivity are essential elements in preventing and alleviating frailty and have wider positive implications for Aboriginal health and wellbeing. Existing tools in practice to assess frailty are not aligned with Aboriginal cultural norms. Culturally appropriate frailty assessment methods co-designed with the community which incorporate holistic and multidimensional approaches are urgently needed.

Is eHealth Research with or on Our People?: Lessons Learned Using the Aboriginal and Torres Strait Islander Quality Appraisal Tool.

There is growing evidence for the benefits of eHealth interventions with Aboriginal and Torres Strait Islander people. Yet, there is a lack of guidance for culturally safe, relevant, and sustainable initiatives with Aboriginal and Torres Strait Islander peoples and organisations. To this end a research program was established to develop a roadmap for eHealth with Aboriginal and Torres Strait Islander peoples. The current phase of the research program is a review of the literature aimed at identifying the important characteristics of eHealth interventions with Aboriginal and Torres Strait Islander people. Thirty-nine publications reporting on a variety of eHealth modalities with Aboriginal and Torres Strait Islander people were identified. To assess the cultural quality of the final papers, the authorship applied the Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Results from the appraisal demonstrated significantly higher QAT scores between studies, including more Indigenous authors. This further substantiates the importance Aboriginal and Torres Strait Islander ways of knowing, doing, and being incorporating Indigenous worldviews and leadership have on the cultural quality of eHealth research studies.

'Handing down of beautiful knowledge': Yarning with workers about feeding practices and mealtimes in Australian First Nations families.

Mealtimes and feeding practices are shaped by culture and have long-term implications for social and emotional wellbeing. To date, there has been little research in Australia that has focused on First Nations families' feeding practices and mealtimes. This co-designed study aimed to explore First Nations' families feeding practices through yarning circles with workers (n = 14) at an Aboriginal Community Controlled Organization. Most workers (79%) were Aboriginal and/or Torres Strait Islander and all worked directly with First Nations families. Using thematic analysis, four themes were inductively identified from the yarns: the importance of childhood experiences, history, and intergenerational knowledges; mealtimes as a point of connection and wellbeing; the impact of structural barriers on feeding practices; and the important roles of First Nations workers supporting families with feeding difficulties. Workers described how First Nations families' feeding practices and mealtimes are informed by cultural values and knowledge that have been passed down through generations. Yet throughout the yarns, participants highlighted the impact of historical and current structural factors (e.g., cost of living, child removal, housing) that affect families' ability to engage in feeding practices that align with their beliefs and culture. Workers described several strengths-based approaches they use to support families, including community-led mealtime groups, liaising with mainstream health services, and providing a respectful space. We propose that the Social and Emotional Wellbeing model is a holistic strengths-based resource for workers to conceptualize First Nations families' strengths, values, and challenges in relation to feeding and mealtimes. More co-designed research including the perspectives of First Nations families is needed to better understand healthy and culturally aligned feeding and mealtime practices.

Community events to increase uptake of Indigenous-specific health assessments: a scoping review.

INTRODUCTION: Innovative, culturally safe strategies are required to address the disproportionate level of poorer health outcomes for Indigenous people in Australia compared to non-Indigenous populations. An emerging body of evidence supports the efficacy of Indigenous-specific health assessments, or health checks, despite poor uptake since their introduction in Australia. This poor uptake is attributed to a range of system, patient and provider barriers. Services have begun to deliver preventative health assessments as a community event to address barriers faced by Aboriginal and Torres Strait Islander people in accessing quality preventative care. However, there is a lack of literature exploring how community events have increased the uptake of Indigenous-specific health assessments to date. We expect this review will underpin a larger study to better understand how community engagement supports increased uptake of health checks. The objective of this scoping review was to investigate what is currently known about how community events have been used to increase uptake of Indigenous-specific health assessments. METHODS: A scoping review guided by the Joanna Briggs Institute methodology for scoping reviews was conducted. A search was completed in eight electronic databases using keywords relating to Aboriginal and Torres Strait Islander health, community engagement and preventative health assessments. Published and unpublished sources of evidence were included in the review. As this study aims to explore the entire published literature on the topic, and given there was an expectation that the subject itself is specific, no date ranges were included in the search criteria. Extracted data were reviewed by numerical analysis and conventional content analysis to conduct a narrative synthesis, allowing a summary of the main findings, and addressing the research question. RESULTS: Eighteen sources met the eligibility criteria and were included in the scoping review. Programs varied widely in the characteristics of program design and delivery across geographical location, setting of delivery, program format and target population. Programs employed a range of methods to engage with community, including incentivising participation, identifying and addressing specific community healthcare needs, and utilising cultural or sporting ambassadors to promote the program. The conventional content analysis identified three key themes regarding how community events have been used to increase uptake of health checks: adapting the program to the community; providing a culturally safe participant experience; and prioritising community engagement. DISCUSSION: The findings indicate that an individualised approach to community events is important to their success. Aboriginal Controlled Community Health Services may be best placed to have responsibility for program design and implementation to ensure community control of programs. Aboriginal health workers play a critical role in ensuring the programs deliver culturally safe healthcare, and a clear role for Aboriginal health workers in program delivery is important in their success. An authentic commitment to community engagement is important for program uptake, including the use of passionate cultural ambassadors and individualised cultural programs. CONCLUSION: Community events are a promising and well-regarded strategy to increase uptake of Indigenous-specific health assessments. Future research that explores how specific community supports increase engagement with Health Check Day programs and evaluates the delivery of 715 health check programs will strengthen the capacity of Aboriginal Community Controlled Health Services to delivery this intervention effectively.

Food intake in an Australian Aboriginal rural community facing food and water security challenges: A cross-sectional survey.

AIMS: Researchers were invited by Aboriginal leaders to collaborate on this study which aimed to assess food intake in the Walgett Aboriginal community to inform long-term community-led efforts to improve food and water security and nutrition. METHODS: Aboriginal adults living in or near Walgett, a remote community in north-west NSW, Australia, completed an adapted Menzies Remote Short-item Dietary Assessment Tool, which was administered verbally and face-to-face in early 2022. Aboriginal people were involved in the survey design, training and collection, and analysis of data. Descriptive statistics were tabulated, overall and by gender, age, and location. Differences by sex, age group (18-44 years versus ≥45 years), and location (Walgett town or other) were determined using a chi-square test. RESULTS: A total of 242 participants completed the survey; 55% were female. Three-quarters of participants reported meeting the recommendations for discretionary foods (73%); however, more than half (56%) exceeded the recommended maximum serves of sugar-sweetened beverages. The proportion of participants meeting core food group guidelines was 72% for meat, 36% for fruit, 20% for bread and cereals, 6% for dairy, and 3% for vegetables. Overall, none of the participants met the recommended serves of all food groups outlined in the Australian Dietary Guidelines. CONCLUSION: Findings show that Walgett Aboriginal community members surveyed were consuming a healthier diet than national data reported for Aboriginal and Torres Strait Islander people in Australia. However, none of the participants were meeting all of the national dietary guidelines, placing them at increased risk of diet-related chronic disease. Local Aboriginal community-led efforts to improve food and water security should include specific strategies to improve nutrition.

Children in out-of-home care's right to family and cultural connection: Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives.

BACKGROUND: Children have a right to participate in decisions about their lives. They also have the right to family and cultural connection, including when they are removed due to child protection concerns. However, the literature highlights barriers children in out-of-home care experience connecting to family-of-origin and culture. Moreover, this literature is predominantly from the perspective of practitioners and carers, with children's perspectives notably absent. OBJECTIVE: This qualitative study addresses this gap by exploring Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives and experiences of family and cultural connection while in out-of-home care. It seeks to uphold children's right to express their views on matters that impact their lives. PARTICIPANTS AND SETTING: The participants were 62 children aged 4-15 years (x̄=9 years), who were in out-of-home care in Queensland (Australia). Forty-two of the children were non-Indigenous and 20 identified as Aboriginal and/or Torres Strait Islander children. METHODS: Lundy's (2007) model of participation guided the data collection approach. Art-based graphic-elicitation interviews were conducted. Verbatim transcripts were analysed thematically. RESULTS: Children had differing levels of understanding as to why they could not reside with their family. Most children referred to a family-of-origin member not living with them as important in their lives, but it was not always their parent/s. Siblings were mentioned frequently. Barriers to connections with family included distance and cost of travel, parents not attending visits and being uncontactable, incarcerated or deceased. Whilst most children desired increased connection with family, a few wished for reduction or cessation. Aboriginal and/or Torres Strait Islander children showed varying levels of connection to culture with both siblings and carers playing key roles in enabling greater connection. CONCLUSIONS: Graphic-elicitation interviews provided an important opportunity for children to voice their experiences of and preferences regarding family and cultural connection. The inclusion of children's voices is needed to inform responsive policies and practices that safely support their rights to family and culture when in out-of-home care.

Perspectives on improving wound care for Aboriginal health workers in rural and remote communities in Queensland, Australia.

BACKGROUND: The care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians' Health Program's objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia. METHODS: Yarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia. RESULTS: Two themes were developed through rigorous data analysis of yarning information and responses: participants' experiences of managing wounds and barriers and enablers to effective wound care. CONCLUSIONS: This study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers.

Wearables are a viable digital health tool for older Indigenous adults living remotely in Australia (research).

Objective: Health programs for Indigenous people are most effective, acceptable, and sustainable when Indigenous perspectives are prioritized. Codesign builds on Indigenous people's creativity and propensity to experiment with new technologies and ensures research is designed and implemented in a culturally safe and respectful manner. Limited research has focused on older Indigenous people as partners in digital health. No research has focused on the acceptability and feasibility of older Indigenous people using wearables for heart health monitoring. This study provides insights into the acceptability and feasibility for ≥55-year-old Indigenous people living in remote locations to use wearables (watches and patches) to detect atrial fibrillation (AF) and high blood pressure. Methods: This mixed methods study was codesigned and coimplemented with the local Aboriginal Controlled Health Service in a remote area of New South Wales, Australia. It included active involvement and codesign with the participants. The devices used in this study included a Withings Scan watch and a Biobeat patch. Results: Despite challenging conditions (>36°C) and variable internet connectivity, 11 Indigenous older adults participated in a five-day wearables program in a remote location. Participants indicated that using digital health devices was acceptable and feasible for older Indigenous users. They described high levels of comfort, safety and convenience when using wearables (patches and watches) to detect AF. They were active participants in codesigning the program. Conclusion: Older Indigenous Australians are motivated to use wearable health devices. They are keen to participate in codesign innovative health tech programs to ensure new health technologies are acceptable to Indigenous people and feasible for remote locations.

Estimating levels of mental health service need by small geographic area: A case study for Aboriginal and Torres Strait Islander adults living in South East Queensland.

OBJECTIVE: The objective of this study was to determine regional variation in need for mental health care for Aboriginal and Torres Strait Islander adults (18+ years). METHODS: Three Australian Indigenous health surveys were analysed, and prevalence rates of high/very high psychological distress (as per the Kessler-5 tool) by the Index of Relative Socio-economic Disadvantage were computed and combined via meta-analysis. These estimates were applied to census population data to estimate regional needs and summed to geographic planning regions. Final estimates were assessed for face validity by comparing with other existing estimates of mental health need. RESULTS: The Index of Relative Socioeconomic Disadvantage had a dose-response relationship with high/very high psychological distress, whereby the more disadvantaged an area, the greater the levels of reported distress. This methodology resulted in varying levels of need within South East Queensland. CONCLUSIONS: The approach was found to have good face validity and provides a data-driven method to determine relative levels of need. IMPLICATIONS FOR PUBLIC HEALTH: To ensure equity of mental health service provision, planners should account for variation in levels of need within a catchment. This method may be used throughout Australia to determine regional variation in need for care where other data are lacking to ensure evidence-based investment planning decisions at the local level.

"It's a big conversation": Views of service personnel on systemic barriers to preventing smoking relapse among pregnant and postpartum Aboriginal and Torres Strait Islander women - A qualitative study.

BACKGROUND: Providing smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers. AIM: This paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal). METHODS: Twenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed. FINDINGS: Themes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women's needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation. CONCLUSION: To drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals' capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.

Administration of Burns First Aid Treatment to Aboriginal and Torres Strait Islander children in community settings.

OBJECTIVE: This paper investigates Burn First Aid Treatment (BFAT) provided to Aboriginal and Torres Strait Islander children in Australia at the scene of injury using data from a population-based cohort study. STUDY DESIGN: The participants were 208 Aboriginal and Torres Strait Islander children aged < 16 years who sustained a burns injury between 2015-2018, and their carers. The primary outcome measure was gold standard BFAT, (defined as at least 20 min of cool, running water within 3 h of the injury); additional measures included type of first aid, length of first aid provided, and carer's knowledge of first aid. RESULTS: Of the 208 caregivers, 168 provided open-ended responses that indicated first aid was applied to their child; however, only 34 received gold standard BFAT at the scene of the injury, 110 did not receive correct BFAT, and 24 were unsure what first aid was applied. CONCLUSION: This study highlights an important need for communities to have access to appropriate evidence-based and co-designed BFAT education and training.

An overview of outputs of Aboriginal- and Torres Strait Islander-related publications from University Departments of Rural Health in Australia; 2010-2021.

INTRODUCTION: Disparities in the health of Indigenous people and in the health of rural populations are well described. University Departments of Rural Health (UDRHs) in Australia are federally funded under a program to address ongoing challenges with health workforce distribution for rural and remote areas. They have a significant role in research in regional, rural and remote areas, including research related to Indigenous health. However, a comprehensive analysis of their contributions to original Indigenous health related to Indigenous health is lacking. OBJECTIVE: This study examines the contributions of UDRHs to Indigenous issues through analysis of publications of UDRHs focused on Indigenous health during the period 2010-2021. DESIGN: This paper examines a database of UDRH Indigenous-related publications from 2010 to 2021. FINDINGS: A total of 493 publications to which UDRHs contributed were analysed, including 354 original research articles. Health services research was the most common category, followed by epidemiology and papers exploring Indigenous culture and health. While health services research substantially increased over the period, the numbers of original research papers specifically focused on Indigenous workforce issues, whether related to Indigenous people, students or existing workforce was relatively small. DISCUSSION: This broad overview shows the nature and trends in Indigenous health research by UDRHs and makes evident a substantial contribution to Indigenous health research, reflecting their commitment to improving the health and well-being of Indigenous communities. CONCLUSIONS: The analysis can help direct future efforts, and future analyses should delve deeper into the impact of this research and further engage Indigenous researchers.

Navigating the cultural adaptation of a US-based online mental health and social support program for use with young Aboriginal and Torres Strait Islander males in the Northern Territory, Australia: Processes, outcomes, and lessons.

BACKGROUND: Despite disproportionate rates of mental ill-health compared with non-Indigenous populations, few programs have been tailored to the unique health, social, and cultural needs and preferences of young Aboriginal and Torres Strait Islander males. This paper describes the process of culturally adapting the US-based Young Black Men, Masculinities, and Mental Health (YBMen) Project to suit the needs, preferences, culture, and circumstances of Aboriginal and Torres Strait Islander males aged 16-25 years in the Northern Territory, Australia. YBMen is an evidence-based social media-based education and support program designed to promote mental health, expand understandings of gender and cultural identities, and enhance social support in college-aged Black men. METHODS: Our adaptation followed an Extended Stages of Cultural Adaptation model. First, we established a rationale for adaptation that included assessing the appropriateness of YBMen's core components for the target population. We then investigated important and appropriate models to underpin the adapted program and conducted a non-linear, iterative process of gathering information from key sources, including young Aboriginal and Torres Strait Islander males, to inform program curriculum and delivery. RESULTS: To maintain program fidelity, we retained the core curriculum components of mental health, healthy masculinities, and social connection and kept the small cohort, private social media group delivery but developed two models: 'online only' (the original online delivery format) and 'hybrid in-person/online' (combining online delivery with weekly in-person group sessions). Adaptations made included using an overarching Aboriginal and Torres Strait Islander social and emotional wellbeing framework and socio-cultural strengths-based approach; inclusion of modules on health and wellbeing, positive Indigenous masculinities, and respectful relationships; use of Indigenous designs and colours; and prominent placement of images of Aboriginal and Torres Strait Islander male sportspeople, musicians, activists, and local role models. CONCLUSIONS: This process resulted in a culturally responsive mental health, masculinities, and social support health promotion program for young Aboriginal and Torres Strait Islander males. Next steps will involve pilot testing to investigate the adapted program's acceptability and feasibility and inform further refinement.

Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017-2019.

BACKGROUND: Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs' geographical and demographic characteristics. METHODS: The study used 2017-2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels. RESULTS: There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and 'other health workers' combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01). CONCLUSIONS: Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs' resources and may also support quality of service delivery due to improved cultural safety and continuity of care.

Disparities in perioperative mortality outcomes between First Nations and non-First Nations peoples in Australia: protocol for a systematic review and planned meta-analysis.

BACKGROUND: Health inequities persist among First Nations people living in developed countries. Surgical care is pivotal in addressing a significant portion of the global disease burden. Evidence regarding surgical outcomes among First Nations people in Australia is limited. The perioperative mortality rate (POMR) indicates timely access to safe surgery and predicts long-term survival after major surgery. This systematic review will examine POMR among First Nations and non-First Nations peoples in Australia. METHODS: A systematic search strategy using MEDLINE, Embase, Emcare, Global Health, and Scopus will identify studies that include First Nations people and non-First Nations people who underwent a surgical intervention under anaesthesia in Australia. The primary focus will be on documenting perioperative mortality outcomes. Title and abstract screening and full-text review will be conducted by independent reviewers, followed by data extraction and bias assessment using the ROBINS-E tool. Meta-analysis will be considered if there is sufficient homogeneity between studies. The quality of cumulative evidence will be evaluated following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. DISCUSSION: This protocol describes the comprehensive methodology for the proposed systematic review. Evaluating disparities in perioperative mortality rates between First Nations and non-First Nations people remains essential in shaping the discourse surrounding health equity, particularly in addressing the surgical burden of disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021258970.

Sexual healthcare to meet the needs of sexuality and gender diverse aboriginal young people: imagined possibilities.

In Australia, Aboriginal young people who are lesbian, gay, bisexual, trans, queer or otherwise sexuality and gender diverse (LGBTQ+) are recognised within several overlapping priority populations in state and federal sexually transmissible infection and HIV strategies. However, limited research has documented their unique sexual health experiences, needs and preferences. In this qualitative study, semi-structured interviews were conducted with 10 LGBTQ+ Aboriginal young people aged 16-24 years in New South Wales. Interviews incorporated questions about service access, positive and negative experiences and self-determined healthcare priorities. We conducted a strengths-based thematic analysis to understand the issues of greatest importance in sexual healthcare for participants. Using the framework of 'imaginaries', we explored how participants imagined sexual healthcare that would meet their individual and cultural needs. The dominant imaginary centred on respect, representation and the as-yet-unrealised possibility of sexual healthcare designed by and for people who shared the intersection of Aboriginal and LGBTQ+ experience. We identified individual-level, service-level and societal-level factors influencing this imaginary, including relationships, accessibility and experiences of racism. Analysing the imaginaries constructed by LGBTQ+ Aboriginal young people of empowering, culturally safe sexual healthcare that is 'for them' provides insight into potential service design to improve sexual health outcomes for this population.

Implementation of the optometry Aboriginal and Torres Strait Islander health curriculum framework.

CLINICAL RELEVANCE: There is now an Optometry Council of Australia and New Zealand (OCANZ) accreditation requirement for Australian and Aotearoa New Zealand optometry programs to ensure students can provide culturally safe care for First Nations Peoples. To assist programs, OCANZ developed the Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework (Optometry Framework). BACKGROUND: The objective of this study was to evaluate early progress towards the implementation. METHODS: All seven Australian optometry programs were invited to complete a modified version of the OCANZ curriculum mapping tool. Where available, online unit outlines were reviewed to verify and supplement the data. Curriculum maps were synthesised using qualitative content analysis. RESULTS: None of the five participating programs had a standalone Aboriginal and Torres Strait Islander health unit; instead, programs were integrating content into core units. Only 25% of the units with relevant content had a directly related learning outcome. All programs had at least some content that was either directly or indirectly related to each of the Optometry Framework themes, and included some content related to novice and intermediate levels of learning. Four programs had content related to entry to practice levels of learning. The average total duration of directly related content in programs (excluding clinical placements) was 18 hours. Not all programs offered an Aboriginal and Torres Strait Islander health setting clinical placement opportunity. Directly related assessment was minimal in most programs, where the format was predominantly reflective journals or questions within written examinations. CONCLUSION: Progress has been made in implementing the Optometry Framework; however, further efforts are required. Programs need to integrate additional directly related learning outcomes, content (particularly entry to practice level learning), and assessment. Further curriculum enhancements will improve the likelihood of optometry students acquiring the necessary capabilities for providing culturally safe care.