Evaluating a social and emotional well-being model of service piloted in Aboriginal Community Controlled Health Services in Western Australia: an Aboriginal Participatory Action Research approach.

INTRODUCTION: The delivery of services to improve Aboriginal health and well-being must centre culture and integrate a social and emotional well-being understanding and approaches. These approaches are essential in increasing access to, and engagement with, health services, as well as ensuring culturally safe, person-centred and community-centred care. This study will evaluate the Aboriginal Health Council of Western Australia's social and emotional well-being model of service being piloted in five Aboriginal Community Controlled Health Services across five of Western Australia's regions. The model of service includes the establishment of interdisciplinary social and emotional well-being teams and a four-pillar approach to service delivery. METHODS AND ANALYSIS: An Aboriginal Participatory Action Research methodology will be undertaken which calls for Indigenous leadership and governance, capacity-building of community co-researchers and engagement in reflexive practice. The evaluation will take a mixed-methods approach to data collection, including at each pilot site, yarns with up to five clients engaging with social and emotional well-being services; qualitative interviews with up to five service providers at each site, and up to five key knowledge holders from stakeholders including funders and commissioning bodies; the collection of clinical data; facilitated discussion using the social and emotional well-being Systems Assessment Tool; and document analysis and cost-estimation. Analysis will be guided by a client journey mapping framework, and data will be collectively analysed through a socioecological framework to understand the connections and inter-relatedness between client outcomes and experiences, social and emotional well-being team and service provider experiences, service systems and governance structures. ETHICS AND DISSEMINATION: This evaluation was approved by the Western Australian Aboriginal Health Ethics Committee (HREC1204). The findings will be disseminated through the production of an evaluation report and academic publications and presentations. Findings will also be disseminated through community forums and plain language summaries. These outputs will detail evaluation findings and recommendations, the process of evaluation through an Aboriginal Participatory Action Research approach and the collaborative stakeholder relationship-building that underpinned the project.

Co-designing research with Aboriginal and Torres Strait Islander consumers of mental health services, mental health workers, elders and cultural healers.

INTRODUCTION: The disparity in mental health outcomes compared with non-Indigenous Australians means that there is an urgent need to develop an evidence base around how services can better support Aboriginal and Torres Strait Islander communities. A critical first step is to embed cultural safety into research methodologies. OBJECTIVE: Here, we aim to establish the foundation of a research project through co-designing a qualitative interview with Aboriginal and Torres Strait Islander consumers and community members about experiences of cultural safety with mainstream mental health services. DESIGN: Voices of Aboriginal and Torres Strait Islander peoples must be empowered across all stages of research. An Aboriginal-led research team conducted focus groups to understand clear, sensitive, and culturally appropriate ways of asking about experiences in mental health care, to co-design an interview on this topic. Participants were Aboriginal and Torres Strait Islander consumers of mental health services, carers, mental health workers, Elders and Cultural Healers, living in Metropolitan and Regional Western Australia. FINDINGS: Results suggest that Indigenous governance, together with investing in ongoing, and meaningful cultural awareness and cultural safety training (cultural awareness being a first step towards safety) for non-Indigenous researchers, together with taking the time to build respectful partnerships with communities through ongoing consultation, were appropriate and comprehensive methods of co-designing an interview. DISCUSSION: The process of working with Aboriginal and Torres Strait Islander peoples in research is as important as the outcome. Aboriginal and Torres Strait Islander leadership, self-determination, and relationship building with communities are essential. CONCLUSION: Empowering co-design methodologies are flexible, iterative, and ensure that the experiences and views of participants are valued, leading to more meaningful results.

The influence of three-dimensional cues on body size judgements.

Research has shown that body size judgements are frequently biased, or inaccurate. Critically, judgement biases are further exaggerated for individuals with eating disorders, a finding that has been attributed to difficulties integrating body features into a perceptual whole. However, current understanding of which body features are integrated when judging body size is lacking. In this study, we examine whether individuals integrate three-dimensional (3D) cues to body volume when making body size judgements. Computer-generated body stimuli were presented in a 3D Virtual Reality environment. Participants (N = 412) were randomly assigned to one of the two conditions: in one condition, the to-be-judged body was displayed binocularly (containing 3D cues to body volume); in the other, bodies were presented monocularly (two-dimensional [2D] cues only). Across 150 trials, participants were required to make a body size judgement of a target female body from a third-person point of view using an unmarked visual analogue scale (VAS). It was found that 3D cues significantly influenced body size judgements. Namely, thin 3D bodies were judged smaller, and overweight 3D bodies were judged larger, than their 2D counterpart. Furthermore, to reconcile these effects, we present evidence that the two perceptual biases, regression to the mean and serial dependence, were reduced by the additional 3D feature information. Our findings increase our understanding of how body size is perceptually encoded and creates testable predictions for clinical populations exhibiting integration difficulties.

Sizing up the crowd: Assessing spatial integration difficulties in body size judgements across eating disorder symptomatology.

Introduction: Body size judgements are frequently biased, or inaccurate, and these errors are further exaggerated for individuals with eating disorders. Within the eating disorder literature, it has been suggested that exaggerated errors in body size judgements are due to difficulties with integration. Across two experiments, we developed a novel integration task, named the Ebbinghaus Illusion for Bodies in Virtual Reality (VR), to assess whether nearby bodies influence the perceived size of a single body. VR was used to simulate the appearance of a small crowd around a central target body. Method and Results: In Experiment 1 (N = 412), participants were required to judge the size of a central female target within a crowd. Experiment 1 revealed an Ebbinghaus Illusion, in which a central female appeared larger when surrounded by small distractors, but comparatively smaller when surrounded by large distractors. In other words, the findings of Experiment 1 demonstrate that surrounding crowd information is integrated when judging an individual's body size; a novel measure of spatial integration (i.e., an Ebbinghaus Illusion for Bodies in VR). In Experiment 2 (N = 96), female participants were selected based on high (n = 43) and low (n = 53) eating disorder symptomatology. We examined whether the magnitude of this illusion would differ amongst those with elevated versus low eating disorder symptomatology, in accordance with weak central coherence theory, with the high symptomatology group displaying less spatial integration relative to the low group. The results of Experiment 2 similarly found an Ebbinghaus Illusion for Bodies in VR. However, illusion magnitude did not vary across high and low symptomatology groups. Discussion: Overall, these findings demonstrate that surrounding crowd information is integrated when judging individual body size; however, those with elevated eating disorder symptomatology did not show any integration deficit on this broader measure of spatial integration.

Mental health and well-being of Aboriginal and Torres Strait Islander peoples in Australia during COVID-19.

In May 2020, an independent working party was convened to determine the mental health and well-being needs of Aboriginal and Torres Strait Islander peoples in Australia, in response to COVID-19. Thirty Aboriginal and Torres Strait Islander leaders and allies worked together in a two-month virtual collaboration process. Here, we provide the working party's five key recommendations and highlight the evidence supporting these proposals. Aboriginal and Torres Strait Islander self-determination and governance must be prioritised to manage the COVID-19 recovery in Aboriginal and Torres Strait Islander communities. To mitigate long-term social and economic impacts of COVID-19 to Australian society, the historical underinvestment in Aboriginal and Torres Strait Islander peoples must be reconciled. Equitable, needs-based funding is required to support strengths-based, place-based initiatives that address the determinants of health. This includes workforce and infrastructure development and effective evaluation. There is a clear, informed pathway to health and healing for Aboriginal and Torres Strait Islander peoples being enacted by Aboriginal and Torres Strait Islander leadership and community organisations; it remains to be seen how these recommendations will be implemented.

An Assessment of Computer-Generated Stimuli for Use in Studies of Body Size Estimation and Bias.

Inaccurate body size judgments are associated with body image disturbances, a clinical feature of many eating disorders. Accordingly, body-related stimuli have become increasingly important in the study of estimation inaccuracies and body image disturbances. Technological advancements in the last decade have led to an increased use of computer-generated (CG) body stimuli in body image research. However, recent face perception research has suggested that CG face stimuli are not recognized as readily and may not fully tap facial processing mechanisms. The current study assessed the effectiveness of using CG stimuli in an established body size estimation task (the "bodyline" task). Specifically, we examined whether employing CG body stimuli alters body size judgments and associated estimation biases. One hundred and six 17- to 25-year-old females completed the CG bodyline task, which involved estimating the size of full-length CG body stimuli along a visual analogue scale. Our results show that perception of body size for CG stimuli was non-linear. Participants struggled to discriminate between extreme bodies sizes and overestimated the size change between near to average bodies. Furthermore, one of our measured size estimation biases was larger for CG stimuli. Our collective findings suggest using caution when employing CG stimuli in experimental research on body perception.

Evidence for a perceptual mechanism relating body size misperception and eating disorder symptoms.

PURPOSE: There are known and serious health risks associated with extreme body weights, including the development of eating disorders. Body size misperceptions are particularly evident in individuals with eating disorders, compared to healthy controls. The present research investigated whether serial dependence, a recently discovered bias in body size judgement, is associated with eating disorder symptomatology. We additionally examined whether this bias operates on holistic body representations or whether it works by distorting specific visual features. METHODS: A correlational analysis was used to examine the association between serial dependence and eating disorder symptomatology. We used a within-subjects experimental design to investigate the holistic nature of this misperception. Participants were 63 young women, who judged the size of upright and inverted female body images using a visual analogue scale and then completed the Eating Disorder Examination-Questionnaire (EDE-Q) to assess eating disorder symptoms. RESULTS: Our findings provide the first evidence of an association between serial dependence and eating disorder symptoms, with significant and positive correlations between body size misperception owing to serial dependence and EDE-Q scores, when controlling for Body Mass Index. Furthermore, we reveal that serial dependence is consistent with distortion of local visual features. CONCLUSIONS: Findings are discussed in relation to the broader theories of central coherence, cognitive inflexibility, and multisensory integration difficulties, and as providing a candidate mechanism for body size misperception in an eating disorder population. LEVEL OF EVIDENCE: Level 1, experimental study.

Past visual experiences weigh in on body size estimation.

Body size is a salient marker of physical health, with extremes implicated in various mental and physical health issues. It is therefore important to understand the mechanisms of perception of body size of self and others. We report a novel technique we term the bodyline, based on the numberline technique in numerosity studies. One hundred and three young women judged the size of sequentially presented female body images by positioning a marker on a line, delineated with images of extreme sizes. Participants performed this task easily and well, with average standard deviations less than 6% of the total scale. Critically, judgments of size were biased towards the previously viewed body, demonstrating that serial dependencies occur in the judgment of body size. The magnitude of serial dependence was well predicted by a simple Kalman-filter ideal-observer model, suggesting that serial dependence occurs in an optimal, adaptive way to improve performance in size judgments.