Learning about Aboriginal health and wellbeing at the postgraduate level: novel application of the Growth and Empowerment Measure.

INTRODUCTION: Public health education strives to transform and empower students to engage in policy and practice improvement. However, little is known of the nature of such change among students, especially when studying Aboriginal health and wellbeing, which may involve disrupting long held assumptions and prejudices. This article reports findings regarding the feasibility, specificity and sensitivity of the Growth and Empowerment Measure (GEM) in the evaluation of two innovative Australian 13-week postgraduate public health electives focused on Aboriginal health and wellbeing. The GEM's 14-item Emotional Empowerment Scale (EES14) and its subscales Inner Peace and Self-Capacity, and 12 Scenarios (S12) and its subscales Healing and Growth and Connection and Purpose were used to examine transformative experiences. A new short form of the S12, the Core6, was also trialled as a briefer measure of functional empowerment. METHODS: Pre-course GEM responses and demographic information were collected from consenting students during the mandatory, face-to-face workshops of the Aboriginal public health Perspectives course and the Aboriginal empowerment and wellbeing Lifespan course. The two-day Perspectives course workshop introduced a group scenario-building activity towards ending health inequality. Lifespan students experienced a 3-day immersion based on Stage 1 of the Aboriginal Family Well Being empowerment program. Insights from both workshops were further integrated through structured online discussions and written assessments. At the end of semester, a post-course GEM was mailed to students for completion and return. Students could also provide feedback through evaluation surveys and semi-structured focus groups. Effect sizes were assessed using paired t-tests, Wilcoxon signed-rank tests and multiple ANOVA. Cronbach's alpha confirmed internal consistency. RESULTS: Baseline GEM data was provided for 147 out of a total of 194 workshop experiences from participating students. Twenty students attended workshops for both Perspectives and Lifespan. Fifty-five matched pairs (representing 52 individual participants) were obtained from 170 students who completed one or both courses. Statistically significant positive change of small to medium effect size was detected in all GEM scales, subscales and some individual items. Lifespan yielded larger effects than Perspectives, most markedly on two subscales: Inner Peace, and Connection and Purpose. Participating students reported significant growth in the Scenario item 'knowing and being who I am' following Perspectives and Lifespan. Those completing Perspectives also reported a significant increase in 'gaining voice and being heard', consistent with its action-oriented scenario-building assessment. In contrast, the psychosocial development approach embedded in Lifespan stimulated strong development in spirituality, responding constructively to judgement, appreciating empowerment in their communities and skills to make changes in their lives. Feedback indicated that students valued these personal and professional growth experiences. CONCLUSION: The GEM was sensitive and specific in measuring components of empowering change among participants. Challenges included low post-course response rates that limited extrapolation to overall course impact, and attention needed to starting point when comparing the increment of change. The GEM is a promising tool for studying postgraduate courses designed to stimulate transformative learning, wellbeing and cultural competence through empowerment, and relevant in the education of health professionals in the fields of Aboriginal and rural health.

Immunisation coverage among a birth cohort of Aboriginal infants in an urban community.

AIM: The aim of this study is to examine the age-appropriate immunisation coverage and the factors associated with this in a cohort of Aboriginal infants in an outer urban Sydney community in comparison with non-Aboriginal infants in this community. METHODS: Data on immunisation coverage were extracted from the Australian Childhood Immunisation Register for a birth cohort of 178 Aboriginal and 356 non-Aboriginal infants born in Campbelltown between October 2005 and May 2007. Non-Aboriginal infants were matched on birthdates and gender. Data on maternal socio-economic and other characteristics were collected by questionnaire. RESULTS: Australian Childhood Immunisation Register records were identified for 92% of infants. Immunisation rates of Aboriginal infants were comparable with those of non-Aboriginal infants except for delay at 4 and 6 months. Rates of delay in immunisation at 12 and 18 months for both Aboriginal and non-Aboriginal infants were similar. Young maternal age and higher parity were both associated with a greater likelihood of delay. CONCLUSIONS: Immunisation rates in this population of Aboriginal infants are comparable to those of non-Aboriginal infants except for delay in immunisation at 4 and 6 months. Identified risk factors for both Aboriginal and non-Aboriginal infants may be amenable to intervention. Strategies to ensure timely compliance with immunisation schedules in this outer urban community have achieved reasonable immunisation coverage for Aboriginal and non-Aboriginal infants.

Under-reporting of birth registrations in New South Wales, Australia.

BACKGROUND: To determine the rates of birth registration over a five-year period in New South Wales (NSW) and explore the factors associated with the rate of registration. METHODS: This is a cross-sectional study using linked population databases. The study population included all births of NSW residents in NSW between 2001 and 2005. RESULTS: Birth registration rates in NSW were 82.66% in the year of birth, 93.19% in the first year, 94.02% in the second, 94.56% in the third and 95.08% in the fourth year after birth. The non-registration of births was mainly associated with such factors as neonatal and postneonatal death (adjusted OR = 3.84, 95% CI: 3.23-4.57); being Indigenous (adjusted OR = 3.26, 95% CI: 3.10-3.43); maternal age <25 or >39 years (adjusted OR = 2.81, 95% CI: 2.72-2.90); low birthweight (<2,500 grams) (adjusted OR = 1.79, 95% CI: 1.69-1.90); living in remote areas (adjusted OR = 1.57, 95% CI: 1.52-1.63); being born after the first quarter of year (adjusted OR = 1.08-1.56, 95% CI between 1.03-1.12 and 1.49-1.64); mother having more pregnancies (adjusted OR = 1.85-7.29, 95% CI between1.78-1.93 and 6.87-7.73). Mothers who were born overseas were more likely to register their births than those born in Australia (adjusted OR = 0.72, 95% CI: 0.69-0.75). Multiple births were more likely to be registered than singleton births (adjusted OR = 0.84, 95% CI: 0.76-0.92). About one-third of the non-registrations of births in NSW were explained by the risk factors. The reasons for the remaining non-registrations need to be investigated. CONCLUSION: Of birth in NSW, 4.92% were not registered by the fourth year after birth.

Strengthening the link between policy formulation and implementation of Indigenous health policy directions.

This study aimed to understand the problems within the Indigenous health policy process in Australia and how weaknesses in the process impact on policy implementation. Using semi-structured questions, 23 key stakeholders in the policy-making process were interviewed. Three main themes dominated; a need for increased Indigenous involvement in policy formulation at the senior Australian Government level, increased participation of Indigenous community-controlled health organisations in the policy-making process and, most importantly, ensuring that policies have the necessary resources for their implementation. The emergence of these specific themes demonstrated weaknesses in policy process from the formulation stage onward. Tackling these would, according to our informants, significantly enhance the effectiveness of the policy process and contribute to further improvement of the health of Indigenous Australians.

Beyond sorry--the first steps in laying claim to a future that embraces all Australians.

The Prime Minister has issued a formal, unqualified apology to Australia's Indigenous peoples for past mistreatment, particularly for the sufferings of those who were affected by the forced removal of children from their families. The Apology needs to be seen as the first step in a reparations process that adheres to human rights principles, involves Australians at all levels, is sustainable and upholds self-determination. The Apology is the first of five steps recommended in Bringing them home: the report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families. Further steps are: guarantees against repetition, measures of restitution, measures of rehabilitation, and monetary compensation, but the Prime Minister has steadfastly refused to discuss reparations or compensation. Monetary compensation has been recognised internationally as an essential component in the redress for similar experiences of the forced removal of children. As long as the final steps in reparation remain unresolved, they will obstruct our pathway to a future that embraces all Australians.

Evaluation of NHMRC funded research completed in 1992, 1997 and 2003: gains in knowledge, health and wealth.

OBJECTIVE: To report on strategies for, and outcomes of, evaluation of knowledge (publications), health and wealth (commercial) gains from medical research funded by the Australian Government through the National Health and Medical Research Council (NHMRC). DESIGN AND METHODS: End-of-grant reports submitted by researchers within 6 months of completion of NHMRC funded project grants which terminated in 2003 were used to capture self-reported publication number, health and wealth gains. Self-reported gains were also examined in retrospective surveys of grants completed in 1992 and 1997 and awards primarily supporting people ("people awards") held between 1992 and 2002. RESULTS: The response rate for the 1992 sample was too low for meaningful analysis. The mean number of publications per grant in the basic biomedical, clinical and health services research areas was very similar in 1997 and 2003. The publication output for population health was somewhat higher in the 2003 than in the 1997 analysis. For grants completed in 1997, 24% (31/131) affected clinical practice; 14% (18/131) public health practice; 9% (12/131) health policy; and 41% (54/131) had commercial potential with 20% (26/131) resulting in patents. Most respondents (89%) agreed that NHMRC people awards improved their career prospects. Interpretation is limited by the relatively low response rates (50% or less). CONCLUSIONS: A mechanism has been developed for ongoing assessment of NHMRC funded research. This process will improve accountability to the community and to government, and refine current funding mechanisms to most efficiently deliver health and economic returns for Australia.

Identification of Aboriginal and Torres Strait Islander women using an urban obstetric hospital.

OBJECTIVES: To determine the accuracy of routine identification of Aboriginal and Torres Strait Islander women confining at King George V (KGV) Hospital, located in Sydney, Australia. DESIGN: Interviewer-administered survey. PARTICIPANTS: Consecutive sample of women who delivered live, well infants from May to July 1999. MAIN OUTCOME MEASURE: Comparison of hospital documentation compared with confidential self-disclosure of Aboriginal or Torres Strait Islander status to a female Aboriginal health professional. RESULTS: Of 536 women in our sample, 29 (5%) self-disclosed as being Aboriginal or Torres Strait Islander. Only 10 of these were identified as Aboriginal or Torres Strait Islander in hospital records (p<0.001). While specificity as determined by us was 100%, sensitivity was low (34.5%). Those Aboriginal and Torres Strait Islander women referred by another organisation were significantly more likely than those who self-referred to the hospital to be correctly identified (p=0.011). Only 1% of non-Aboriginal women indicated they would have objected to an explicit question by staff about their Aboriginal or Torres Strait Islander status. CONCLUSIONS: Routine identification significantly under-represents Aboriginal or Torres Strait Islander women giving birth at an urban obstetric hospital. We recommend the development and use of a sensitive but also specific series of questions to ensure women always are given the opportunity to disclose their status, especially as few women appear to mind such questions.