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.

Juvenile social status predicts primary sex allocation in a sex changing fish.

Both individual sex and population sex ratio can affect lifetime reproductive success. As a result, multiple mechanisms have evolved to regulate sexual phenotype, including adult sex change in fishes. While adult sex change is typically socially regulated, few studies focus on the non-chromosomal mechanisms regulating primary sex allocation. We investigated primary sex determination in the bluebanded goby (Lythrypnus dalli), a bidirectionally sex-changing fish. Of the studies investigating primary sex determination in species with adult sex change, this is the first to incorporate the roles of social status and size, key factors for determining adult sex allocation. For L. dalli, adult sex is regulated by social status: dominants are male; subordinates are female. In social groups of laboratory-reared juveniles, we demonstrate that status also predicts primary sex. Dominant juveniles developed male-typical genitalia, and their gonads contained significantly less ovarian tissue than subordinates, which developed female-typical genitalia. To better understand natural development, we quantified the distribution of juveniles and adults on the reef and analyzed genital papilla and gonad morphology in a sample of wild-caught juveniles. Juveniles were observed in various social environments, and most grouped with other juveniles and/or adults. The majority of field-caught juveniles had female-typical genitalia and bisexual, female-biased gonads. These data are consistent with a single mechanism that regulates sexual phenotype throughout life. Social status could first cause and then maintain through adulthood a female-biased population, allowing individuals to regulate sex based on local conditions, which is important for optimizing lifetime reproductive success.