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1.
Int J Equity Health ; 19(1): 8, 2020 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931810

RESUMO

BACKGROUND: Aboriginal women are frequently called upon to support their families and other community members. At times, such supporting roles can be burdensome for these women. Many Aboriginal women live with chronic conditions. We explored the ways in which the women's caring roles impacted on how they maintained their own health. METHODS: The aim of this manuscript is to explore the psychosocial factors associated with the management of health and chronic disease in Aboriginal women. An interpretive phenomenological approach was used for the analysis of 72 in-depth semi-structured interviews. These interviews were conducted in four community controlled Aboriginal health services, in urban, rural and remote settings, across two states and a territory in Australia. RESULTS: Women living with chronic disease experience multiple challenges while caring for family, such as intergenerational trauma, mental health issues relating to addiction, domestic and family violence and incarceration. When these women become ill, they also have to take care of themselves. These women provided informal and unfunded care in response to a range of complex family and community problems. This continuous caring for family affected the women's ability to maintain their health and manage their own chronic conditions. CONCLUSION: The caring roles and responsibilities Aboriginal women have in their community impact on their health. Aboriginal women provide much needed refuge and support to family and the wider community. Underfunded and over-burdened formal support services are not meeting the needs of many Aboriginal women. Improved culturally secure resources and social services are required within communities to support Aboriginal women to successfully manage their own health.


Assuntos
Doença Crônica/etnologia , Doença Crônica/terapia , Grupo com Ancestrais Oceânicos/psicologia , Autocuidado/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Serviços de Saúde do Indígena , Humanos , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pesquisa Qualitativa
2.
Artigo em Inglês | MEDLINE | ID: mdl-31878049

RESUMO

Conservation and environmental management have been reported as offering opportunities to substantially improve the wellbeing of Indigenous people. Using the holistic wellbeing impact evaluation (W-IE) approach-well suited for use in Indigenous communities-we interviewed 190 Indigenous Australians across four communities. All communities were involved in the Indigenous land and sea management programs (ILSMPs). Our study explored the conceptualisation of 'wellbeing' by participants. In particular, we were interested in the aspects of wellbeing perceived to be affected by ILSMPs. Out of the 26 wellbeing factors explored, 'Health centres'; 'Language'; 'Schools'; and 'Safe community' emerged as being of highest importance to the largest percentage of the respondents. When grouped using principle components analysis (PCA), the 'Community and society' domain emerged as the most important; accounting for 52% of the overall importance of all wellbeing factors. The second most important domain was the 'Country and culture', contributing 31%. Lastly, 'Economic aspects' contributed only 17%. Respondents believed that ILSMPs have played a considerable causal role in improving wellbeing, by positively changing factors most important to them. Specifically, 73% of perceived causal links were related to improvements in the 'Country and Culture' and 23% to 'Community and Society' domain. We thus conclude that land management for Indigenous people is much more than ecological or environmental management with ILSMPs, perceived to cause a wide range of cultural and social benefits. We also propose ways in which the future design of such programs could be improved to further increase benefits.


Assuntos
Programas Governamentais , Grupo com Ancestrais Oceânicos/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Ecologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Inquéritos e Questionários , Adulto Jovem
3.
Aust N Z J Public Health ; 43(6): 538-543, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667912

RESUMO

OBJECTIVE: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. METHODS: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. RESULTS: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. CONCLUSION: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.


Assuntos
Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Atenção Primária à Saúde/organização & administração , Prisioneiros , Assistência à Saúde/métodos , Feminino , Humanos , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Pesquisa Qualitativa , Apoio Social
4.
Aust N Z J Public Health ; 43(6): 544-550, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667969

RESUMO

OBJECTIVE: To investigate the association between hearing impairment (HI) and Year 1 school attendance in Aboriginal children in the Northern Territory (NT) of Australia. METHODS: Observational cohort study (n=3,744) by analysing linked individual-level information for Aboriginal children from the NT Government school attendance records, NT Perinatal Register and Remote Hearing Assessment dataset, and community level data for relative remoteness, socioeconomic disadvantage and housing crowdedness. RESULTS: Children with unilateral hearing loss, mild HI and moderate or worse HI had significantly lower Year 1 attendance than those with normal hearing, attending 5.6 (95%CI, -9.10 ∼-2.10), 4.0 (95%CI, -7.17 ∼-0.90) and 6.1 (95%CI, -10.71 ∼-1.49) days fewer, respectively. Other variables that yielded significant association were: male gender, having attended preschool less than 20% of available days, speaking English as second language, twin birth and average household size >5. CONCLUSIONS: Aboriginal children with any level of HI are likely to have lower school attendance rates in Year 1 than their peers with normal hearing. Implications for public health: In this population, where the prevalence of otitis media and accompanying HI remains extremely high, the early detection and management of hearing loss on entry into primary school should be included in the measures to improve school attendance.


Assuntos
Perda Auditiva/etiologia , Habitação , Grupo com Ancestrais Oceânicos/psicologia , Otite Média/complicações , Instituições Acadêmicas , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Serviços de Saúde do Indígena , Perda Auditiva/epidemiologia , Perda Auditiva/etnologia , Humanos , Masculino , Northern Territory , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Otite Média/epidemiologia , Otite Média/etnologia , Prevalência , Fatores Socioeconômicos
5.
BMC Public Health ; 19(1): 1521, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727039

RESUMO

BACKGROUND: Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum's Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the 'real world' validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. METHODS: The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach's alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. DISCUSSION: This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. TRIAL REGISTRATION: The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).


Assuntos
Afeto , Ansiedade/diagnóstico , Depressão/diagnóstico , Programas de Rastreamento/métodos , Saúde Mental/etnologia , Grupo com Ancestrais Oceânicos/psicologia , Assistência Perinatal/métodos , Adolescente , Adulto , Ansiedade/etnologia , Depressão/etnologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etnologia , Feminino , Humanos , Lactente , Recém-Nascido , Ilhas , Programas de Rastreamento/normas , Mães/psicologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etnologia , Gestantes/etnologia , Gestantes/psicologia , Psicometria , Queensland , Projetos de Pesquisa , Estudos Retrospectivos , Adulto Jovem
6.
Med Care ; 57(12): 937-944, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567862

RESUMO

BACKGROUND: Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) face unique challenges in mental health and accessing high-quality health care. OBJECTIVE: The objective of this study was to identify barriers and facilitators for shared decision making (SDM) between AAPI SGM and providers, especially surrounding mental health. RESEARCH DESIGN: Interviews, focus groups, and surveys. SUBJECTS: AAPI SGM interviewees in Chicago (n=20) and San Francisco (n=20). Two focus groups (n=10) in San Francisco. MEASURES: Participants were asked open-ended questions about their health care experiences and how their identities impacted these encounters. Follow-up probes explored SDM and mental health. Participants were also surveyed about attitudes towards SGM disclosure and preferences about providers. Transcripts were analyzed for themes and a conceptual model was developed. RESULTS: Our conceptual model elucidates the patient, provider, and encounter-centered factors that feed into SDM for AAPI SGM. Some participants shared the stigma of SGM identities and mental health in their AAPI families. Their AAPI and SGM identities were intertwined in affecting mental health. Some providers inappropriately controlled the visibility of the patient's identities, ignoring or overemphasizing them. Participants varied on whether they preferred a provider of the same race, and how prominently their AAPI and/or SGM identities affected SDM. CONCLUSIONS: Providers should understand identity-specific challenges for AAPI SGM to engage in SDM. Providers should self-educate about AAPI and SGM history and intracommunity heterogeneity before the encounter, create a safe environment conducive to patient disclosure of SGM identity, and ask questions about patient priorities for the visit, pronouns, and mental health.


Assuntos
Americanos Asiáticos/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Participação do Paciente/psicologia , Minorias Sexuais e de Gênero/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Estigma Social
7.
N Z Med J ; 132(1503): 66-74, 2019 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581183

RESUMO

AIM: To investigate Maori (Indigenous people of Aotearoa New Zealand) understandings of dementia, its causes, and ways to manage a whanau (extended family) member with dementia. METHOD: We undertook kaupapa Maori research (Maori informed research) with 223 kaumatua (Maori elders) who participated in 17 focus groups across seven study regions throughout Aotearoa New Zealand and eight whanau from the Waikato region. We audio recorded all interviews, transcribed them and then coded and categorised the data into themes. RESULTS: Mate wareware (becoming forgetful and unwell) ('dementia') affects the wairua (spiritual dimension) of Maori. The findings elucidate Maori understandings of the causes of mate wareware, and the role of aroha (love, compassion) and manaakitanga (hospitality, kindness, generosity, support, caring) involved in caregiving for whanau living with mate wareware. Participants perceived cultural activities acted as protective factors that optimised a person's functioning within their whanau and community. CONCLUSION: Whanau are crucial for the care of a kaumatua with mate wareware, along with promoting healthy wairua for all. Whanau urgently need information to assist with their knowledge building and empowerment to meet the needs of a member affected by mate wareware. This requires collaborative healthcare practice and practitioners accessing the necessary matauranga Maori (Maori knowledge) to provide culturally appropriate and comprehensive care for whanau.


Assuntos
Envelhecimento/psicologia , Atitude Frente a Saúde/etnologia , Demência , Etnopsicologia/métodos , Grupo com Ancestrais Oceânicos , Adulto , Idoso , Cultura , Demência/diagnóstico , Demência/etnologia , Demência/psicologia , Feminino , Grupos Focais , Transição Epidemiológica , Humanos , Incidência , Entrevistas como Assunto/métodos , Masculino , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Técnicas Psicológicas
8.
Artigo em Inglês | MEDLINE | ID: mdl-31618944

RESUMO

Traditional languages are a key element of Indigenous peoples' identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors; connection to Country; connection to culture; connection to community; connection to family and kinship; connection to mind and emotions; and impacts upon identity and cultural pride at an individual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.


Assuntos
Idioma , Saúde Mental , Grupo com Ancestrais Oceânicos/psicologia , Adolescente , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Austrália do Sul , Adulto Jovem
9.
Int J Equity Health ; 18(1): 136, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477114

RESUMO

BACKGROUND: Indigenous Australians are under-represented in the health workforce, with large disparities between rates of Indigenous and non-Indigenous people in every health profession, including nurses, medical practitioners and all allied health professionals. Yet Indigenous people have long requested to have Indigenous practitioners involved in their health care, with this increasing the likelihood of culturally safe care. To address the shortage of Indigenous health professionals, it is important to not only recruit more Indigenous people into health courses, but also to support them throughout their studies so that they graduate as qualified health professionals. The aim of this systematic literature review was two-fold: to identify the factors affecting the retention of Indigenous students across all tertiary health disciplines, and to identify strategies that support Indigenous students to remain with, and successfully complete, their studies. METHODS: Eight electronic databases were systematically searched between July and September 2018. Articles were screened for inclusion using pre-defined criteria and assessed for quality using the Mixed Methods Assessment Tool and the Joanna Briggs Institute Checklist for Text and Opinion. RESULTS: Twenty-six articles met the criteria for inclusion. Key factors reported by students as affecting retention were: family and peer support; competing obligations; academic preparation and prior educational experiences; access to the Indigenous Student Support Centre; financial hardship; and racism and discrimination. The most successful strategies implemented by nursing, health and medical science faculties to improve retention were multi-layered and included: culturally appropriate recruitment and selection processes; comprehensive orientation and pre-entry programs; building a supportive and enabling school culture; appointing Indigenous academics; embedding Indigenous content throughout the curriculum; developing mentoring and tutoring programs; flexible delivery of content; partnerships with the Indigenous Student Support Centre; providing social and financial support; and 'leaving the university door open' for students who leave before graduation to return. CONCLUSIONS: Universities have an important role to play in addressing inequities in the Indigenous health workforce. A suite of measures implemented concurrently to provide support, starting with recruitment and pre-entry preparation programs, then continuing throughout the student's time at university, can enable talented Indigenous people to overcome adversities and graduate as health professionals.


Assuntos
Grupo com Ancestrais Oceânicos/psicologia , Evasão Escolar/estatística & dados numéricos , Estudantes de Ciências da Saúde/psicologia , Austrália , Humanos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fatores de Risco , Estudantes de Ciências da Saúde/estatística & dados numéricos
10.
BMC Public Health ; 19(1): 1270, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533670

RESUMO

BACKGROUND: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. METHODS: Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. RESULTS: Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). CONCLUSION: Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ANZCTR12614000705684 , 03/07/2014.


Assuntos
Depressão/diagnóstico , Programas de Rastreamento/normas , Grupo com Ancestrais Oceânicos/psicologia , Adulto , Austrália , Estudos de Viabilidade , Feminino , Serviços de Saúde do Indígena/normas , Humanos , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Questionário de Saúde do Paciente , Atenção Primária à Saúde , Projetos de Pesquisa
11.
Artigo em Inglês | MEDLINE | ID: mdl-31470580

RESUMO

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.


Assuntos
Saúde Mental , Grupo com Ancestrais Oceânicos/psicologia , Serviços Preventivos de Saúde , Ideação Suicida , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Austrália/epidemiologia , Humanos , Prevalência
12.
BMC Public Health ; 19(1): 1245, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500594

RESUMO

BACKGROUND: New Zealand's Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Maori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter. METHODS: The study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Maori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment. RESULTS: 2333 Maori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Maori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Maori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1-15.5%) in Maori (13.6% versus 25.9%) and 8.3% (95% CI 5.8-10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Maori and 42.1% versus 21.9% in Pacific). CONCLUSION: The DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12612001259831 . Registered 30 November 2013.


Assuntos
Neoplasias Colorretais/etnologia , Promoção da Saúde/métodos , Programas de Rastreamento/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/psicologia , Gravação em Vídeo , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde
13.
Int J Equity Health ; 18(1): 142, 2019 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492177

RESUMO

BACKGROUND: Racial discrimination is acknowledged as a central social determinant of Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health, although quantitative empirical literature on the impacts of racism on Aboriginal children remains sparse. We use a novel, longitudinal dataset to explore the relationship between caregiver-perceived racism exposure and a range of mental health and related behavioural and physiological outcomes in childhood. METHOD: The study cohort comprised 1759 Aboriginal children aged 4-12 years from waves 2-8 (2009-2015) of the Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) dataset. We examined exposure to caregiver-perceived racism between 4 and 11 years as a predictor for mental health and related outcomes at ages 7-12 and substance use at 10-12 years. Unadjusted models and models adjusted for remoteness, community-level and family-level socio-economic status, child age and gender were used in analysis. Multilevel logistic regression was used in all analysis. RESULTS: In fully adjusted models, perceived exposure to racism at ages 4-11 was associated with twice the risk of negative mental health (95% CI: 1.3-3.0), sleep difficulties (95% CI: 1.4-3.0), and behaviour issues at school (95% CI: 1.2-2.9), 1.7 times the risk of obesity (95% CI: 1.1-2.5), and nearly 7 times the risk of trying cigarettes (95% CI: 1.1-43.9). Increased risks were also found for being underweight and trying alcohol though estimates did not reach statistical significance. There was no evidence that racism was associated with poorer general health. CONCLUSION: Exposure to racial discrimination in Aboriginal children increased the risk for a spectrum of interrelated psychological, behavioural and physiological factors linked to negative mental health. Our results further affirm the importance of interventions aimed at reducing the prevalence of racial discrimination for the benefits of population health and health inequalities. The services and institutions which aim to support the mental health and wellbeing of Aboriginal children should also support interventions to reduce racism and implement accountable policies which prioritise this goal.


Assuntos
Cuidadores/psicologia , Transtornos Mentais/etnologia , Grupo com Ancestrais Oceânicos/psicologia , Racismo/psicologia , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fatores de Risco
14.
Int J Equity Health ; 18(1): 132, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438974

RESUMO

BACKGROUND: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. METHODS: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child's main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RRa) effects of racism on SEWB for both cohorts separately. RRa were pooled in a random effects meta-analysis. RESULTS: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RRa 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RRa for total difficulties (RRa 1.72, 95% CI 1.16, 2.54), whilst older children had higher RRa for hyperactive behaviour (RRa 1.66, 95% CI 1.01, 2.73). CONCLUSIONS: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.


Assuntos
Transtornos do Comportamento Infantil/etiologia , Comportamento Infantil/psicologia , Bem-Estar da Criança/psicologia , Emoções , Saúde Mental , Grupo com Ancestrais Oceânicos/psicologia , Racismo/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Austrália , Cuidadores , Criança , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários
15.
BMC Health Serv Res ; 19(1): 606, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464615

RESUMO

BACKGROUND: There is a disparity in the burden of gynaecological cancer for Indigenous women compared with non-Indigenous women in Australia. Understanding how Indigenous women currently experience gynaecological cancer care services and factors that impact on their engagement with care is critical. This study explored Indigenous Australian women's experience of gynaecological cancer care at a major metropolitan hospital in Queensland. METHODS: Indigenous women receiving care at a major metropolitan Queensland hospital for investigation or diagnosis of gynaecological cancer were invited to participate in a larger longitudinal study exploring women's experiences of gynaecological cancer care. This component was an in-depth, qualitative interview exploring the women's experiences of hospital care at approximately three-month post initial referral. A peer-approach was used to interview women. Hospital-based care providers involved in the care of Indigenous gynaecological cancer patients were invited to be interviewed. Interviews were transcribed and thematically analysed using an interpretative phenomenological approach enabling a multi-layered, contextualised understanding of the patients' experience and their interaction with tertiary cancer services. RESULTS: Eight Indigenous patients and 18 care providers were interviewed. Analysis of all interviews revealed four broad issues affecting Indigenous patients' early experiences of care: (1) navigating the system, impacted by timely diagnosis, access to support services and follow up; (2) communication and decision-making, patients' decision-making, efficacy of doctor-patient communication, and patients' knowledge about cancer; (3) coping with treatment demands, was impacted by emotional stress, access to services and support by hospital staff; and (4) feeling welcome and safe in the hospital, impacted by patients' relationship with care providers and their access to culturally-safe services. The combination of factors impacting these women's' experience of gynaecological care commonly left these women at breaking point, often with limited access to information, resources or support. CONCLUSIONS: Our findings revealed that experiences of cancer care for Indigenous women are overlain by challenges associated with late referral, misdiagnosis, miscommunication, lack of information, logistics in accessing treatment and services and system cultural insensitivities. Our findings offer insights that can inform cancer care provision to more effectively support Indigenous women accessing gynaecological cancer services.


Assuntos
Neoplasias dos Genitais Femininos/terapia , Determinação de Necessidades de Cuidados de Saúde , Grupo com Ancestrais Oceânicos/etnologia , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Comunicação , Tomada de Decisões , Detecção Precoce de Câncer , Feminino , Neoplasias dos Genitais Femininos/etnologia , Hospitais Urbanos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/psicologia , Satisfação do Paciente , Assistência Centrada no Paciente/normas , Pesquisa Qualitativa , Queensland/epidemiologia , Queensland/etnologia , Adulto Jovem
16.
Contemp Nurse ; 55(2-3): 250-260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31340716

RESUMO

Background: It is not understood how Maori and Pacific students in New Zealand choose nursing as a health career. Findings regarding influences arose from a study focusing on an incubator programme in New Zealand. Objectives: The aim of this study was to investigate whether secondary school students' participation in an Incubator Programme at secondary school influences students' choice of tertiary education. One of the aims of Programme Incubator (PI) is to encourage Indigenous (Maori) and Pacific students to consider a career in health. Methods: This longitudinal cohort study followed two cohorts of secondary school students from five schools. Participants completed a survey before and after participating in PI. Results: Of possible career options, nursing was the most common. Influences on career choices were personal experience, exposure to the media, careers advisors and teachers. Conclusions: PI is more attractive to Maori and Pacific people, than other populations. PI has been found to broaden and confirm available career options for some students. Nursing is a popular career choice for secondary students.


Assuntos
Escolha da Profissão , Cuidados de Enfermagem/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Estudantes/psicologia , Adulto , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Nova Zelândia , Cuidados de Enfermagem/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adulto Jovem
17.
BMC Health Serv Res ; 19(1): 488, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307436

RESUMO

BACKGROUND: Australia provides health care services for Indigenous peoples as part of its effort to enhance Indigenous peoples' wellbeing. However, biomedical frameworks shape Australia's health care system, often without reference to Indigenous wellbeing priorities. Under Indigenous leadership the Interplay research project explored wellbeing for Indigenous Australians in remote regions, through defining and quantifying Indigenous people's values and priorities. This article aimed to quantify relationships between health care access, mental and physical health, and wellbeing to guide services to enhance wellbeing for Indigenous Australians in remote regions. METHODS: Indigenous and non-Indigenous researchers worked with Indigenous people in remote Australia to create a framework of wellbeing priorities. Indigenous community priorities were community, culture and empowerment; these interplay with government priorities for Indigenous development of health, education and employment. The wellbeing framework was further explored in four Indigenous communities through a survey which measured aspects of the wellbeing priorities. Indigenous community researchers administered the survey in their home communities to 841 Indigenous people aged 15 to 34 years from June 2014. From the survey items, exploratory factor analysis was used to develop constructs for mental and physical health, barriers to health care access and wellbeing. Relationships between these constructs were quantified through structural equation modelling. RESULTS: Participants reported high levels of health and physical health (mean scores (3.17/4 [SD 0.96]; and 3.76/4 [SD 0.73]) and wellbeing 8.07/10 [SD 1.94]. Transport and costs comprised the construct for barriers to health care access (mean access score 0.89/1 [SD 0.28]). Structural equation modelling showed that mental health, but not physical health was associated with wellbeing (ß = 0.25, P < 0.001; ß = - 0.038, P = 0.3). Health care access had an indirect positive relationship with wellbeing through mental health (ß = 0.047, P = 0.007). Relationships differed significantly for participants in remote compared with those in very remote communities. CONCLUSIONS: Greater attention to mental health and recognition of the role of services outside the health care sector may have positive impacts on wellbeing for Indigenous people in remote/ very remote Australia. Aggregation of remote and very remote populations may obscure important differences between Indigenous communities.


Assuntos
Saúde Mental , Grupo com Ancestrais Oceânicos/psicologia , Satisfação Pessoal , Adolescente , Adulto , Austrália , Feminino , Acesso aos Serviços de Saúde , Serviços de Saúde do Indígena , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
18.
Women Birth ; 32(5): 427-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326382

RESUMO

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde do Indígena , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Tocologia/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Parto/etnologia , Adulto , Austrália , Características Culturais , Feminino , Humanos , Obstetrícia , Gravidez , Fumar
19.
Women Birth ; 32(5): 437-448, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326383

RESUMO

BACKGROUND: Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM: To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS: This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS: No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION: A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Cuidado Pré-Natal/métodos , Adulto , Austrália , Feminino , Pessoal de Saúde , Disparidades em Assistência à Saúde , Humanos , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
20.
Women Birth ; 32(5): 383-390, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257181

RESUMO

BACKGROUND: This case study explores the four pregnancy and birthing journeys of Wiradjuri & Ngemba-Wayilwan woman, Fleur Magick Dennis. Fleur provides a personal account of her journeys and relates them to socio-cultural issues surrounding her life during these times. Fleur experienced her first birth in hospital and her three next births at different locations out of hospital on Wiradjuri Country. Fleur is able to show that her personal wellbeing & healing and that of her family & community is linked to her having been able to birth according to her spiritual & cultural beliefs. The midwife for Fleur's third and fourth pregnancy, Hazel Keedle, then provides a brief account of her experiences supporting Fleur in her choices and explores the impact of these births on her midwifery and personal life.


Assuntos
Continuidade da Assistência ao Paciente , Parto Domiciliar , Tocologia , Mães/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Satisfação Pessoal , Austrália , Centros de Assistência à Gravidez e ao Parto , Feminino , Hospitais , Humanos , Gravidez
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