Aboriginal young people's experiences of type 2 diabetes diagnosis, management and support: A qualitative study in the Kimberley region of Western Australia.

ISSUES ADDRESSED: In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most-affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self-management, to improve models of care. METHODS: A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12-24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De-identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher. RESULTS: Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self-management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued. CONCLUSIONS: There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes-related support. SO WHAT?: Alongside broader efforts to support good health at the societal level, enhanced health education and family-oriented support structures including Aboriginal clinical staff for young people with T2D are needed.

Unacceptably high: an audit of Kimberley self-harm data 2014-2018.

OBJECTIVE: To explore the rates and characteristics of self-harm across the Kimberley region of Western Australia. METHOD: Retrospective, cross-sectional audit. We obtained and descriptively analysed routinely collected self-harm data from the Kimberley District of the Western Australia Police Force (2014-2018) and the Emergency Department Data Collection (June 2017-December 2018). Variables included age, sex, Indigenous status, time of incident, and alcohol and drug use. RESULTS: The rate of emergency department attendance for self-harm was three times higher in the Kimberley than the rest of Western Australia. Both emergency department and police data showed a disproportionately high percentage of incidents involving Aboriginal people, with highest rates in the 15-19 and 20-24 year age groups. Almost 80% of self-harm events recorded by police involving individuals aged 25-50 years involved alcohol. Many self-harm incidents occurred in the evening and at night. CONCLUSIONS: The rates of self-harm across the Kimberley region from 2014-2018 are unacceptably high. Increased funding and alignment of services to meet regional need are required as part of a holistic effort to reduce regional rates of self-harm.

Risk and resilience: a mixed methods investigation of Aboriginal Australian women's perinatal mental health screening assessments.

PURPOSE: To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women's Kimberley Mum's Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome. METHODS: We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into 'risk' and 'protective' factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety. RESULTS: Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11-33% high vs 61-100% no risk) and more commonly had risk factors (22-67% high vs 6-28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety. CONCLUSION: Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.

A Mixed Methods Study of 15 Years of Aboriginal Health Research in the Kimberley: 'We've Been Researched, We Think, from Head to Toe, Inside and Outside, Upside Down'.

Indigenous peoples have long been the subjects of research, with the burden generally outweighing the benefit. This mixed methods study investigates the characteristics and outcomes of Aboriginal health research in the Kimberley region of Western Australia from 2006-2020 to inform future research practices. Quantitative data from projects submitted to the Kimberley Aboriginal Health Planning Forum Research Subcommittee were reviewed, and key characteristics were recorded and descriptively analysed. Fifteen individuals from a range of local organisations who were involved with research during this time participated in qualitative semi-structured interviews, including 11 Aboriginal people. The project team, including Aboriginal investigators, integrated quantitative and qualitative findings. Three major interview themes were questionable 'research world' behaviours; translation of findings and impact of research; and local involvement and control. The experiences of interviewees were congruent with quantitative data for the larger body of projects (N = 230). Most projects (60%) were not initiated within the Kimberley, with positive impact for local communities often not clear. There were, however, examples of Kimberley Aboriginal-led research excellence. A way forward includes research that is developed, driven, and led by the community; alignment with research priorities; local Aboriginal involvement that is resourced and acknowledged; and comprehensive knowledge translation plans embedded in projects.

Above and Beyond: Fashioning an Accessible Health Service for Aboriginal Youth in Remote Western Australia.

BACKGROUND: Young Aboriginal people are at an important stage in the development of their health and wellbeing. They experience significant morbidity and mortality, and their access to medical services may be limited by geographic remoteness and difficulty obtaining appropriate care. Aboriginal Community Controlled Health Services offer primary health care considered to be more accessible for Aboriginal people. OBJECTIVE: This study is one component of research aiming to enhance access for young Aboriginal people in a remote area of Western Australia. It aims to add to our previous study focusing on perceptions of local young people, through exploring the understandings of health care staff regarding access for young Aboriginal people. METHODS: This qualitative study involved semistructured individual and group interviews with 24 staff who work with young Aboriginal people at a remote Aboriginal Community Controlled Health Service. Transcripts were descriptively coded and thematically analyzed by the research team. RESULTS: Staff identified a number of challenges in working with 16- to 25-year-old Aboriginal people, which revolved around the interface between the service, its staff and the young people. They also suggested strategies designed to engage these young people. The strategies included relationship-building, communication, trust and confidentiality with individuals; and targeted clinics, partnerships, health promotion, and an open door policy by clinics. The strategies used by staff were flexible and expansive in nature. CONCLUSIONS: Engagement can be enhanced by a health service willing to "go the extra mile," with a strategic, enveloping and innovative approach, resourcing and the right people with the right attitude.

Aboriginal women's experiences of strengths and challenges of antenatal care in the Kimberley: A qualitative study.

BACKGROUND: High-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women's experiences of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care. METHODS: Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015-2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed. FINDINGS: Most women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles. CONCLUSIONS: The experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.

Maboo wirriya, be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town.

Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15-25 years and refine it after piloting. This 8-session program, 'Maboo wirriya, be healthy' involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.

'It's Important to Make Changes.' Insights about Motivators and Enablers of Healthy Lifestyle Modification from Young Aboriginal Men in Western Australia.

Lifestyle modification can improve the health of people with or at risk of non-communicable diseases; however, initiating and maintaining positive health behaviours including healthy eating and physical activity is challenging. Young remote Aboriginal people who had successfully made significant healthy lifestyle changes were sought out to explore how they achieved this success. Four Aboriginal men aged 20⁻35 years were identified and consented to participate. Their perceptions of motivation for change, strategies, and facilitators and barriers were explored through in-depth interviews. Themes developed from the interviews included self-efficacy, self-reliance, and increased knowledge and altered health beliefs underpinning change. Participants with diabetes were highly motivated to avoid diabetes complications and had a strong belief that their actions could achieve this. In a setting with high levels of disadvantage, participants had relatively favourable socioeconomic circumstances with solid social supports. These findings highlight that lifestyle modification programs that foster internal motivation, enhance key health knowledge, and modify health beliefs and risk perception are needed. Increasing diabetes awareness among at-risk young people is important, emphasising the largely preventable and potentially reversible nature of the condition. Broad health improvements and individual changes will be facilitated by equitable socioeconomic circumstances and environments that support health.

Piloting a culturally appropriate, localised diabetes prevention program for young Aboriginal people in a remote town.

Lifestyle changes are central to preventing type 2 diabetes. Embarking upon and sustaining change is challenging, and translation of prevention approaches into a wider range of real-world settings is needed. In this study, a locally adapted community-led diabetes prevention program with local young Aboriginal facilitators was created and trialled through the Derby Aboriginal Health Service (DAHS). The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. Ten Aboriginal women and men aged 18-38 years participated in the pilot program. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. Limitations included participant recruitment and attendance difficulties, which were attributed to program timing and competing demands. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies.