Gaba Binggi (Good Needles): Developing an understanding of how two Aboriginal* communities see and experience immunisation during pregnancy

Background: First Nation pregnant women experience five times the rate of admission to intensive care from influenza compared with non-First Nations women despite the influenza vaccine being found to be safe and effective in pregnancy. Preliminary coverage data already indicates a gap in immunisation coverage between First Nations women and others. To understand this gap this research explored stories around the experience of pregnancy and immunisation through the eyes of the participating communities and the researcher. Method: The study employed a community-based participatory action research (PAR) framework with decolonising methodologies. Based on the oral tradition of Murri culture, semi-structured interviews (talking listening and yarning) with Mums, family members and key stakeholders were undertaken. Twenty-five interviews were conducted along with two yarning circles. Interviews were recorded and notes taken. PAR phases of planning, action, observation and reflection were conducted. Results: Five main themes emerged from the data and recommendations for action: Special Bond & Celebrating Survival, “It connects family on so many levels, past and present and future”; Believe In Immunisation, “I don’t think I have ever seen anyone in our community refuse to get their child immunised”; Fear/Trust Balance, “Trust takes a long time to build but can be easily damaged”; Cultural Safety; and Ways Forward. Discussion: Gaba Binggi in the language of my people (Gomeroi), and means good needles. This is how immunisation is seen, more than acceptance but a stronger sense of “good needles”. The past, present and future are inextricably connected and this needs to be embraced by health services. What has gone before impacts today and what we do today about immunisation in pregnancy speaks into the future. Conclusion: Pregnancy is deeply important to families and culture. The balance of fear and trust is integral in decisions about immunisation during pregnancy. Current services that provide immunisation to pregnant First Nations women must be designed to be culturally safe, flexible and empathetic to family and community issues. They must name and address racism in all its forms and further culturally safe research needs to be undertaking surrounding immunisation during pregnancy for/with/by First Nations peoples

Interacting With Providers: An Intersectional Exploration of the Experiences of Carers of Aboriginal Children With a Disability

© The Author(s) 2018. Intersectionality has potential to create new ways to describe disparities and craft meaningful solutions. This study aimed to explore Aboriginal carers’ experiences of interactions with health, social, and education providers in accessing services and support for their child. Carers of Aboriginal children with a disability were recruited from an Australian metropolitan Aboriginal community-controlled health service. In-depth, semistructured interviews were conducted with 19 female carers. Intersectionality was applied as an analytical framework due to the inherent power differentials for Aboriginal Australians and carers for people with a disability. Marginalization and a lack of empowerment were evident in the experiences of interactions with providers due to cultural stereotypes and racism, lack of cultural awareness and sensitivity, and poverty and homelessness. Community-led models of care can help overcome the intersectional effects of these identities and forms of oppression in carers’ interactions with providers and enhance access to care

Implementation of a consumer-focused eHealth intervention for people with moderate-to-high cardiovascular disease risk: protocol for a mixed-methods process evaluation

Technology-mediated strategies have potential to engage patients in modifying unhealthy behaviour and improving medication adherence to reduce morbidity and mortality from cardiovascular disease (CVD). Furthermore, electronic tools offer a medium by which consumers can more actively navigate personal healthcare information. Understanding how, why and among whom such strategies have an effect can help determine the requirements for implementing them at a scale. This paper aims to detail a process evaluation that will (1) assess implementation fidelity of a multicomponent eHealth intervention; (2) determine its effective features; (3) explore contextual factors influencing and maintaining user engagement; and (4) describe barriers, facilitators, preferences and acceptability of such interventions.Methods and analysis: Mixed-methods sequential design to derive, examine, triangulate and report data from multiple sources. Quantitative data from 3 sources will help to inform both sampling and content framework for the qualitative data collection: (1) surveys of patients and general practitioners (GPs); (2) software analytics; (3) programme delivery records. Qualitative data from interviews with patients and GPs, focus groups with patients and field notes taken by intervention delivery staff will be thematically analysed. Concurrent interview data collection and analysis will enable a thematic framework to evolve inductively and inform theory building, consistent with a realistic evaluation perspective. Eligible patients are those at moderate-to-high CVD risk who were randomised to the intervention arm of a randomised controlled trial of an eHealth intervention and are contactable at completion of the follow-up period; eligible GPs are the primary healthcare providers of these patients.Ethics and dissemination: Ethics approval has been received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council (AH&MRC) of New South Wales. Results will be disseminated via scientific forums including peer-reviewed publications and national and international conferences

Ironbark: Developing a healthy community program for older Aboriginal people

Issue addressed: Programs by, with and for Aboriginal older people must be culturally safe and relevant. Successful elements include being Aboriginal specific and group based. Co-design with Aboriginal people and stakeholders is essential. We describe the co-design process of developing the Ironbark: Healthy Community program. Methods: Aboriginal ways of knowing, being and doing and yarning conversational methods guided the development process, during 2018. A desktop review provided details of current group characteristics and key community stakeholders. Stakeholder engagement regarding views about group operations, participants and benefits also occurred. Aboriginal Elders views of their groups were gathered through yarning circles in New South Wales (NSW). Grounded theory approach was used to ascertain key themes. Results: Initial engagement occurred with 13 different community stakeholders and organisations in three Australian states (NSW, South Australia (SA), Western Australia (WA)). Three yarning circles occurred with Elders from urban (N = 10), regional coastal (N = 10) and regional country (N = 4) groups. Six key themes were organised in three groups according to an Aboriginal ontology. 1. Knowing: groups provide opportunities to share knowledge and connect socially. Adequate program resourcing and sustainability are valued. 2. Being: groups strengthen culture, providing important social, emotional and other forms of support to age well. 3. Doing: previous program experiences inform perceptions for new program operations. Group venues and operational aspects should be culturally safe, acknowledging diversity among Elders, their preferences and community control. Themes were used to develop the program and its resource manual that were finalised with stakeholders, including steering committee approval. Conclusions: Stakeholder feedback at multiple stages and Aboriginal Elders’ perspectives resulted in a new co-designed community program involving weekly yarning circles and social activities. So what?: Co-design, guided by Aboriginal ways of knowing, being and doing, can develop programs relevant for Aboriginal people

Knowledge translation in Aboriginal and Torres Strait Islander research contexts in Australia: scoping review protocol

Introduction: Knowledge translation (KT) involves bridging the gaps between research knowledge and research application or practice, by sharing this knowledge with knowledge-users. KT is increasingly being used in research with Indigenous peoples globally to address the top-down and inappropriate research approaches commonly used in Indigenous research. Employing KT in Indigenous research in Australia is an emergent field, despite Aboriginal and Torres Strait Islander peoples having conducted KT for generations. There is limited evidence which demonstrates how KT is applied in the Aboriginal/Torres Strait Islander context. Results will benefit researchers by demonstrating ways of appropriately translating research findings to knowledge-users, including Aboriginal and Torres Strait Islander communities, researchers and policy makers. The scoping review will also inform a KT definition, method and practices used in a large-scale, longitudinal cohort study of Aboriginal and Torres Strait Islander adults: the Mayi Kuwayu Study. Methods and analysis: Under guidance of an Aboriginal and Torres Strait Islander governance committee, we will conduct a scoping review on KT in Aboriginal/Torres Strait Islander research. We will follow the scoping review method outlined by the Joanna Briggs Institute. We will search the ANU SuperSearch, and grey and hard to find literature in June 2022. Abstracts and full-text articles will be screened by two independent reviewers. We will include studies that relate to KT in Aboriginal/Torres Strait Islander research, regardless of the research topic. Results will be used to inform the KT definition, method and practices that can be used in Aboriginal/Torres Strait Islander research contexts in Australia. Ethics and dissemination: The Mayi Kuwayu Study has ethics approvals from the Australian Institute of Aboriginal and Torres Strait Islander Studies, 12 Aboriginal/Torres Strait Islander organisations, and the Australian National University Human Research Ethics Committee. Results will be disseminated through peer-review publication and community workshops. Protocol registration is available online (10.17605/OSF.IO/JMFQ3)

A research protocol - Indigenous culture, saves lives - Australian Indigenous cultural views and knowledge in health policy: A case study - the National Aboriginal and Torres Strait Islander Health Plan 2013 - 2023

In Australia, an evidence gap exists for governments and policymakers about what it means when the cultures of Aboriginal and Torres Strait Islander people are included in public policies.  Specifically, when the cultures of Indigenous Australians have been incorporated in a public health policy like the Australian Government's National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (Health Plan), how do policymakers implement - enable, embed, and enact - cultures?  More disturbing is the non-recognition of Indigenous culture's innate relationship to the knowledges held by Indigenous Australians.  In recognition of the importance of Indigenous cultures to the health and wellbeing of Indigenous Australians, the centrality of culture in the Health Plan represents the first national Indigenous public policy that reflects its relevance.  This research protocol describes a public policy qualitative research study that aims to address this evidence gap by using the Health Plan as a case study

Decolonising qualitative research with respectful, reciprocal, and responsible research practice: A narrative review of the application of Yarning method in qualitative Aboriginal and Torres Strait Islander health research

Background Indigenous academics have advocated for the use and validity of Indigenous methodologies and methods to centre Indigenous ways of knowing, being and doing in research. Yarning is the most reported Indigenous method used in Aboriginal and Torres Strait Islander qualitative health research. Despite this, there has been no critical analysis of how Yarning methods are applied to research conduct and particularly how they privilege Indigenous peoples. Objective To investigate how researchers are applying Yarning method to health research and examine the role of Aboriginal and Torres Strait Islander researchers in the Yarning process as reported in health publications. Design Narrative review of qualitative studies. Data sources Lowitja Institute LitSearch January 2008 to December 2021 to access all literature reporting on Aboriginal and Torres Strait Islander health research in the PubMed database. A subset of extracted data was used for this review to focus on qualitative publications that reported using Yarning methods. Methods Thematic analysis was conducted using hybrid of inductive and deductive coding. Initial analysis involved independent coding by two authors, with checking by a third member. Once codes were developed and agreed, the remaining publications were coded and checked by a third team member. Results Forty-six publications were included for review. Yarning was considered a culturally safe data collection process that privileges Indigenous knowledge systems. Details of the Yarning processes and team positioning were vague. Some publications offered a more comprehensive description of the research team, positioning and demonstrated reflexive practice. Training and experience in both qualitative and Indigenous methods were often not reported. Only 11 publications reported being Aboriginal and/or Torres Strait Islander led. Half the publications reported Aboriginal and Torres Strait Islander involvement in data collection, and 24 reported involvement in analysis. Details regarding the role and involvement of study reference or advisory groups were limited. Conclusion Aboriginal and Torres Strait Islander people should be at the forefront of Indigenous research. While Yarning method has been identified as a legitimate research method to decolonising research practice, it must be followed and reported accurately. Researcher reflexivity and positioning, and Aboriginal and Torres Strait Islander ownership, stewardship and custodianship of data collected were significantly under detailed in the publications included in our review. Journals and other establishments should review their processes to ensure necessary details are reported in publications and engage Indigenous Editors and peer reviewers to uphold respectful, reciprocal, responsible and ethical research practice

Clinicians’ views on cognitive assessment with Aboriginal Australians

Background: A shortage of standardised cognitive assessment tools for use with Aboriginal Australians is evident. Clinicians also miss the range of guidelines necessary to inform test selection and interpretation for all Aboriginal clients. This mixed methods study examines clinicians’ confidence, views and current practices when conducting cognitive assessments with Aboriginal Australian clients. Methods: Clinicians were asked about factors that influence their likelihood of using standardised testing in Aboriginal vs non-Indigenous Australian people. Twenty-one health professionals with experience conducting cognitive assessments with Aboriginal and non-Aboriginal Australians participated. Clinicians were presented with a series of different scenarios per the client’s level of education and language of origin via an online survey. Clinicians rated their likelihood and confidence using standardised cognitive assessment for each scenario. Open-ended questions captured clinicians’ views and information about their current clinical practices. Results: Clients’ age, education and language of origin influence the likelihood of clinicians’ use of standardised cognitive assessment measures with Aboriginal people. Overall, clinicians reported feeling only slightly more confident working with non-Indigenous clients than Aboriginal clients. Qualitative data indicate a lack of consistency regarding test selection. Conclusion: Clinicians expressed concerns about the validity of available cognitive assessment tools for use with Aboriginal Australians and the absence of evidence to assist decision-making. Cited barriers included language, educational attainment and cultural factors