Setting and meeting priorities in Indigenous health research in Australia and its application in the Cooperative Research Centre for Aboriginal Health

Priority setting is about making decisions. Key issues faced during priority setting processes include identifying who makes these decisions, who sets the criteria, and who benefits. The paper reviews the literature and history around priority setting in research, particularly in Aboriginal health research. We explore these issues through a case study of the Cooperative Research Centre for Aboriginal Health (CRCAH)'s experience in setting and meeting priorities

Is peer review useful in assessing research proposals in Indigenous health? A case study

Background: There has been considerable examination and critique of traditional (academic) peer review processes in quality assessment of grant applications. At the same time, the use of traditional research processes in Indigenous research has been questioned. Many grant funding organisations have changed the composition of their peer review panels to reflect these concerns but the question remains do these reforms go far enough? In this project we asked people working in areas associated with Aboriginal health research in a number of capacities, their views on the use of peer review in assessing Indigenous research proposals. Methods: In semi-structured interviews we asked 18 individuals associated with an Australian Indigenous research funding organisation to reflect on their experience with peer review in quality assessment of grant applications. We also invited input from a steering group drawn from a variety of organisations involved in Aboriginal research throughout Australia and directly consulted with three Aboriginal-controlled health organisations. Results: There was consensus amongst all participants that traditional academic peer review is inappropriate for quality assessment in Indigenous research. Many expressed the view that using a competitive grant review system in Aboriginal health was counterintuitive, since good research transfer is based on effective collaboration. The consensus within the group favoured a system which built research in a collaborative manner incorporating a variety of different stakeholders in the process. In this system, one-off peer review was still seen as valuable in the form of a "critical friend" who provided advice as to how to improve the research proposal. Conclusion: Peer review in the traditional mould should be recognised as inappropriate in Aboriginal research. Building research projects relevant to policy and practice in Indigenous health may require a shift to a new way of selecting, funding and conducting research.Jackie Street, Fran Baum and Ian P.S. Anderso

Voting with their feet - predictors of discharge against medical advice in Aboriginal and non-Aboriginal ischaemic heart disease inpatients in Western Australia: an analytic study using data linkage

Background: Discharge Against Medical Advice (DAMA) from hospital is associated with adverse outcomes and is considered an indicator of the responsiveness of hospitals to the needs of Aboriginal and Torres Strait Islander Australians, the indigenous people of Australia. We investigated demographic and clinical factors that predict DAMA in patients experiencing their first-ever inpatient admission for ischaemic heart disease (IHD). The study focuse sparticularly on the differences in the risk of DAMA in Aboriginal and non-Aboriginal patients while also investigating other factors in their own right. Methods: A cross-sectional analytical study was undertaken using linked hospital and mortality data with complete coverage of Western Australia. Participants included all first-ever IHD inpatients (aged 25–79 years) admitted between 2005 and 2009, selected after a 15-year clearance period and who were discharged alive. The main outcome measure was DAMA as reflected in the hospital record. Multiple logistic regression was used to determine disparities in DAMA between Aboriginal and non-Aboriginal patients, adjusting for a range of demographic and clinical factors, including comorbidity based on 5-year hospitalization history. A series of additional models were run on subgroups of the cohort to refine the analysis. Ethics approval was granted by the WA Human Research and the WA Aboriginal Health Ethics Committees.Results: Aboriginal patients comprised 4.3% of the cohort of 37,304 IHD patients and 23% of the 224 DAMAs. Emergency admission (OR=5.9, 95% CI 2.9-12.2), alcohol admission history (alcohol-related OR=2.9, 95% CI 2.0-4.2) and Aboriginality (OR 2.3, 95% CI 1.5-3.5) were the strongest predictors of DAMA in the multivariate model. Patients living in rural areas while attending non-metropolitan hospitals had a 50% higher risk of DAMA than those living and hospitalised in metropolitan areas. There was consistency in the ORs for Aboriginality in the different multivariate models using restricted sub-cohorts and different Aboriginal identifiers. Sex, IHD diagnosis type and co-morbidity scores imparted different risks in Aboriginal versus non-Aboriginal patients. Conclusions: Understanding the risks and reasons for DAMA is important for health system policy and proactive management of those at risk of DAMA. Improving care to prevent DAMA should target unplanned admissions, rural hospitals and young men, Aboriginal people and those with alcohol and mental health comorbidities

Developing a collaborative research system for Aboriginal health

The definitive version may be found at www.wiley.comObjectiveInvestigator-driven research and the use of peer review are contentious in community-based research and are particularly problematic in Indigenous research. In this project, we conducted a qualitative study among stakeholders in an Australian Aboriginal majority-controlled research-funding organisation to examine the research funding process.MethodsA steering group guided the project and contributed to the research findings. In-depth interviews (n=18) with stakeholders in the Cooperative Research Centre for Aboriginal Health were conducted to canvass views on the research funding process and options for alternate processes. A discussion document, supported by an extensive literature review, was provided prior to interview. This research was an iterative process where the discussion document and interview schedule were revised as the research findings informed the project.FindingsParticipants overwhelmingly endorsed a move to a more collaborative research culture, although the form the culture might take varied. Suggested elements included involvement of grant funding bodies as brokers in building collaborative networks and the substitution of named 'critical friends' for blinded peer review. Barriers to changing the research culture to a more collaborative model were described.Conclusions and implicationsA collaborative structure with targeted project development would permit redistribution of the time and effort (previously expended on peer review) into research development and would increase community participation in decision-making in the research funding process.Jackie Street, Fran Baum, Ian Anderso

On regional and cultural approaches to Australian Indigenous violence

Based on a national analysis of Indigenous family violence, the 2001 monograph on ‘Violence in Indigenous Communities’ by the author and his colleagues for the Australian Attorney-General's Department called for government agencies to ‘take a regional approach to supporting and co-ordinating local community initiatives’ together with ‘partnerships between Indigenous program personnel and mainstream services …’ (Memmott et al., 2001, p. 4). This current article reports on regional aspects of two subsequent pieces of research by the author, one in the Barkly Region of central-east Northern Territory for Anyinginyi Health Aboriginal Corporation (2007) and the other in the Torres Strait for the Queensland Department of Communities (2008). The research findings from both of these studies develop the case for government policy to accommodate regional approaches to Indigenous family violence due to combinations of geographic and culturally specific causal factors. The importance of nurturing social and cultural capital in Indigenous communities to strengthen social values, leadership and cohesion in addressing Indigenous violence will be emphasised. Some comment will be made on the role of underlying factors (‘deep historical circumstances’) in contributing to violence, in conjunction with precipitating causes and situational factors, the former being somewhat downplayed in policy debate over the period of the Howard government