Exploring the Experiences of the Consent Process for Aboriginal and Torres Strait Islander People Having Cardiac Surgery and Participating in Medical Research: A Study Protocol

Background: Gaining informed consent is a critical step before any medical procedure, and before taking part in medical research. Cultural differences in concepts of health and healing, communication, language, and racism, can play a part in forming barriers to gaining informed consent for Aboriginal and Torres Strait Islander people. For Aboriginal and Torres Strait Islander people, a lack of informed consent can worsen distrust and contribute to continuing health disparities. This protocol describes a study aimed at providing a better understanding of informed consent experiences of Aboriginal and Torres Strait Islander people undergoing heart surgery and participating in research. This will be complemented by comparing those experiences to the ones of the clinicians and researchers who obtain informed consent from Aboriginal and Torres Strait Islander people. Methods: The study will be conducted at the Fiona Stanley Hospital in Western Australia and Townsville University Hospital in Queensland. Participants will include Aboriginal and Torres Strait Islander patients undergoing cardiac surgery, clinicians of the cardiothoracic surgery team and medical researchers at both hospitals. Yarning will be used as an Indigenous research method to collect meaningful data from Aboriginal and Torres Strait Islander people undergoing cardiac surgery whilst semi-structured interviews will be conducted to explore Clinician’s and researchers’ experiences. Data from Aboriginal and Torres Strait Islander participant will be analysed following a cyclical approach to ensure Aboriginal and Torres Strait Islander voices are not lost during data interpretation. Inductive thematic analysis of data will be conducted to yield practical recommendations. Conclusions: We present the protocol of a study that will inform the development of strategies to ensure that informed consent processes are culturally appropriate and guarantee Aboriginal and Torres Strait Islander people’s right to self-determination. This will contribute to the provision of culturally safe healthcare services and promote the conduct of medical research that is ethical, safe and benefits Aboriginal and Torres Strait Islander people

Effects of Nutritional Interventions on Cardiovascular Disease Health Outcomes in Aboriginal and Torres Strait Islander Australians: A Scoping Review

Nutrition interventions can support Aboriginal and Torres Strait Islander peoples to reduce their risk of cardiovascular disease (CVD). This review examines nutritional interventions aiming to improve CVD outcomes and appraises peer-reviewed interventions using an Aboriginal and Torres Strait Islander Quality Appraisal Tool. Five electronic databases and grey literature were searched, applying no time limit. Two reviewers completed the screening, data extraction and quality assessment independently. The study quality was assessed using the South Australian Health and Medical Research Institute and the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Twenty-one nutrition programs were included in this review. Twelve reported on anthropometric measurements, ten on biochemical and/or hematological measurements and sixteen on other outcome domains. Most programs reported improvements in measurable CVD risk factors, including reduced body mass index (BMI), waist circumference (WC), weight, blood pressure and improved lipid profiles. Most programs performed well at community engagement and capacity strengthening, but many lacked the inclusion of Indigenous research paradigms, governance and strengths-based approaches. This review highlights the need for contemporary nutrition programs aimed at improving cardiovascular health outcomes to include additional key cultural components

The intersection between driver licensing, employment, and health for Aboriginal and Torres Strait Islander Australians

University of Technology Sydney. Faculty of Health.Employment and driver licensing are key social determinants that impact on the health and wellbeing of individuals. This dissertation examined how obtaining a licence through culturally appropriate driver licensing programs influence employment outcomes of Aboriginal and Torres Strait Islander Australians, and its subsequent impact on their health and wellbeing. This work included a systematic review, and a mixed-method approach, including use of Indigenous research methods, to examine two independent driver licensing programs in the Australian Capital Territory (ACT) and New South Wales (NSW). The systematic review showed forty-two programs were identified as being delivered across Australia, however very few (n = 4) were evaluated, and none examined the impact on employment outcomes. ACT clients who achieved a driver licence self-reported a successful range of transitions into employment. In NSW, clients were shown more likely (OR: 2.5, CI: 1.22 – 5.24, p = 0.011) to report gaining a job/or having a change in job, with those from regional areas more likely (OR: 1.72, 95% CI: 1.27 – 2.33, p < 0.001) to obtain a licence than those from urban areas. Holistic programs that address social and economic priorities of Aboriginal and Torres Strait Islander Australians can contribute to better health and wellbeing outcomes

Overcoming barriers to use of child car seats in an urban Aboriginal community—formative evaluation of a program for Aboriginal Community Controlled Health Services

Background Little is known about the barriers to use of child car seats in Australian Aboriginal communities, or the acceptability of programs to increase appropriate car seat use. This formative evaluation sought to consult and partner with Aboriginal Community Controlled Health Services (ACCHS) to develop and evaluate the feasibility and acceptability of a program intended to improve optimal use of child car seats. Methods Focus groups were conducted with parents and carers of Aboriginal children to identify the barriers and facilitating factors for child car seat use, and staff of two ACCHS were interviewed to inform program development. Following the implementation of the resulting multi-faceted program, consisting of staff training, education, hands-on demonstrations and a subsidised car seat distribution scheme, interviews were conducted to assess process issues and acceptability with 13 staff members. Results Parents and carers in the focus groups reported a lack of awareness of child car seat use, confusion about the right car seats for different aged children but agreed about the importance of safety and community responsibility to keep children safe in cars. Interviews with service staff informed an approach to deliver relevant information. Information and resources were delivered to families, while the car seat distribution scheme supplied 33 families with child car seats. Following the conclusion of the program, staff reported that the program was relevant to their role. They also valued the car seat distribution scheme. Staff training in selection and installation of car seats increased confidence in staff knowledge. Conclusions We developed a program to promote child car seat use in ACCHS, which focused on developing capacity, made use of existing infrastructure and developed resources for use in this setting. The program shows promise as a means to promote child car seat use in Aboriginal communities; however, the impact on child car seat use will need to be evaluated in a larger scale prospective trial

Programs Addressing Food Security for First Nations Peoples: A Scoping Review

Access to food is a right that every individual must have to ensure a standard of living that is sufficient for maintaining good health and wellbeing. This review, developed and implemented by a team of First Nations and non-First Nations peoples, aimed to scope the literature on programs addressing food security for First Nations peoples in Australia, Aotearoa/New Zealand, Canada, and the United States of America. Collectively, First Nations groups share continued traumas, disadvantages, and devastation brought upon them as a result of British colonisation. Despite the impacts of colonial conquest, the resilience of First Nations peoples continues through the fight for self-determination, sovereignty, equity, and equality. Three databases and grey literature were searched from 2010. Two reviewers completed screening, data extraction, and critical appraisal. Nine food security programs were included in this review. Five were from the United States of America and four from Canada, with no program from Australia or Aotearoa/New Zealand meeting the inclusion criteria. The programs that appear to be most suitable for addressing food security for First Nations peoples were participatory in design, had community governance, integrated cultural knowledge and food systems to increase the accessibility and availability of cultural foods, incorporated educational components, and utilized collaborations among various agencies. Findings showed that while it is important to address short-term emergency food relief, the aim should be sustainable food security through a longer-term system and policy change underpinned by co-designed research and evaluation

Discharge interventions for First Nations people with a chronic condition or injury: a systematic review

Abstract Background Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. Methods A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. Results Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. Conclusion Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. Registration This study was prospectively registered in PROSPERO (ID CRD42021254718)