Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study

Objectives To explore the perceptions of Aboriginal Community Controlled Health Service (ACCHS) staff involved in providing mental healthcare to Aboriginal young people of the current and ideal pathways to mental healthcare for urban Aboriginal young people attending ACCHSs, and to identify what additional supports staff may need to provide optimal mental healthcare to Aboriginal young people.The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) is funded through the Australian National Health and Medical Research Council (grant numbers APP358457, APP1035378, APP1023998), and an Australian Primary Health Care Research Institute Centre for Research Excellence Grant

Developmental risk among Aboriginal children living in urban areas in Australia : the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)

Background: Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers' concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods: Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents' Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Results: Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62-3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21-6.54), prior history of ear infection (1.95, 1.21-3.15), having lived in 4 or more houses versus one house (4.13, 2.04-8.35), foster care versus living with a parent (5.45, 2.32-12.78), and having a caregiver with psychological distress (2.40, 1.37-4.20). Conclusion: In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed

The impact of unhealthy food sponsorship vs. pro-health sponsorship models on young adults' food preferences: A randomised controlled trial

Background: Unhealthy foods are promoted heavily, through food company sponsorship of elite sport, resulting in extensive exposure among young adults who are avid sport spectators. This study explores the effects of sponsorship of an elite sporting event by: (A) non-food brands (control), (B) unhealthy food brands, (C) healthier food brands, or (D) an obesity prevention public health campaign on young adults' brand awareness, attitudes, image perceptions, event-sponsor fit perceptions, and preference for food sponsors' products. Methods: A between-subjects web-based experiment was conducted, consisting of four sponsorship conditions (A through D) featuring three product categories within each condition. Australian adults (N = 1132) aged 18-24 years were recruited via a national online panel. Participants viewed promotional videos and news stories about an upcoming international, multi-sport event (with sponsor content edited to reflect each condition), completed a distractor task, and then answered questions assessing the response variables. Regression analyses were conducted to test for differences by sponsorship condition on the respective outcome measures. Results: Compared to the control condition, unhealthy food sponsorship promoted higher awareness of, and more favourable attitudes towards, unhealthy food sponsor brands. Unhealthy food sponsorship also led to greater perceived event-sponsor fit and transfer of perceptions of the sporting event to the unhealthy food sponsor brands, relative to the control group. Exposure to sponsorship for healthier foods produced similar sponsorship effects for healthier food sponsor brands, as well as prompting a significant increase in the proportion of young adults showing a preference for these products. Obesity prevention campaign sponsorship promoted higher campaign awareness and perceived event-sponsor fit, but did not impact food attitudes or preference for unhealthy versus healthier foods. Conclusion: Findings suggest that restricting elite sport sponsorship to healthier food brands that meet set nutritional criteria could help promote healthier eating among young adults. Sporting organisations should be encouraged to seek sponsorship from companies who produce healthier food brands and government-funded social marketing campaigns. Clinical trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) registration number ACTRN12618000368235. Retrospectively registered 12 March 2018

Pathways between foodways and wellbeing for First Nations Australians

Abstract Background Supporting the health and wellbeing of Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as First Nations peoples) is a national priority for Australia. Despite immense losses of land, language, and governance caused by the continuing impact of colonisation, First Nations peoples have maintained strong connections with traditional food culture, while also creating new beliefs, preferences, and traditions around food, which together are termed foodways. While foodways are known to support holistic health and wellbeing for First Nations peoples, the pathways via which this occurs have received limited attention. Methods Secondary data analysis was conducted on two national qualitative datasets exploring wellbeing, which together included the views of 531 First Nations peoples (aged 12–92). Thematic analysis, guided by an Indigenist research methodology, was conducted to identify the pathways through which foodways impact on and support wellbeing for First Nations peoples. Results and conclusions Five pathways through which wellbeing is supported via foodways for First Nations peoples were identified as: connecting with others through food; accessing traditional foods; experiencing joy in making and sharing food; sharing information about food and nutrition; and strategies for improving food security. These findings offer constructive, nationally relevant evidence to guide and inform health and nutrition programs and services to harness the strengths and preferences of First Nations peoples to support the health and wellbeing of First Nations peoples more effectively

Barriers in care pathways and unmet mental health needs in LGBTIQ+ communities

Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience

Barriers in care pathways and unmet mental health needs in LGBTIQ + communities

Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing, EAr health and Language Services (HEALS) project

Objective: To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. Methods: A case-study involving a mixed-methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi-structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. Results: To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech-language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. Conclusions: HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health: HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the ‘no research without service’ philosoph

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing, EAr health and Language Services (HEALS) project

Abstract Objective: To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. Methods: A case‐study involving a mixed‐methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi‐structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. Results: To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech‐language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. Conclusions: HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health: HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the ‘no research without service’ philosophy