Approaches to the development of new mental well-being screening tools for Indigenous peoples: a systematic mixed studies review protocol

Introduction: Indigenous peoples' world views are intricately interrelated and interconnected with those of their communities and the environments where they live. Consequently, Indigenous peoples have a holistic view of their health, which contrasts with the dominant Western biomedical paradigm. However, the mental well-being of Indigenous peoples is predominately screened using tools developed using the Western paradigm that may not be culturally appropriate. The objective of this systematic mixed studies review (SMSR) is to assess the extent of the literature related to approaches used to develop new tools to screen the mental well-being of Indigenous adults. Methods and analysis: This SMSR will be conducted in accordance with the method proposed by Pluye et al. It will include studies that describe the development of any type of tool or approach to screen for mental well-being in Indigenous adults, globally. Searches will be limited to the English language and literature published since January 2000. Databases to be searched include: CINAHL, Medline, PsycINFO, PubMed and Scopus. Only published studies will be included in the SMSR. Data that answers the research questions will be extracted from the literature and recorded on the associated data charting form. A sequential synthesis method will be used to analyse data from qualitative, quantitative and mixed-method studies. Data will be presented graphically, diagrammatically or in tabular form depending on what approach best conveys its meaning. Ethics and dissemination: The SMSR will describe the approach to developing new tools for screening the mental well-being of Indigenous peoples across the globe. It will support researchers, clinicians and practitioners to consider both their approach to new tool development or, if they are using a previously developed tool, how reliable and valid it is for the population that they intend to use it with. Peer-reviewed publications will be used to disseminate SMSR findings

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community

Background The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. Methods/design The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. Discussion There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015

Efficacy and safety of open-label etanercept on extended oligoarticular juvenile idiopathic arthritis, enthesitis-related arthritis and psoriatic arthritis: part 1 (week 12) of the CLIPPER study

OBJECTIVE: To investigate the efficacy and safety of etanercept (ETN) in paediatric subjects with extended oligoarticular juvenile idiopathic arthritis (eoJIA), enthesitis-related arthritis (ERA), or psoriatic arthritis (PsA). METHODS: CLIPPER is an ongoing, Phase 3b, open-label, multicentre study; the 12-week (Part 1) data are reported here. Subjects with eoJIA (2-17 years), ERA (12-17 years), or PsA (12-17 years) received ETN 0.8 mg/kg once weekly (maximum 50 mg). Primary endpoint was the percentage of subjects achieving JIA American College of Rheumatology (ACR) 30 criteria at week 12; secondary outcomes included JIA ACR 50/70/90 and inactive disease. RESULTS: 122/127 (96.1%) subjects completed the study (mean age 11.7 years). JIA ACR 30 (95% CI) was achieved by 88.6% (81.6% to 93.6%) of subjects overall; 89.7% (78.8% to 96.1%) with eoJIA, 83.3% (67.2% to 93.6%) with ERA and 93.1% (77.2% to 99.2%) with PsA. For eoJIA, ERA, or PsA categories, the ORs of ETN vs the historical placebo data were 26.2, 15.1 and 40.7, respectively. Overall JIA ACR 50, 70, 90 and inactive disease were achieved by 81.1, 61.5, 29.8 and 12.1%, respectively. Treatment-emergent adverse events (AEs), infections, and serious AEs, were reported in 45 (35.4%), 58 (45.7%), and 4 (3.1%), subjects, respectively. Serious AEs were one case each of abdominal pain, bronchopneumonia, gastroenteritis and pyelocystitis. One subject reported herpes zoster and another varicella. No differences in safety were observed across the JIA categories. CONCLUSIONS: ETN treatment for 12 weeks was effective and well tolerated in paediatric subjects with eoJIA, ERA and PsA, with no unexpected safety findings

Aboriginal and Torres Strait Islander young people and staff 'talk up' the value of flexible learning options

Since the early 1990's, a number of government-driven initiatives have been implemented in a bid to improve educational outcomes for Aboriginal and Torres Strait Islander peoples-some with ambitious targets. More recently, closing the school completion gap has become a national challenge. Research has identified that good educational outcomes for Aboriginal and Torres Strait Islander peoples may be minimal unless other aspects of socioeconomic disadvantage such as health, housing, employment and access to education are addressed. It is therefore paramount to understand how participation in Flexible Learning Options (FLOs) may open pathways to improved health, social wellbeing and employment for Aboriginal and Torres Strait Islander young people. This chapter focuses on the experiences of Aboriginal and Torres Strait Islander students and staff who have participated in FLO programs. Findings should inform discussions around the value of FLOs' holistic approach to education for improved life outcomes

Their story: homeless Indigenous women in Cairns and Mount Isa, Australia

Homelessness is affecting Australian Indigenous women disproportionately in comparison with the Australian population. Homeless Indigenous women in Cairns and Mount Isa, Australia, were interviewed about their experiences of homelessness, understanding of causes and services available to them. Reasons for homelessness for the women interviewed circled around relationship breakdowns, patterns of repeated homelessness, lack of access to services in remote areas and lack of affordable housing. The need for affordable and safe housing, suitable to accommodate a variety of family groups, from single women to large families was a recurrent theme

Challenging normative assumptions regarding disengaged youth: a phenomenological perspective

This paper explores the experiences of 12 young people, all teenagers, who have chosen to attend alternative schools known as flexible learning options within the Australian context. Using a phenomenological approach, the study seeks to understand their experiences outside the normalised public discourse that they had 'disengaged' from mainstream school. A phenomenological approach is employed because of its potential to draw attention to predetermined assumptions about, in this study's case, student disengagement, a concept commonly framed within a pathologised and deficit perspective. The study gives evidence for the utility of a phenomenological approach in providing insight into how macrosystem policy, such as a nationalistic neoliberal agenda, influences 'schooling' and subsequently students' experiences with schools. The implications of this study with attention to the nexus between methodology and policy are discussed, especially in drawing attention to how phenomenology as a qualitative methodology provides a means of agency for the disenfranchised to challenge existing policy and public assumptions

Why are so many Indigenous women homeless in Far North and North West Queensland, Australia? Service providers' views of causes

Homelessness is a complex problem affecting Australian Indigenous women disproportionately compared to the rest of the Australian population. Homelessness service providers in Cairns and Mount Isa, Australia, provided their perceptions as to why Indigenous women were presenting to homeless services. The key reasons cited by service providers were: domestic violence; alcohol and other drugs; and financial hardship. Other reasons included racist real estate agents; avoiding alcohol and family; overcrowding; literacy and numeracy skills; difficulty returning home and; not enough public housing. Potential solutions to help break this cycle of homelessness are explored. This research suggests that an important overall goal in reducing homelessness is to ensure that Indigenous women are safe at home in their own communities

Outcomes from Flexible Learning Options for disenfranchised youth: what counts?

Flexible Learning Options (FLOs) are common across many countries to enable secondary school completion by young people for whom mainstream schooling has not worked well. Access to high quality education through FLOs is a social justice issue. In the context of an inclination among governments for accountability and evidence-based policy, as well as of financial austerity, there is pressure on FLOs to demonstrate and publicise their outcomes. This work is not straightforward, due to debates about the purposes of education and to difficulties in measurement. \ud This paper analyses Australian practical and evaluation reports, so-called grey literature, to examine the specific outcomes that are the focus of those publications, alongside the evidence that is provided to substantiate these claims. Our aim is to contribute to better understandings of what counts as success in these settings, and how that success may be demonstrated. \ud Overall, the reports focus on five different sets of outcomes: traditional academic outcomes, post-program destinations, student engagement, personal and social well-being, and broader community engagement and well-being. Across the reports, there was a strong emphasis on qualitative research methods, often supplemented with descriptive statistics and case studies. The paper concludes by exploring the implications of the analysis for determining 'what counts' as outcomes from Flexible Learning Options. \u

Approaches to the development of new screening tools that assess distress in Indigenous peoples: A systematic mixed studies review.

This mixed studies review assessed the extent of the literature related to approaches used to develop new tools that screen for distress in Indigenous adults globally. It answered the research question: What qualitative and quantitative approaches are used to develop new screening tools that assess distress in Indigenous peoples globally? CINAHL, Embase, Emcare, Medline, PsychInfo and Scopus databases were systematically searched to identify relevant articles published between January 2000 and February 2023. Articles describing the development of a new screening tool for Indigenous peoples, globally, published in English since 2000 and constituted a full publication of primary research, met the inclusion criteria. Studies underwent quality appraisal using the Mixed-Methods Appraisal Tool. A sequential exploratory design guided data analysis. Synthesis occurred using a two-phase sequential method. Nineteen articles constituted the data set. Articles described the use of qualitative, quantitative, or mixed methods in approximately equal numbers. Overall, qualitative methods were used in early stages of tool development, with mixed and quantitative methods used to pilot and validate them. However, most studies did not follow the theoretical guidelines for tool development, and while validation studies took place in over half of the data set, none adequately assessed construct validity. Sixty percent of the articles were located using citation searches, which suggests database searches were ineffective. Valid tools that screen for distress in Indigenous populations support equitable access to health care. This review found that most screening tools were developed in Australia. However, additional evidence of their validity is needed in addition to a valid diagnostic tool that supports the determination of criterion validity. These needs present important future research opportunities