Addressing uncomfortable issues: the role of White health professionals in Aboriginal health

This research investigated the role of White health professionals in addressing Aboriginal health in South Australia. Set within the discipline of nutrition and dietetics and the area of obesity prevention, it explored the practice of White health professionals from the point of view of Aboriginal and White workers. This research, currently in the form of an unpublished Doctor of Philosophy thesis, arose from practice dilemmas the author experienced as a dietitian working in rural and remote South Australia. The setting for this research was the eat well be active Community Programs, a community-based, childhood obesity prevention program in South Australia. In order to conduct ethical research, the author worked closely with Aboriginal community members and workers, through building and maintaining relationships and activities of reciprocity. This research is positioned in a social constructionist epistemology and uses a critical theoretical approach. Critical social research and reflexivity are the methodological approaches. The kept a reflexive journal and conducted 41 semi-structured interviews with White health professionals and Aboriginal health workers and one focus group with White health professionals; all of which formed the data for this research. This research identified that there are a number of elements to the practice of White health professionals that make it ideal when they are working with Aboriginal communities. However, such ideal practice does not always occur and this research sought to identify why. The organisation, profession and individual were identified as systems within the wider system of Aboriginal health. Within these systems, the author identified structures (rules and resources) that either constrain or enable the practice of White health professionals with Aboriginal people. While many White health professionals focussed on external factors that constrained their practice, this thesis identifies the role of individuals in creating and maintaining barriers and enablers, thus highlighting their agency. It was also identified that White health professionals progress through a number of stages in their work in Aboriginal health, from not knowing how, to being scared, to finding it too hard and ultimately being able to practice regardless of barriers. In summary, this research identified that moving forward in Aboriginal health requires White health professionals to look at themselves, which generally requires them to address uncomfortable issues

Addressing Uncomfortable Issues: Reflexivity as a Tool for Culturally Safe Practice in Aboriginal and Torres Strait Islander Health

This article has been published in a revised form in Australian Journal of Indigenous Education https://doi.org/10.1017/jie.2014.24 . This version is free to view and download for private research and study only. Not for re-distribution or re-use. Copyright © The Author(s) 2014It is well recognised that research with Aboriginal communities needs to be ethical, meaningful and useful, in a way that is defined by communities themselves. This article provides an example of how reflexivity, from a number of positions and paradigms, can be used to undertake such research. I used a reflexive journal to document and critically assess the challenges and discomfort I experienced while undertaking research with Aboriginal communities, including uncertainty and feeling in the minority. Reflexivity allowed me to experience a number of key learnings, including: the importance of relationships; the importance of time, transparency and trust in relationships; reciprocity; the importance of listening; a partnership approach; and the impact of Aboriginal culture and past experience. The way in which I redefined my success as a researcher is also explored. In using reflexivity I reached new levels of understanding about myself, which enabled me to alter my practice and therefore change the experiences of those I was working with, ideally towards experiences that were perceived as culturally safe. Using reflexivity also enabled me to identify my position as a White researcher and centralise the needs and perspectives of Aboriginal people in my research. The purpose of this article is to present my own journey, as well as start a dialogue and provide a framework for how others might use reflexivity to become a culturally safe health professional or researcher and centralise the needs and perspectives of Aboriginal people in research and practice

Reliability and relative validity of a child nutrition questionnaire to simultaneously assess dietary patterns associated with positive energy balance and food behaviours, attitudes, knowledge and environments associated with healthy eating

Food behaviours, attitudes, environments and knowledge are relevant to professionals in childhood obesity prevention, as are dietary patterns which promote positive energy balance. There is a lack of valid and reliable tools to measure these parameters. The aim of this study was to determine the reliability and relative validity of a child nutrition questionnaire assessing all of these parameters, used in the evaluation of a community-based childhood obesity prevention project

Community-based obesity prevention initiatives in aboriginal communities: the experience of the eat well be active community programs in South Australia

Childhood obesity is a growing concern world-wide, and obesity rates are higher in certain groups in the developed world, including Australian Aboriginal people. Community-based obesity prevention interventions (CBOPI) can help to address obesity, however the approach of such programs to reach diverse groups, including Aboriginal people, must be considered. This paper considers one mainstream1 CBOPI, the eat well be active (ewba) Community Programs in South Australia, which was delivered in two communities and sought to reach Aboriginal people as part of the overall program. This paper considers how well this approach was received by the Aboriginal people living and working in those communities. Semi-structured interviews were conducted with nine Aboriginal workers who had some connection to the ewba program, and seven ewba project staff. Qualitative data analysis was performed and factors found to affect how well the program was received by Aboriginal people include relationships, approach and project target group, including geographical area. A different response was observed in the two communities, with a more positive response being observed in the community where more relationships were developed between ewba and Aboriginal staff. For any CBOPI seeking to work with Aboriginal (or other Indigenous) communities, it is vital to consider and plan how the program will meet the needs and preferences of Aboriginal people in all stages of the project, in order to reach this group

The challenges of quantitative evaluation of a multi-setting, multi-strategy community-based childhood obesity prevention programme: lessons learnt from the eat well be active Community Programs in South Australia

Objective To describe the rationale, development and implementation of the quantitative component of evaluation of a multi-setting, multi-strategy, community-based childhood obesity prevention project (the eat well be active (ewba) Community Programs) and the challenges associated with this process and some potential solutions. Design ewba has a quasi-experimental design with intervention and comparison communities. Baseline data were collected in 2006 and post-intervention measures will be taken from a non-matched cohort in 2009. Schoolchildren aged 10–12 years were chosen as one litmus group for evaluation purposes. Setting Thirty-nine primary schools in two metropolitan and two rural communities in South Australia. Subjects A total of 1732 10–12-year-old school students completed a nutrition and/or a physical activity questionnaire and 1637 had anthropometric measures taken; 983 parents, 286 teachers, thirty-six principals, twenty-six canteen and thirteen out-of-school-hours care (OSHC) workers completed Program-specific questionnaires developed for each of these target groups. Results The overall child response rate for the study was 49 %. Sixty-five per cent, 43 %, 90 %, 90 % and 68 % of parent, teachers, principals, canteen and OSHC workers respectively, completed and returned questionnaires. A number of practical, logistical and methodological challenges were experienced when undertaking this data collection. Conclusions Learnings from the process of quantitative baseline data collection for the ewba Community Programs can provide insights for other researchers planning similar studies with similar methods, particularly those evaluating multi-strategy programmes across multiple settings

Attitudes and characteristics of health professionals working in Aboriginal health

There is an unacceptable gap in health status between Aboriginal and non-Aboriginal people in Australia. Linked to social inequalities in health and political and historical marginalisation, this health gap must be urgently addressed. It is important that health professionals, the majority of whom in Australia are non-Aboriginal, are confident and equipped to work in Aboriginal health in order to contribute towards closing the health gap. The purpose of this study was to explore the attitudes and characteristics of non-Aboriginal health professionals working in Aboriginal health. Methods: The research was guided and informed by a social constructionist epistemology and a critical theoretical approach. It was set within a larger healthy eating and physical activity program delivered in one rural and one metropolitan community in South Australia from 2005 to 2010. Non-Aboriginal staff working in the health services where the program was delivered and who had some experience or an interest working in Aboriginal health were invited to participate in a semi-structured interview. Dietitians working across South Australia (rural and metropolitan locations) were also invited to participate in an interview. Data were coded into themes that recurred throughout the interview and this process was guided by critical social research. Results: Thirty-five non-Aboriginal health professionals participated in a semi-structured interview about their experiences working in Aboriginal health. The general attitudes and characteristics of non-Aboriginal health professionals were classified using four main groupings, ranging from a lack of practical knowledge (‘don’t know how’), a fear of practice (‘too scared’), the area of Aboriginal health perceived as too difficult (‘too hard’) and learning to practice regardless (‘barrier breaker’). Workers in each group had different characteristics including various levels of willingness to work in the area; various understandings of Australia’s historical relationship with Aboriginal peoples; varying awareness of their own cultural identity and influence on working with Aboriginal people; and different levels of (dis)comfort expressed in discussions about social, political and intercultural issues that impact on the healthcare encounter. Conclusions: These groupings can be used to assist non-Aboriginal health professionals to reflect on their own levels of confidence, attitudes, characteristics, experiences, approaches and assumptions to Aboriginal health, as an important precursor to further practice and development in Aboriginal health. By encouraging self-reflection of non-Aboriginal health professionals about where their experiences, characteristics and confidence lie, the groupings presented in this paper can be used to encourage non-Aboriginal health professionals, rather than Aboriginal clients or workers, to be the focus for change and deliver health care that is more acceptable to patients and clients, hence influencing health service delivery. The groupings presented can also begin to enable discussions between all health professionals about working together in Aboriginal health

Improving weight status in childhood: results from the 'eat well be active' community programs

There is a clear need for effective prevention and treatment interventions to manage the high prevalence of childhood overweight globally. It is well recognised that changes in the social and economic environment in the last three decades have been a major contributor to altered eating and activity patterns resulting in positive energy balance. The most recent update to the Cochrane review of interventions for preventing obesity in children identified that the majority of childhood obesity prevention intervention evaluations were short-term (12 months or less) and largely focussed on individual behaviour change. Also from this review there is now some early evidence that settings-based obesity prevention interventions are effective at reducing body mass index in the short term. However, given the short-term nature of these interventions, sustainability of this change is unclear, and stronger evidence from larger-scale evaluations is needed about what intervention components are feasible to be embedded into children’s settings and systems (e.g. the school environment) to be able to translate and scale up research findings into effective public health approaches. Until recently, effective obesity prevention interventions have largely drawn upon behaviour change theories, which appear to be unlikely to produce sustainable change in outcomes if they do not consider the broader social and environmental context. Models based on ecological theory show the complex interaction between individuals’ behaviour and their broader environments, that influence eating and activity. A community-based, capacity-building approach aims to promote sustainable skill development and increase the ability of individuals to improve environments that promote health outcomes.This presents a promising approach to obesity prevention, and evidence is needed on processes and outcomes of interventions guided by such theories

Impact Evaluation of a Central Australian Aboriginal Cultural Awareness Training Program for Health Professionals and Students

The aim of this study was to prospectively evaluate the impact of a Central Australian cultural awareness training program for health care staff. A mixed methods approach was used. Program participants completed a baseline and post-program questionnaire, which included an attitude scale assessing cultural safety, critical thinking and transformative unlearning, and open-ended questions. An online follow-up survey two months later repeated these questions. Mean scale scores were compared using paired and unpaired t-tests. Qualitative data were analysed thematically. Baseline scale mean was 45.7. At post-program it had statistically significantly increased to 47.3, using both the paired (p=\u3c 0.01) and unpaired t-test (p=\u3c 0.03). At the two-month follow-up it had decreased to 42.2. This was not statistically different from the baseline score with a paired (n=11) t-test (p=\u3c 0.37), however the difference was statistically significant with an unpaired t-test (p=\u3c 0.01) which included an additional eight respondents. Qualitative feedback was consistently positive. Many respondents learnt new information about the negative effects of colonisation on Aboriginal and/or Torres Strait Islander people, and how this continues to affect current health. Learning about Aboriginal and/or Torres Strait Islander cultures, kinship relationships and systems, and communication styles was identified as directly relevant to work practices. A cultural education program produced positive short-term changes in attitudes and was highly valued by participants. However, it is unclear if these changes are maintained in the medium term