Helen Travers

Bridging the triple divide: performance and innovative multimedia in the service of behavioural health change in remote Indigenous settings.

Objectives: The use of innovative information technology is now well established in health. However, while the gap in health status between Indigenous and other Australians is both significant and unchanging, there is limited application of these new approaches to addressing this national health priority. This may in part reflect the ‘digital divide’, which is another facet of Indigenous disadvantage. This paper describes an approach to address both issues in remote Indigenous settings. Results: The Health Interactive Technology Network began as a proof-of-concept study of touchscreen technology in two Indigenous health settings. It has subsequently expanded to a number of remote Indigenous communities and developed new platforms and applications to respond to emerging health issues. In creating narrative, interactive approaches to address choices in relation to health behaviours, the community development and engagement effects of the creative process have been highlighted. These findings suggest that these approaches will be suited to further expansion in the area of mental health.

Empowerment and change management in Aboriginal organisations: A case study

The social organisation of work, management styles and social relationships in the workplace all matter for health. It is now well recognised that people who have control over their work have better health and that stress in the workplace increases the level of disease. In the context of organisational change, the potential benefits of empowerment strategies are two-fold: a positive impact on the organisations effectiveness and enhancements in staff health, wellbeing and sense of control. This case study describes the University of Queensland Empowerment Research Programs experience working with the Apunipima Cape York Health Council in a change management process. Participatory action research and empowerment strategies were utilised to facilitate shifts in work culture and group cohesion towards achieving Apunipimas vision of being an effective lead agency for Indigenous health reform in Cape York. As part of the project, staff morale and confidence were monitored using a pictorial tool, Change Curve, which outlined the phases of organisational change. The project findings indicated that organisational change did not follow a clear linear trajectory. In some ways the dynamics mapped over a period of 18 months mirror the type of struggles individuals commonly encounter as a part of personal growth and development. In this case, one of the factors which influenced the programs success was the willingness of executive employees to actively support and participate in the change management process.

Bridging the information gap: IT and health in Indigenous populations

Objective: A proof of concept evaluation of the use of touch-screen technology to address specific health issues in Indigenous settings and exploration of potential relevance to Indigenous mental health. Methods: Quantitative and qualitative approaches were utilised to evaluate two touchscreen units with sound located in Indigenous settings (one clinical and the other a Centrelink office) with content on two topics-diabetes and musculoskeletal problems. Quantitative information included trace analysis and on-screen questionnaires. Qualitative information included individual and group interviews, and observation over a period of 10 months. Results: Use was consistent over time. Subject areas were equally accessed with most users entering only one area per session. Mean session time was five minutes and clinical setting users were more likely to answer on-screen questions. The majority considered use ‘easy’ with the proportion indicating use‘very hard’ increasing with age. Across both sites, womens health, children and drugs and alcohol were identified as issues for which more information was needed. Interview data emphasised the importance of Indigenous and recognisable voices with non-text based content relevant to the local context. Conclusion: Touch-screen technology offers a means to provide relevant and accessible health information in Indigenous settings and may contribute to overcoming the‘information gap’. There are obvious implications in relation to Indigenous mental health.

Pride and performance: evaluation challenges of a multimedia and information technologies project in remote Aboriginal Australia

Objectives: This paper explores an approach to an evaluation challenge: to demonstrate the impact of an initiative drawing on innovative use of information/multimedia technology and performance to address perceived social needs within a disadvantaged, remote Indigenous Australian community. Results: The approach is described and preliminary data are presented supporting the importance of local production and participation.

The Use of Touch-Screen Technology for Health-Related Information in Indigenous Communities: Some Economic Issues

Abstract The low health status of indigenous communities in Australia, and other countries, has been a continuing societal problem. One way to improve health status involves the provision of health‐related information. Computer‐based systems offer new ways to provide such information: thus their application can be seen as process innovations. This paper describes the use of touch‐screen technology to present health information in a culturally relevant fashion for Aboriginal and Torres Strait Islanders in Queensland, Australia. Touch‐screen kiosks incorporate both computer hardware and software. The paper also outlines some of the key economic concepts relevant to an economic analysis of an information system employing touch‐screen technology. It is shown that the economic analysis involves a two‐stage process, and it is somewhat more complex than setting up an Internet website.

Performative evaluation and social return on investment: potential in innovative health promotion interventions

Objective: The purpose of this study was to describe an approach to evaluation of a project involving complex health behaviours that incorporates collateral social outcomes. Method: Evaluation challenges and responses for an innovative information and communication technologies for development (ICT4D) initiative (HITnet) operating in remote Indigenous Australia are presented. Conclusions: Innovation in evaluation must match innovation in project design and application. Two methodologies – performative research, and social return on investment – as proposed for a HITnet, sexual health promotion project, are considered.

Out of a digital chrysalis: NIHNMF (pronounced nymph--the National Indigenous Health and New Media Forum).

In conjunction with the Creating Futures conference, the inaugural meeting of the National Indigenous Health and New Media Forum (NIHNMF – pronounced as ‘nymph’) was held at the Tanks Gallery in Cairns, Queensland, Australia. This paper describes the background to this innovative meeting of media minds. It also explores an emerging vision for addressing Indigenous health disparities through digital inclusion to overcome the ‘digital divide’ between mainstream and Indigenous Australians that constrains the delivery of appropriate health promotion to this health priority population.

Psychosocial interventions to arrest cognitive decline in at-risk women

The hepatitis C virus (HCV) is the leading notifiable disease in Australia.It is described as a stigmatised disease, as the majority of new infections are associated with intravenous drug use.The current qualitative study explored the lived experiences of those diagnosed with HCV.Fifteen participants (10 women & 5 men) who were HCV positive and not current drug users were interviewed about the impact of their diagnosis and how they have adjusted to it.The data were analysed using open and closed coding methods.Diagnosis was found to be a traumatic experience with considerable emotional impact that could be exacerbated by stigma, discrimination and a lack of information.Support is provided for a selfmanagement construct encompassing medical, emotional and life role facets.It was concluded that positive reactions to disclosure contribute to adjustment, whereas perceptions of stigma and negative reactions to disclosure may create barriers to self-management and personal growth.Much of the research into attendance to psychological services has investigated the predictors after the initiation of an appointment or following prior attendance. The aim of this study was to assess why some patients that are referred for treatment do not make contact for a first appointment. By investigating the factors that result in a patient not contacting it would assist referrers and psychological services to save time and money, to know whether they should be followed up, and to identify ways to support and increase the likelihood that they will contact and attend a service. The Sunshine Coast GP Allied Health Service, established by the Sunshine Coast Division of General Practice and funded by the Commonwealth Governments Better Outcomes in Mental Health Initiative, was chosen for investigation. Patients referred during a three month period were followed up whether they had contacted or not. The Health Behaviour Model and Transtheoretical Model were applied to understanding the internal and external factors that might be involved in predicting contact following referral. This study produced some interesting findings and recommendations have been made for referrers and psychological services.This retrospective study used archival data to gain a better understanding of potential and determined deficits in the practise of Psychology in Queensland. Using thematic coding in a grounded theory approach, 134 complaints received by the Psychologists Board of Queensland between 1998 and 2004 were analysed to identify what factors or themes health consumers had complained about. Additionally, 186 cases of determined unsatisfactory professional conduct (as defined by the Health Practitioners Professional Standards Act 1999) for the same period were quantitatively analysed to identify potential predictive factors of those psychologists found to have engaged in professional misconduct. Within the limitations of the data, this study identified that 4 year graduates were found to have engaged in unsatisfactory professional conduct more than their professional peers with post-graduate qualifications and that health consumer complaints covered many areas of psychological practice notably that of poor communication.Age-related cognitive decline and dementia are major health issues in developed countries. Risk factors associated with these conditions include the presence of the apolipoprotein E isoform e4 (ApoE), premorbid IQ, cardiovascular disease, and lifestyle factors including level of physical activity and degree of involvement in intellectually stimulating activities. Evidence from several large-scale observational studies shows that regular engagement in these activities is associated with better cognitive function, less cognitive decline in later life and a lower incidence of dementia. In addition, intervention studies have demonstrated that the cognitive performance of older persons (with and without cognitive impairment) can be improved through brief training programs involving educational, physical and cognitive interventions. To date, however, there has been little investigation of the capacity of these interventions to slow the rate of deterioration among people with identified risk. To address this gap, we have developed a program of research to assess the efficacy and viability of interventions involving physical exercise and cognitive stimulation to arrest or slow cognitive decline in a group of at-risk women. The research evidence in relation to physical exercise, intellectual stimulation and cognitive decline and dementia will be summarised in this presentation and the proposed body of research outlined.The aim of this study was to investigate dissociation, measured as a continuous dimension from normal experiences through to the severe symptoms characteristic of dissociative identity disorder, by modelling dissociation as an outcome of childhood trauma, adult personality and adjustment.A questionnaire package was completed by a sample of 279 adults (M = 27.80 years, SD = 12.77), 47 males and 231 females.Participants completed the Dissociative Experiences Scale II (DES-II), the NEO Five-Factor Inventory (NEOFFI), the Resilience Scale (RS), the Childhood Trauma Questionnaire (CTQ), and the Creative Experiences Questionnaire (CEQ).Structural equation analyses using AMOS generated a model that fit the data well (χ/df = 1.87).Inspection of significant paths in the model found, consistent with theory and existing research, that childhood trauma had a direct link to dissociation (regression weight = .13).A benefit of the modelling approach was the capacity to identify a complex pattern of relationships by which personality (neuroticism and agreeableness) and adjustment (fantasy proneness and resilience) mediated the relationship between childhood trauma and dissociation.

Bridging the information gap: Enhancing health literacy and local it capacity in remote aboriginal communities

RODGER BROUGH: Next we have a joint presentation Coralie Ober who currently works as a research fellow, Queensland Alcohol and Drug Research and Education Centre at the University of Queensland School of Population Health. She has a very broad experience in clinical nursing through to teaching, advocacy and advisory roles. Her work with Indigenous communities is widely recognised inside and outside this country and her role with the WHO is testimony to that.Alcoholism results in changes in the human brain which reinforce the cycle of craving and dependency, and these changes are manifest in the pattern of expression of mRNA and proteins in key cells and brain areas. Long-term alcohol abuse also results in damage to selected regions of the cortex. We have used cDNA microarrays to show that less than 1% of mRNA transcripts differ signifi cantly between cases and controls in the susceptible area and that the expression profi le of a subset of these transcripts is suffi cient to distinguish alcohol abusers from controls. In addition, we have utilized a 2D gel proteomics based approach to determine the identity of proteins in the superior frontal cortex (SFC) of the human brain that show differential expression in controls and long term alcohol abusers. Overall, 182 proteins differed by the criterion of > 2-fold between case and control samples. Of these, 139 showed signifi cantly lower expression in alcoholics, 35 showed signifi cantly higher expression, and 8 were new or had disappeared. To date 63 proteins have been identifi ed. The expression of one family of proteins, the synucleins, has been further characterized using Real Time PCR and Western Blotting. The expression of alpha-synuclein mRNA was signifi cantly lower in the SFC of alcoholics compared with the same area in controls (P = 0.01) whereas no such difference in expression was found in the motor cortex. The expression of beta- and gamma- synuclein were not signifi cantly different between alcoholics and controls. In contrast, the pattern of alphasynuclein protein expression differs from that of the corresponding RNA transcript. Because of the key role of synaptic proteins in the pathogenesis of alcoholism, we are developing 2-D DIGE based techniques to quantify expression changes in synaptosomes prepared from the SFC of controls and alcoholics.Chronic alcohol misuse leads to both widespread and localized damage in human cerebral cortex. The latter, as neuronal loss, is marked in superior frontal cortex (SFC) but milder in primary motor cortex (PMC) and elsewhere. Quantitative morphometry by Harper et al showed that neuronal loss is greater in alcoholics with comorbidity (Wernicke Korsakoff syndrome, liver cirrhosis). Previous work revealed a paradox: the marked differences in GABAA receptor density, pharmacology, and expression between alcoholics without cormorbidity and controls are muted or absent in cirrhotic alcoholics. This concurs with work by the Butterworth group on hepatic encephalopathy cases — most of whom had an alcoholic aetiology — who show only minor differences from controls. Glutamate receptor differences are muted in many autopsy studies, though we have evidence that NMDA site pharmacology may vary in cirrhotic alcoholics. Here we used Real-Time PCR normalized to GAPDH deltaCT to quantify NMDA NR1, NR2A and NR2B subunit expression in SFC and PMC samples obtained at autopsy from alcoholics with and without comorbid cirrhosis and matched controls. Overall subunit transcript expression was signifi cantly lower in alcoholic cirrhotics than in either of the other groups (F2,42 = 12.942, P < 0.001). The effect was most marked for the NR1 subunit; males differed from females, particularly in SFC. The data suggest that if excitotoxicity mediates neuronal loss in SFC, it may be implemented differently: passively in uncomplicated alcoholics, by altered GABAergic transmission; actively in cirrhotic alcoholics, by altered glutamatergic transmission. We also subdivided cases on a panel of genetic markers. Different genotypes interacted with NMDA and GABAA pharmacology and expression. Cirrhotic and uncomplicated alcoholics may differ pathogenically because of inherent characteristics in addition to possible neurotoxic sequelae to the liver damage.