Joyce Doyle

Identifying psychosocial mediators of health amongst Indigenous Australians for the Heart Health Project

Objective. The Heart Health Project is an ongoing community-directed health promotion programme encompassing the collection of health-related data and interventions promoting cardiovascular health. Following research which has emphasised the importance of psychological factors including mastery, or personal control, in mitigating cardiovascular health outcomes, this qualitative study explored whether such constructs were relevant from Indigenous perspectives, or whether there were other, more meaningful and relevant psychosocial factors identified by participants that should be incorporated into models of Indigenous health and which could be effective targets for change. Design. The study fits within the broader participatory action research design of the Heart Health Project. Data comprised 30 in-depth interviews with members of a rural Aboriginal community in south-eastern Australia to identify psychosocial factors relevant to their health. Interviews were semi-structured and carried out by two interviewers, one Aboriginal and one non-Aboriginal. Qualitative analysis using QN6 software resulted in a number of salient themes and sub-themes. These are summarised using extracts from the data. Results/Conclusions. Five major themes and 15 sub-themes emerged from data analysis. The findings indicated that while a sense of control may be one factor impacting on health and health behaviours, there were other factors that participants spoke about more readily that have specific relevance to the social and cultural context of Indigenous health. These included history, relationship with mainstream and connectedness. These may be worthy of further empirical investigation and are likely to assist in the design of community health promotion interventions for Aboriginal people.

A Review of Programs That Targeted Environmental Determinants of Aboriginal and Torres Strait Islander Health

Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.

Strengths and limitations of a tool for monitoring and evaluating First Peoples’ health promotion from an ecological perspective

BackgroundAn ecological approach to health and health promotion targets individuals and the environmental determinants of their health as a means of more effectively influencing health outcomes. The approach has potential value as a means to more accurately capture the holistic nature of Australian First Peoples’ health programs and the way in which they seek to influence environmental, including social, determinants of health.MethodsWe report several case studies of applying an ecological approach to health program evaluation using a tool developed for application to mainstream public health programs in North America – Richard’s ecological coding procedure.ResultsWe find the ecological approach in general, and the Richard procedure specifically, to have potential for broader use as an approach to reporting and evaluation of health promotion programs. However, our experience applying this tool in academic and community-based program evaluation contexts, conducted in collaboration with First Peoples of Australia, suggests that it would benefit from cultural adaptations that would bring the ecological coding procedure in greater alignment with the worldviews of First Peoples and better identify the aims and strategies of local health promotion programs.ConclusionsEstablishing the cultural validity of the ecological coding procedure is necessary to adequately capture the underlying program activities of community-based health promotion programs designed to benefit First Peoples, and its collaborative implementation with First Peoples supports a human rights approach to health program evaluation.

Implementing health promotion tools in Australian Indigenous primary health care

Background In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. Methods Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. Results An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. Conclusion The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.