Mary Whiteside

Social Determinants of Health, the ‘Control Factor’ and the Family Wellbeing Empowerment Program

Objective: To explore links between the social determinants of health, the ‘control factor’, and an Aboriginal empowerment program. Methods: The evidence that rank or social status is one of the most important determinants of health is briefly presented. This is followed by a critique of the Australian policy and intervention framework for tackling and reducing social inequalities. The concept of ‘control’ as an important element in addressing social determinants of health is examined next and the Family Wellbeing empowerment program is analysed to illustrate how the concept of control might be operationalised at program or intervention level. Implications for health practitioners are identified. Results: By providing a safe group environment for participants to explore sets of critical questions about themselves, their families and communities, through the process of participatory action research, Family Wellbeing has demonstrated its potential to ‘enable’ Indigenous people to take greater control and responsibility for their situation. While program participants first address personal and immediate family issues, evidence is emerging of a ripple effect of increasing harmony and capacity to address issues within the wider community Conclusions: The social determinants of health are complex and multi-layered and so addressing them needs to involve multilevel thinking and action. The control factor is only one element, albeit an important one, and Family Wellbeing is providing evidence that ‘control’ can be addressed in Indigenous settings. For empowerment programs to achieve their full potential, however, there is a need to ensure that such programs reach a critical mass of the target group. It is also imperative that policy-makers and practitioners take a longer-term approach, including properly resourced longitudinal studies to document and enhance the evidence base for such interventions. As health practitioners it is vital we consider our work within this broader context, creatively seek to enhance linkages between services and programs, and support processes for change or intervention at other levels.

Adapting the ‘Family Wellbeing’ empowerment program to the needs of remote Indigenous school children

Objective: To adapt the Family Wellbeing empowerment program, which was initially designed to support adults to take greater control and responsibility for their decisions and lives, to the needs of Indigenous school children living in remote communities.

A microanalysis of a participatory action research process with a rural Aboriginal men's health group

Our recent paper (Tsey, Patterson, Whiteside, Baird, & Baird, 2002) analysed the early stages of a participatory action research process (PAR) designed to support members of a rural Aboriginal men?s group to take greater control and responsibility for the factors influencing their health and wellbeing. This follow-up paper focusses on key challenges and opportunities associated with the PAR process. Among other things, the paper highlights: a need for training providers and policy-makers to give more attention to the issue of community development skills and how to promote the uptake of such skills more widely in Indigenous settings; the importance of taking a ?solution-focussed approach? in line with the principles of PAR when doing community development work; a need for relevant training and creation of real employment opportunities to be central to strategies designed to support rural Aboriginal men to take their rightful place; a need for the men?s group to promote the broad spectrum of its activities more widely so as to minimise an image problem that the men?s group is only for men having problems; and, above all, an urgent need for the men?s group organisers to play leadership roles through, for example, dialogue with local gay men so as to jointly come up with ideas to make the men?s group more accessible for all men, including gay men.

Empowerment as a Framework for Indigenous Workforce Development and Organisational Change

Abstract Relative powerlessness resulting from colonial dispossession and associated passive welfare policies has long been recognised as a critical factor influencing the health and wellbeing of Indigenous Australians, yet it is hard to find well-evaluated health and social interventions that take an explicit empowerment approach. This paper presents the findings of a Family Wellbeing Empowerment programme pilot delivered to Cairns Region Department of Families Indigenous youth workers and family and community workers in 2003/2004. The aim of the pilot was to build the capacity of these workers to address personal and professional issues as a basis for providing better support for their clients. The pilot demonstrated the effectiveness of the programme as a tool for worker empowerment and, to a lesser degree, organisational change.

Being, Knowing, and Doing: A Phronetic Approach to Constructing Grounded Theory With Aboriginal Australian Partners

Researchers working with Aboriginal Australian partners are confronted with an array of historical, social, and political complexities which make it difficult to come to theoretical and methodological decisions. In this article, we describe a culturally safe and respectful framework that maintains the intellectual and theoretical rigor expected of academic research. As an Aboriginal woman and two non-Aboriginal women, we discuss the arguments and some of the challenges of using grounded theory methods in Aboriginal Australian contexts, giving examples from our studies of Aboriginal empowerment processes. We argue that the ethics of care and responsibility embedded in Aboriginal research methodologies fit well with grounded theory studies of Aboriginal social processes. We maintain that theory development grounded in data provides useful insights into the processes for raising the health, well-being, and prosperity of Aboriginal Australians.

The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search

BackgroundHealth promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools.MethodsIndigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors’ knowledge (n = 1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively.ResultsThe review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies.ConclusionsThe small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation.

Using Secondary Data for Grounded Theory Analysis

Abstract Grounded theory is well utilised in qualitative research for building theoretical understanding of complex social processes. Grounded theory data analysis strategies can be used with different types of data, including secondary data. Despite the potential advantages of secondary data, it is rarely used for grounded theory studies, largely due to a perception that researchers are unable to follow the guidelines of this research design with data that they themselves have not collected. This paper demonstrates the use of secondary data in a study investigating the substantive area of Indigenous empowerment. Potential pitfalls and advantages of using grounded theory methods to analyse secondary data are discussed, as well as factors that facilitated the analytic process in this study. These factors included having a large data set across multiple sites and the use of literature as a source of data. The findings provide a valuable model for combining research and practise.

Locating Empowerment in the Context of Indigenous Australia

Abstract Empowerment provides a potentially useful framework for social work practice with Indigenous Australians. However, there is little systematic research on what empowerment actually means in this context. This study sought to examine the concept of empowerment for Indigenous Australians through a grounded theory analysis of the stories of people who experienced empowerment, having participated in the Indigenous developed Family Wellbeing empowerment program. The emergent theoretical model delineates central interconnected and mutually reinforcing elements that enabled people to effect life changes, even where many aspects of their social context remained constraints. The elements involve particular beliefs and attitudes, and skills and knowledge manifested in agency and leading to achievements. All of the elements correspond with theoretical literature pertaining to empowerment. However, the proposed emergent theory places a greater emphasis on attributes associated with a belief in God, strong personal values, and having the skills to help others. These attributes resonate with Indigenous concepts of culture and spirituality. The findings provide a valuable conceptual model for social workers engaging with Indigenous groups, communities, and organisations, whether through policy, planning, research, or practice.

The challenge of interdisciplinary collaboration in addressing the social determinants

The importance of professional disciplines working together to address the critical social and health issues facing society today cannot be overstated. Policy makers, service providers and researchers have long been calling for greater interdisciplinary collaboration. Despite this there has been little systemic analysis of the constraints involved in such collaboration. Far too often disciplines continue to work in silos. This paper aims to analyse the barriers to interdisciplinary collaboration through a case study of the relationship between social work and public health. These two disciplines have a lot more in common than might first appear. There is real potential for social work and public health to work together and enhance each others efforts to address their common goal of greater social equality. However, this will require a genuine commitment from both disciplines to develop a shared political analysis, common language and a framework for action, which utilises their respective strengths.

Responding to Indigenous Australian Sexual Assault: A Systematic Review of the Literature

Indigenous Australians experience a high prevalence of sexual assault, yet a regional sexual assault service found few Indigenous Australians accessed their services. This prompted exploration of how its services might be improved. A resultant systematic search of the literature is reported in this article. Seven electronic databases and seven websites were systematically searched for peer reviewed and gray literature documenting responses to the sexual assault of Indigenous Australians. These publications were then classified by response type and study type. Twenty-three publications met the inclusion criteria. They included studies of legal justice, media, and community-based and mainstream service responses for Indigenous survivors and perpetrators. We located program descriptions, measurement, and descriptive research, but no intervention studies. There is currently insufficient evidence to confidently prescribe what works to effectively respond to Indigenous Australian sexual assault. The study revealed an urgent need for researchers, Indigenous communities, and services to work together to develop the evidence base.