Rachel Reilly

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.

Visualizations of binary data: a comparative evaluation

Data visualization has the potential to assist humans in analysing and comprehending large volumes of data, and to detect patterns, clusters and outliers that are not obvious using nongraphical forms of presentation. For this reason, data visualizations have an important role to play in a diverse range of applied problems, including data exploration and mining, information retrieval, and intelligence analysis. Unfortunately, while various different approaches are available for data visualization, there have been few rigorous evaluations of their effectiveness. This paper presents the results of three controlled experiments comparing the ability of four different visualization approaches to help people answer meaningful questions for binary data sets. Two of these visualizations, Chernoff faces and star glyphs, represent objects using simple icon-like displays. The other two visualizations use a spatial arrangement of the objects, based on a model of human mental representation, where more similar objects are placed nearer each other. One of these spatial displays uses a common features model of similarity, while the other uses a distinctive features model. The first experiment finds that both glyph visualizations lead to slow, inaccurate answers being given with low confidence, while the faster and more confident answers for spatial visualizations are only accurate when the common features similarity model is used. The second experiment, which considers only the spatial visualizations, supports this finding, with the common features approach again producing more accurate answers. The third experiment measures human performance using the raw data in tabular form, and so allows the usefulness of visualizations in facilitating human performance to be assessed. This experiment confirms that people are faster, more confident and more accurate when an appropriate visualization of the data is made available.

Suicide Ideation and Attempt in a Community Cohort of Urban Aboriginal Youth: A Cross-Sectional Study

BACKGROUND There has been increasing attention over the last decade on the issue of indigenous youth suicide. A number of studies have documented the high prevalence of suicide behavior and mortality in Australia and internationally. However, no studies have focused on documenting the correlates of suicide behavior for indigenous youth in Australia. AIMS To examine the prevalence of suicide ideation and attempt and the associated factors for a community1 cohort of Koori2 (Aboriginal) youth. METHOD Data were obtained from the Victorian Aboriginal Health Service (VAHS) Young Peoples Project (YPP), a community initiated cross-sectional data set. In 1997/1998, self-reported data were collected for 172 Koori youth aged 12-26 years living in Melbourne, Australia. The data were analyzed to assess the prevalence of current suicide ideation and lifetime suicide attempt. Principal components analysis (PCA) was used to identify closely associated social, emotional, behavioral, and cultural variables at baseline and Cox regression modeling was then used to identify associations between PCA components and suicide ideation and attempt. RESULTS Ideation and attempt were reported at 23.3% and 24.4%, respectively. PCA yielded five components: (1) emotional distress, (2) social distress A, (3) social distress B, (4) cultural connection, (5) behavioral. All were positively and independently associated with suicide ideation and attempt, while cultural connection showed a negative association. CONCLUSIONS Suicide ideation and attempt were common in this cross-section of indigenous youth with an unfavorable profile for the emotional, social, cultural, and behavioral factors.

Equality of the psychological model underlying depressive symptoms in patients with temporal lobe epilepsy versus heterogeneous neurological disorders.

Controversy surrounds the question of whether there is a specific pattern of psychopathology or personality style observed in patients with temporal lobe epilepsy (TLE) or whether the symptoms of psychological distress reflect a common disorder such as depression. Measurement equivalence was examined to test the hypothesis that the latent variable model underlying scores on the Beck Depression Inventory (BDI) was equivalent across samples of patients with TLE (n = 187) and patients with heterogeneous neurological disorders (n = 150). A well-replicated model of depression or psychological distress comprising three related variables, negative attitude, performance difficulty, and somatic elements, displayed a pattern of strict metric invariance. This result suggests that the same set of latent variables is measured with the same metric relationship between item scores and latent variables in patients with TLE and in patients with heterogeneous neurological disorders.

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.

Men, hearts and minds: developing and piloting culturally specific psychometric tools assessing psychosocial stress and depression in central Australian Aboriginal men

PurposeThe health inequalities experienced by Aboriginal and Torres Strait Islander Australians are well documented but there are few empirical data outlining the burden, consequences, experience and expression of depressive illness. This paper seeks to address the lack of accessible, culturally specific measures of psychosocial stress, depression or quality of life developed for, and validated within, this population.MethodsBuilding on an extensive qualitative phase of research, a psychosocial questionnaire comprising novel and adapted scales was developed and piloted with 189 Aboriginal men across urban and remote settings in central Australia. With a view to refining this tool for future use, its underlying structure was assessed using exploratory factor analysis, and the predictive ability of the emergent psychosocial constructs assessed with respect to depressive symptomatology.ResultsThe latent structure of the psychosocial questionnaire was conceptually aligned with the components of the a priori model on which the questionnaire was based. Regression modelling indicated that depressive symptoms were driven by a sense of injury and chronic stress and had a non-linear association with socioeconomic position.ConclusionsThis represents the first community-based survey of psychosocial stress and depression in Aboriginal men. It provides both knowledge of, and an appropriate process for, the further development of psychometric tools, including quality of life, in this population. Further research with larger and more diverse samples of Aboriginal people is required to refine the measurement of key constructs such as chronic stress, socioeconomic position, social support and connectedness. The further refinement, validation against criterion-based methods and incorporation within primary care services is essential.

Cancer Data and Aboriginal Disparities Project (CanDAD) – an overdue cancer control initiative

HEALTH RESEARCH CHAIR, Centre for Population Health Research, University of South Australia, Adelaide, SA, P. YERRELL, PHD, BSC, PGTC, SENIOR RESEARCH FELLOW, Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, M. CARGO, BSC, MSC, PHD, ASSOCIATE PROFESSOR, Centre for Population Health Research, University of South Australia, Adelaide, SA, R. REILLY, BA, PSY.D, POST-DOCTORAL

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.

Effectiveness, cost effectiveness, acceptability and implementation barriers/facilitators of chronic kidney disease management programs and models of care for Aboriginal and Torres Strait Islander Australians: a mixed methods systematic review protocol

Rachel Reilly, Katharine Evans, Judith Gomersall, Gillian Gorham, Steven Warren, Rebekah O, Shea, Micah Peters, Alex Brown, Alan Cass

Web-based therapeutic interventions for assessing, managing and treating health conditions in Indigenous people: a scoping review protocol

REVIEW OBJECTIVES/QUESTIONS The objective of the scoping review is to map the international scientific literature on web-based therapeutic interventions (WBTI) used by Indigenous people for assessing, managing and treating health conditions. The focus of this review is WBTIs for a broad range of health conditions, including but not limited to, communicable and non-communicable diseases, mental health conditions (including the broader concept of social and emotional wellbeing), use of harmful substances and gambling.The questions for the scoping review are.