Richard Chenhall

Walkin' about at Night: The Background to Teenage Pregnancy in a Remote Aboriginal Community.

In Australia, Indigenous young women are more likely to become pregnant while in their teens than non-Indigenous young women. Factors such as poverty, educational outcomes and unemployment play a major role; however, there is little understanding of the attitudes of young women themselves with regards to pregnancy. This paper explores young womens decisions regarding their sexual relationships and pregnancy in a remote Australian Aboriginal community, called River Town. It focuses on young womens motivations to pursue sexual relationships and the information about sex and male behaviour to women that informs their decision-making. ‘Walkin’ about at night’ is the term that River Town residents use to describe the nocturnal activities of adolescent females. The focus of this activity is for a young woman to find and maintain a relationship with a boy. Although it is considered by the young women to be one of the most exciting parts of their lives, it carries with it the risk of pregnancy and sexually transmitted disease. Young women are very aware of the first of these risks, if not the second, as teenage pregnancy is the norm in the community.

‘Young clean and safe?’ Young people's perceptions of risk from sexually transmitted infections in regional, rural and remote Australia

This paper examines young peoples perceived vulnerability to sexually transmitted infections (STIs) and their efforts to create a sense of personal safety within an environment in which risks may be high and where STIs are highly stigmatised. The paper reports on findings from research involving both Indigenous and non-Indigenous 16- to 25-year-olds from remote, rural and regional Australia, including communities in the Northern Territory, Western Australia and South Australia. The study used qualitative methods, including body mapping and scenario based interviewing, to explore how young people made decisions about potential sexual partners and how STIs were understood within the context of young peoples everyday social worlds. The paper has important implications for the design and implementation of sexual-health education programmes by documenting the stigmatisation of young people with STIs and the protective mechanisms peer groups employ to create perceptions of personal safety.

Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study.

Background Previous research suggests that Internet-based cognitive behavioral therapy (ICBT) has a positive effect on symptoms of depression. ICBT appears to be more effective with therapist support, but it is unclear what this support should comprise. General practitioners (GPs) have positive attitudes toward ICBT. However, ICBT is rarely used in regular care in general practice. More research is warranted to integrate the potential of ICBT as part of regular care. Objective The aim of this study was to explore aspects perceived by GPs to affect the implementation of guided ICBT in daily practice. Understanding their perspectives may contribute to improving the treatment of depression in the context of general practice. Methods A training package (3-day course) introducing a Norwegian translation of the ICBT program MoodGYM was developed and presented to GPs in Norway. Following training, GPs were asked to include guided ICBT in their regular care of patients with symptoms of depression by providing brief, face-to-face follow-up consultations between modules. We interviewed 11 GPs who had taken the course. Our interview guide comprised open questions that encouraged GPs to frame their responses using examples from their experiences when implementing ICBT. Thematic analysis was chosen to explore patterns across the data. Results An overall belief that ICBT would benefit both the patients’ health and the GPs’ own work satisfaction prompted the GPs to take the ICBT course. ICBT motivated them to invest time and effort in improving treatment. The most important motivating aspects in MoodGYM were that a program based on cognitive behavioral therapy could add a structured agenda to their consultations and empower depressed patients. Organizational aspects, such as a lack of time and varied practice, inhibited the use of ICBT. Inadequate knowledge, recalling the program, and changing own habits were also challenging. The GPs were ambivalent about whether ICBT had a negative impact on the doctor–patient interaction in the module follow-ups. Generally, GPs made an effort to recommend MoodGYM, but the expected module follow-ups were often not provided to patients and instead the GPs returned to standard treatment. Conclusions GPs’ feedback in the present study contribute to our understanding of the challenges of changing treatment for depression. Our findings indicated that recommending ICBT could add to the GP’s toolkit. Offering training and highlighting the following aspects may increase recommendation of ICBT by GPs: (1) ICBT is theory-based and credible, (2) ICBT increases the GPs’ work satisfaction by having a tool to offer, and (3) ICBT facilitates empowerment of patients in their own health. In addition, the present study also indicated that complex aspects must be accommodated before module follow-ups can be incorporated into GPs’ treatment of depression.

Boyfriends, babies and basketball: present lives and future aspirations of young women in a remote Australian Aboriginal community

This paper explores the aspirations of a group of young women in a remote Aboriginal community in the Northern Territory of Australia. It examines how their hopes and expectations are influenced by the reality of their everyday lives and the extent to which they are able to influence the course of their lives and become agents for change in their own communities. As with adolescents in lower socio-economic groups, the majority of young women in River Town have not developed life goals or clear strategies of how to achieve these goals. The choices that young women have are constrained by their narrow range of experience, which is characterized by early pregnancies and the potential threat of male violence. However, young women have articulated specific domains where they are able to control and structure their lives. This paper discusses the experiences of young women in this remote Aboriginal community.

Those young people all crankybella: Indigenous youth mental health and globalization

The subject of mental health has been discussed for some time in the literature on Australian Aboriginal peoples, although the volume of this work has been relatively small. This literature can be separated into two main approaches. The first has been concerned with documenting and analyzing disorders that are culturally specific to a particular group. The second, more recent body of literature understands mental health issues as resulting from a combination of factors related to the effects of colonization, such as loss of land, poverty, and the destruction of families. This literature is often aimed at diagnosis and the provision of appropriate services for Indigenous people without a comprehensive ethnographic understanding of the cultural specificities of certain mental health disorders. Although mental health problems are discussed, such as suicide, depression, and anxiety, little analysis is undertaken of how such states are locally experienced and understood. This paper reports the complexities involved in understanding mental health from the perspective of youth in a remote Aboriginal community in northern Australia. We argue that it is necessary to understand mental health within the broader context of the lives of Indigenous youth and, in particular, the interaction between their marginalization from participating in the opportunities that globalization offers with issues related to poverty, substance misuse, and specific cultural beliefs.

Problematising school space for Indigenous education: teachers’ and parents’ perspectives

This interpretive study explores the relationship between spatial qualities and school-parent engagement in three primary schools which serve low income periurban Indigenous families in north Australia. Drawing from interviews with educators and parents, school-based observations and community fieldwork conducted over the course of two years in two different towns, we found that educators are very concerned that schools, as western institutions, present cultural and physical barriers to effective engagement; but that this view is not shared by Indigenous parents. Rather than seeing this as a simple issue of cultural difference, our analysis seeks to unravel the curious way in which the otherness of school space is acknowledged in educator discourse. Only some place features of school are suggested as a barrier by educators while other aspects – such as the clear identification of insiders and outsiders through school routines and locales – remain unremarked. We conclude by suggesting that schools are inherently exclusionary, a foundational fact which both parents and educators accept and respond to, in ways which both explain the push for engagement within education policy and its irrelevance as a concern for parents.

Stuck Nose: Experiences and Understanding of Petrol Sniffing in a Remote Aboriginal Community

While petrol sniffing amonge Australian Aboriginal youth has received significant public and academic attention, the experience of petrol sniffing as articulated by sniffers themselves and communitys perceptions of petrol sniffing have been underexplored. Through an ethnographic analysis of a remote Aboriginal community in the Northern Territory Australia, a range of perspectives on petrol sniffing are elucidated in order to understand both the experiences associated with sniffing and non-sniffers’ perceptions of the activity. We argue that contextualizing sniffing within the community is essential to understanding petrol sniffing, and hence to providing appropriate health interventions. It would be incorrect to presume a causal connection between the introduction of a petrol sniffing intervention, described in this article, and the sudden cessation of all petrol sniffing activities in late 2005. Rather, a number of factors and occurrences within the community combined with the effects of the intervention were associated with a significant decrease in petrol sniffing.

Health Beliefs and Behavior

Recently, social determinants of health frameworks are receiving some criticism in that they do not engage with questions related to individual subjectivity and agency as they relate to health decision-making behavior. This article examines the different ways in which people living in a remote Arnhem Land community in the Northern Territory of Australia, take responsibility for their own health and the extent to which they are able to prevent illness. A number of related sub-questions are explored relating to how people perceive their health and their role in health care in their community, including their engagement with the health clinic, traditional medicines, and the influence of sorcery on ill health and sickness.

Treating Indigenous Australians with Alcohol/Drug Problems: Assessing Quality of Life

This study investigated the quality of life (QoL) of clients in an Indigenous Australian residential alcohol and drug treatment center. Qualitative and quantitative data were collected from a random sample of Indigenous clients utilizing the Self Evaluated Individual Quality of Life–Direct Weight tool. The findings from this study provide support for the inclusion of QoL as important in understanding the recovery process from substance misuse. A discrepancy was found between the self-reported aspirations of clients and the focus of the treatment provided, and recommendations were provided for inclusion of new areas in the education provided to the clients of this service.

‘Stopping sniffing is our responsibility’: Community ownership of a petrol-sniffing program in Arnhem Land

Abstract This is an account of various unsuccessful efforts to combat petrol-sniffing in River Town, a remote Aboriginal settlement in north Australia. The paper provides insights into the dynamics of remote Aboriginal settlements, highlighting the dissonance between non-Aboriginal service providers and the Aboriginal residents. Attention is drawn to the need for more involvement of Aboriginal people in policy making and program implementation. The paper suggests also that there is a need for adequate resources to resolve the problems experienced in settlements such as River Town.