Vicki Saunders

No one’s discussing the elephant in the room: contemplating questions of research impact and benefit in Aboriginal and Torres Strait Islander Australian health research

BackgroundThere remains a concern that Indigenous Australians have been over-researched without corresponding improvements in their health; this trend is applicable to most Indigenous populations globally. This debate article has a dual purpose: 1) to open a frank conversation about the value of research to Indigenous Australian populations; and 2) to stimulate ways of thinking about potential resolutions to the lack of progress made in the Indigenous research benefit debate.DiscussionCapturing the meaning of research benefit takes the form of ethical value-oriented methodological considerations in the decision-making processes of Indigenous research endeavours. Because research practices come from Western knowledge bases, attaining such positions in research means reconciling both Indigenous and Western knowledge systems to produce new methodologies that guide planning, evaluating and monitoring of research practices as necessary. Increasingly, more sophisticated performance measures have been implemented to ensure academic impact and benefits are captured. Assessing societal and other non-academic impacts and benefits however, has not been accorded corresponding attention. Research reform has only focussed on research translation in more recent years. The research impact debate must take account of the various standards of accountability (to whom), impact priorities (for whom), positive and negative impacts, and biases that operate in describing impact and measuring benefit.SummaryA perennial question in Indigenous research discourse is whether the abundance of research conducted; purportedly to improve health, is justified and benefits Indigenous people in ways that are meaningful and valued by them. Different research stakeholders have different conceptions of the value and nature of research, its conduct, what it should achieve and the kinds of benefits expected. We need to work collaboratively and listen more closely to the voice of Indigenous Australians to better understand, demonstrate and measure health research benefits. The authors conclude that as an imperative, a systematic benefit assessment strategy that includes identification of research priorities and planning, monitoring and evaluation components needs to be developed and implemented across research projects. In Indigenous health research, this will often mean adopting a benefit-led approach by changing the way research is done and preferencing alternative research methodologies. As a point of departure to improving impact and reaching mutually beneficial outcomes for researchers and partners in Indigenous health research, we need to routinise the assessment of benefit from outset of research as one of the standards toward which we work.

Listening, sharing understanding and facilitating consumer, family and community empowerment through a priority driven partnership in Far North Queensland

Objectives: This paper provides an example of a mental health research partnership underpinned by empowerment principles that seeks to foster strength among community organizations to support better outcomes for consumers, families and communities. It aims to raise awareness among researchers and service providers that empowerment approaches to assist communities to address mental health problems are not too difficult to be practical but require long-term commitment and appropriate support. Methods: A collaborative research strategy that has become known as the Priority Driven Research (PDR) Partnership emerged through literature review, consultations, Family Wellbeing Program delivery with community groups and activities in two discrete Indigenous communities. Progress to date on three of the four components of the strategy is described. Results: The following key needs were identified in a pilot study and are now being addressed in a research-based implementation phase: (i) gaining two-way understanding of perspectives on mental health and promoting universal awareness; (ii) supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation; (iii) developing pathways of care at the primary health centre level to enable support of social and emotional wellbeing as well as more integrated mental health care; (iv) accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity. Conclusion: One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organizations. These include social health teams and mens and womens groups that can engage local people in an action orientation.

Building Indigenous Australian research capacity.

Abstract Objectives: To build individual Indigenous research capacity and strengthen the capability of health research programmes to be culturally and ethically inclusive of Indigenous Australians in public health research. Methods: In order to facilitate optimal participation and in recognition of the differing levels of research experience and knowledge held within this community of practice, an inclusive and culturally appropriate mixed methods approach with influences from action research and Indigenous research principles was undertaken. Results: Over the duration of the project, participants improved their research outcomes as measured by a range of factors including publications, completion of degrees and retention of project members. Conclusions: Provision of an Indigenous led, culturally appropriate system of infrastructure and support centred on capacity building is effective in strengthen the inclusion of Indigenous Australians in research.

An intervention to discourage Australian mothers from unnecessarily exposing their babies to the sun for therapeutic reasons.

Parents play a key role in childrens sun-protective behaviour, with good sun-protective habits established early tending to be sustained. We designed a maternity hospital-based educational intervention to reduce myths that could result in mothers intentionally sunning their babies. Interviews were conducted with two cross-sections of healthy post-partum inpatients in the maternity ward of a large regional public hospital. The first group (n = 106) was recruited before the commencement of educational in-services for maternity nursing staff; the second group (n = 203) was interviewed after the last staff in-service session. More pre-intervention than post-intervention women reported they would expose their baby to sunlight to: treat suspected jaundice (28.8% vs. 13.3%; p < 0.001) or help their babys skin adapt to sunlight (10.5% vs. 2.5%; p = 0.003). Fewer post-intervention women indicated they would sun themselves to treat breastfeeding-associated sore/cracked nipples (7.6% vs. 2%; p = 0.026). This educational intervention should be used to educate parents, health professionals and students.

A community-directed integrated 'Strongyloides' control program in Queensland, Australia

This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven ‘treat-and-test’ mass drug administration (MDA) intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested) that resulted in increased morbidity and at least one death in the community. Between 2004–2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the ‘treat-and-test’ intervention was 16.6% [95% confidence interval 14.2–19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis, the community also takes pride in having developed and implemented this program. This appears to be the first community-directed S. stercoralis control program in Australia, and is an important part of the national story of controlling infectious diseases in Indigenous communities.

Validation and Factor Analysis of the Child and Youth Resilience Measure for Indigenous Australian Boarding School Students

Introduction: Resilience is a strengths-based construct that is useful for understanding differences in health and wellbeing among youth. There are a range of validated survey instruments available to measure resilience for Aboriginal and Torres Strait Islander (hereafter respectfully Indigenous1) youth. However, standard international instruments should only be used if they have been subjected to a rigorous cross-cultural adaptation process and psychometric evaluation in the target population to ensure their validity. The aim of the study was to validate an adapted Child and Youth Resilience Measure (CYRM-28) within a sample of Indigenous Australian boarding school students. Method: The CYRM-28, augmented with an additional 11 site specific items was administered to a purposive sample of Australian Indigenous boarding school students (n = 233) as part of the broader T4S survey instrument that captures demographic information and measures resilience, psychological distress and risk, and service usage. Confirmatory factor analysis was undertaken to verify the relationship between the observed variables with the theoretical constructs of the CYRM-28 and previous findings on the factor structure. Cronbach alpha was also calculated to assess the internal consistency of the CYRM-28 within this sample. Results: Survey data were not a good fit for any previously identified models of the CYRM-28, although the inclusion of a site-specific variable improved the overall fit statistics. Two separate scales were confirmed that capture the sources and expressions of resilience for Indigenous Australian boarding school students. This structure is different to previous findings in relation to the CYRM-28, but consistent with conceptualizations of resilience as a dynamic process. Conclusions: The findings are useful in guiding the future use of the CYRM-28 instrument, explorations of Indigenous youth resilience, and for services working with Indigenous youth in out of home care situations. They highlight contextual differences in the measurement of resilience and the importance of validating standard instruments that have been subjected to rigorous cross-cultural adaptation processes. The two scales offer practical guidance to human services working with Indigenous youth on strategies to build and monitor resilience in Indigenous Australian youth and contribute to the emergent understanding of their resilience.

If you knew the end of a story would you still want to hear it? Using research poems to listen to Aboriginal stories

ABSTRACT This paper presents a poem created whilst conducting an inquiry into one of the endings of stories told of, and by, people living with mental illness: this story ending is grouped by a word (and social movement) widely known as Recovery in mental health care. Recovery, however, is not a word commonly used in the places where this Inquiry occurred. Nor is it a category of story ending often told about Australian Aboriginal people living with a diagnosis of chronic mental illness. This inquiry was, and is, thus focussed on how the current endings of stories that surround Australian Aboriginal peoples in mental health care are being/were told and “heard”. This paper is an attempt to use poetry as a therapeutic and storytelling strategy to highlight the difference between hearing and listening, and how that difference relates to the word Recovery as a paradigm shift and story of social change.

Changing the risky beliefs of post-partum women about therapeutic sun-exposure.

BACKGROUND Many post-partum women hold risky beliefs about perceived therapeutic benefits of sun-exposure in the post-partum period and infancy. QUESTION Can a maternity hospital based educational intervention reduce the prevalence of such beliefs among post-partum women? METHODS In this outcome evaluation of an interventional study, two groups of healthy post-partum women (hospital inpatients) were interviewed, 1-4 days following delivery. The first cross-section (106 women) was recruited prior to in-services for maternity staff; the second (203 women) was recruited after completion of the in-services. Data were compared between the groups. FINDINGS More pre-intervention than post-intervention women reported they would expose their baby to sunlight to treat suspected jaundice (28.8% vs. 13.3%; p<0.001) or help his/her skin adapt to the sun (10.5% vs. 2.5%; p=0.003); or use sunlight to manage breastfeeding-associated sore/cracked nipples (7.6% vs. 2%; p=0.026). CONCLUSION This simple, effective educational intervention could be implemented in programmes for parents, health professionals and students.

Work in Progress: Creative Recovery to Creative Livelihoods

Objective: The purpose of this study was to provide an update on the performative outcomes of the Creative Recovery project, an innovative community based Arts in Health initiative, since the initial launch in Lockhart River 2008, expansion to Aurukun in 2009, and Mornington Island in 2010. Results: With works from those three communities, the exhibition Work In Progress was launched during the Creating Futures Conference 2010. Selections from that exhibition are presented here. Conclusions: The Arts in Health model is both a culturally appropriate and sustainable model for the meaningful engagement of Indigenous people living in remote communities experiencing mental health problems. These types of projects offer unique opportunities for social enterprise, utilizing creativity as the tool for social inclusion. It has the potential to provide a niche economic opportunity which builds on the notion of recovery as incorporating meaningful livelihoods.