Yvonne Cadet-James

Empowerment-based research methods: a 10-year approach to enhancing Indigenous social and emotional wellbeing

Objectives: This paper describes a research program that has operationalized the links between empowerment at personal/family, group/organizational and community/structural levels and successful mechanisms to address Indigenous social and emotional wellbeing issues such as family violence and abuse, suicide prevention and incarceration. Methods: A two-pronged approach, involving the Family Wellbeing Empowerment Program and Participatory Action Research, was used to enhance the capacity of program participants and their communities to take greater charge of issues affecting their health and wellbeing. Results: Key program outcomes include an enhancement of participants’ sense of self worth, resilience, problem-solving ability, ability to address immediate family difficulties as well as belief in the mutability of the social environment. There is also evidence of increasing capacity to address wider structural issues such as poor school attendance rates, the critical housing shortage, endemic family violence, alcohol and drug misuse, chronic disease, and over-representation of Indigenous men in the criminal justice system. Participants are also breaking new ground in areas such as values-based Indigenous workforce development and organizational change, as well as issues about contemporary Indigenous spirituality. Conclusions: The use of a long-term (10-year) community research strategy focussing directly on empowerment has demonstrated the power of this approach to facilitate Indigenous peoples capacity to regain social and emotional wellbeing and begin to rebuild the social norms of their families and community.

Psychometric validation of the Growth and Empowerment Measure (GEM) applied with Indigenous Australians

Objective: Empowerment is a complex process of psychological, social, organizational and structural change. It allows individuals and groups to achieve positive growth and effectively address the social and psychological impacts of historical oppression, marginalization and disadvantage. The Growth and Empowerment Measure (GEM) was developed to measure change in dimensions of empowerment as defined and described by Aboriginal Australians who participated in the Family Well Being programme. Method: The GEM has two components: a 14-item Emotional Empowerment Scale (EES14) and 12 Scenarios (12S). It is accompanied by the Kessler 6 Psychological Distress Scale (K6), supplemented by two questions assessing frequency of happy and angry feelings. For validation, the measure was applied with 184 Indigenous Australian participants involved in personal and/or organizational social health activities. Results: Psychometric analyses of the new instruments support their validity and reliability and indicate two-component structures for both the EES (Self-capacity; Inner peace) and the 12S (Healing and enabling growth, Connection and purpose). Strong correlations were observed across the scales and subscales. Participants who scored higher on the newly developed scales showed lower distress on the K6, particularly when the two additional questions were included. However, exploratory factor analyses demonstrated that GEM subscales are separable from the Kessler distress measure. Conclusion: The GEM shows promise in enabling measurement and enhancing understanding of both process and outcome of psychological and social empowerment within an Australian Indigenous context.

Mind, body, spirit: co-benefits for mental health from climate change adaptation and caring for country in remote Aboriginal Australian communities.

The evident and unresolved health disparity between Aboriginal and other Australians is testament to a history of systematic disenfranchisement. Stigma, lack of appropriate services and the expense of delivering services in remote settings make it impossible to adequately address mental health needs, including suicide, solely using a mainstream medical approach. Nor do mainstream approaches accommodate the relationship between Aboriginal health and connectedness to land, whether traditional or new land, remote or metropolitan. This review describes how caring-for-country projects on traditional lands in remote locations may provide a novel way to achieve the linked goals of climate change adaptation with co-benefits for social and emotional wellbeing.

Nobody smokes in the house if there's a new baby in it: Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia

BACKGROUND Smoking prevalence in Aboriginal and Torres Strait Islander pregnant women is quadruple that of non-Indigenous counterparts, impacting on the health of babies and children. AIMS To explore attitudes and experiences related to prenatal tobacco smoking by Aboriginal women and household smoking, and to provide recommendations for culturally appropriate interventions. METHODS We conducted five focus groups with clients and family members of a regional NSW Aboriginal maternity service (n=18). Committees, including Aboriginal representatives, oversaw the study. We analysed transcripts with the constant comparative method and developed key categories. FINDINGS Categories included: social and family influences, knowing and experiencing the health effects of smoking, responses to health messages, cravings and stress, giving up and cutting down, managing smoke-free homes and cars, and community recommendations. Smoking in pregnancy and passive smoking were acknowledged as harmful for babies and children. Anti-tobacco messages and cessation advice appeared more salient when concordant with womens lived experience. Reduced cigarette consumption was reported in pregnancy. Despite smoking in the home, families were engaged in the management of environmental tobacco smoke to reduce harm to babies and children. Abstinence was difficult to initiate or maintain with the widespread use of tobacco in the social and family realm. CONCLUSION Anti-tobacco messages and interventions should relate to Aboriginal womens experiences, improve understanding of the quitting process, support efficacy, and capitalise on the positive changes occurring in smoke-free home management. Focus group participants recommended individual, group and family approaches, and access to cessation services and nicotine replacement therapy for Aboriginal pregnant women who smoke.

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.

An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland

Objective: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland.

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.

Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey.

BackgroundSmoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations.MethodsTelephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships.ResultsAmong organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n = 24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p < 0.005) and advised smokers to quit (p < 0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p < 0.05) and government organisations (p < 0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p < 0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as “cultural understanding” (bottom-up, community-based approaches, deep structures) and “rigour” (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data.ConclusionMessage features, associated with successful campaigns in other populations, are starting to be used for Aboriginal and Torres Strait Islander peoples. A model is proposed to facilitate the development of targeted anti-tobacco messages for Aboriginal and Torres Strait Islander peoples. Organisations could consider incorporating both components of cultural understanding-rigour to enable the growth of evidence-based practice.

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.

Stages of change, smoking behaviour and readiness to quit in a large sample of indigenous Australians living in eight remote north Queensland communities.

Tobacco smoking is a major health issue for Indigenous Australians, however there are few interventions with demonstrated efficacy in this population. The Transtheoretical Model may provide a useful framework for describing smoking behaviour and assessing readiness to quit, with the aim of developing better interventions. Interviews were conducted with 593 Indigenous Australians in eight rural and remote communities in north Queensland, to examine stages of change and smoking behaviour. Among current smokers, 39.6% and 43.4% were in Precontemplation and Contemplation stages respectively. A further 13.9% were making preparations to quit (Preparation) whilst only 3.2% said they were actively trying to quit (Action). When analysed by stage of change, the pattern of smoking-related behaviours conformed to the results of past research using the model. Importantly however, distribution of individuals across the stages opposes those observed in investigations of smoking behaviour in non-Indigenous Australian populations. The Transtheoretical Model can be used to meaningfully classify Indigenous smokers in remote north Queensland according to stages along the behaviour change continuum. Importantly, in this large sample across eight communities, most Indigenous smokers were not making preparations to change their smoking behaviour. This suggests that interventions should focus on promoting movement toward the Preparation and Action stages of change.