PMID- 24188503 OWN - NLM STAT- In-Data-Review DA - 20140117 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 13 DP - 2013 TI - Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. PG - 460 LID - 10.1186/1472-6963-13-460 [doi] AB - BACKGROUND: Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians' perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers' (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs' views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). METHODS: A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. RESULTS: CSPs' lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients' limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient-provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people's distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients' psychosocial and logistical needs, and in-service coordination. CONCLUSION: Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants' comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. FAU - Shahid, Shaouli AU - Shahid S AD - Combined Universities Centre for Rural Health (CUCRH), University of Western Australia, Perth, Western Australia. shaouli.shahid@uwa.edu.au. FAU - Durey, Angela AU - Durey A FAU - Bessarab, Dawn AU - Bessarab D FAU - Aoun, Samar M AU - Aoun SM FAU - Thompson, Sandra C AU - Thompson SC LA - eng PT - Journal Article DEP - 20131104 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM PMC - PMC3835135 OID - NLM: PMC3835135 EDAT- 2013/11/06 06:00 MHDA- 2013/11/06 06:00 CRDT- 2013/11/06 06:00 PHST- 2012/08/22 [received] PHST- 2013/09/26 [accepted] PHST- 2013/11/04 [aheadofprint] AID - 1472-6963-13-460 [pii] AID - 10.1186/1472-6963-13-460 [doi] PST - epublish SO - BMC Health Serv Res. 2013 Nov 4;13:460. doi: 10.1186/1472-6963-13-460. PMID- 24179280 OWN - NLM STAT- MEDLINE DA - 20131101 DCOM- 20140107 IS - 1468-2877 (Electronic) IS - 0033-3549 (Linking) VI - 128 Suppl 3 DP - 2013 Nov TI - The role of effective partnerships in an Australian place-based intervention to reduce race-based discrimination. PG - 54-60 AB - Localities Embracing and Accepting Diversity (LEAD) is an ongoing place-based pilot program aimed at improving health outcomes among Aboriginal and migrant communities through increased social and economic participation. Specifically, LEAD works with mainstream organizations to prevent race-based discrimination from occurring. The partnership model of LEAD was designed to create a community intervention that was evidence-based, effective, and flexible enough to respond to local contexts and needs. LEAD's complex organizational and partnership model, in combination with an innovative approach to reducing race-based discrimination, has necessitated the use of new language and communication strategies to build genuinely collaborative partnerships. Allocating sufficient time to develop strategies aligned with this new way of doing business has been critical. However, preliminary data indicate that a varied set of partners has been integral to supporting the widespread influence of the emerging LEAD findings across partner networks in a number of different sectors. FAU - Ferdinand, Angeline Samantha AU - Ferdinand AS AD - University of Melbourne, Melbourne School of Population Health, Centre for Health Policy, Programs and Economics, Parkville, Victoria, Australia. FAU - Paradies, Yin AU - Paradies Y FAU - Kelaher, Margaret Anne AU - Kelaher MA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Public Health Rep JT - Public health reports (Washington, D.C. : 1974) JID - 9716844 SB - AIM SB - IM MH - Australia MH - *Emigrants and Immigrants MH - Health Promotion/*methods MH - Humans MH - *Oceanic Ancestry Group MH - Pilot Projects MH - *Public-Private Sector Partnerships MH - Racism/*prevention & control MH - Residence Characteristics PMC - PMC3789613 OID - NLM: PMC3789613 [Available on 11/01/14] EDAT- 2013/11/05 06:00 MHDA- 2014/01/08 06:00 CRDT- 2013/11/02 06:00 PMCR- 2014/11/01 00:00 PST - ppublish SO - Public Health Rep. 2013 Nov;128 Suppl 3:54-60. PMID- 23822115 OWN - NLM STAT- MEDLINE DA - 20130722 DCOM- 20130918 LR - 20131111 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 13 DP - 2013 TI - Local co-ordination and case management can enhance Indigenous eye care--a qualitative study. PG - 255 LID - 10.1186/1472-6963-13-255 [doi] AB - BACKGROUND: Indigenous adults suffer six times more blindness than other Australians but 94% of this vision loss is unnecessary being preventable or treatable. We have explored the barriers and solutions to improve Indigenous eye health and proposed significant system changes required to close the gap for Indigenous eye health. This paper aims to identify the local co-ordination and case management requirements necessary to improve eye care for Indigenous Australians. METHODS: A qualitative study, using semi-structured interviews, focus groups, stakeholder workshops and meetings was conducted in community, private practice, hospital, non-government organisation and government settings. Data were collected at 21 sites across Australia. Semi-structured interviews were conducted with 289 people working in Indigenous health and eye care; focus group discussions with 81 community members; stakeholder workshops involving 86 individuals; and separate meetings with 75 people. 531 people participated in the consultations. Barriers and issues were identified through thematic analysis and policy solutions developed through iterative consultation. RESULTS: Poorly co-ordinated eye care services for Indigenous Australians are inefficient and costly and result in poorer outcomes for patients, communities and health care providers. Services are more effective where there is good co-ordination of services and case management of patients along the pathway of care. The establishment of clear pathways of care, development local and regional partnerships to manage services and service providers and the application of sufficient workforce with clear roles and responsibilities have the potential to achieve important improvements in eye care. CONCLUSIONS: Co-ordination is a key to close the gap in eye care for Indigenous Australians. Properly co-ordinated care and support along the patient pathway through case management will save money by preventing dropout of patients who haven't received treatment and a successfully functioning system will encourage more people to enter for care. FAU - Anjou, Mitchell D AU - Anjou MD AD - Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, Melbourne, VIC 3010, Australia. manjou@unimelb.edu.au FAU - Boudville, Andrea I AU - Boudville AI FAU - Taylor, Hugh R AU - Taylor HR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130703 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Australia MH - Case Management/*organization & administration MH - Critical Pathways MH - Delivery of Health Care/*organization & administration MH - *Eye Diseases/ethnology/therapy MH - Health Services Accessibility/*organization & administration MH - Health Services, Indigenous/*organization & administration MH - *Healthcare Disparities MH - Humans MH - Oceanic Ancestry Group MH - Qualitative Research PMC - PMC3716985 OID - NLM: PMC3716985 EDAT- 2013/07/05 06:00 MHDA- 2013/09/21 06:00 CRDT- 2013/07/05 06:00 PHST- 2012/04/17 [received] PHST- 2013/06/18 [accepted] PHST- 2013/07/03 [aheadofprint] AID - 1472-6963-13-255 [pii] AID - 10.1186/1472-6963-13-255 [doi] PST - epublish SO - BMC Health Serv Res. 2013 Jul 3;13:255. doi: 10.1186/1472-6963-13-255. PMID- 22918939 OWN - NLM STAT- MEDLINE DA - 20130613 DCOM- 20140114 IS - 1468-3318 (Electronic) IS - 0964-4563 (Linking) VI - 22 IP - 4 DP - 2013 Jul TI - Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis. PG - e7 LID - 10.1136/tobaccocontrol-2012-050436 [doi] AB - OBJECTIVE: To summarise published empirical research on culturally targeted anti-tobacco media messages for Indigenous or First Nations people and examine the evidence for the effectiveness of targeted and non-targeted campaigns. METHODS: Studies were sought describing mass media and new media interventions for tobacco control or smoking cessation in Indigenous or First Nations populations. Studies of any design were included reporting outcomes of media-based interventions including: cognitions, awareness, recall, intention to quit and quit rates. Then, 2 reviewers independently applied inclusion criteria, which were met by 21 (5.8%) of the studies found. One author extracted data with crosschecking by a second. Both independently assessed papers using Scottish Intercollegiate Guidelines Network (SIGN; quantitative studies) and Daly et al (qualitative studies). RESULTS: A total of 21 studies were found (4 level 1 randomised controlled trials (RCTs), 11 level 2 studies and 6 qualitative studies) and combined with narrative synthesis. Eight evaluated anti-tobacco TV or radio campaigns; two assessed US websites; three New Zealand studies examined mobile phone interventions; five evaluated print media; three evaluated a CD-ROM, a video and an edutainment intervention. CONCLUSIONS: Although Indigenous people had good recall of generic anti-tobacco messages, culturally targeted messages were preferred. New Zealand Maori may be less responsive to holistic targeted campaigns, despite their additional benefits, compared to generic fear campaigns. Culturally targeted internet or mobile phone messages appear to be as effective in American Indians and Maori as generic messages in the general population. There is little research comparing the effect of culturally targeted versus generic messages with similar message content in Indigenous people. FAU - Gould, Gillian Sandra AU - Gould GS AD - School of Public Health,Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville,Queensland, Australia. gillian.gould1@my.jcu.edu.au FAU - McEwen, Andy AU - McEwen A FAU - Watters, Tracey AU - Watters T FAU - Clough, Alan R AU - Clough AR FAU - van der Zwan, Rick AU - van der Zwan R LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20120822 PL - England TA - Tob Control JT - Tobacco control JID - 9209612 SB - IM MH - *Cultural Competency MH - *Culture MH - Fear MH - Health Promotion/*methods MH - Humans MH - Indians, North American MH - *Mass Media MH - Mental Recall MH - New Zealand MH - Oceanic Ancestry Group MH - *Population Groups MH - Smoking/*prevention & control MH - *Smoking Cessation MH - Tobacco MH - United States OTO - NOTNLM OT - Cigarette smoking OT - health communication OT - health promotion OT - indigenous populations OT - mass media EDAT- 2012/08/25 06:00 MHDA- 2014/01/15 06:00 CRDT- 2012/08/25 06:00 PHST- 2012/08/22 [aheadofprint] AID - tobaccocontrol-2012-050436 [pii] AID - 10.1136/tobaccocontrol-2012-050436 [doi] PST - ppublish SO - Tob Control. 2013 Jul;22(4):e7. doi: 10.1136/tobaccocontrol-2012-050436. Epub 2012 Aug 22. PMID- 23672247 OWN - NLM STAT- MEDLINE DA - 20130524 DCOM- 20130923 LR - 20131111 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 13 DP - 2013 TI - Indigenous perspectives on active living in remote Australia: a qualitative exploration of the socio-cultural link between health, the environment and economics. PG - 473 LID - 10.1186/1471-2458-13-473 [doi] AB - BACKGROUND: The burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities. METHODS: Qualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author. RESULTS: The findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment. CONCLUSION: This different construction of physical activity in remote Indigenous communities highlights the importance of involving Indigenous people in the development and implementation of physical activity promotion. Physical activities associated with traditional Indigenous cultural practices and being active 'on country' need to be viewed as legitimate health promotion activities. Exploring further ways to enable Indigenous people in remote NT to be involved in creating viable active livelihoods on 'traditional country' needs to be considered as imperative to health improvement. FAU - Thompson, Sharon L AU - Thompson SL AD - Menzies School of Health Research; Institute of Advanced Studies, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811, Australia. sharon.thompson@menzies.edu.au FAU - Chenhall, Richard D AU - Chenhall RD FAU - Brimblecombe, Julie K AU - Brimblecombe JK LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130515 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - *Activities of Daily Living MH - Adult MH - Aged MH - Chronic Disease/prevention & control/*therapy MH - Community-Based Participatory Research MH - Cultural Competency MH - *Culture MH - Female MH - Health Knowledge, Attitudes, Practice/ethnology MH - Health Promotion MH - Humans MH - Life Style MH - Male MH - Middle Aged MH - *Motor Activity MH - Northern Territory MH - *Oceanic Ancestry Group/psychology MH - Rural Population MH - Social Environment PMC - PMC3662620 OID - NLM: PMC3662620 EDAT- 2013/05/16 06:00 MHDA- 2013/09/24 06:00 CRDT- 2013/05/16 06:00 PHST- 2012/11/23 [received] PHST- 2013/05/08 [accepted] PHST- 2013/05/15 [aheadofprint] AID - 1471-2458-13-473 [pii] AID - 10.1186/1471-2458-13-473 [doi] PST - epublish SO - BMC Public Health. 2013 May 15;13:473. doi: 10.1186/1471-2458-13-473. PMID- 23663304 OWN - NLM STAT- MEDLINE DA - 20130522 DCOM- 20130716 LR - 20131111 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 13 DP - 2013 TI - The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints. PG - 460 LID - 10.1186/1471-2458-13-460 [doi] AB - BACKGROUND: The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. METHODS: Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. RESULTS: While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services' responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse "dilemmatic space" in their work. CONCLUSIONS: The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health's recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value of community control of PHC services and the types of policy, resource and managerial environments that support action on social determinants is warranted by this study's findings. FAU - Baum, Frances E AU - Baum FE AD - Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. fran.baum@flinders.edu.au FAU - Legge, David G AU - Legge DG FAU - Freeman, Toby AU - Freeman T FAU - Lawless, Angela AU - Lawless A FAU - Labonte, Ronald AU - Labonte R FAU - Jolley, Gwyneth M AU - Jolley GM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130510 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Attitude of Health Personnel MH - Australia MH - Evidence-Based Medicine MH - *Guidelines as Topic MH - Health Policy MH - Health Promotion/*organization & administration MH - *Health Status Disparities MH - Humans MH - Organizational Case Studies MH - Patient Advocacy MH - Primary Health Care/economics/*methods PMC - PMC3660265 OID - NLM: PMC3660265 EDAT- 2013/05/15 06:00 MHDA- 2013/07/17 06:00 CRDT- 2013/05/14 06:00 PHST- 2013/01/16 [received] PHST- 2013/04/30 [accepted] PHST- 2013/05/10 [aheadofprint] AID - 1471-2458-13-460 [pii] AID - 10.1186/1471-2458-13-460 [doi] PST - epublish SO - BMC Public Health. 2013 May 10;13:460. doi: 10.1186/1471-2458-13-460. PMID- 23452404 OWN - NLM STAT- MEDLINE DA - 20130318 DCOM- 20130617 LR - 20131113 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 13 DP - 2013 TI - A qualitative study of a social and emotional well-being service for a remote Indigenous Australian community: implications for access, effectiveness, and sustainability. PG - 80 LID - 10.1186/1472-6963-13-80 [doi] AB - BACKGROUND: People living in rural and remote Australia experience increased mental health problems compared with metropolitan Australians. Moreover, Indigenous Australians are twice as likely as non Indigenous Australians to report high or very high levels of mental health problems. It is imperative, therefore, that effective and sustainable social and emotional wellbeing services (Indigenous Australians prefer the term "social and emotional wellbeing" to "mental health") are developed for Indigenous Australians living in remote communities. In response to significant and serious events such as suicides and relationship violence in a remote Indigenous community, a social and emotional wellbeing service (SEWBS) was developed. After the service had been running for over three years, an independent evaluation was initiated by the local health board. The aim of the evaluation was to explore the impact of SEWBS, including issues of effectiveness and sustainability, from the experiences of people involved in the development and delivery of the service. METHODS: Purposive sampling was used to recruit 21 people with different involvement in the service such as service providers, service participants, and referrers. These people were interviewed and their interviews were transcribed. Interpretative Phenomenological Analysis (IPA) was used to analyse the interview transcripts to identify superordinate themes and subthemes in the data. RESULTS: Two superordinate themes and nine subthemes were developed from the interview transcripts. The first superordinate theme was called "The Big Picture" and it had the sub themes: getting started; organizational factors; funding; the future, and; operational problems. The second superordinate theme was called "On the Ground" and it had the subthemes: personal struggles; program activities; measuring outcomes, and; results. CONCLUSIONS: While the evaluation indicated that the service had been experienced as an effective local response to serious problems, recommendations and directions for future research and development emerged that were more broadly applicable. Issues such as appropriate staffing, localising decision making, identifying priorities and how they will be evaluated, and developing flexibility in terms of job descriptions and qualifications are highlighted. FAU - Carey, Timothy A AU - Carey TA AD - Centre for Remote Health, a joint Centre of Flinders University and Charles Darwin University, PO Box 4066, Alice Springs, NT, 0871, Australia. Tim.Carey@flinders.edu.au LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130304 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Australia MH - *Community Mental Health Services MH - Cross-Sectional Studies MH - Female MH - *Health Services Accessibility MH - Humans MH - Male MH - Mental Disorders/therapy MH - Oceanic Ancestry Group/*psychology MH - *Personal Satisfaction MH - Program Evaluation MH - Qualitative Research MH - Rural Population PMC - PMC3599325 OID - NLM: PMC3599325 EDAT- 2013/03/05 06:00 MHDA- 2013/06/19 06:00 CRDT- 2013/03/05 06:00 PHST- 2012/10/14 [received] PHST- 2013/03/01 [accepted] PHST- 2013/03/04 [aheadofprint] AID - 1472-6963-13-80 [pii] AID - 10.1186/1472-6963-13-80 [doi] PST - epublish SO - BMC Health Serv Res. 2013 Mar 4;13:80. doi: 10.1186/1472-6963-13-80. PMID- 23435590 OWN - NLM STAT- MEDLINE DA - 20130225 DCOM- 20130730 LR - 20131113 IS - 1660-4601 (Electronic) IS - 1660-4601 (Linking) VI - 10 IP - 2 DP - 2013 Feb TI - Developing an exploratory framework linking Australian Aboriginal peoples' connection to country and concepts of wellbeing. PG - 678-98 LID - 10.3390/ijerph10020678 [doi] AB - Aboriginal people across Australia suffer significant health inequalities compared with the non-Indigenous population. Evidence indicates that inroads can be made to reduce these inequalities by better understanding social and cultural determinants of health, applying holistic notions of health and developing less rigid definitions of wellbeing. The following article draws on qualitative research on Victorian Aboriginal peoples' relationship to their traditional land (known as Country) and its link to wellbeing, in an attempt to tackle this. Concepts of wellbeing, Country and nature have also been reviewed to gain an understanding of this relationship. An exploratory framework has been developed to understand this phenomenon focusing on positive (e.g., ancestry and partnerships) and negative (e.g., destruction of Country and racism) factors contributing to Aboriginal peoples' health. The outcome is an explanation of how Country is a fundamental component of Aboriginal Victorian peoples' wellbeing and the framework articulates the forces that impact positively and negatively on this duality. This review is critical to improving not only Aboriginal peoples' health but also the capacity of all humanity to deal with environmental issues like disconnection from nature and urbanisation. FAU - Kingsley, Jonathan AU - Kingsley J AD - School of Health and Social Development, Deakin University, Burwood, Victoria 3125, Australia. jkingsley@vichealth.vic.gov.au FAU - Townsend, Mardie AU - Townsend M FAU - Henderson-Wilson, Claire AU - Henderson-Wilson C FAU - Bolam, Bruce AU - Bolam B LA - eng PT - Journal Article DEP - 20130207 PL - Switzerland TA - Int J Environ Res Public Health JT - International journal of environmental research and public health JID - 101238455 SB - IM MH - Australia MH - Culture MH - *Environment MH - Health Status MH - Humans MH - *Models, Theoretical MH - *Oceanic Ancestry Group MH - Quality of Life PMC - PMC3635170 OID - NLM: PMC3635170 EDAT- 2013/02/26 06:00 MHDA- 2013/07/31 06:00 CRDT- 2013/02/26 06:00 PHST- 2012/12/23 [received] PHST- 2013/01/17 [revised] PHST- 2013/01/18 [accepted] AID - ijerph10020678 [pii] AID - 10.3390/ijerph10020678 [doi] PST - epublish SO - Int J Environ Res Public Health. 2013 Feb 7;10(2):678-98. doi: 10.3390/ijerph10020678. PMID- 23360645 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20130301 DCOM- 20130304 LR - 20130418 IS - 1478-7954 (Electronic) IS - 1478-7954 (Linking) VI - 11 IP - 1 DP - 2013 TI - Decomposing Indigenous life expectancy gap by risk factors: a life table analysis. PG - 1 LID - 10.1186/1478-7954-11-1 [doi] AB - BACKGROUND: The estimated gap in life expectancy (LE) between Indigenous and non-Indigenous Australians was 12 years for men and 10 years for women, whereas the Northern Territory Indigenous LE gap was at least 50% greater than the national figures. This study aims to explain the Indigenous LE gap by common modifiable risk factors. METHODS: This study covered the period from 1986 to 2005. Unit record death data from the Northern Territory were used to assess the differences in LE at birth between the Indigenous and non-Indigenous populations by socioeconomic disadvantage, smoking, alcohol abuse, obesity, pollution, and intimate partner violence. The population attributable fractions were applied to estimate the numbers of deaths associated with the selected risks. The standard life table and cause decomposition technique was used to examine the individual and joint effects on health inequality. RESULTS: The findings from this study indicate that among the selected risk factors, socioeconomic disadvantage was the leading health risk and accounted for one-third to one-half of the Indigenous LE gap. A combination of all six selected risks explained over 60% of the Indigenous LE gap. CONCLUSIONS: Improving socioeconomic status, smoking cessation, and overweight reduction are critical to closing the Indigenous LE gap. This paper presents a useful way to explain the impact of risk factors of health inequalities, and suggests that reducing poverty should be placed squarely at the centre of the strategies to close the Indigenous LE gap. FAU - Zhao, Yuejen AU - Zhao Y AD - Health Gains Planning Branch, Northern Territory Department of Health, Darwin Plaza, 1st Floor, Smith St Mall, Darwin, NT 0801, Australia. yuejen.zhao@nt.gov.au. FAU - Wright, Jo AU - Wright J FAU - Begg, Stephen AU - Begg S FAU - Guthridge, Steven AU - Guthridge S LA - eng PT - Journal Article DEP - 20130129 PL - England TA - Popul Health Metr JT - Population health metrics JID - 101178411 PMC - PMC3585166 OID - NLM: PMC3585166 EDAT- 2013/01/31 06:00 MHDA- 2013/01/31 06:01 CRDT- 2013/01/31 06:00 PHST- 2012/02/28 [received] PHST- 2012/12/26 [accepted] PHST- 2013/01/29 [aheadofprint] AID - 1478-7954-11-1 [pii] AID - 10.1186/1478-7954-11-1 [doi] PST - epublish SO - Popul Health Metr. 2013 Jan 29;11(1):1. doi: 10.1186/1478-7954-11-1. PMID- 23102409 OWN - NLM STAT- MEDLINE DA - 20121225 DCOM- 20130520 LR - 20131114 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 12 DP - 2012 TI - Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment. PG - 369 LID - 10.1186/1472-6963-12-369 [doi] AB - BACKGROUND: Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. METHODS: Two theories informed the study: (1) 'candidacy', which explores "the ways in which people's eligibility for care is jointly negotiated between individuals and health services"; and (2) kanyini or 'holding', a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. RESULTS: Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is 'tractable' and 'navigable' to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as 'non-ideal users' and are denied from being 'held' by hospital staff. CONCLUSIONS: Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs 'hold' their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care. FAU - Peiris, David AU - Peiris D AD - The George Institute for Global Health, University of Sydney, Sydney, Australia. dpeiris@georgeinstitute.org.au FAU - Brown, Alex AU - Brown A FAU - Howard, Michael AU - Howard M FAU - Rickards, Bernadette A AU - Rickards BA FAU - Tonkin, Andrew AU - Tonkin A FAU - Ring, Ian AU - Ring I FAU - Hayman, Noel AU - Hayman N FAU - Cass, Alan AU - Cass A LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20121028 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Australia MH - Delivery of Health Care/*organization & administration/standards MH - Focus Groups MH - Health Policy MH - Health Services Accessibility MH - Healthcare Disparities MH - Humans MH - Interviews as Topic MH - *Oceanic Ancestry Group MH - *Quality Assurance, Health Care MH - Quality of Health Care PMC - PMC3529689 OID - NLM: PMC3529689 EDAT- 2012/10/30 06:00 MHDA- 2013/05/22 06:00 CRDT- 2012/10/30 06:00 PHST- 2011/11/29 [received] PHST- 2012/10/24 [accepted] PHST- 2012/10/28 [aheadofprint] AID - 1472-6963-12-369 [pii] AID - 10.1186/1472-6963-12-369 [doi] PST - epublish SO - BMC Health Serv Res. 2012 Oct 28;12:369. doi: 10.1186/1472-6963-12-369. PMID- 22998612 OWN - NLM STAT- MEDLINE DA - 20121204 DCOM- 20130416 LR - 20131114 IS - 1471-2415 (Electronic) IS - 1471-2415 (Linking) VI - 12 DP - 2012 TI - Access to eye health services among indigenous Australians: an area level analysis. PG - 51 LID - 10.1186/1471-2415-12-51 [doi] AB - BACKGROUND: This project is a community-level study of equity of access to eye health services for Indigenous Australians. METHODS: The project used data on eye health services from multiple sources including Medicare Australia, inpatient and outpatient data and the National Indigenous Eye Health Survey.The analysis focused on the extent to which access to eye health services varied at an area level according to the proportion of the population that was Indigenous (very low = 0-1.0%, low = 1.1-3.0%, low medium = 3.1-6.0%, high medium = 6.1-10.0%, high = 10.1-20.0%, very high = 20 + %). The analysis of health service utilisation also took into account age, remoteness and the Socioeconomic Indices for Areas (SEIFA). RESULTS: The rate of eye exams provided in areas with very high Indigenous populations was two-thirds of the rate of eye exams for areas with very low indigenous populations. The cataract surgery rates in areas with high medium to very high Indigenous populations were less than half that reference areas. In over a third of communities with very high Indigenous populations the cataract surgery rate fell below the World Health Organization (WHO) guidelines compared to a cataract surgery rate of 3% in areas with very low Indigenous populations. CONCLUSIONS: There remain serious disparities in access to eye health service in areas with high Indigenous populations. Addressing disparities requires a co-ordinated approach to improving Indigenous people's access to eye health services. More extensive take-up of existing Medicare provisions is an important step in this process. Along with improving access to health services, community education concerning the importance of eye health and the effectiveness of treatment might reduce reluctance to seek help. FAU - Kelaher, Margaret AU - Kelaher M AD - Centre for Health Policy, Programs and Economics School of Population Health, Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, 207 Bouverie st Parkville, Melbourne, 3010, Australia. mkelaher@unimelb.edu.au FAU - Ferdinand, Angeline AU - Ferdinand A FAU - Taylor, Hugh AU - Taylor H LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120924 PL - England TA - BMC Ophthalmol JT - BMC ophthalmology JID - 100967802 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Australia/epidemiology MH - Child MH - Child, Preschool MH - Female MH - Health Services Accessibility/*statistics & numerical data MH - Health Services, Indigenous/*utilization MH - *Health Surveys MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Middle Aged MH - *National Health Programs MH - Oceanic Ancestry Group/*statistics & numerical data MH - Prevalence MH - Refractive Errors/*ethnology MH - Vision, Low/*ethnology MH - Young Adult PMC - PMC3514169 OID - NLM: PMC3514169 EDAT- 2012/09/25 06:00 MHDA- 2013/04/17 06:00 CRDT- 2012/09/25 06:00 PHST- 2011/09/12 [received] PHST- 2012/09/20 [accepted] PHST- 2012/09/24 [aheadofprint] AID - 1471-2415-12-51 [pii] AID - 10.1186/1471-2415-12-51 [doi] PST - epublish SO - BMC Ophthalmol. 2012 Sep 24;12:51. doi: 10.1186/1471-2415-12-51. PMID- 22958495 OWN - NLM STAT- MEDLINE DA - 20121129 DCOM- 20130220 LR - 20131114 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 12 DP - 2012 TI - Socioeconomic disparities in the mental health of Indigenous children in Western Australia. PG - 756 LID - 10.1186/1471-2458-12-756 [doi] AB - BACKGROUND: The burden of mental health problems among Aboriginal and Torres Strait Islander children is a major public health problem in Australia. While socioeconomic factors are implicated as important determinants of mental health problems in mainstream populations, their bearing on the mental health of Indigenous Australians remains largely uncharted across all age groups. METHODS: We examined the relationship between the risk of clinically significant emotional or behavioural difficulties (CSEBD) and a range of socioeconomic measures for 3993 Indigenous children aged 4-17 years in Western Australia, using a representative survey conducted in 2000-02. Analysis was conducted using multivariate logistic regression within a multilevel framework. RESULTS: Almost one quarter (24%) of Indigenous children were classified as being at high risk of CSEBD. Our findings generally indicate that higher socioeconomic status is associated with a reduced risk of mental health problems in Indigenous children. Housing quality and tenure and neighbourhood-level disadvantage all have a strong direct effect on child mental health. Further, the circumstances of families with Indigenous children (parenting quality, stress, family composition, overcrowding, household mobility, racism and family functioning) emerged as an important explanatory mechanism underpinning the relationship between child mental health and measures of material wellbeing such as carer employment status and family financial circumstances. CONCLUSIONS: Our results provide incremental evidence of a social gradient in the mental health of Aboriginal and Torres Strait Islander children. Improving the social, economic and psychological conditions of families with Indigenous children has considerable potential to reduce the mental health inequalities within Indigenous populations and, in turn, to close the substantial racial gap in mental health. Interventions that target housing quality, home ownership and neighbourhood-level disadvantage are likely to be particularly beneficial. FAU - Shepherd, Carrington C J AU - Shepherd CC AD - Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia. carringtons@ichr.uwa.edu.au FAU - Li, Jianghong AU - Li J FAU - Mitrou, Francis AU - Mitrou F FAU - Zubrick, Stephen R AU - Zubrick SR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120910 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Adolescent MH - Child MH - Child, Preschool MH - Female MH - *Health Status Disparities MH - Health Surveys MH - Humans MH - Logistic Models MH - Male MH - Mental Disorders/*ethnology MH - Multilevel Analysis MH - Oceanic Ancestry Group/*psychology/statistics & numerical data MH - Risk Factors MH - Socioeconomic Factors MH - Western Australia PMC - PMC3508977 OID - NLM: PMC3508977 EDAT- 2012/09/11 06:00 MHDA- 2013/02/21 06:00 CRDT- 2012/09/11 06:00 PHST- 2012/03/28 [received] PHST- 2012/09/05 [accepted] PHST- 2012/09/10 [aheadofprint] AID - 1471-2458-12-756 [pii] AID - 10.1186/1471-2458-12-756 [doi] PST - epublish SO - BMC Public Health. 2012 Sep 10;12:756. doi: 10.1186/1471-2458-12-756. PMID- 22954136 OWN - NLM STAT- MEDLINE DA - 20121011 DCOM- 20130522 LR - 20131114 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 12 DP - 2012 TI - Differences in primary health care delivery to Australia's Indigenous population: a template for use in economic evaluations. PG - 307 LID - 10.1186/1472-6963-12-307 [doi] AB - BACKGROUND: Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia's Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting. METHODS: The 'Indigenous Health Service Delivery Template' has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS. RESULTS: The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly. CONCLUSIONS: The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal. FAU - Ong, Katherine S AU - Ong KS AD - Centre for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Carlton, Victoria 3010, Australia. ksong@unimelb.edu.au FAU - Carter, Rob AU - Carter R FAU - Kelaher, Margaret AU - Kelaher M FAU - Anderson, Ian AU - Anderson I LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120907 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Administrative Personnel/statistics & numerical data MH - Australia MH - Costs and Cost Analysis MH - Delivery of Health Care/*economics/methods MH - Guidelines as Topic MH - *Health Knowledge, Attitudes, Practice MH - Health Services, Indigenous/*economics/standards MH - Humans MH - Interviews as Topic MH - *Medical Indigency MH - *Models, Economic MH - Northern Territory MH - *Oceanic Ancestry Group MH - Primary Prevention/economics MH - Professional Practice Location MH - Referral and Consultation MH - Rural Health Services/manpower MH - Urban Health Services/manpower PMC - PMC3468365 OID - NLM: PMC3468365 EDAT- 2012/09/08 06:00 MHDA- 2013/05/23 06:00 CRDT- 2012/09/08 06:00 PHST- 2011/11/30 [received] PHST- 2012/08/27 [accepted] PHST- 2012/09/07 [aheadofprint] AID - 1472-6963-12-307 [pii] AID - 10.1186/1472-6963-12-307 [doi] PST - epublish SO - BMC Health Serv Res. 2012 Sep 7;12:307. doi: 10.1186/1472-6963-12-307. PMID- 22856688 OWN - NLM STAT- MEDLINE DA - 20121107 DCOM- 20130422 LR - 20131115 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 12 DP - 2012 TI - Applying what works: a systematic search of the transfer and implementation of promising Indigenous Australian health services and programs. PG - 600 LID - 10.1186/1471-2458-12-600 [doi] AB - BACKGROUND: The transfer and implementation of acceptable and effective health services, programs and innovations across settings provides an important and potentially cost-effective strategy for reducing Indigenous Australians' high burden of disease. This study reports a systematic review of Indigenous health services, programs and innovations to examine the extent to which studies considered processes of transfer and implementation within and across Indigenous communities and healthcare settings. METHODS: Medline, Informit, Infotrac, Blackwells Publishing, Proquest, Taylor and Francis, JStor, and the Indigenous HealthInfoNet were searched using terms: Aborigin* OR Indigen* OR Torres AND health AND service OR program* OR intervention AND Australia to locate publications from 1992-2011. The reference lists of 19 reviews were also checked. Data from peer reviewed journals, reports, and websites were included. The 95% confidence intervals (95% CI) for proportions that referred to and focussed on transfer were calculated as exact binomial confidence intervals. Test comparisons between proportions were calculated using Fisher's exact test with an alpha level of 5%. RESULTS: Of 1311 publications identified, 119 (9.1%; 95% CI: 7.6%-10.8%) referred to the transfer and implementation of Indigenous Australian health services or programs, but only 21 studies (1.6%; 95% CI: 1.0%-2.4%) actually focused on transfer and implementation. Of the 119 transfer studies, 37 (31.1%; 95% CI: 22.9-40.2%) evaluated the impact of a service or program, 28 (23.5%; 95% CI: 16.2%-32.2%) reported only process measures and 54 were descriptive. Of the 37 impact evaluation studies, 28 (75.7%; 95% CI: 58.8%-88.2%) appeared in peer reviewed journals but none included experimental designs. CONCLUSION: While services and programs are being transferred and implemented, few studies focus on the process by which this occurred or the effectiveness of the service or program in the new setting. Findings highlight a need for partnerships between researchers and health services to evaluate the transfer and implementation of Indigenous health services and programs using rigorous designs, and publish such efforts in peer-reviewed journals as a quality assurance mechanism. FAU - McCalman, Janya AU - McCalman J AD - The Cairns Institute and School of Education, James Cook University, McGregor Rd, Smithfield 4878, Australia. Janya.mccalman@jcu.edu.au FAU - Tsey, Komla AU - Tsey K FAU - Clifford, Anton AU - Clifford A FAU - Earles, Wendy AU - Earles W FAU - Shakeshaft, Anthony AU - Shakeshaft A FAU - Bainbridge, Roxanne AU - Bainbridge R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20120803 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Australia MH - Health Plan Implementation/*organization & administration MH - Health Services Accessibility/*organization & administration MH - Health Services, Indigenous/*organization & administration MH - Humans MH - *Oceanic Ancestry Group PMC - PMC3490811 OID - NLM: PMC3490811 EDAT- 2012/08/04 06:00 MHDA- 2013/04/23 06:00 CRDT- 2012/08/04 06:00 PHST- 2012/03/29 [received] PHST- 2012/07/26 [accepted] PHST- 2012/08/03 [aheadofprint] AID - 1471-2458-12-600 [pii] AID - 10.1186/1471-2458-12-600 [doi] PST - epublish SO - BMC Public Health. 2012 Aug 3;12:600. doi: 10.1186/1471-2458-12-600. PMID- 22716205 OWN - NLM STAT- MEDLINE DA - 20120813 DCOM- 20121221 LR - 20131115 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 12 DP - 2012 TI - An oral health literacy intervention for Indigenous adults in a rural setting in Australia. PG - 461 LID - 10.1186/1471-2458-12-461 [doi] AB - BACKGROUND: Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy. METHODS/DESIGN: This is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrollment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism. DISCUSSION: This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities. FAU - Parker, Eleanor J AU - Parker EJ AD - Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, Australia. Eleanor.parker@adelaide.edu.au FAU - Misan, Gary AU - Misan G FAU - Chong, Alwin AU - Chong A FAU - Mills, Helen AU - Mills H FAU - Roberts-Thomson, Kaye AU - Roberts-Thomson K FAU - Horowitz, Alice M AU - Horowitz AM FAU - Jamieson, Lisa M AU - Jamieson LM LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20120620 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Adult MH - Australia MH - Dental Health Services/utilization MH - Follow-Up Studies MH - Health Knowledge, Attitudes, Practice/ethnology MH - Health Literacy/*statistics & numerical data MH - Humans MH - Oceanic Ancestry Group/*education MH - Oral Health/*ethnology MH - Program Evaluation MH - Questionnaires MH - Rural Health/*ethnology MH - Self Care MH - Self Efficacy PMC - PMC3416720 OID - NLM: PMC3416720 EDAT- 2012/06/22 06:00 MHDA- 2012/12/22 06:00 CRDT- 2012/06/22 06:00 PHST- 2012/03/05 [received] PHST- 2012/06/20 [accepted] PHST- 2012/06/20 [aheadofprint] AID - 1471-2458-12-461 [pii] AID - 10.1186/1471-2458-12-461 [doi] PST - epublish SO - BMC Public Health. 2012 Jun 20;12:461. doi: 10.1186/1471-2458-12-461. PMID- 22682504 OWN - NLM STAT- MEDLINE DA - 20121016 DCOM- 20130107 LR - 20131106 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 12 DP - 2012 TI - Acceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships. PG - 152 LID - 10.1186/1472-6963-12-152 [doi] AB - BACKGROUND: While participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery. METHODS: Local research groups comprising 13-19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively. RESULTS: Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by "putting issues on the table". While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships. CONCLUSION: Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that "boundary spanning" staff can facilitate commitment to partnership goals. FAU - Fuller, Jeffrey AU - Fuller J AD - School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. jeffrey.fuller@flinders.edu.au FAU - Hermeston, Wendy AU - Hermeston W FAU - Passey, Megan AU - Passey M FAU - Fallon, Tony AU - Fallon T FAU - Muyambi, Kuda AU - Muyambi K LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120610 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Australia MH - Capacity Building MH - *Community-Based Participatory Research MH - Cross-Cultural Comparison MH - Health Services, Indigenous MH - Humans MH - Oceanic Ancestry Group MH - Organizational Case Studies MH - *Problem Solving MH - Questionnaires MH - *Social Networking PMC - PMC3472193 OID - NLM: PMC3472193 EDAT- 2012/06/12 06:00 MHDA- 2013/01/08 06:00 CRDT- 2012/06/12 06:00 PHST- 2011/12/02 [received] PHST- 2012/04/20 [accepted] PHST- 2012/06/10 [aheadofprint] AID - 1472-6963-12-152 [pii] AID - 10.1186/1472-6963-12-152 [doi] PST - epublish SO - BMC Health Serv Res. 2012 Jun 10;12:152. doi: 10.1186/1472-6963-12-152. PMID- 22682494 OWN - NLM STAT- MEDLINE DA - 20120831 DCOM- 20121127 LR - 20131106 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 12 DP - 2012 TI - Reducing the health disparities of Indigenous Australians: time to change focus. PG - 151 LID - 10.1186/1472-6963-12-151 [doi] AB - BACKGROUND: Indigenous peoples have worse health than non-Indigenous, are over-represented amongst the poor and disadvantaged, have lower life expectancies, and success in improving disparities is limited. To address this, research usually focuses on disadvantaged and marginalised groups, offering only partial understanding of influences underpinning slow progress. Critical analysis is also required of those with the power to perpetuate or improve health inequities. In this paper, using Australia as a case example, we explore the effects of 'White', Anglo-Australian cultural dominance in health service delivery to Indigenous Australians. We address the issue using race as an organising principle, underpinned by relations of power. METHODS: Interviews with non-Indigenous medical practitioners in Western Australia with extensive experience in Indigenous health encouraged reflection and articulation of their insights into factors promoting or impeding quality health care to Indigenous Australians. Interviews were audio-taped and transcribed. An inductive, exploratory analysis identified key themes that were reviewed and interrogated in light of existing literature on health care to Indigenous people, race and disadvantage. The researchers' past experience, knowledge and understanding of health care and Indigenous health assisted with data interpretation. Informal discussions were also held with colleagues working professionally in Indigenous policy, practice and community settings. RESULTS: Racism emerged as a key issue, leading us to more deeply interrogate the role 'Whiteness' plays in Indigenous health care. While Whiteness can refer to skin colour, it also represents a racialized social structure where Indigenous knowledge, beliefs and values are subjugated to the dominant western biomedical model in policy and practice. Racism towards Indigenous patients in health services was institutional and interpersonal. Internalised racism was manifest when Indigenous patients incorporated racist attitudes and beliefs into their lived experience, lowering expectations and their sense of self-worth. CONCLUSIONS: Current health policies and practices favour standardised care where the voice of those who are marginalised is often absent. Examining the effectiveness of such models in reducing health disparities requires health providers to critically reflect on whether policies and practices promote or compromise Indigenous health and wellbeing--an important step in changing the discourse that places Indigenous people at the centre of the problem. FAU - Durey, Angela AU - Durey A AD - Curtin Health Innovation Research Unit, Curtin University, Perth, 6845, Western Australia. a.durey@curtin.edu.au FAU - Thompson, Sandra C AU - Thompson SC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120610 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Cultural Competency/education MH - Ethics, Institutional MH - European Continental Ancestry Group/psychology MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Health Services, Indigenous/ethics/*manpower/standards MH - Healthcare Disparities/*standards MH - Humans MH - Interviews as Topic MH - Male MH - Models, Organizational MH - *Oceanic Ancestry Group MH - Organizational Case Studies MH - Organizational Culture MH - *Physician-Patient Relations MH - Physicians/*psychology MH - Professional-Patient Relations MH - Qualitative Research MH - *Racism/prevention & control/statistics & numerical data MH - Skin Pigmentation MH - Western Australia PMC - PMC3431273 OID - NLM: PMC3431273 EDAT- 2012/06/12 06:00 MHDA- 2012/12/10 06:00 CRDT- 2012/06/12 06:00 PHST- 2011/10/25 [received] PHST- 2012/06/10 [accepted] PHST- 2012/06/10 [aheadofprint] AID - 1472-6963-12-151 [pii] AID - 10.1186/1472-6963-12-151 [doi] PST - epublish SO - BMC Health Serv Res. 2012 Jun 10;12:151. doi: 10.1186/1472-6963-12-151. PMID- 22682627 OWN - NLM STAT- MEDLINE DA - 20121026 DCOM- 20130314 LR - 20131106 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 12 DP - 2012 TI - A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern Territory, Australia. PG - 44 LID - 10.1186/1471-2393-12-44 [doi] AB - BACKGROUND: Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities. These comparisons obscure Indigenous disparities. There is much variation in terms of culture, language, residence, and access to services amongst Australian Indigenous peoples. We examined outcomes by region and remoteness for Indigenous subgroups and explored data for communities to inform health service delivery and interventions. METHODS: Our population-based study examined maternal and neonatal outcomes for 7,560 mothers with singleton pregnancies from Australia's Northern Territory Midwives' Data Collection (2003-2005) using uni- and multivariate analyses. Groupings were by Indigenous status; region (Top End (TE)/Central Australia (CA)); Remote/Urban residence; and across two large TE communities. RESULTS: Of the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non-Indigenous women. In comparison to CA Urban mothers: TE Remote (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13, 1.90) and TE Urban mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but CA Remote mothers (aOR 0.43; 95% CI: 0.31, 0.58) less likely to smoke during pregnancy; CA Remote mothers giving birth at >32 weeks gestation were less likely to have attended >/= five antenatal visits (aOR 0.55; 95%CI: 0.36, 0.86); TE Remote (aOR 0.71; 95%CI: 0.53, 0.95) and CA Remote women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/spinal/narcotic pain relief; and TE Remote (aOR 0.47; 95%CI: 0.34, 0.66), TE Urban (aOR 0.67; 95%CI: 0.46, 0.96) and CA Remote mothers (aOR 0.52; 95%CI: 0.35, 0.76) all had lower odds of having a 'normal' birth. The aOR for preterm birth for TE Remote newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137 g (95%CI: -216 g, -59 g) less than CA Urban babies. There were few significant differences for communities, except for smoking prevalence. CONCLUSIONS: This paper is one of few quantifying inequalities between groups of Australian Indigenous women and newborns at a regional level. Indigenous mothers and newborns do worse on some outcomes if they live remotely, especially if they live in the TE. Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper. FAU - Steenkamp, Malinda AU - Steenkamp M AD - University Centre for Rural Health North Coast, School of Public Health, University of Sydney, Lismore, Australia. malinda.steenkamp@sydney.edu.au FAU - Rumbold, Alice AU - Rumbold A FAU - Barclay, Lesley AU - Barclay L FAU - Kildea, Sue AU - Kildea S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120609 PL - England TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Adult MH - Cross-Sectional Studies MH - Culture MH - Female MH - Healthcare Disparities MH - Humans MH - Infant, Newborn MH - Northern Territory MH - *Oceanic Ancestry Group MH - Pregnancy MH - Pregnancy Outcome/*ethnology MH - Rural Population MH - Smoking/epidemiology PMC - PMC3480936 OID - NLM: PMC3480936 EDAT- 2012/06/12 06:00 MHDA- 2013/03/15 06:00 CRDT- 2012/06/12 06:00 PHST- 2011/08/25 [received] PHST- 2012/05/23 [accepted] PHST- 2012/06/09 [aheadofprint] AID - 1471-2393-12-44 [pii] AID - 10.1186/1471-2393-12-44 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2012 Jun 9;12:44. doi: 10.1186/1471-2393-12-44. PMID- 21503691 OWN - NLM STAT- MEDLINE DA - 20120425 DCOM- 20120914 IS - 1573-6628 (Electronic) IS - 1092-7875 (Linking) VI - 16 IP - 4 DP - 2012 May TI - Have the health gaps between Indigenous and non-Indigenous Australian children changed over time? Results from an Australian National Representative Longitudinal Study. PG - 814-23 LID - 10.1007/s10995-011-0786-9 [doi] AB - The purpose of this study was to evaluate the changes of health gaps between Indigenous and non-Indigenous children over time and to explore critical factors that contribute to the changes. We employed data consisting of two cohorts of Australian children: infant (0/1 year) and children (4/5 years) that are part of the Longitudinal Study of Australian Children. Health outcomes were measured by physical outcome index (POI) and parent-rated health during 2004, 2006 and 2008. We used first-order autoregressive modelling to examine the longitudinal relationship between the changes in health outcomes and possible contributing risk factors. The results showed that the trends of POIs between Indigenous and non-Indigenous children were closing, while the gap of parent-rated health between the two populations persisted. We found that health outcomes (both POI and parent-rated health) at an earlier time point (t - 1) were significant predictors of the outcomes at the later time point (t). Carer's depression status, socio-economic position and neighbourhood liveability had significant and consistent impacts on parent-rated health, but had only varying impacts on POIs between Indigenous and non-Indigenous children as well as between the birth cohorts at different time periods. Similarly, low birth weight, carer's binge drinking behaviour and other risk factors showed such varying impacts at a particular time period. The study implied that appropriate interventions accompanied by monitoring of health outcomes are necessary in order to decrease the health gaps between Indigenous and non-Indigenous children. FAU - Ou, Lixin AU - Ou L AD - The Simpson Centre for Health Services Research, University of New South Wales, Australia. lixin.ou@unsw.edu.au FAU - Chen, Jack AU - Chen J FAU - Hillman, Ken AU - Hillman K LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Matern Child Health J JT - Maternal and child health journal JID - 9715672 SB - IM MH - Australia MH - Child MH - Child, Preschool MH - Female MH - *Health Status Disparities MH - Healthcare Disparities/*statistics & numerical data MH - Humans MH - Infant MH - Infant, Newborn MH - Longitudinal Studies MH - Male MH - Oceanic Ancestry Group/*statistics & numerical data MH - Outcome Assessment (Health Care) MH - Residence Characteristics MH - Risk Factors MH - Socioeconomic Factors EDAT- 2011/04/20 06:00 MHDA- 2012/09/15 06:00 CRDT- 2011/04/20 06:00 AID - 10.1007/s10995-011-0786-9 [doi] PST - ppublish SO - Matern Child Health J. 2012 May;16(4):814-23. doi: 10.1007/s10995-011-0786-9. PMID- 22730934 OWN - NLM STAT- MEDLINE DA - 20120626 DCOM- 20120731 IS - 1036-1073 (Print) IS - 1036-1073 (Linking) VI - 23 IP - 1 DP - 2012 Apr TI - Developing and implementing a state-wide Aboriginal health promotion program: the process and factors influencing successful delivery. PG - 25-9 AB - ISSUE ADDRESSED: The prevalence of smoking among the adult Aboriginal population is almost double that of the non-Aboriginal population. Research shows smoking cessation brief interventions have a positive impact on quit attempts. However, examples of statewide, Aboriginal-led initiatives that ensure health service delivery of brief intervention to all Aboriginal clients are limited. METHODS: Guidance from an Aboriginal chief investigator and key health stakeholders supported the development of the NSW SmokeCheck Program. One component of the program was the establishment of a state-wide network of Aboriginal Health Workers (AHWs) and other health professional participants. Another was a culturally specific training program to strengthen the knowledge, skills, and confidence of participants to provide an evidence-based brief smoking-cessation intervention to Aboriginal clients. The brief intervention was based on the transtheoretical model of behaviour change, adapted for use in Aboriginal communities. RESULTS: SmokeCheck training reached 35.5% of the total NSW AHW workforce over a 15-month period. More than 90% of participants surveyed indicated satisfaction with the curriculum content, workshop structure and training delivery, agreeing that they found it relevant, easy to understand and applicable to practice. CONCLUSIONS: An evidence-based approach to designing and delivering an Aboriginal-specific health promotion intervention appears to have facilitated the development of a state-wide network of Aboriginal and non-Aboriginal health professionals and strengthened their capacity to deliver a brief smoking cessation intervention with Aboriginal clients. FAU - Wise, Marilyn AU - Wise M AD - School of Public Health and Community Medicine, University of New South Wales, Australia. m.wise@unsw.edu.au FAU - Massi, Luciana AU - Massi L FAU - Rose, Miranda AU - Rose M FAU - Nancarrow, Hannah AU - Nancarrow H FAU - Conigrave, Katherine AU - Conigrave K FAU - Bauman, Adrian AU - Bauman A FAU - Hearn, Shane AU - Hearn S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Health Promot J Austr JT - Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals JID - 9710936 SB - IM MH - Community Health Workers/organization & administration MH - Cultural Competency MH - Health Plan Implementation MH - Health Promotion/methods/*organization & administration MH - Health Services, Indigenous/*organization & administration MH - Humans MH - New South Wales/epidemiology MH - *Oceanic Ancestry Group MH - Patient Satisfaction MH - Smoking/ethnology MH - Smoking Cessation/*ethnology/*methods MH - Social Planning EDAT- 2012/06/27 06:00 MHDA- 2012/08/01 06:00 CRDT- 2012/06/27 06:00 PST - ppublish SO - Health Promot J Austr. 2012 Apr;23(1):25-9. PMID- 22333047 OWN - NLM STAT- MEDLINE DA - 20120315 DCOM- 20120620 LR - 20131014 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 12 DP - 2012 TI - The DRUID study: racism and self-assessed health status in an indigenous population. PG - 131 LID - 10.1186/1471-2458-12-131 [doi] AB - BACKGROUND: There is now considerable evidence from around the world that racism is associated with both mental and physical ill-health. However, little is known about the mediating factors between racism and ill-health. This paper investigates relationships between racism and self-assessed mental and physical health among Indigenous Australians as well as potential mediators of these relationships. METHODS: A total of 164 adults in the Darwin Region Urban Indigenous Diabetes (DRUID) study completed a validated instrument assessing interpersonal racism and a separate item on discrimination-related stress. Self-assessed health status was measured using the SF-12. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as mediators and moderators of the relationship between racism/discrimination and self-assessed health status. RESULTS: After adjusting for socio-demographic factors, interpersonal racism was significantly associated with the SF-12 mental (but not the physical) health component. Stress, lack of control and feeling powerless as a reaction to racism emerged as significant mediators of the relationship between racism and general mental health. Similar findings emerged for discrimination-related stress. CONCLUSIONS: Racism/discrimination is significantly associated with poor general mental health among this indigenous population. The mediating factors between racism and mental health identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health. In particular, the importance of reducing racism-related stress, enhancing general levels of mastery, and minimising negative social connections in order to ameliorate the negative consequences of racism. FAU - Paradies, Yin C AU - Paradies YC AD - McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia. yinp@unimelb.edu.au FAU - Cunningham, Joan AU - Cunningham J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120214 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Australia MH - Female MH - *Health Status Disparities MH - Humans MH - Male MH - Middle Aged MH - *Oceanic Ancestry Group MH - *Prejudice MH - *Self Report MH - Stress, Psychological MH - Young Adult PMC - PMC3305656 OID - NLM: PMC3305656 EDAT- 2012/02/16 06:00 MHDA- 2012/06/21 06:00 CRDT- 2012/02/16 06:00 PHST- 2011/08/02 [received] PHST- 2012/02/14 [accepted] PHST- 2012/02/14 [aheadofprint] AID - 1471-2458-12-131 [pii] AID - 10.1186/1471-2458-12-131 [doi] PST - epublish SO - BMC Public Health. 2012 Feb 14;12:131. doi: 10.1186/1471-2458-12-131. PMID- 22304605 OWN - NLM STAT- MEDLINE DA - 20120206 DCOM- 20120619 IS - 1326-5377 (Electronic) IS - 0025-729X (Linking) VI - 196 DP - 2012 Feb 6 TI - Mental health of Indigenous Australians: a review of findings from community surveys. PG - 118-21 AB - OBJECTIVE: To assemble what is known about the mental health of Indigenous Australians from community surveys. DATA SOURCES: A systematic search was carried out of publications and data sources since 2000 using PubMed, PsycINFO, Australian Medical Index, the National Library of Australia and datasets known to the authors. STUDY SELECTION: Surveys had to involve representative sampling of a population, identify Aboriginal and Torres Strait Islander people and include a measure of mental health. DATA EXTRACTION: 11 surveys were found. Data were extracted on prevalence rates for Indigenous people by age and sex, along with comparison data from the general population, where available. DATA SYNTHESIS: Across seven studies, Indigenous adults were consistently found to have a higher prevalence of self-reported psychological distress than the general community. However, two studies of Indigenous adolescents did not find a higher prevalence of psychological distress. Two surveys of parents and carers of Indigenous children and adolescents found a higher prevalence of behaviour problems. CONCLUSIONS: There is an inequality in mental health between Indigenous and non-Indigenous Australians that starts from an early age. This needs to be a priority for research, preventive action and health services. FAU - Jorm, Anthony F AU - Jorm AF AD - Orygen Youth Health Research Centre, University of Melbourne, Melbourne, VIC. ajorm@unimelb.edu.au FAU - Bourchier, Sarah J AU - Bourchier SJ FAU - Cvetkovski, Stefan AU - Cvetkovski S FAU - Stewart, Gavin AU - Stewart G LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM CIN - Med J Aust. 2012 Feb 6;196:89-90. PMID: 22304588 MH - Australia/epidemiology MH - *Health Status Disparities MH - Health Surveys MH - Humans MH - Mental Disorders/*ethnology MH - Mental Health/*ethnology MH - Oceanic Ancestry Group/*psychology MH - Prevalence EDAT- 2012/02/07 06:00 MHDA- 2012/06/20 06:00 CRDT- 2012/02/07 06:00 AID - jor10041_fm [pii] PST - ppublish SO - Med J Aust. 2012 Feb 6;196:118-21. PMID- 22095336 OWN - NLM STAT- MEDLINE DA - 20120306 DCOM- 20120425 LR - 20140109 IS - 1541-0048 (Electronic) IS - 0090-0036 (Linking) VI - 102 IP - 1 DP - 2012 Jan TI - Social gradients in the health of Indigenous Australians. PG - 107-17 LID - 10.2105/AJPH.2011.300354 [doi] AB - The pattern of association between socioeconomic factors and health outcomes has primarily depicted better health for those who are higher in the social hierarchy. Although this is a ubiquitous finding in the health literature, little is known about the interplay between these factors among indigenous populations. We begin to bridge this knowledge gap by assessing evidence on social gradients in indigenous health in Australia. We reveal a less universal and less consistent socioeconomic status patterning in health among Indigenous Australians, and discuss the plausibility of unique historical circumstances and social and cultural characteristics in explaining these patterns. A more robust evidence base in this field is fundamental to processes that aim to reduce the pervasive disparities between indigenous and nonindigenous population health. FAU - Shepherd, Carrington C J AU - Shepherd CC AD - Centre for Developmental Health, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia. carringtons@ichr.uwa.edu.au FAU - Li, Jianghong AU - Li J FAU - Zubrick, Stephen R AU - Zubrick SR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20111128 PL - United States TA - Am J Public Health JT - American journal of public health JID - 1254074 SB - AIM SB - IM MH - Birth Weight MH - Culture MH - *Health Status MH - Health Status Disparities MH - *Hierarchy, Social MH - Humans MH - Mental Health MH - Morbidity MH - Oceanic Ancestry Group/*statistics & numerical data MH - Socioeconomic Factors PMC - PMC3490556 OID - NLM: PMC3490556 EDAT- 2011/11/19 06:00 MHDA- 2012/04/26 06:00 CRDT- 2011/11/19 06:00 PHST- 2011/11/28 [aheadofprint] AID - AJPH.2011.300354 [pii] AID - 10.2105/AJPH.2011.300354 [doi] PST - ppublish SO - Am J Public Health. 2012 Jan;102(1):107-17. doi: 10.2105/AJPH.2011.300354. Epub 2011 Nov 28. PMID- 21426422 OWN - NLM STAT- MEDLINE DA - 20120103 DCOM- 20120427 IS - 1465-3362 (Electronic) IS - 0959-5236 (Linking) VI - 31 IP - 1 DP - 2012 Jan TI - How and when health-care practitioners in Aboriginal Community Controlled Health Services deliver alcohol screening and brief intervention, and why they don't: a qualitative study. PG - 13-9 LID - 10.1111/j.1465-3362.2011.00305.x [doi] AB - INTRODUCTION: Indigenous Australians experience a disproportionately high burden of alcohol-related harm. Alcohol screening and brief intervention (SBI) offers the potential to reduce this harm if barriers to its delivery in Aboriginal Community Controlled Health Services (ACCHSs) can be optimally targeted. AIMS: . Examine health-care practitioners' perceptions of, and practices in, alcohol SBI in ACCHSs. METHODS: Semi-structured group interviews with 37 purposively selected health staff across five ACCHSs. RESULTS: Alcohol screening independent of standard health assessments was generally selective. The provision of brief intervention was dependent upon factors related to the patient. Four key factors underlying health-care practitioners' perceptions of alcohol SBI were prominent: outcome expectancy; role congruence; utilisation of clinical systems and processes; and options for alcohol referral. Discussion. The influence of outcome expectancy and role congruence on health-care practitioners' alcohol SBI practices has been identified previously, as has to a lesser extent, their less than optimal use of clinical systems and processes. The influence of options for alcohol referral on health-care practitioners' willingness to deliver alcohol SBI primarily related to their misunderstanding of alcohol SBI and the lack of culturally appropriate alcohol referral options for their patients. CONCLUSION: An intervention combining interactive, supportive and reinforcing evidence-based dissemination strategies is most likely required to enhance health-care practitioners' knowledge and skills in alcohol SBI delivery, positively orientate them to their role in its delivery, and facilitate integration of evidence-based alcohol SBI into routine clinical processes and locally available systems CI - (c) 2011 Australasian Professional Society on Alcohol and other Drugs. FAU - Clifford, Anton AU - Clifford A AD - National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia. a.clifford@unsw.edu.au FAU - Shakeshaft, Anthony AU - Shakeshaft A FAU - Deans, Catherine AU - Deans C LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110322 PL - England TA - Drug Alcohol Rev JT - Drug and alcohol review JID - 9015440 SB - IM MH - Alcohol Drinking/epidemiology/ethnology/*prevention & control MH - Alcohol-Related Disorders/*diagnosis/epidemiology/ethnology/prevention & control MH - Attitude of Health Personnel MH - Australia/epidemiology MH - Community Health Services/*organization & administration MH - Counseling/statistics & numerical data MH - Health Care Surveys MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Oceanic Ancestry Group/statistics & numerical data MH - Psychotherapy, Brief/statistics & numerical data MH - Referral and Consultation/statistics & numerical data MH - Substance Abuse Detection/methods/*statistics & numerical data EDAT- 2011/03/24 06:00 MHDA- 2012/04/28 06:00 CRDT- 2011/03/24 06:00 PHST- 2011/03/22 [aheadofprint] AID - 10.1111/j.1465-3362.2011.00305.x [doi] PST - ppublish SO - Drug Alcohol Rev. 2012 Jan;31(1):13-9. doi: 10.1111/j.1465-3362.2011.00305.x. Epub 2011 Mar 22. PMID- 22032537 OWN - NLM STAT- MEDLINE DA - 20120126 DCOM- 20120601 LR - 20120810 IS - 1445-5994 (Electronic) IS - 1444-0903 (Linking) VI - 42 IP - 1 DP - 2012 Jan TI - Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. PG - 17-22 LID - 10.1111/j.1445-5994.2011.02628.x [doi] AB - Improvements in Aboriginal health have been slow. Research demonstrates ongoing discrimination towards Aboriginal Australians based on race, including in health services, leads to poor health outcomes. Using an eclectic methodology based on observations and discussions with health practitioners experienced in working with Aboriginal patients, this paper identifies how cross-cultural misunderstandings undermine the quality of care to Aboriginal patients in hospital and offers suggestions for improving practice. It also explores the concept of institutional racism and challenges doctors to reflect on their role in perpetuating power imbalances. We argue that physicians and healthcare providers need to do more than just deliver evidence-based interventions, by critically reflecting on their own attitudes to and practices with Aboriginal Australians and work collectively to effect systemic change which creates a more inclusive and safe environment for all people accessing healthcare. CI - (c) 2011 The Authors. Internal Medicine Journal (c) 2011 Royal Australasian College of Physicians. FAU - Durey, A AU - Durey A AD - Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia. a.durey@curtin.edu.au FAU - Thompson, S C AU - Thompson SC FAU - Wood, M AU - Wood M LA - eng PT - Journal Article PL - Australia TA - Intern Med J JT - Internal medicine journal JID - 101092952 SB - IM CIN - Intern Med J. 2012 Jun;42(6):734-5. PMID: 22697163 MH - Attitude of Health Personnel MH - *Communication Barriers MH - Cultural Characteristics MH - Forecasting MH - Humans MH - Institutional Practice/*standards MH - *Oceanic Ancestry Group/psychology MH - *Organizational Policy MH - Physician's Role MH - *Prejudice MH - Professional-Patient Relations MH - Quality Improvement MH - Quality of Health Care/standards MH - Social Change MH - Socioeconomic Factors EDAT- 2011/10/29 06:00 MHDA- 2012/06/02 06:00 CRDT- 2011/10/29 06:00 AID - 10.1111/j.1445-5994.2011.02628.x [doi] PST - ppublish SO - Intern Med J. 2012 Jan;42(1):17-22. doi: 10.1111/j.1445-5994.2011.02628.x. PMID- 21951514 OWN - NLM STAT- MEDLINE DA - 20111017 DCOM- 20120124 LR - 20131016 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 11 DP - 2011 TI - A multilevel analysis on the relationship between neighbourhood poverty and public hospital utilization: is the high Indigenous morbidity avoidable? PG - 737 LID - 10.1186/1471-2458-11-737 [doi] AB - BACKGROUND: The estimated life expectancy at birth for Indigenous Australians is 10-11 years less than the general Australian population. The mean family income for Indigenous people is also significantly lower than for non-Indigenous people. In this paper we examine poverty or socioeconomic disadvantage as an explanation for the Indigenous health gap in hospital morbidity in Australia. METHODS: We utilised a cross-sectional and ecological design using the Northern Territory public hospitalisation data from 1 July 2004 to 30 June 2008 and socio-economic indexes for areas (SEIFA) from the 2006 census. Multilevel logistic regression models were used to estimate odds ratios and confidence intervals. Both total and potentially avoidable hospitalisations were investigated. RESULTS: This study indicated that lifting SEIFA scores for family income and education/occupation by two quintile categories for low socio-economic Indigenous groups was sufficient to overcome the excess hospital utilisation among the Indigenous population compared with the non-Indigenous population. The results support a reframing of the Indigenous health gap as being a consequence of poverty and not simplistically of ethnicity. CONCLUSIONS: Socio-economic disadvantage is a likely explanation for a substantial proportion of the hospital morbidity gap between Indigenous and non-Indigenous populations. Efforts to improve Indigenous health outcomes should recognise poverty as an underlying determinant of the health gap. FAU - Zhao, Yuejen AU - Zhao Y AD - Health Gains Planning Branch, Northern Territory Department of Health, PO Box 40596, Casuarina NT 0811, Australia. yuejen.zhao@nt.gov.au FAU - You, Jiqiong AU - You J FAU - Guthridge, Steven L AU - Guthridge SL FAU - Lee, Andy H AU - Lee AH LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110927 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Australia MH - Confidence Intervals MH - Cross-Sectional Studies MH - Female MH - *Health Status Disparities MH - Hospitals, Public/*utilization MH - Humans MH - Male MH - Middle Aged MH - Morbidity/*trends MH - *Oceanic Ancestry Group MH - Odds Ratio MH - *Poverty Areas MH - Regression Analysis MH - Social Class PMC - PMC3203263 OID - NLM: PMC3203263 EDAT- 2011/09/29 06:00 MHDA- 2012/01/25 06:00 CRDT- 2011/09/29 06:00 PHST- 2011/03/14 [received] PHST- 2011/09/27 [accepted] PHST- 2011/09/27 [aheadofprint] AID - 1471-2458-11-737 [pii] AID - 10.1186/1471-2458-11-737 [doi] PST - epublish SO - BMC Public Health. 2011 Sep 27;11:737. doi: 10.1186/1471-2458-11-737. PMID- 21871191 OWN - NLM STAT- MEDLINE DA - 20110829 DCOM- 20110930 IS - 0156-5788 (Print) IS - 0156-5788 (Linking) VI - 35 IP - 3 DP - 2011 Aug TI - Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services. PG - 297-308 LID - 10.1071/AH10936 [doi] AB - BACKGROUND: Although effective partnerships between Aboriginal and mainstream health services are critical to improve Aboriginal health outcomes, many factors can cause these partnerships to be tenuous and unproductive. Understanding the elements of best practice for successful partnerships is essential. METHODS: A literature review was conducted in 2009 using keyword searches of electronic databases. Sourced literature was assessed for relevance regarding the benefits, challenges, lessons learnt and factors contributing to successful Aboriginal and mainstream partnerships. Key themes were collated. RESULTS: Although there is much literature regarding general partnerships generally, few specifically examine Aboriginal and mainstream health service partnerships. Twenty-four sources were reviewed in detail. Benefits include broadening service capacity and improving the cultural security of healthcare. Challenges include the legacy of Australia's colonial history, different approaches to servicing clients and resource limitations. Recommendations for success include workshopping tensions early, building trust and leadership. CONCLUSION: Although successful partnerships are crucial to optimise Aboriginal health outcomes, failed collaborations risk inflaming sensitive Aboriginal-non-Aboriginal relationships. Factors supporting successful partnerships remind us to develop genuine, trusting relationships that are tangibly linked to the Aboriginal community. Failure to invest in this relational process and push forward with 'business as usual' can ultimately have negative ramifications on client outcomes. FAU - Taylor, Kate P AU - Taylor KP AD - Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, WA 6531, Australia. kate.taylor@cucrh.uwa.edu.au FAU - Thompson, Sandra C AU - Thompson SC LA - eng PT - Journal Article PT - Review PL - Australia TA - Aust Health Rev JT - Australian health review : a publication of the Australian Hospital Association JID - 8214381 SB - H MH - *Cooperative Behavior MH - *Health Services Accessibility MH - *Healthcare Disparities MH - Humans MH - *Oceanic Ancestry Group EDAT- 2011/08/30 06:00 MHDA- 2011/10/01 06:00 CRDT- 2011/08/30 06:00 PHST- 2010/06/17 [received] PHST- 2010/10/21 [accepted] AID - AH10936 [pii] AID - 10.1071/AH10936 [doi] PST - ppublish SO - Aust Health Rev. 2011 Aug;35(3):297-308. doi: 10.1071/AH10936. PMID- 21770871 OWN - NLM STAT- MEDLINE DA - 20110720 DCOM- 20110921 IS - 1326-5377 (Electronic) IS - 0025-729X (Linking) VI - 195 IP - 2 DP - 2011 Jul 18 TI - Improving Aboriginal and Torres Strait Islander people's access to medicines--the QUMAX program. PG - 62-3 FAU - Couzos, Sophie AU - Couzos S FAU - Sheedy, Vicki AU - Sheedy V FAU - Delaney Thiele, Dea AU - Delaney Thiele D LA - eng PT - Journal Article PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 RN - 0 (Prescription Drugs) SB - IM MH - Australia MH - *Health Services Accessibility/organization & administration MH - Humans MH - *Oceanic Ancestry Group MH - Prescription Drugs/*supply & distribution MH - Quality of Health Care/organization & administration EDAT- 2011/07/21 06:00 MHDA- 2011/09/22 06:00 CRDT- 2011/07/21 06:00 AID - cou10504_fm [pii] PST - ppublish SO - Med J Aust. 2011 Jul 18;195(2):62-3. PMID- 21953661 OWN - NLM STAT- MEDLINE DA - 20110928 DCOM- 20120217 LR - 20120501 IS - 1554-558X (Electronic) IS - 0894-1912 (Linking) VI - 31 IP - 3 DP - 2011 Summer TI - Educating clinicians about cultural competence and disparities in health and health care. PG - 196-206 LID - 10.1002/chp.20127 [doi] AB - An extensive body of literature has documented significant racial and ethnic disparities in health and health care. Cultural competency interventions, including the training of physicians and other health care professionals, have been proposed as a key strategy for helping to reduce these disparities. The continuing medical education (CME) profession can play an important role in addressing this need by improving the quality and assessing the outcomes of multicultural education programs. This article provides an overview of health care policy, legislative, accreditation, and professional initiatives relating to these subjects. The status of CME offerings on cultural competence/disparities is reviewed, with examples provided of available curricular resources and online courses. Critiques of cultural competence training and selected studies of its effectiveness are discussed. The need for the CME profession to become more culturally competent in its development, implementation, and evaluation of education programs is examined. Future challenges and opportunities are described, and a call for leadership and action is issued. CI - Copyright (c) 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education. FAU - Like, Robert C AU - Like RC AD - Center for Healthy Families and Cultural Diversity, Department of Family Medicine and Community Health, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA. like@umdnj.edu LA - eng PT - Journal Article PT - Review PL - United States TA - J Contin Educ Health Prof JT - The Journal of continuing education in the health professions JID - 8805847 SB - IM MH - Continental Population Groups MH - Cultural Competency/*education MH - Education, Medical, Continuing/*organization & administration MH - Ethnic Groups MH - Health Policy MH - *Health Status Disparities MH - Healthcare Disparities/*ethnology MH - Humans MH - United States EDAT- 2011/09/29 06:00 MHDA- 2012/02/18 06:00 CRDT- 2011/09/29 06:00 AID - 10.1002/chp.20127 [doi] PST - ppublish SO - J Contin Educ Health Prof. 2011 Summer;31(3):196-206. doi: 10.1002/chp.20127. PMID- 21627724 OWN - NLM STAT- MEDLINE DA - 20110601 DCOM- 20110808 IS - 1753-6405 (Electronic) IS - 1326-0200 (Linking) VI - 35 IP - 3 DP - 2011 Jun TI - Successful chronic disease care for Aboriginal Australians requires cultural competence. PG - 238-48 LID - 10.1111/j.1753-6405.2011.00701.x [doi] AB - OBJECTIVE: To review the literature to determine the attributes of culturally appropriate healthcare to inform the design of chronic disease management (CDM) models for Aboriginal patients in urban general practice. METHODS: A comprehensive conceptual framework, drawing on the Access to Care, Pathway to Care, Chronic Care, Level of Connectedness, and Cultural Security, Cultural Competency and Cultural Respect models, was developed to define the search strategy, inclusion criteria and appraisal methods for the literature review. Selected papers were reviewed in detail if they examined a chronic disease intervention for an Aboriginal population and reported on its evaluation, impacts or outcomes. RESULTS: In the 173 papers examined, only 11 programs met the inclusion criteria. All were programs conducted in rural and remote Aboriginal community-controlled health services. Successful chronic disease care and interventions require adequate Aboriginal community engagement, utilising local knowledge, strong leadership, shared responsibilities, sustainable resources and integrated data and systems. These success factors fitted within the conceptual framework developed. CONCLUSIONS: Research and development of culturally appropriate CDM models concurrently in both urban and rural settings will enable more rigorous evaluation, leading to stronger evidence for best practice. A partnership of mainstream and Aboriginal-controlled health services is essential to successfully 'close the gap'. IMPLICATIONS: Findings will inform and guide the development, implementation and evaluation of culturally appropriate CDM in mainstream general practice and primary care. CI - (c) 2011 The Authors. ANZJPH (c) 2011 Public Health Association of Australia. FAU - Liaw, Siaw Teng AU - Liaw ST AD - School of Public Health and Community Medicine, University of New South Wales, Australia. FAU - Lau, Phyllis AU - Lau P FAU - Pyett, Priscilla AU - Pyett P FAU - Furler, John AU - Furler J FAU - Burchill, Marlene AU - Burchill M FAU - Rowley, Kevin AU - Rowley K FAU - Kelaher, Margaret AU - Kelaher M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - Australia TA - Aust N Z J Public Health JT - Australian and New Zealand journal of public health JID - 9611095 SB - IM MH - Australia MH - Chronic Disease/*ethnology/therapy MH - *Cultural Characteristics MH - *Cultural Competency MH - Culture MH - Delivery of Health Care/*methods MH - Health Knowledge, Attitudes, Practice MH - Health Services, Indigenous/*organization & administration MH - Humans MH - Models, Theoretical MH - *Oceanic Ancestry Group MH - Primary Health Care/organization & administration MH - Urban Population EDAT- 2011/06/02 06:00 MHDA- 2011/08/09 06:00 CRDT- 2011/06/02 06:00 AID - 10.1111/j.1753-6405.2011.00701.x [doi] PST - ppublish SO - Aust N Z J Public Health. 2011 Jun;35(3):238-48. doi: 10.1111/j.1753-6405.2011.00701.x. PMID- 21644897 OWN - NLM STAT- MEDLINE DA - 20110607 DCOM- 20110810 IS - 1326-5377 (Electronic) IS - 0025-729X (Linking) VI - 194 IP - 10 DP - 2011 May 16 TI - Social determinants and the health of Indigenous Australians. PG - 512-3 AB - Health is dependent on conditions that enable people to live lives they would choose to live. FAU - Marmot, Michael AU - Marmot M LA - eng PT - Editorial PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM MH - Australia MH - *Health Status Disparities MH - Humans MH - Life Expectancy/ethnology MH - *Oceanic Ancestry Group MH - *Socioeconomic Factors EDAT- 2011/06/08 06:00 MHDA- 2011/08/11 06:00 CRDT- 2011/06/08 06:00 PHST- 2011/04/17 [received] PHST- 2011/04/17 [accepted] AID - mar10460_fm [pii] PST - ppublish SO - Med J Aust. 2011 May 16;194(10):512-3. PMID- 21644891 OWN - NLM STAT- MEDLINE DA - 20110607 DCOM- 20110810 LR - 20110922 IS - 1326-5377 (Electronic) IS - 0025-729X (Linking) VI - 194 IP - 10 DP - 2011 May 16 TI - How can Australia do better for Indigenous health? PG - 501-2 AB - Respect, tolerance and trust in Aboriginal and Torres Strait Islander people are needed from government to improve the health and wellbeing of Indigenous Australians. FAU - Tait, Peter W AU - Tait PW LA - eng PT - Editorial PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM CIN - Med J Aust. 2011 Sep 5;195(5):265-6. PMID: 21895590 MH - Australia MH - Female MH - *Health Policy MH - *Health Status MH - Healthcare Disparities MH - Humans MH - Life Expectancy MH - Male MH - *Oceanic Ancestry Group MH - Prejudice MH - *Quality of Health Care EDAT- 2011/06/08 06:00 MHDA- 2011/08/11 06:00 CRDT- 2011/06/08 06:00 PHST- 2011/03/21 [received] PHST- 2011/04/13 [accepted] AID - tai10318_fm [pii] PST - ppublish SO - Med J Aust. 2011 May 16;194(10):501-2. PMID- 21438948 OWN - NLM STAT- MEDLINE DA - 20110328 DCOM- 20110729 IS - 1440-1584 (Electronic) IS - 1038-5282 (Linking) VI - 19 IP - 2 DP - 2011 Apr TI - Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa. PG - 70-4 LID - 10.1111/j.1440-1584.2011.01186.x [doi] AB - OBJECTIVE: Access barriers to health care for minority populations has been a feature of medical, health and social science literature for over a decade. Considerations of cultural barriers have featured in this literature, but definitions of what constitutes a cultural barrier have varied. In this paper, data from recent interviews with Aboriginal and Torres Strait Islander people, Aboriginal Health Workers and other non-Indigenous health professionals in north-west Queensland assist to refine the meaning of this term and uncovered other issues disguised as 'cultural' difference. DESIGN: Semistructured interviews with community and health professionals. SETTING: Mount Isa, Queensland, Australia. PARTICIPANTS: Aboriginal and Torres Strait Islanders, Aboriginal Health Workers and other health professionals in Mount Isa between 2007 and 2009. RESULTS: Cultural barriers were considered differently by Aboriginal patients and health practitioners. While Aboriginal patients focused heavily on social relationships and issues of respect and trust, most practitioners seemed more focused on making Aboriginal people feel comfortable with changes to physical environments and systems, with less emphasis on creating strong interpersonal relationships. CONCLUSIONS: For Aboriginal patients the focus on interpersonal relationships between themselves and health practitioners is paramount. Creating comforting physical environments and systems that are easier to navigate do assist in overcoming cultural barriers, but are often seen as little more than token gestures if trusting interpersonal relationships are not formed between patient and practitioner. CI - (c) 2011 The Authors. Australian Journal of Rural Health (c) National Rural Health Alliance Inc. FAU - McBain-Rigg, Kristin E AU - McBain-Rigg KE AD - Mount Isa Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland 4825, Australia. kris.mcbain@jcu.edu.au FAU - Veitch, Craig AU - Veitch C LA - eng PT - Journal Article PL - Australia TA - Aust J Rural Health JT - The Australian journal of rural health JID - 9305903 SB - N MH - *Culture MH - Health Personnel MH - Health Services, Indigenous MH - Humans MH - Interviews as Topic MH - *Oceanic Ancestry Group MH - Patient Acceptance of Health Care/*ethnology MH - Queensland EDAT- 2011/03/29 06:00 MHDA- 2011/07/30 06:00 CRDT- 2011/03/29 06:00 AID - 10.1111/j.1440-1584.2011.01186.x [doi] PST - ppublish SO - Aust J Rural Health. 2011 Apr;19(2):70-4. doi: 10.1111/j.1440-1584.2011.01186.x. PMID- 21385387 OWN - NLM STAT- MEDLINE DA - 20110330 DCOM- 20110712 LR - 20131018 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 11 DP - 2011 TI - Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative. PG - 16 LID - 10.1186/1471-2393-11-16 [doi] AB - BACKGROUND: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. METHODS: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. RESULTS: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. CONCLUSION: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services. FAU - Rumbold, Alice R AU - Rumbold AR AD - Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA, Australia. alice.rumbold@adelaide.edu.au. FAU - Bailie, Ross S AU - Bailie RS FAU - Si, Damin AU - Si D FAU - Dowden, Michelle C AU - Dowden MC FAU - Kennedy, Catherine M AU - Kennedy CM FAU - Cox, Rhonda J AU - Cox RJ FAU - O'Donoghue, Lynette AU - O'Donoghue L FAU - Liddle, Helen E AU - Liddle HE FAU - Kwedza, Ru K AU - Kwedza RK FAU - Thompson, Sandra C AU - Thompson SC FAU - Burke, Hugh P AU - Burke HP FAU - Brown, Alex D H AU - Brown AD FAU - Weeramanthri, Tarun AU - Weeramanthri T FAU - Connors, Christine M AU - Connors CM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110307 PL - England TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Adolescent MH - Adult MH - Australia MH - Cross-Sectional Studies MH - Delivery of Health Care/*statistics & numerical data MH - Documentation MH - Female MH - Guideline Adherence/statistics & numerical data MH - Humans MH - Maternal Health Services/*utilization MH - Medical Audit MH - Middle Aged MH - Oceanic Ancestry Group MH - Postnatal Care/*statistics & numerical data/utilization MH - Pregnancy MH - Prenatal Care/*statistics & numerical data/utilization MH - Primary Health Care MH - Quality Improvement MH - Quality Indicators, Health Care MH - Tobacco Use Cessation/statistics & numerical data MH - Young Adult PMC - PMC3066246 OID - NLM: PMC3066246 EDAT- 2011/03/10 06:00 MHDA- 2011/07/13 06:00 CRDT- 2011/03/10 06:00 PHST- 2010/10/07 [received] PHST- 2011/03/07 [accepted] PHST- 2011/03/07 [aheadofprint] AID - 1471-2393-11-16 [pii] AID - 10.1186/1471-2393-11-16 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2011 Mar 7;11:16. doi: 10.1186/1471-2393-11-16. PMID- 21367325 OWN - NLM STAT- MEDLINE DA - 20110303 DCOM- 20110622 IS - 0156-5788 (Print) IS - 0156-5788 (Linking) VI - 35 IP - 1 DP - 2011 Feb TI - Making the connection: a qualitative study of brokerage in Aboriginal health in a metropolitan area of Victoria and a regional area of New South Wales. PG - 18-22 LID - 10.1071/AH09809 [doi] AB - OBJECTIVE: Health brokerage is one method being employed by government health agencies in an attempt to improve Aboriginal and Torres Strait Islander people's access to primary healthcare. This qualitative study explores key stakeholders' understanding and acceptance of the health brokerage model, prior to the implementation of brokerage services. METHODS: Semistructured interviews and focus groups were conducted with key stakeholders. The resulting data was analysed using a grounded theory approach. RESULTS: Qualitative analysis of the interviews and focus groups revealed five major themes. These were: (1) the perceived limitations of brokerage as a service delivery model; (2) the benefits of health brokerage such as increased flexibility; (3) issues relating to patient independence; (4) the necessity for broker independence; and (5) a mistrust of health brokerage and the authority handling the brokerage funds. CONCLUSIONS: Since this study was conducted in 2008, ongoing funding for urban brokerage services has been suspended. Although the reasons for this are unclear, our study suggests that barriers to the acceptance of brokerage services by the community may have existed even before such services were implemented, thus highlighting the need for transparency when launching new health initiatives that hope to engage the Aboriginal community. FAU - Cheng, Melanie S AU - Cheng MS AD - Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053, Australia. mscheng@unimelb.edu.au FAU - Clarke, Angela AU - Clarke A FAU - Moore, Timothy D AU - Moore TD FAU - Lau, Phyllis M AU - Lau PM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Aust Health Rev JT - Australian health review : a publication of the Australian Hospital Association JID - 8214381 SB - H MH - Focus Groups MH - *Health Knowledge, Attitudes, Practice MH - Health Services Accessibility/*organization & administration MH - Humans MH - Interviews as Topic MH - Models, Organizational MH - New South Wales MH - *Oceanic Ancestry Group MH - Victoria EDAT- 2011/03/04 06:00 MHDA- 2011/06/23 06:00 CRDT- 2011/03/04 06:00 PHST- 2009/07/15 [received] PHST- 2010/06/23 [accepted] AID - AH09809 [pii] AID - 10.1071/AH09809 [doi] PST - ppublish SO - Aust Health Rev. 2011 Feb;35(1):18-22. doi: 10.1071/AH09809. PMID- 21299698 OWN - NLM STAT- MEDLINE DA - 20110208 DCOM- 20110406 IS - 1753-6405 (Electronic) IS - 1326-0200 (Linking) VI - 35 IP - 1 DP - 2011 Feb TI - Ethnic and Indigenous access to early childhood healthcare services in Australia: parents' perceived unmet needs and related barriers. PG - 30-7 LID - 10.1111/j.1753-6405.2010.00633.x [doi] AB - OBJECTIVE: To evaluate the parents' perceived unmet needs in early childhood healthcare services among Indigenous, non-English-speaking background (NESB) and English-speaking background (ESB) children and the related barriers. METHOD: Data was from the Longitudinal Study of Australian Children (LSAC). Rao-Scott chi-square was used to examine the level of parents' perceived unmet needs in three ethnic groups in early childhood healthcare services over a 12 month period. Survey logistic regression was used to assess the association between the groups of infants and the barriers to utilisation. RESULTS: Ten per cent of Australian infants have at least one parents' perceived unmet need in early childhood healthcare services. NESB (15.3%) and Indigenous (15.1%) infants were more likely than ESB infants (9.9%, p<0.001) to have parents' perceived unmet needs in health care services. The barriers to service access include cost, transport problems, child care difficulties, service availability and family reasons. Parents of ESB infants were more likely to cite operating hours as the major barrier to accessing services. CONCLUSION: There were parents' perceived unmet needs in a number of health services for all Australian infants, but at different levels by Indigenous, NESB and ESB groups. The most common barrier to services utilisation related to cost or private health insurance, availability and accessibility of service provision and other socioeconomic issues. IMPLICATIONS: Policy attention and operational changes are required to improve equity in accessing early childhood services, as well as to improve the overall access to healthcare services for all Australian infants. CI - (c) 2011 The Authors. ANZJPH (c) 2011 Public Health Association of Australia. FAU - Ou, Lixin AU - Ou L AD - The Simpson Centre for Health Services Research, University of New South Wales. Lixin.Ou@sswahs.nsw.gov.au FAU - Chen, Jack AU - Chen J FAU - Garrett, Pamela AU - Garrett P FAU - Hillman, Ken AU - Hillman K LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20101209 PL - Australia TA - Aust N Z J Public Health JT - Australian and New Zealand journal of public health JID - 9611095 SB - IM MH - Australia MH - Child Health Services/organization & administration/*utilization MH - Communication Barriers MH - Ethnic Groups MH - Female MH - Health Services Accessibility/organization & administration/*statistics & numerical data MH - Health Services Needs and Demand/organization & administration/*statistics & numerical data MH - *Healthcare Disparities MH - Humans MH - Infant MH - Logistic Models MH - Longitudinal Studies MH - Male MH - Oceanic Ancestry Group MH - Parents/*psychology MH - Questionnaires MH - Socioeconomic Factors EDAT- 2011/02/09 06:00 MHDA- 2011/04/07 06:00 CRDT- 2011/02/09 06:00 PHST- 2010/12/09 [aheadofprint] AID - 10.1111/j.1753-6405.2010.00633.x [doi] PST - ppublish SO - Aust N Z J Public Health. 2011 Feb;35(1):30-7. doi: 10.1111/j.1753-6405.2010.00633.x. Epub 2010 Dec 9. PMID- 21301687 OWN - NLM STAT- MEDLINE DA - 20110208 DCOM- 20110607 IS - 0300-8495 (Print) IS - 0300-8495 (Linking) VI - 40 IP - 1-2 DP - 2011 Jan-Feb TI - Indigenous health - a role for private general practice. PG - 16-9 AB - BACKGROUND: The Aboriginal and Torres Strait Islander life expectancy gap is associated with lower primary care usage by Indigenous Australians. Many Indigenous Australians regard private general practitioners as their usual source of healthcare. However, a range of barriers results in relatively low access to primary care, with subsequent inadequate prevention and management of chronic disease. Indigenous primary care requires development of a set of attributes by the GP. Clinician autonomy may need to be tempered to be responsive to the needs of local indigenous communities. OBJECTIVE: A partnership between an urban indigenous community and a private general practice is described. DISCUSSION: Over a period of 1 year, registered indigenous patients at the private general practice clinic increased from 10 to 147; monthly attendance increased from five to 40 (p<0.001). Local engagement between private practices and indigenous communities may be implemented widely to reduce the primary care gap. FAU - Johanson, R Paul AU - Johanson RP AD - Majellan Medical Centre, Scarborough, Queensland, Australia. p-johans@bigpond.net.au FAU - Hill, Peter AU - Hill P LA - eng PT - Journal Article PL - Australia TA - Aust Fam Physician JT - Australian family physician JID - 0326701 SB - IM MH - Delivery of Health Care/organization & administration MH - General Practice/organization & administration MH - General Practitioners MH - Health Resources/supply & distribution MH - Health Services Accessibility/*organization & administration MH - Health Services Needs and Demand MH - Health Services, Indigenous/*organization & administration MH - Healthcare Disparities MH - Humans MH - *Oceanic Ancestry Group MH - Patient Acceptance of Health Care MH - Physician's Role MH - Primary Health Care/utilization MH - Private Practice/*organization & administration MH - Queensland MH - Socioeconomic Factors EDAT- 2011/02/09 06:00 MHDA- 2011/06/08 06:00 CRDT- 2011/02/09 06:00 PST - ppublish SO - Aust Fam Physician. 2011 Jan-Feb;40(1-2):16-9. PMID- 21219498 OWN - NLM STAT- MEDLINE DA - 20110111 DCOM- 20110727 IS - 1465-3362 (Electronic) IS - 0959-5236 (Linking) VI - 30 IP - 1 DP - 2011 Jan TI - Evidence-based alcohol screening and brief intervention in Aboriginal Community Controlled Health Services: experiences of health-care providers. PG - 55-62 LID - 10.1111/j.1465-3362.2010.00192.x [doi] AB - INTRODUCTION AND AIMS: Alcohol screening and brief intervention (SBI) is a cost-effective treatment for reducing alcohol misuse in non-Indigenous populations. To increase the likelihood of alcohol SBI proving cost-effective for Indigenous Australians in practice, strategies to increase its uptake in Aboriginal Community Controlled Health Services (ACCHSs) should be implemented. The aim of this study is to describe the experiences of health-care providers supported to implement evidence-based alcohol SBI in two ACCHSs. DESIGN AND METHODS: Pre- and post-surveys were administered to health staff (n = 32) participating in training workshops, followed by group interviews with health-care providers delivering alcohol SBI. Patient group interviews were also conducted. Survey results were summarised using descriptive statistics and interviews were analysed using a phenomenological approach. RESULTS: Thirty-two per cent (n = 10) of workshop participants were confident or very confident at baseline to deliver alcohol SBI, increasing significantly to 81% (n = 25) post-training (McNemar Test, P < 0.05). Fifty-seven per cent (n = 16) of health-care providers attending workshops reported delivering alcohol SBI in the following 6 months. Group interviews with health-care providers elicited five themes relating to their experiences of alcohol SBI delivery. Patients in group interviews expressed a preference to be screened for alcohol as part of health assessments. DISCUSSION AND CONCLUSIONS: Training workshops appear to be an acceptable initial strategy for disseminating alcohol SBI to ACCHSs. Outreach support is required to assist health-care providers to tailor guidelines and resources, and optimally integrate their clinical skills with evidence-based practice. Patients' needs should inform the tailoring process. Tailored collaborative and supportive strategies are probably required to optimally disseminate alcohol SBI in ACCHSs. CI - (c) 2010 Australasian Professional Society on Alcohol and other Drugs. FAU - Clifford, Anton AU - Clifford A AD - National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia. a.shakeshaft@unsw.edu.au FAU - Shakeshaft, Anthony AU - Shakeshaft A LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Drug Alcohol Rev JT - Drug and alcohol review JID - 9015440 SB - IM MH - Alcohol Drinking/prevention & control MH - Attitude to Health MH - Australia MH - *Community Health Services MH - Community-Institutional Relations MH - Cost-Benefit Analysis MH - *Counseling MH - Evidence-Based Medicine MH - Focus Groups MH - *Health Personnel/education MH - Humans MH - Male MH - Oceanic Ancestry Group/*psychology MH - *Primary Health Care MH - Questionnaires MH - Substance Abuse Detection/*psychology EDAT- 2011/01/12 06:00 MHDA- 2011/07/28 06:00 CRDT- 2011/01/12 06:00 AID - 10.1111/j.1465-3362.2010.00192.x [doi] PST - ppublish SO - Drug Alcohol Rev. 2011 Jan;30(1):55-62. doi: 10.1111/j.1465-3362.2010.00192.x. PMID- 21688948 OWN - NLM STAT- MEDLINE DA - 20110621 DCOM- 20111012 LR - 20120413 IS - 1445-6354 (Electronic) IS - 1445-6354 (Linking) VI - 11 IP - 2 DP - 2011 TI - 'Gotta be sit down and worked out together': views of Aboriginal caregivers and service providers on ways to improve dementia care for Aboriginal Australians. PG - 1650 AB - INTRODUCTION: Dementia is five-fold more prevalent among Aboriginal than non-Aboriginal Australians. Despite this, the quality of care available to people living with dementia in remote Aboriginal communities is poor. The objective of this study was to determine ways to overcome factors affecting the successful delivery of services to Aboriginal people with dementia living in remote communities, and to their families and communities. METHODS: This qualitative research took place in the Kimberley Region of Western Australia. Data collection occurred in three stages: (1) interviews with service providers to identify the services available; (2) interviews with the caregivers of Aboriginal people living with dementia and community-based care workers; and (3) focus groups with community representatives and community care staff. Each stage was concluded when no new themes emerged. At each stage the transcribed information was analysed and joint interpretation identified common themes. RESULTS: In total, 42 service providers, 31 caregivers and community-based care workers were interviewed and 3 focus groups were conducted. Obstacles to accessing quality care were mentioned and recommendations on ways to improve care were made. The key themes that emerged were caregiver role, perspectives of dementia, community and culturally-appropriate care, workforce, education and training, issues affecting remote communities and service issues. Detailed information on how each theme affects the successful delivery of dementia care is provided. CONCLUSIONS: These research findings indicate that people living with dementia and their caregivers in remote Aboriginal communities are struggling to cope. They are requesting and require better community care. Implementing a culturally safe model of dementia care for remote Aboriginal communities that encompasses the recommendations made and builds on the strengths of the communities could potentially deliver the required improvements to dementia care for this population. FAU - Smith, Kate AU - Smith K AD - WA Centre for Health and Ageing, University of WA, Perth, Western Australia, Australia. FAU - Flicker, Leon AU - Flicker L FAU - Shadforth, Geraldine AU - Shadforth G FAU - Carroll, Emily AU - Carroll E FAU - Ralph, Naomi AU - Ralph N FAU - Atkinson, David AU - Atkinson D FAU - Lindeman, Melissa AU - Lindeman M FAU - Schaper, Frank AU - Schaper F FAU - Lautenschlager, Nicola T AU - Lautenschlager NT FAU - LoGiudice, Dina AU - LoGiudice D LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110614 PL - Australia TA - Rural Remote Health JT - Rural and remote health JID - 101174860 SB - IM MH - Adaptation, Psychological MH - *Attitude to Health MH - Caregivers/*psychology MH - Community Mental Health Services MH - Dementia/*therapy MH - Health Education MH - *Health Services Accessibility MH - Healthcare Disparities MH - Humans MH - Interviews as Topic MH - Oceanic Ancestry Group/*psychology MH - Rural Health Services MH - Social Support MH - Western Australia EDAT- 2011/06/22 06:00 MHDA- 2011/10/13 06:00 CRDT- 2011/06/22 06:00 PHST- 2011/06/14 [epublish] AID - 1650 [pii] PST - ppublish SO - Rural Remote Health. 2011;11(2):1650. Epub 2011 Jun 14. PMID- 21034386 OWN - NLM STAT- MEDLINE DA - 20101101 DCOM- 20101223 IS - 0025-729X (Print) IS - 0025-729X (Linking) VI - 193 IP - 9 DP - 2010 Nov 1 TI - The health of urban Aboriginal people: insufficient data to close the gap. PG - 521-4 AB - The Australian Government has committed to reducing Indigenous disadvantage, including closing the life-expectancy gap within a generation, and to halving the gap in mortality rates for children under 5 years of age within a decade. Sixty per cent of the health gap between Indigenous and non-Indigenous Australians is attributable to the health of Indigenous people living in non-remote areas of Australia. We conducted a brief review of recent Australian original research publications on the health of the 53% of Indigenous people who live in urban areas, and found that data are sparse; there were only 63 studies in the past 5 years (11% of all articles about Indigenous health during this period). Although Indigenous Australians living in remote areas experience greater health disparity, the government will not achieve its aims without paying due attention to the non-remote-living population. More research is required, and particularly research that actually tests the impact of policies and programs. FAU - Eades, Sandra J AU - Eades SJ AD - Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia. Sandra.eades@bakeridi.edu.au FAU - Taylor, Bronwen AU - Taylor B FAU - Bailey, Sandra AU - Bailey S FAU - Williamson, Anna B AU - Williamson AB FAU - Craig, Jonathan C AU - Craig JC FAU - Redman, Sally AU - Redman S CN - SEARCH Investigators LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM MH - Australia MH - Health Policy MH - *Health Services Needs and Demand MH - *Health Status Disparities MH - Healthcare Disparities MH - Humans MH - *Oceanic Ancestry Group MH - *Research MH - *Urban Population IR - Bailey S FIR - Bailey, Sandra IR - Baker A FIR - Baker, Ann IR - Banks E FIR - Banks, Emily IR - Cass A FIR - Cass, Alan IR - Clapham K FIR - Clapham, Katherine IR - Craig J FIR - Craig, Jonathan IR - Daniels J FIR - Daniels, John IR - Eades S FIR - Eades, Sandra IR - Kippax S FIR - Kippax, Sue IR - McIntyre P FIR - McIntyre, Peter IR - Raphael B FIR - Raphael, Beverley IR - Redman S FIR - Redman, Sally IR - Taylor R FIR - Taylor, Richard IR - Vincent F FIR - Vincent, Frank IR - Williamson A FIR - Williamson, Anna IR - Appoo S FIR - Appoo, Sean IR - Cockayne N FIR - Cockayne, Nicole IR - Fernando D FIR - Fernando, Debra IR - Fernando P FIR - Fernando, Peter IR - Makamoo L FIR - Makamoo, Leone IR - McNamara B FIR - McNamara, Bridgette IR - Taylor B FIR - Taylor, Bronwen IR - Wutzke S FIR - Wutzke, Sonia IR - West M FIR - West, Michael IR - Williamson A FIR - Williamson, Anna IR - Atkinson M FIR - Atkinson, Mark IR - Brown V FIR - Brown, Vicky IR - Cashman K FIR - Cashman, Karen IR - Fernando J FIR - Fernando, Joshua IR - Fowles S FIR - Fowles, Sue IR - Kilpatrick J FIR - Kilpatrick, Jess IR - Robinson R FIR - Robinson, Ronald IR - Skinner T FIR - Skinner, Tracey IR - Wait D FIR - Wait, Don IR - Welsh P FIR - Welsh, Paul EDAT- 2010/11/03 06:00 MHDA- 2010/12/25 06:00 CRDT- 2010/11/02 06:00 PHST- 2010/03/11 [received] PHST- 2010/06/01 [accepted] AID - ead10268_fm [pii] PST - ppublish SO - Med J Aust. 2010 Nov 1;193(9):521-4. PMID- 20618302 OWN - NLM STAT- MEDLINE DA - 20100712 DCOM- 20100915 IS - 1753-6405 (Electronic) IS - 1326-0200 (Linking) VI - 34 Suppl 1 DP - 2010 Jul TI - Reducing racism in Aboriginal health care in Australia: where does cultural education fit? PG - S87-92 LID - 10.1111/j.1753-6405.2010.00560.x [doi] AB - OBJECTIVE: This paper discusses whether educating health professionals and undergraduate students in culturally respectful health service delivery is effective in reducing racism, improving practice and lessening the disparities in health care between Aboriginal and non-Aboriginal Australians. APPROACH: The paper supports the concept of race as a social construction that is discursively produced and reproduced. Studies on the effectiveness of cross-cultural education for undergraduate students and health professionals to reduce racism and deliver culturally respectful health care to indigenous or minority populations are examined for evidence of sustained improvements to practice. CONCLUSION: Programs in culturally respectful health care delivery can lead to short-term improvements to practice. Sustained change is more elusive as few programs conducted long-term evaluations. Long-term evaluation of programs in culturally respectful health care delivery is necessary to identify whether early changes to behavior and practices are sustained. Strategies linking policies to practice to reduce health disparities between Aboriginal and non-Aboriginal Australians are also needed. IMPLICATIONS: Confronting the effects of racism in health services towards Aboriginal Australians is a priority requiring a multi-tiered commitment to strategies linking policy to practice to reduce health disparities between Aboriginal and non-Aboriginal Australians. Part of this strategy includes preparing undergraduates and health professionals for culturally respectful health care with education programs that are evaluated for long-term improvements to practice. FAU - Durey, Angela AU - Durey A AD - Centre for International Health, Curtin Health Innovation Research Institute, Curtin University, Western Australia. a.durey@curtin.edu.au LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Aust N Z J Public Health JT - Australian and New Zealand journal of public health JID - 9611095 SB - IM MH - *Attitude of Health Personnel MH - Australia MH - Cross-Cultural Comparison MH - Culture MH - Delivery of Health Care/organization & administration MH - Health Knowledge, Attitudes, Practice MH - Health Services Accessibility MH - Health Services, Indigenous/*organization & administration MH - *Healthcare Disparities MH - Humans MH - Oceanic Ancestry Group MH - *Prejudice MH - Quality Assurance, Health Care MH - Race Relations EDAT- 2010/07/21 06:00 MHDA- 2010/09/17 06:00 CRDT- 2010/07/13 06:00 AID - AZPH560 [pii] AID - 10.1111/j.1753-6405.2010.00560.x [doi] PST - ppublish SO - Aust N Z J Public Health. 2010 Jul;34 Suppl 1:S87-92. doi: 10.1111/j.1753-6405.2010.00560.x. PMID- 20618286 OWN - NLM STAT- MEDLINE DA - 20100712 DCOM- 20100915 IS - 1753-6405 (Electronic) IS - 1326-0200 (Linking) VI - 34 Suppl 1 DP - 2010 Jul TI - Socio-economic gradients in self-reported diabetes for Indigenous and non-Indigenous Australians aged 18-64. PG - S18-24 LID - 10.1111/j.1753-6405.2010.00547.x [doi] AB - OBJECTIVE: To examine and compare socio-economic gradients in diabetes among Indigenous and non-Indigenous Australians. METHODS: I analysed weighted data on self-reported diabetes and a range of socio-economic status (SES) measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05. RESULTS: After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non-Indigenous populations. The age- and sex-adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3-5 combined) was 2.3 (95% CI 1.6-3.4) for the Indigenous population and 2.0 (95% CI 1.5-2.8) for the non-Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non-Indigenous people on every SES measure examined. CONCLUSION: Socio-economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non-Indigenous Australians. Other factors that may operate across the socio-economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. Implications: Indigenous Australians do not constitute a homogeneous group with respect to socio-economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage. FAU - Cunningham, Joan AU - Cunningham J AD - Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, Northern Territory. joan.cunningham@menzies.edu.au LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Aust N Z J Public Health JT - Australian and New Zealand journal of public health JID - 9611095 SB - IM MH - Adolescent MH - Adult MH - Age Distribution MH - Australia/epidemiology MH - Diabetes Mellitus/economics/epidemiology/*ethnology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Oceanic Ancestry Group/*statistics & numerical data MH - Prevalence MH - Residence Characteristics MH - Risk Factors MH - *Self Disclosure MH - Sex Distribution MH - *Social Class MH - Socioeconomic Factors MH - Young Adult EDAT- 2010/07/21 06:00 MHDA- 2010/09/17 06:00 CRDT- 2010/07/13 06:00 AID - AZPH547 [pii] AID - 10.1111/j.1753-6405.2010.00547.x [doi] PST - ppublish SO - Aust N Z J Public Health. 2010 Jul;34 Suppl 1:S18-24. doi: 10.1111/j.1753-6405.2010.00547.x. PMID- 20406155 OWN - NLM STAT- MEDLINE DA - 20100421 DCOM- 20100622 IS - 1036-1073 (Print) IS - 1036-1073 (Linking) VI - 21 IP - 1 DP - 2010 Apr TI - Health promotion resources for Aboriginal people: lessons learned from consultation and evaluation of diabetes foot care resources. PG - 64-9 AB - ISSUES ADDRESSED: Despite the startling age specific rate ratio for amputations in 25-49 year olds of, 41.25 for knee amputations and 27.5 for toe/foot amputations for Aboriginal/non-Aboriginal people, there are no diabetes foot care education brochures or health promotion media available free of charge for Aboriginal people. This study consulted Aboriginal people about existing and potential resources for education on foot care. METHOD: An Aboriginal and non-Aboriginal interviewer conducted six focus group discussions with a total of 60 Aboriginal people including Elders, community members, health workers, students and nurses. Focus groups discussed which materials, media and foot care messages worked best to communicate diabetes foot care messages. RESULTS: Participants were unequivocal in their preference for real pictures of foot problems rather than cartoons, clearly identifying a superior existing educational resource from the Indigenous Diabetic Foot Program. There was minimal support for many existing media and foot care messages. Participants preferred to develop their own messages and selected utilitarian media that would be used by all members of the Aboriginal community. CONCLUSIONS: We recommend the delivery of the Indigenous Diabetic Foot Program in Western Australia. Consultation and involvement of Aboriginal people was consistent with Aboriginal peoples' preferred style of conversation and inclusion and allowed the target audience to determine the end product for use in education and health promotion. FAU - Schoen, Deborah AU - Schoen D AD - Royal Perth Hospital, Western Australia. dschoen@bigpond.com FAU - Balchin, Delma AU - Balchin D FAU - Thompson, Sandra AU - Thompson S LA - eng PT - Journal Article PL - Australia TA - Health Promot J Austr JT - Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals JID - 9710936 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Consumer Participation MH - *Cultural Competency MH - Diabetic Foot/ethnology/*prevention & control MH - Female MH - Focus Groups MH - *Health Promotion MH - Health Services Accessibility MH - Humans MH - Male MH - Middle Aged MH - *Oceanic Ancestry Group MH - *Patient Education as Topic MH - Young Adult EDAT- 2010/04/22 06:00 MHDA- 2010/06/23 06:00 CRDT- 2010/04/22 06:00 PST - ppublish SO - Health Promot J Austr. 2010 Apr;21(1):64-9. PMID- 20367644 OWN - NLM STAT- MEDLINE DA - 20100406 DCOM- 20100825 IS - 1447-0349 (Electronic) IS - 1445-8330 (Linking) VI - 19 IP - 2 DP - 2010 Apr TI - Barriers and facilitators to the utilization of adult mental health services by Australia's Indigenous people: seeking a way forward. PG - 75-82 LID - 10.1111/j.1447-0349.2009.00647.x [doi] AB - Mental disorders are the second leading cause of disease burden among Australia's Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well-being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people. FAU - Isaacs, Anton Neville AU - Isaacs AN AD - Department of Rural and Indigenous Health, Monash University, Moe, Victoria 3825, Australia. anton.isaacs@med.monash.edu.au FAU - Pyett, Priscilla AU - Pyett P FAU - Oakley-Browne, Mark A AU - Oakley-Browne MA FAU - Gruis, Hilton AU - Gruis H FAU - Waples-Crowe, Peter AU - Waples-Crowe P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Int J Ment Health Nurs JT - International journal of mental health nursing JID - 101140527 SB - N MH - Adult MH - Australia MH - Health Services Accessibility MH - Health Services Needs and Demand MH - *Health Services, Indigenous/trends MH - Humans MH - Mental Disorders/psychology/*therapy MH - *Mental Health Services/trends MH - Minority Groups/*psychology MH - *Prejudice EDAT- 2010/04/07 06:00 MHDA- 2010/08/26 06:00 CRDT- 2010/04/07 06:00 AID - INM647 [pii] AID - 10.1111/j.1447-0349.2009.00647.x [doi] PST - ppublish SO - Int J Ment Health Nurs. 2010 Apr;19(2):75-82. doi: 10.1111/j.1447-0349.2009.00647.x. PMID- 20359413 OWN - NLM STAT- MEDLINE DA - 20100402 DCOM- 20100518 IS - 1479-1072 (Print) IS - 1479-1064 (Linking) VI - 18 IP - 1 DP - 2010 TI - Facilitating uptake of Aboriginal Adult Health Checks through community engagement and health promotion. PG - 57-64 AB - BACKGROUND: Adult Health Checks (AHCs) for Aboriginal and Torres Strait Islander people (MBS Item 710) promote comprehensive physical and psychosocial health assessments. Despite the poor uptake of health assessments in Aboriginal and Torres Strait Islander people, a small number of successful implementation initiatives have been reported. In order to ensure uptake of these screening initiatives, there remains a need to demonstrate the feasibility of models of implementing AHCs. AIMS: The aim of this paper is to address the process issues and overarching outcomes of a two-day targeted screening and assessment programme to increase the uptake of AHCs at an Aboriginal Community Controlled Medical Service. METHOD: Clients of an urban Aboriginal Medical Service (AMS) were invited to undertake an AHC during a two-day screening initiative. On-site general practitioners (GPs), nurses, and Aboriginal Health Workers (AHWs) worked within a team to facilitate screenings at an AMS. Barriers and facilitators to the initiative and strategies for quality improvement were discussed by the team. A review of medical notes was undertaken six months following the screening days to document uptake of recommendations. RESULTS: Forty clients undertook AHCs as part of the initiative. In total, 113 diagnostic tests, interventions, specialist referrals and medication initiatives had been enacted within the following six months as a result of screening day visits. Benefits to individual clients, the community, the AMS and staff were identified. CONCLUSIONS: The screening day demonstrated feasibility and acceptability of this approach and provides support for its implementation in other health facilities. Importantly, this service was provided in a culturally sensitive framework and within an interdisciplinary teamwork model. This targeted approach increased uptake of assessment items and provided opportunities for health advice and risk factor modification. FAU - Digiacomo, Michelle AU - Digiacomo M AD - Centre for Cardiovascular and Chronic Care, Curtin Health Innovation Research Institute, Curtin University of Technology, 39 Regent Street, Chippendale NSW 2008, Australia. m.digiacomo@curtin.edu.au FAU - Abbott, Penny AU - Abbott P FAU - Davison, Joyce AU - Davison J FAU - Moore, Louise AU - Moore L FAU - Davidson, Patricia M AU - Davidson PM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Qual Prim Care JT - Quality in primary care JID - 101182136 SB - IM MH - Adult MH - Aged MH - Australia MH - Female MH - Health Promotion/*organization & administration MH - Health Services Accessibility/*organization & administration MH - Humans MH - Male MH - Mass Screening/*organization & administration MH - Middle Aged MH - *Oceanic Ancestry Group MH - Primary Health Care/*organization & administration MH - Urban Population EDAT- 2010/04/03 06:00 MHDA- 2010/05/19 06:00 CRDT- 2010/04/03 06:00 PST - ppublish SO - Qual Prim Care. 2010;18(1):57-64. PMID- 20359409 OWN - NLM STAT- MEDLINE DA - 20100402 DCOM- 20100518 IS - 1479-1072 (Print) IS - 1479-1064 (Linking) VI - 18 IP - 1 DP - 2010 TI - Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: a qualitative study. PG - 17-26 AB - BACKGROUND: Aboriginal Australians have low rates of participation in cardiac rehabilitation (CR), despite having high rates of cardiovascular disease. Barriers to CR participation reflect multiple patient-related issues. However, an examination of the broader context of health service delivery design and implementation is needed. AIMS: To identify health professionals' perspectives of systems related barriers to implementation of the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples. METHOD: Semi-structured interviews were conducted with health professionals involved in CR within mainstream and Aboriginal Community Controlled Health Services in Western Australia (WA). Thirty-eight health professionals from 17 services (ten rural, seven metropolitan) listed in the WA Directory of CR services and seven Aboriginal Medical Services in WA were interviewed. RESULTS: Respondents reported barriers encountered in health information management and the impact of access to CR services for Aboriginal people. Crucial issues identified by participants were: poor communication across the health care sector and between providers, inconsistent and insufficient data collection processes (particularly relating to Aboriginal ethnicity identification), and challenges resulting from multiple clinical information systems and incompatible technologies. CONCLUSIONS: This study has demonstrated that inadequate information systems and communication strategies, particularly those representing the interface between primary and secondary care, contribute to the low participation rates of Aboriginal Australians in CR. Although these challenges are shared by non-Aboriginal Australians, the needs are greater for Aboriginal Australians and innovative solutions are required. FAU - Digiacomo, Michelle AU - Digiacomo M AD - Centre for Cardiovascular and Chronic Care, Curtin Health Innovation Research Institute, Curtin University of Technology, 39 Regent Street, Chippendale, NSW 2008, Australia. m.digiacomo@curtin.edu.au FAU - Davidson, Patricia M AU - Davidson PM FAU - Taylor, Kate P AU - Taylor KP FAU - Smith, Julie S AU - Smith JS FAU - Dimer, Lyn AU - Dimer L FAU - Ali, Mohammed AU - Ali M FAU - Wood, Marianne M AU - Wood MM FAU - Leahy, Timothy G AU - Leahy TG FAU - Thompson, Sandra C AU - Thompson SC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Qual Prim Care JT - Quality in primary care JID - 101182136 SB - IM MH - Australia MH - Cardiovascular Diseases/*rehabilitation MH - Communication MH - Continuity of Patient Care/organization & administration MH - Cultural Competency MH - Health Care Sector/*organization & administration MH - Health Services Accessibility/*organization & administration MH - Humans MH - Information Storage and Retrieval/methods MH - Information Systems/*organization & administration MH - Interprofessional Relations MH - *Oceanic Ancestry Group MH - Referral and Consultation/organization & administration EDAT- 2010/04/03 06:00 MHDA- 2010/05/19 06:00 CRDT- 2010/04/03 06:00 PST - ppublish SO - Qual Prim Care. 2010;18(1):17-26. PMID- 19887577 OWN - NLM STAT- MEDLINE DA - 20091116 DCOM- 20100201 IS - 1460-2245 (Electronic) IS - 0957-4824 (Linking) VI - 24 IP - 4 DP - 2009 Dec TI - Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps. PG - 404-15 LID - 10.1093/heapro/dap039 [doi] AB - Indigenous Australians experience a disproportionately greater burden of harm from smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) than the general Australian population. A critical step in further improving efforts to reduce this harm is to review existing efforts aimed at increasing the uptake of evidence-based interventions in Indigenous-specific health-care settings and programs. This study systematically identifies and reviews published Indigenous-specific dissemination studies targeting SNAP interventions. An electronic search of eight databases and a manual search of reference lists of previous literature reviews were undertaken. Eleven dissemination studies were identified for review: six for nutrition and physical activity as a component of diabetes care, three for alcohol and two for smoking. The majority of studies employed continuing medical education (n = 9 studies), suggesting that improving health-care providers' knowledge and skills is a focus of current efforts to disseminate best-evidence SNAP interventions in Indigenous health-care settings. Only two studies evaluated reminder systems, despite their widespread use in Indigenous-specific health-care services, and only one study employed academic detailing, despite its cost-effectiveness at modifying health-care provider behavior. There is a clear need for more Indigenous-specific dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measures of Indigenous-specific health-care delivery, in order to determine which dissemination strategies are most likely to be effective in Indigenous health-care settings and programs. FAU - Clifford, A AU - Clifford A AD - National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW, Sydney, Australia. a.clifford@unsw.edu.au FAU - Jackson Pulver, L AU - Jackson Pulver L FAU - Richmond, R AU - Richmond R FAU - Shakeshaft, A AU - Shakeshaft A FAU - Ivers, R AU - Ivers R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20091103 PL - England TA - Health Promot Int JT - Health promotion international JID - 9008939 SB - IM MH - Alcoholism/ethnology MH - Australia/epidemiology MH - Diet/ethnology MH - Evidence-Based Practice/*organization & administration MH - Exercise MH - Health Behavior/*ethnology MH - Health Promotion/organization & administration MH - Health Status Disparities MH - Humans MH - Information Dissemination/*methods MH - *Oceanic Ancestry Group MH - Smoking/ethnology RF - 70 EDAT- 2009/11/06 06:00 MHDA- 2010/02/02 06:00 CRDT- 2009/11/06 06:00 PHST- 2009/11/03 [aheadofprint] AID - dap039 [pii] AID - 10.1093/heapro/dap039 [doi] PST - ppublish SO - Health Promot Int. 2009 Dec;24(4):404-15. doi: 10.1093/heapro/dap039. Epub 2009 Nov 3. PMID- 19761623 OWN - NLM STAT- MEDLINE DA - 20091007 DCOM- 20120425 LR - 20130827 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 9 DP - 2009 TI - A case study of physical and social barriers to hygiene and child growth in remote Australian Aboriginal communities. PG - 346 LID - 10.1186/1471-2458-9-346 [doi] AB - BACKGROUND: Despite Australia's wealth, poor growth is common among Aboriginal children living in remote communities. An important underlying factor for poor growth is the unhygienic state of the living environment in these communities. This study explores the physical and social barriers to achieving safe levels of hygiene for these children. METHODS: A mixed qualitative and quantitative approach included a community level cross-sectional housing infrastructure survey, focus groups, case studies and key informant interviews in one community. RESULTS: We found that a combination of crowding, non-functioning essential housing infrastructure and poor standards of personal and domestic hygiene underlie the high burden of infection experienced by children in this remote community. CONCLUSION: There is a need to address policy and the management of infrastructure, as well as key parenting and childcare practices that allow the high burden of infection among children to persist. The common characteristics of many remote Aboriginal communities in Australia suggest that these findings may be more widely applicable. FAU - McDonald, Elizabeth AU - McDonald E AD - Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia. liz.mcdonald@menzies.edu.au FAU - Bailie, Ross AU - Bailie R FAU - Grace, Jocelyn AU - Grace J FAU - Brewster, David AU - Brewster D LA - eng PT - Case Reports PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20090918 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 SB - IM MH - Child MH - Cross-Sectional Studies MH - Crowding MH - *Cultural Characteristics MH - Female MH - Health Education/methods MH - Health Policy MH - Health Services Needs and Demand MH - Humans MH - Hygiene/*standards MH - Male MH - Oceanic Ancestry Group/*statistics & numerical data MH - Public Health Practice/standards MH - *Rural Population MH - *Social Environment MH - South Australia PMC - PMC2758870 OID - NLM: PMC2758870 EDAT- 2009/09/19 06:00 MHDA- 2012/04/26 06:00 CRDT- 2009/09/19 06:00 PHST- 2008/12/15 [received] PHST- 2009/09/18 [accepted] PHST- 2009/09/18 [aheadofprint] AID - 1471-2458-9-346 [pii] AID - 10.1186/1471-2458-9-346 [doi] PST - epublish SO - BMC Public Health. 2009 Sep 18;9:346. doi: 10.1186/1471-2458-9-346. PMID- 19450218 OWN - NLM STAT- MEDLINE DA - 20090519 DCOM- 20090807 IS - 0025-729X (Print) IS - 0025-729X (Linking) VI - 190 IP - 10 DP - 2009 May 18 TI - Improving Indigenous patients' access to mainstream health services: the Inala experience. PG - 604-6 AB - In 1994, only 12 Indigenous people attended the mainstream general practice in Inala, south-western Brisbane, Queensland. An Indigenous community focus group and telephone interviews revealed deficits such as: few items (eg, artwork) that Indigenous people could identify with; lack of Indigenous staff; staff perceived as unfriendly; inflexibility regarding time; and intolerance of Indigenous children's behaviour. Access to the Inala Indigenous Health Service by Indigenous people improved when these issues were addressed, and has grown significantly every year from 1995 to 2008. Other important factors in improving access include: energetic Indigenous leadership; enabling bulk billing to increase funding; moving to a stand-alone clinic; and engaging with teaching, research and community programs. A Centre of Excellence in Indigenous Primary Health Care is envisaged as the next innovation required to improve access and quality of service, and to close the gap between Indigenous and non-Indigenous health outcomes. FAU - Hayman, Noel E AU - Hayman NE AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. N.Hayman@uq.edu.au FAU - White, Nola E AU - White NE FAU - Spurling, Geoffrey K AU - Spurling GK LA - eng PT - Journal Article PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM MH - Cultural Competency MH - Health Services Accessibility/*trends MH - Health Services, Indigenous/*trends MH - Humans MH - *Oceanic Ancestry Group MH - Patient Acceptance of Health Care/statistics & numerical data MH - Poverty Areas MH - Queensland EDAT- 2009/05/20 09:00 MHDA- 2009/08/08 09:00 CRDT- 2009/05/20 09:00 PHST- 2008/08/04 [received] PHST- 2009/03/16 [accepted] AID - hay10930_fm [pii] PST - ppublish SO - Med J Aust. 2009 May 18;190(10):604-6. PMID- 19450194 OWN - NLM STAT- MEDLINE DA - 20090519 DCOM- 20090807 IS - 0025-729X (Print) IS - 0025-729X (Linking) VI - 190 IP - 10 DP - 2009 May 18 TI - "Closing the gap" by 2030: aspiration versus reality in Indigenous health. PG - 542-4 AB - The goal of "closing the gap" in life expectancy between Indigenous and non-Indigenous people by 2030 is probably unattainable. Despite our best efforts, it is implausible that, within 21 years, preventive strategies, social or medical, will extinguish all excess expression and risk of chronic disease, the greatest contributor to excess Indigenous deaths. Developing systems to supply optimal primary care, as we currently know it, will take time. In addition, we have an incomplete understanding of the nature of excess risk, and lack remedies to totally contain it. Furthermore, vertical imprinting of excess risk will take some generations to ameliorate. To avoid failure by specifying unattainable goals, emphasis should be given to process measures that will lead to better outcomes. It is self-evident that sustained change requires better education, nutrition, employment opportunities and infrastructure. Within the health system, access to good quality, integrated primary care, needs-based health services funding, and an urgent and intensified focus on areas with the highest mortality rates, are top priorities. FAU - Hoy, Wendy E AU - Hoy WE AD - Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, QLD, Australia. w.hoy@uq.edu.au LA - eng PT - Editorial PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM MH - Australia MH - *Health Policy MH - *Health Promotion MH - *Health Services, Indigenous MH - Health Status Disparities MH - Humans MH - *Oceanic Ancestry Group MH - *Primary Health Care MH - Risk Reduction Behavior EDAT- 2009/05/20 09:00 MHDA- 2009/08/08 09:00 CRDT- 2009/05/20 09:00 PHST- 2008/11/06 [received] PHST- 2009/03/10 [accepted] AID - hoy11300_fm [pii] PST - ppublish SO - Med J Aust. 2009 May 18;190(10):542-4. PMID- 19047078 OWN - NLM STAT- MEDLINE DA - 20090402 DCOM- 20090507 IS - 1464-3685 (Electronic) IS - 0300-5771 (Linking) VI - 38 IP - 2 DP - 2009 Apr TI - Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. PG - 470-7 LID - 10.1093/ije/dyn240 [doi] AB - BACKGROUND: Disparities in health status between Aboriginal and Torres Strait Islander peoples and the total Australian population have been documented in a fragmentary manner using disparate health outcome measures. METHODS: We applied the burden of disease approach to national population health datasets and Indigenous-specific epidemiological studies. The main outcome measure is the Indigenous health gap, i.e. the difference between current rates of Disability-Adjusted Life Years (DALYs) by age, sex and cause for Indigenous Australians and DALY rates if the same level of mortality and disability as in the total Australian population had applied. RESULTS: The Indigenous health gap accounted for 59% of the total burden of disease for Indigenous Australians in 2003 indicating a very large potential for health gain. Non-communicable diseases explained 70% of the health gap. Tobacco (17%), high body mass (16%), physical inactivity (12%), high blood cholesterol (7%) and alcohol (4%) were the main risk factors contributing to the health gap. While the 26% of Indigenous Australians residing in remote areas experienced a disproportionate amount of the health gap (40%) compared with non-remote areas, the majority of the health gap affects residents of non-remote areas. DISCUSSION: Comprehensive information on the burden of disease for Indigenous Australians is essential for informed health priority setting. This assessment has identified large health gaps which translate into opportunities for large health gains. It provides the empirical base to determine a more equitable and efficient funding of Indigenous health in Australia. The methods are replicable and would benefit priority setting in other countries with great disparities in health experienced by Indigenous peoples or other disadvantaged population groups. FAU - Vos, Theo AU - Vos T AD - School of Population Health, University of Queensland, Brisbane, Australia. t.vos@sph.uq.edu.au FAU - Barker, Bridget AU - Barker B FAU - Begg, Stephen AU - Begg S FAU - Stanley, Lucy AU - Stanley L FAU - Lopez, Alan D AU - Lopez AD LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20081130 PL - England TA - Int J Epidemiol JT - International journal of epidemiology JID - 7802871 SB - IM CIN - Int J Epidemiol. 2009 Apr;38(2):477-9. PMID: 19155281 MH - Adolescent MH - Adult MH - Aged MH - Australia/epidemiology MH - Child MH - Child, Preschool MH - Disability Evaluation MH - Disease/*ethnology/etiology MH - Female MH - *Health Status Disparities MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Middle Aged MH - Minority Health MH - Oceanic Ancestry Group/*statistics & numerical data MH - Risk Factors MH - Wounds and Injuries/*ethnology MH - Young Adult EDAT- 2008/12/03 09:00 MHDA- 2009/05/08 09:00 CRDT- 2008/12/03 09:00 PHST- 2008/11/30 [aheadofprint] AID - dyn240 [pii] AID - 10.1093/ije/dyn240 [doi] PST - ppublish SO - Int J Epidemiol. 2009 Apr;38(2):470-7. doi: 10.1093/ije/dyn240. Epub 2008 Nov 30. PMID- 19402759 OWN - NLM STAT- MEDLINE DA - 20090430 DCOM- 20090526 IS - 1445-6354 (Electronic) IS - 1445-6354 (Linking) VI - 9 IP - 2 DP - 2009 Apr-Jun TI - There should be more help out here! A qualitative study of the needs of Aboriginal adolescents in rural Australia. PG - 1137 AB - INTRODUCTION: Aboriginal adolescents living in or near rural towns have different social and cultural needs than Aboriginal adolescents living in large cities or remote areas. Identification of health needs by the community is an established principle of health promotion for improving community health. The objective of this study was to identify the views of rural Aboriginal adolescents regarding health promotion topics, the most important health problems they faced, their support networks and their beliefs about who should help them meet their health needs. METHODS: Ninety-nine adolescents aged between 12 and 18 years were involved in in-depth interviews or focus group discussions using a tested and trialled questionnaire. Data collection took place at three sites in rural Australia from 2006 to 2008: two Aboriginal-controlled communities and one rural town. All locations were de-identified at the request of participants because confidentiality and anonymity were concerns of the adolescents, who felt that identifying their own community would result in stereotyping. After preliminary interviews with parents, teachers, youth and health workers, snowball sampling was used to identify 'vulnerable' adolescents with low school attendance. The mean age of respondents was 13 years. There were 40 male participants and 59 female participants, representing 6 language groups. Informed consent was obtained from both participants and their guardians. Data were analysed using thematic matrices and cross-checked in subsequent interactions with participants. RESULTS: Alcohol, drugs and violence were identified as the biggest problems facing Aboriginal adolescents in rural areas and the topic they would most like to know about. The youth from a smaller Aboriginal community near a town with a population of 1500 stated that boredom was an equally important problem. Racism and bullying were noted as reasons for poor school attendance. Family members were the most important supports, and the people they felt would help solve their health problems. They strongly identified with sports and were proud to be Aboriginal although there were many adolescents who had no future plans or ambitions. Most participants wanted a 'safe and fun' place to go to in the evenings. CONCLUSIONS: The importance of engaging the community and being sensitive to social and cultural contexts in research and programming was confirmed. Policy-makers, health providers and agencies working with youth need to focus on inclusion of families in youth health promotion and drug and alcohol prevention for Aboriginal adolescents in rural areas. Mentorship and peer-support programs are more effective than health professionals and agencies in working with youth. The expertise of those traditionally working with youth could be channelled into coordinating a mentorship program. Personal wellbeing and safety is an important issue and multipurpose youth centres may provide a secure place for adolescents to learn, interact and develop a vision for their futures. FAU - Mohajer, Nicole AU - Mohajer N AD - Centre for International Health, Curtin University of Technology, Perth, Western Australia, Australia. nicole.mohajer@gmail.com FAU - Bessarab, Dawn AU - Bessarab D FAU - Earnest, Jaya AU - Earnest J LA - eng PT - Journal Article DEP - 20090429 PL - Australia TA - Rural Remote Health JT - Rural and remote health JID - 101174860 SB - IM MH - Adolescent MH - Adolescent Behavior MH - Adolescent Health Services MH - *Adolescent Psychology MH - Australia MH - Child MH - Female MH - Health Promotion MH - Humans MH - Interviews as Topic MH - Male MH - Needs Assessment MH - Oceanic Ancestry Group/*psychology MH - Qualitative Research MH - Rural Population MH - *Social Environment MH - *Social Problems MH - Social Support MH - Substance-Related Disorders MH - Violence EDAT- 2009/05/01 09:00 MHDA- 2009/05/27 09:00 CRDT- 2009/05/01 09:00 PHST- 2009/04/29 [epublish] AID - 1137 [pii] PST - ppublish SO - Rural Remote Health. 2009 Apr-Jun;9(2):1137. Epub 2009 Apr 29. PMID- 19142280 OWN - NLM STAT- MEDLINE DA - 20090114 DCOM- 20090210 IS - 0300-8495 (Print) IS - 0300-8495 (Linking) VI - 37 IP - 12 DP - 2008 Dec TI - Aboriginal and Torres Strait Islander health assessments - barriers to improving uptake. PG - 1033-8 AB - BACKGROUND: This study investigated the reasons for low uptake of Medicare Benefits Schedule rebated health assessments for Aboriginal people and Torres Strait Islanders in mainstream general practice in the Australian Capital Territory region. METHOD: Surveys gauging attitudes to Aboriginal and Torres Strait Islander health issues were completed by 145 general practitioners, practice and division staff, and semistructured interviews were conducted with 16 staff members from nine general practices. RESULTS: Survey responses indicated concerns about introducing routine identification processes for all patients. Interviews showed low levels of identification and significant barriers to change. DISCUSSION: Barriers to the uptake of health assessments include low levels of routine identification of Aboriginal and Torres Strait Islander patients, little awareness of Aboriginal and Torres Strait Islander specific GP mediated health interventions, and lack of support for preventive health interventions targeted on the basis of Aboriginal and or Torres Strait Islander status. Poor uptake is likely to persist without a more strategic approach to overcoming these barriers. FAU - Kehoe, Helen AU - Kehoe H AD - Office for Aboriginal and Torres Strait Islander Health, Commonwealth Department of Health and Ageing, Canberra, Australian Capital Territory. helen.kehoe@health.gov.au FAU - Lovett, Ray W AU - Lovett RW LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Aust Fam Physician JT - Australian family physician JID - 0326701 SB - IM MH - *Attitude of Health Personnel MH - Australia MH - Cross-Sectional Studies MH - *Family Practice MH - *Health Services Accessibility MH - Health Services, Indigenous/*organization & administration MH - Healthcare Disparities MH - Humans MH - Interviews as Topic MH - Mass Screening/*economics MH - *Oceanic Ancestry Group MH - Questionnaires EDAT- 2009/01/15 09:00 MHDA- 2009/02/12 09:00 CRDT- 2009/01/15 09:00 PST - ppublish SO - Aust Fam Physician. 2008 Dec;37(12):1033-8. PMID- 16719755 OWN - NLM STAT- MEDLINE DA - 20060524 DCOM- 20060629 IS - 0025-729X (Print) IS - 0025-729X (Linking) VI - 184 IP - 10 DP - 2006 May 15 TI - Making a difference: the early impact of an Aboriginal health undergraduate medical curriculum. PG - 522-5 AB - OBJECTIVE: To describe the implementation of an integrated Aboriginal health curriculum into the medical course at the University of Western Australia (UWA) and the early effect on students' perceptions of their knowledge and ability in the area of Aboriginal health. DESIGN, SETTING AND PARTICIPANTS: Final-year medical students at UWA in 2003 (first cohort) and 2004 (second cohort) were surveyed by questionnaire (with answers on a five-point Likert scale) to assess their attitudes to various aspects of Aboriginal health. A subset of students provided open-ended comments on key priorities in Aboriginal health, cultural security and suggestions for Aboriginal health policy. INTERVENTIONS: Integrated learning experiences were implemented within each year of the medical course, based on specific learning outcomes in Aboriginal health. MAIN OUTCOME MEASURES: Changes in students' self-perceptions of their preparedness for and future commitment to working for change in Aboriginal health. RESULTS: Response rates were 76% and 85% in the 2003 and 2004 cohorts, respectively. Compared with first-cohort students, second-cohort students were more likely to agree with items relating to their preparedness and ability to work with and care for Aboriginal and Torres Strait Islander people (P < 0.05); second-cohort students also reported greater preparedness to advocate and improve the health of Aboriginal people (P < 0.05); 65% of respondents in the second cohort (versus 34% in the first) agreed they had a social responsibility to work for change in Aboriginal health (P < 0.05). CONCLUSION: With a relatively small amount of targeted and structured teaching and learning in Aboriginal health, significant shifts in students' self-perceived levels of knowledge, skills and attitudes are possible. FAU - Paul, David AU - Paul D AD - Faculty of Medicine, Dentistry and Health Science, University of Western Australia, Perth, WA, Australia. david.paul@Tuwa.edu.au FAU - Carr, Sandra AU - Carr S FAU - Milroy, Helen AU - Milroy H LA - eng PT - Journal Article PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM CIN - Med J Aust. 2006 May 15;184(10):483-4. PMID: 16719742 MH - Adult MH - Attitude of Health Personnel MH - *Curriculum MH - *Education, Medical, Undergraduate MH - Health Services, Indigenous MH - Humans MH - *Oceanic Ancestry Group MH - Students, Medical MH - Western Australia EDAT- 2006/05/25 09:00 MHDA- 2006/06/30 09:00 CRDT- 2006/05/25 09:00 PHST- 2006/02/23 [received] PHST- 2006/04/10 [accepted] AID - pau10192_fm [pii] PST - ppublish SO - Med J Aust. 2006 May 15;184(10):522-5. PMID- 15574447 OWN - NLM STAT- MEDLINE DA - 20041202 DCOM- 20050426 LR - 20130908 IS - 0306-6800 (Print) IS - 0306-6800 (Linking) VI - 30 IP - 6 DP - 2004 Dec TI - Is there an Aboriginal bioethic? PG - 570-5 AB - It is well recognised that medicine manifests social and cultural values and that the institution of healthcare cannot be structurally disengaged from the sociopolitical processes that create such values. As with many other indigenous peoples, Aboriginal Australians have a lower heath status than the rest of the community and frequently experience the effects of prejudice and racism in many aspects of their lives. In this paper the authors highlight values and ethical convictions that may be held by Aboriginal peoples in order to explore how health practitioners can engage Aboriginal patients in a manner that is more appropriate. In doing so the authors consider how the ethics, values, and beliefs of the dominant white Australian culture have framed the treatment and delivery of services that Aboriginal people receive, and whether sufficient effort has been made to understand or acknowledge the different ethical predispositions that form the traditions and identity of Aboriginal Australia(ns). FAU - Garvey, G AU - Garvey G AD - Clinical Unit in Ethics and Health Law, School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, David Maddison Building, Royal Newcastle Hospital, Newcastle NSW 2300, Australia. FAU - Towney, P AU - Towney P FAU - McPhee, J R AU - McPhee JR FAU - Little, M AU - Little M FAU - Kerridge, I H AU - Kerridge IH LA - eng PT - Journal Article PL - England TA - J Med Ethics JT - Journal of medical ethics JID - 7513619 SB - E SB - IM MH - Australia MH - *Bioethics MH - *Ethical Analysis MH - Female MH - Health Services MH - Humans MH - *Oceanic Ancestry Group MH - Physician-Patient Relations PMC - PMC1733993 OID - KIE: 120404 OID - NLM: PMC1733993 OTO - KIE OT - Health Care and Public Health OT - Professional Patient Relationship GN - KIE: 29 refs. GN - KIE: KIE Bib: health care/foreign countries; professional patient relationship EDAT- 2004/12/03 09:00 MHDA- 2005/04/27 09:00 CRDT- 2004/12/03 09:00 AID - 30/6/570 [pii] AID - 10.1136/jme.2002.001529 [doi] PST - ppublish SO - J Med Ethics. 2004 Dec;30(6):570-5. PMID- 15679932 OWN - NLM STAT- Publisher DA - 20050131 IS - 1743-8462 (Print) IS - 1743-8462 (Linking) VI - 1 IP - 1 DP - 2004 Nov 18 TI - Recent developments in national Aboriginal and Torres Strait Islander health strategy. PG - 3 AB - In this paper I will describe some of the sentinel events in Aboriginal and Torres Strait Islander health policy and strategy during 2003 and the early part of 2004. This will involve discussion on the:* National Strategic Framework in Aboriginal and Torres Strait Islander Health* National Strategic Framework for Aboriginal and Torres Strait Islander Peoples Mental Health and Social and Emotional Well Being 2004-2009* National Aboriginal and Torres Strait Islander Health Performance Framework* The roll-out of the Primary Health Care Access Program* The National Aboriginal and Torres Strait Islander Social Survey and the National Indigenous Health SurveyThese developments are consistent with a policy agenda that has evolved, in general terms, since the release of the National Aboriginal Health Strategy in 1989. However, I will also consider significant developments in the broader context for Aboriginal and Torres Strait Islander affairs, particularly the decision made in early 2004 by the Howard government to abolish the Aboriginal and Torres Strait Islander Commission (ATSIC). While the key events and developments that are reported in this paper elaborate on an agenda that has been developing for more than a decade, the decision to abolish ATSIC is likely to have a revolutionary impact on the future development of Aboriginal health strategy. FAU - Anderson, Ian Ps AU - Anderson IP AD - Centre for the Study of Health and Society & VicHealth Koori Health Research and Community Development Unit, Department of Public Health, University of Melbourne, Melbourne, Australia. ipa@unimelb.edu.au. LA - ENG PT - EDITORIAL DEP - 20041118 TA - Aust New Zealand Health Policy JT - Australia and New Zealand health policy JID - 101235428 PMC - PMC544962 EDAT- 2005/02/01 09:00 MHDA- 2005/02/01 09:00 CRDT- 2005/02/01 09:00 PHST- 2004/08/13 [received] PHST- 2004/11/18 [accepted] PHST- 2004/11/18 [aheadofprint] AID - 1743-8462-1-3 [pii] AID - 10.1186/1743-8462-1-3 [doi] PST - epublish SO - Aust New Zealand Health Policy. 2004 Nov 18;1(1):3.