Aboriginal Health Council of South Australia

IntroductionThe commercial determinants of health (CDoH) are a rapidly growing field of research and global health priority. Despite being disproportionately affected, Indigenous Peoples’ voices and perspectives are conspicuously absent from CDoH research and policy. This article outlines the protocol for Addressing Commercial Health determinants: Indigenous Empowerment and Voices for Equity (ACHIEVE), an Aboriginal and Torres Strait Islander-led project in Australia.Methods and analysisACHIEVE integrates four research streams, using a novel combination of methods. The first three streams will (i) conceptualise the CDoH using Indigenous yarning methodology, (ii) evaluate the effectiveness and cost-effectiveness of policies to reduce exposure to harmful marketing and (iii) assess the impacts of specific commercial entities on Aboriginal and Torres Strait Islander health using case studies. The final stream will consolidate findings from streams 1–3 and work with Aboriginal Community Controlled Health Organisations (ACCHOs) to co-create strategies for addressing the commercial determinants of Aboriginal and Torres Strait Islander health.Ethics and disseminationEthical approval for streams 1–3 has been granted by Deakin University Human Research Ethics Committee. ACHIEVE is guided by a governance model that prioritises Indigenous data sovereignty, community and ACCHO partnerships, capacity building and knowledge translation. Findings will be shared with participants, ACCHOs and policymakers to maximise research impact.

Peer-reviewed

BackgroundAustralian governments and the First Nations Coalition of Peaks, through the Closing the Gap reforms, have committed to build the Aboriginal and Torres Strait Islander community-controlled sector and increase decision making by community-controlled services. This paper describes a First Nations-led place-based research program with community-controlled health and youth service partners in Far North Queensland to understand and map the regional child and youth wellbeing service system and co-design strategies to improve service provision.MethodsThis mixed-method research was conducted through a First Nations-led approach that is both place-based and systems focused. Following research planning workshops with community-controlled health and youth service partners, 47 staff members from 27 Cairns and Yarrabah intersectoral child and youth-wellbeing organisations were interviewed in 2021-22 to map the characteristics of their services. Their responses were coded using a modified version of the internationally validated Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) mapping tool to determine the characteristics of whole system intersectoral services. Forty-four participants then attended co-design workshops in each place to discuss the results and identify further priorities.ResultsA high 68% of the main types of care were crisis-related services (focused on child protection, youth justice, mental illness, homelessness, illness/injury, and disengagement from education), with just a third (32%) focused on prevention/early intervention. Despite clear leadership from community-controlled services, only 23% of the main types of care were delivered by community-controlled organisations, with 51% delivered by mainstream non-government organisations, and 26% by government departments. Funding agreements drove the characteristics of services, with community-controlled organisations providing a higher proportion of the more complex crisis-oriented services, whilst non-government organisations received funding for preventive programs. Service providers prioritised a need for greater investment in prevention and early intervention, with community control of decision making considered critical to improving the appropriateness of care.ConclusionsThese findings speak to the recent national commitment to increase decision making by Aboriginal and/or Torres Strait Islander community-controlled services. The recommendations of north Queensland regional service providers can inform improvements in the Closing the Gap reforms, and hence in the systems that support the wellbeing of First Nations children, youth and families.

Climate change is one of the most critical challenges facing Australia and the global community today. Data from the Australian Bureau of Meteorology (BoM) indicates that Australia has been experiencing rising temperatures, particularly since the late 20th century. The frequency, duration, and intensity of heatwaves are projected to continue increasing . Since national records began in 1910, Australia has warmed by an average of 1.47°C (±0.24°C), with the highest official temperature recorded at 50.7 degrees Celsius in Onslow, Western Australia (WA), on January 13, 2022. Furthermore, a recent unprecedented high temperature of +41.6°C was recorded during winter on August 26, 2024, in Yampi Sound, WA. Among all natural disasters in Australia, heatwave (HW) represents a leading silent killer and pose a significant public health threat. However, innovative methods for assessing vulnerability for HW-related health services remain limited.

BackgroundThe siloed nature of the health and social service system threatens access for clients engaging numerous organisations. Many Aboriginal and Torres Strait Islander people face adverse circumstances which contribute to multiple health and social needs. Effective relationships between health and social services are integral to coordinated service provision to meet the diverse needs of Aboriginal and Torres Strait Islander clients. Place-specific insights into inter-agency relationships are needed to inform targeted strategies that bolster service coordination to benefit Aboriginal and Torres Strait Islander people.MethodsThis study sought to understand experiences of inter-agency partnerships among health and social service providers on Kaurna Country in northern Adelaide using semi-structured interviews and yarning circles to explore partnership actions, outcomes, enablers, challenges, and identify strategies to strengthen partnerships. Fifty-nine service providers (78% female, 62% Aboriginal) participated including six from non-government organisations, 17 from Aboriginal community-controlled services and 36 from government organisations.ResultsA content analysis identified partnership actions such as client advocacy, referrals, sharing information, case management meetings and collaborative tender submissions which were seen to improve client access, navigation and outcomes and strengthen worker connectedness and job satisfaction. Motivated workers, listening to Aboriginal people, shared goals and values, and partnership agreements (e.g., memorandum of understanding, service contracts) were identified enablers of partnerships. Racism and ignorance, lack of networking events, communication breakdown, red tape and administrative barriers, competition between services, short-term funding, high turnover of staff and a focus on key performance indicators rather than community needs were among the challenges. Effective partnerships to benefit Aboriginal communities in northern Adelaide was reported to require aligned intersectoral strategic intentions, reforms to service commissioning processes, sustainable funding, regular network events for management and frontline workforce, Aboriginal practitioner-led service coordination approaches and a network of Aboriginal and Torres Strait Islander workers across organisations.ConclusionsThis study identified key leverage points for action on inter-agency partnerships to benefit Aboriginal and Torres Strait Islander communities on Kaurna Country. System drivers such as funded inter-agency networks and reforms to commissioning of services must support organisational- and practitioner-level enablers to strengthen partnerships between health and social services across northern Adelaide.

PurposeFear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR in early-stage cancer survivors.MethodsAustralian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree–strongly agree), with optional qualitative feedback. Consensus was defined as ≥ 80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented to Round 1 participants in two subsequent rounds with new items, derived from content analysis of qualitative feedback.ResultsFrom 94 participants in Round 1 (89% health professionals), 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations and stepped care management (i.e. tailored and staged treatment) were endorsed. However, the timing of FCR screening/triage did not reach consensus.ConclusionsThis world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts.Implications for Cancer SurvivorsImplementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-024-01685-1.

IntroductionAboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention and Risk Management Program for Aboriginal Australians (DAMPAA) is an Aboriginal Health Practitioner led programme that aims to reduce cognitive decline and functional impairment in older Aboriginal people.MethodsDesign: DAMPAA is a multisite, randomised controlled trial aiming to deliver and evaluate a culturally appropriate risk factor management programme. Population: Community-dwelling Aboriginal people aged 45–90 years. Intervention: Participants will be randomly assigned to either usual care (control) or to a group programme comprising exercise and health education yarning sessions and pharmacist-delivered medication reviews delivered over a 12-month period. Primary outcome: Cognitive function (Kimberley Indigenous Cognitive Assessment (KICA)-Cog score), daily function (KICA-Activities of Daily Living (ADL) score) and quality of life (Good Spirit, Good Life and EQ-5D-5L scores). Secondary outcomes: Process evaluation interviews, cardiovascular risk factors, falls and death. Process evaluation will be conducted with qualitative methods. Quantitative outcomes will be analysed with generalised linear mixed models.Ethics and disseminationThe study was approved by the Western Australian Aboriginal Health Ethics Committee and the University of Western Australia Human Research Ethics Committee. Study results will be published in peer-reviewed journals and presented at scientific meetings. We will also develop and disseminate a comprehensive DAMPAA toolkit for health services. The study’s findings will guide future prevention strategies and outline a comprehensive process evaluation that may be useful in other Aboriginal health research to contextualise findings.

Aboriginal Australians experience a high prevalence of chronic obstructive pulmonary disease (COPD), with high rates of potentially preventable hospitalisations. However, little is known about Aboriginal peoples' experiences of living with COPD and how they navigate health care systems. This study used thematic analysis and Aboriginal methodology to explore Aboriginal peoples' lived experiences of COPD, their health care journey from receiving a diagnosis of COPD to the clinical management, and the impact of COPD on their daily lives. We conducted in-depth semi-structured interviews over a 6-month period with 18 Aboriginal adults diagnosed with COPD from four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. Reflexive thematic analysis was employed to ensure rigour. The findings revealed deeply personal and reflective stories shaped by historical, social, and cultural realities of Aboriginal peoples living with COPD. Four themes were identified characterising their experiences. Based on the findings, the following guidance is provided on future COPD care for Aboriginal peoples: Better alignment of existing COPD management with Aboriginal peoples' cultural contexts and perspectives to improve access to culturally safe care; Increased funding for ACCHS to enhance COPD management, such as early detection through case finding and access to ACCHS-led pulmonary rehabilitation; Engaging family members in COPD management and providing culturally centred COPD education that facilitates discussions and builds health literacy and self-management skills; Implementing health promotion initiatives to increase awareness and counteract fear and shame to improve early COPD detection.

PurposeThe Aboriginal Families Study is a prospective, intergenerational cohort study with well-established Aboriginal governance arrangements and community partnerships to support all research processes including data collection, interpretation and knowledge translation.Participants344 Aboriginal and Torres Strait Islander children born in South Australia between July 2011 and June 2013 and their mothers and other primary caregivers. Two waves of survey data collection have been undertaken: early in the first year postpartum and when the study children were aged 5–8 years. Children participated in direct developmental assessments of their cognitive, speech and language development at 5–8 years of age. Social and cultural determinants of health and well-being have been assessed at each wave of data collection.Findings to datePublications and policy briefs to date focus on social determinants of women’s and children’s physical and mental health; identifying gaps in access to pregnancy, postnatal, primary, specialist and allied healthcare; and evidence that Aboriginal-led services in South Australia have improved women’s experiences and access to antenatal care.Future plansWave 3 follow-up is planned as the study children reach 14–16 years of age. Longitudinal follow-up of women and children in the cohort will generate new knowledge about factors promoting children and young people’s social and emotional well-being. Our goal is to build a stronger understanding of the potential for key domains of social and emotional well-being (eg, connection to community, family and kin, country and spirituality) to buffer the impacts of social determinants of health, including intergenerational trauma and social inequity.