Remote School Retention in Australia

Whither the Aborigine

‘Guḻarri (fresh water) has met the dhukun (metaphorically meaning confusion, doubt, misunderstandings or myths) and over the past three years become clear again, drinkable and nourishing.’ This story of freshwater, contamination and nourishment was told during a yarning circle by a community member. It was used to describe their research journey in a collaborative research project that sought to create, enact and evaluate a ‘bridge’ that early childhood education curriculum supported at one end by the strengths and content of local culture, and at the other by a proven pedagogy and learning strategy from the broader culture. This chapter draws on our experiences of implementing 3a (Abecedarian Approach Australia) in Families as First Teachers (FaFT) playgroups in two remote Indigenous communities in the Northern Territory (NT), Australia and explores the contextual realities and relational aspects of researching family practices and young children's early learning in remote communities. Specifically, we discuss the factors that shaped the implementation of the research and consider the approaches to grow research relationships of trust and collaboration. These partnerships within the research team (university and FaFT) enabled culturally appropriate adaptations and local language interpretations that ensured the strengths of Aboriginal identity, culture and language were upheld in the implementation of the programme. Insights from our efforts to collaboratively develop a culturally responsive Early Childhood Education and Care (ECEC) programme are discussed as design principles that might influence Indigenous early childhood educational research more broadly.

Objectives. The purpose of this study was to delineate and describe the local palliative care services available to residents of remote Aboriginal communities in northern Manitoba; to identify attitudes and beliefs ab0ut death, dying and palliative care in these communities; and to explore obstacles related to palliative care service delivery from the perspectives of culture and geographic isolation.Study Design. Forty-four in-depth semi-strn.ctured interviews were conducted with a reputational sample of key informants including Aboriginal people resident in remote communities, community elders and religious leaders, doctors, nurses and allied health care providers working in First Nations Communities, as well as specialist service providers in Winnipeg. Thematic qualitative analysis was done on the data collected. Data collected from interviews with northern physicians and nurses was coded and analyzed.Results. Currently, many Aboriginal people living in remote communities are transported to large urban centers to die, isolated from friends, family and their culture. However, the majority of Aboriginal people and health care providers interviewed reported that Aboriginal people living in remote communities would prefer to die at home. The issues surrounding palliative care provision in remote Aboriginal communities are cultural and geographic. Culturally sensitive care requires that patients have access to family supports and traditional services if requested. Geographic isolation requires that:1. patient-specific care plans be created for use in the remote community;2. effective lines of communication are established between remote health care providers and urban specialists;3. health care providers and family care-givers be properly trained to fill their respective roles; and4. appropriate guidelines and resources be available in the community to support this type of care.Conclusions. Providing the equipment, supports and education necessary for home-based palliative care in remote Aboriginal communities can be an effective way of addressing the medical, psycho-social, and spiritual needs of these patients. (Int J Circumpolar Health 2004; 63: 25–38)

BackgroundBronchiectasis is a chronic pulmonary disorder which is prevalent among Australian First Nations people in the Northern Territory (NT). Current guidelines recommend physiotherapy as part of multi-disciplinary management of children with bronchiectasis, however in our setting, involvement of physiotherapy remains unknown. We thus undertook a retrospective chart audit to examine physiotherapy management of First Nations children (<18 years) from remote First Nations communities in the Top End of the NT at the index bronchiectasis diagnosis and 12 months following diagnosis.MethodsParticipants were identified from a larger prospective study of children investigated for bronchiectasis at Royal Darwin Hospital, NT (2007–2016). Children were included if they were First Nations, aged <18 years, had a radiological diagnosis of bronchiectasis on high resolution computed tomography scan and lived in a remote community serviced by NT Government health clinics. The medical records from NT Government hospitals, health clinics and where possible other medical service attendance were reviewed for physiotherapy referral and management at the time of bronchiectasis diagnosis and in the following 12 months in the community.ResultsOf 143 children included, the mean age was 3.1 (standard deviation 2.4) years and 84 (58.7%) were males. At the index diagnosis, 76/122 (62.3%) children were reviewed by a physiotherapist, consisting of airway clearance techniques (83.8%), physical activity/exercise (81.7%) and caregiver education (83.3%), with only 7/127 (5.5%) having evidence of referral for community-based physiotherapy. In the following 12 months, only 11/143 (7.7%) children were reviewed by a physiotherapist, consisting of airway clearance techniques (54.5%), physical activity/exercise (45.5%) and caregiver education (36.4%).ConclusionThis study demonstrates a significant gap in the provision of physiotherapy services in our setting and the need to develop a standardized pathway, to support the best practice management of children with bronchiectasis in remote Top End communities of the NT.

Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia.

ObjectivesTo co‐create a culturally responsive student‐implemented allied health service in a First Nations remote community and to determine the feasibility and acceptability of the service.DesignCo‐creation involved a pragmatic iterative process, based on participatory action research approaches. Feasibility and acceptability were determined using a mixed‐method pre/postdesign.SettingThe service was in Nhulunbuy, Yirrkala and surrounding remote First Nations communities of East Arnhem Land, Northern Territory, Australia.ParticipantsCo‐creation of the service was facilitated by the Northern Australia Research Network, guided by Indigenous Allied Health Australia leadership, with East Arnhem local community organisations and community members. Co‐creation of the day‐to‐day service model involved local cultural consultants, service users and their families, staff of community organisations, students, supervisors, placement coordinators and a site administrator.FindingsA reciprocal learning service model was co‐created in which culturally responsive practice was embedded. The service was feasible and acceptable: it was delivered as intended; resources were adequate; the service management system was workable; and the service was acceptable. Health outcome measures, however, were not appropriate to demonstrate impact, particularly through the lens of the people of East Arnhem. Recommendations for the service included: continuing the reciprocal learning service model in the long term; expanding to include all age groups; and connecting with visiting and community‐based services.ConclusionThe co‐created service was feasible and acceptable. To demonstrate the impact of the service, measures of health service impact that are important to First Nations people living in remote communities of northern Australia are required.

This study aimed to explore the lived experiences of Kimberley Aboriginal people with type 2 diabetes managed by remote Aboriginal Community Controlled Health Services using phenomenological analysis. Semi-structured interviews formulated by Aboriginal Health Workers, researchers and other clinicians were used to obtain qualitative data from 13 adult Aboriginal patients with type 2 diabetes managed in two remote communities in the Kimberley. Together with expert opinion from local Aboriginal Health Workers and clinicians, the information was used to develop strategies to improve diabetes management. Of 915 regular adult patients in the two communities, 27% had type 2 diabetes; 83% with glycated haemoglobin A >10%. Key qualitative themes included: the need for culturally relevant education and pictorial resources; importance of continuous therapeutic relationships with healthcare staff; lifestyle management advice that takes into account local and cultural factors; and the involvement of Aboriginal community members and families in support roles. Recommendations to improve diabetes management in the remote communities have been made collaboratively with community input. This study provides a framework for culturally relevant recommendations to assist patients with diabetes, for collaborative research, and for communication among patients, Aboriginal Health Workers, community members, researchers and other clinicians. Interventions based on recommendations from this study will be the focus of further collaborative research.

BackgroundThere is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women. Postpartum diabetes programs have the potential to prevent recurrent GDM and improve management of type 2 diabetes. However, data on such programs are limited, particularly in the Indigenous context. We aimed to explore Aboriginal Australian women’s and health providers’ preferences for a program to prevent and improve diabetes after pregnancy.MethodsA phenomenological methodology underpinned semi-structured in-depth interviews with eleven Aboriginal women and seven health professionals across the Northern Territory from October 2019- February 2020. Interviews were analysed using an inductive analysis framework to address the barriers and enablers of proposed diabetes prevention programs identified by participants.ResultsIdentified structural barriers to lifestyle change included: food insecurity, persuasive marketing of unhealthy food options, lack of facilities and cultural inappropriateness of previous programs. Enablers to lifestyle change included: a strong link between a healthy lifestyle and connection with Country, family and community. Suggested strategies to improve lifestyle included: co-designed cooking classes or a community kitchen, team sports and structural change (targeting the social determinants of health). Lifestyle change was preferred over metformin to prevent and manage diabetes after pregnancy by participants and health care providers.ConclusionsWe recommend individual level programs be designed alongside policies that address systemic inequalities. A postpartum lifestyle program should be co-designed with community members and grounded in Aboriginal conceptions of health to adequality address the health disparities experienced by Aboriginal people in remote communities.

IntroductionI work at a regional campus of La Trobe University, Australia. More precisely, I work at the Bendigo campus of La Trobe University. At Bendigo, we are often annoyed when referred to and addressed as ‘regional’ students and staff. Really, we should not be. After all, Bendigo campus is an outpost of La Trobe’s metropolitan base. It is funded, run, and directed from Bundoora (Melbourne). The word ‘regional’ simply describes the situation. A region is an “administrative division of a city or a district [… or …] a country” (Brown 2528). And the Latin etymology of region (regio, regere) includes “direction, line”, and “rule” (Kidd 208, 589). Just as the Bendigo campus of La Trobe is a satellite of the metropolitan campus, the town of Bendigo is an outpost of Melbourne. So, when we are addressed and interpellated (Althusser 48) as regional, it is a reminder of the ongoing fact that Australia is (still) a colony, an outpost of empire, a country organised on the colonial model. From central administrative hubs, spokes of communication, and transportation spread to the outposts. When Bendigo students and staff are addressed as regional, in a way we are also being addressed as colonial.In this article, the terms ‘region’ and ‘regional’ are deployed as inextricably associated with the Australian version of colonialism. In Australia, in the central metropolitan hubs, where the colonial project is at its most comprehensive, it is hard to see what remains, to see what has escaped that project. The aim of this article is to explore how different aspects of the country escape the totalising project of Australian colonialism. This exploration is undertaken primarily through a discussion of the ways in which some places on this continent remain not regional (and thus, not colonial) how they keep the metropolis at bay, and how they, thus, keep Europe at bay. This discussion includes a general overview of the Australian colonial project, particularly as it pertains to First Nations Peoples, their knowledge and philosophies, and the continent’s unique ecologies. Then the article becomes more speculative, imagining different ways of seeing and experiencing time and place in this country, ways of seeing the remains and refuges of pre-1788, not-regional, and not-colonial Australia. In these remains and refuges, there persist the flourishing and radical difference of this continent’s ecologies and, not surprisingly, the radical suitedness of tens of thousands of years of First Nations Peoples’ culture and thinking to that ecology, as Country. In what remains not regional, I argue, are answers to the question: How will we live here in the Anthropocene?A Totalising ProjectSince 1788, in the face of the ongoing presence and resistance of First Nations cultures, and the continent’s radically unique ecologies, the Australian colonial project has been to convert the continent into a region of Europe. As such, the imposed political, administrative, scientific, and economic institutions are largely European. This is also so, to a lesser extent, of social and cultural institutions. While the continent is not Europe geologically, the notion of the Anthropocene suggests that this is changing (Crutzen and Stoermer). This article does not resummarise the vast body of scholarship on the effects of colonisation, from genocide to missionary charity, to the creation of bureaucratic and comprador classes, and so on. Suffice to say that the different valences of colonisation—from outright malevolence to misguided benevolence–produce similar and common effects. As such, what we experience in metropolitan and regional Australia, is chillingly similar to what people experience in London. Chilling, because this experience demonstrates how the effects of the project tend towards the total.To clarify, when I use the name ‘Australia’ I understand it as the continent’s European name. When I use the term ‘Europe’ or ‘European’, I refer to both the European continent and to the reach and scope of the various colonial and imperial projects of European nations. I take this approach because I think it is necessary to recognise their global effects and loads. In Australia, this load has been evident and present for more than two centuries. On one hand, it is evident in the social, cultural, and political institutions that come with colonisation. On another, it is evident in the environmental impacts of colonisation: impacts that are severely compounded in Australia. In relation to this, there is vital, ongoing scholarship that explores the fact that, ecologically, Australia is a radically different place, and which discusses the ways in which European scientific, aesthetic, and agricultural assumptions, and the associated naturalised and generic understandings of ‘nature’, have grounded activities that have radically transformed the continent’s biosphere. To name but a few, Tim Flannery (Eaters, “Ecosystems”) and Stephen Pyne, respectively, examine the radical difference of this continent’s ecology, geology, climate, and fire regimes. Sylvia Hallam, Bill Gammage, and Bruce Pascoe (“Bolt”, Emu) explore the relationships of First Nations Peoples with that ecology, climate, and fire before 1788, and the European blindness to the complexity of these relationships. For instance, William Lines quotes the strikingly contradictory observations of the colonial surveyor, Thomas Mitchell, where the land is simultaneously “populous” and “without inhabitants” and “ready for the immediate reception of civilised man” and European pastoralism (Mitchell qtd. in Lines 71). Flannery (Eaters) and Tim Low (Feral, New) discuss the impacts of introduced agricultural practices, exotic animals, and plants. Tom Griffiths tells the story of ‘Improving’ and ‘Acclimatisation Societies’, whose explicit aims were to convert Australian lands into European lands (32–48). The notion of ‘keeping Europe at bay’ is a response to the colonial assumptions, practices, and impositions highlighted by these writers.The project of converting this continent and hundreds of First Nations Countries into a region of Europe, ‘Australia’, is, in ambition, a totalising one. From the strange flag-plantings, invocations and incantations claiming ownership and dominion, to legalistic conceptions such as terra nullius, the aim has been to speak, to declare, to interpellate the country as European. What is not European, must be made European. What cannot be made European is either (un)seen in a way which diminishes or denies its existence, or must be made not to exist. These are difficult things to do: to not see, to unsee, or to eradicate.One of the first acts of administrative division (direction and rule) in the Port Phillip colony (now known as Victoria) was that of designating four regional Aboriginal Protectorates. Edward Stone Parker was appointed Assistant Protector of Aborigines for the Loddon District, a district which persists today for many state and local government instrumentalities as the Loddon-Mallee region. In the 1840s, Parker experienced the difficulty described above, in attempting to ‘make European’ the Dja Dja Wurrung people. As part of Parker’s goal of Christianising Dja Dja Wurrung people, he sought to learn their language. Bain Attwood records his frustration:[Parker] remarked in July 1842. ‘For physical objects and their attributes, the language readily supplies equivalent terms, but for the metaphysical, so far I have been able to discover scarcely any’. A few years later Parker simply despaired that this work of translation could be undertaken. ‘What can be done’, he complained, ‘with a people whose language knows no such terms as holiness, justice, righteousness, sin, guilt, repentance, redemption, pardon, peace, and c., and to whose minds the ideas conveyed by those words are utterly foreign and inexplicable?’ (Attwood 125)The assumption here is that values and concepts that are ‘untranslatable’ into European understandings mark an absence of such value and concept. Such assumptions are evident in attempts to convince, cajole, or coerce First Nations Peoples into abandoning traditional cultural and custodial relationships with Country in favour of individual private property ownership. The desire to maintain relationships with Country are described by conservative political figures such as Tony Abbott as “lifestyle choices” (Medhora), effectively declaring them non-existent. In addition, processes designed to recognise First Nations relationships to Country are procedurally frustrated. Examples of this are the bizarre decisions made in 2018 and 2019 by Nigel Scullion, the then Indigenous Affairs Minister, to fund objections to land claims from funds designated to alleviate Indigenous disadvantage and to refuse to grant land rights claims even when procedural obstacles have been cleared (Allam). In Australia, given that First Nations social, cultural, and political life is seamlessly interwoven with the environment, ecology, the land–Country, and that the colonial project has always been, and still is, a totalising one, it is a project which aims to sever the connections to place of First Nations Peoples. Concomitantly, when the connections cannot be severed, the people must be either converted, dismissed, or erased.This project, no matter how brutal and relentless, however, has not achieved totality.What Remains Not Regional? If colonisation is a totalising project, and regional Australia stands as evidence of this project’s ongoing push, then what remains not regional, or untouched by the colonial? What escapes the administrative, the institutional, the ecological, the incantatory, and the interpellative reach of the regional? I think that despite this reach, there are such remains. The frustration, the anger, and antipathy of Parker, Abbott, and Scullion bear this out. Their project is unfinished and the resistance to it infuriates. I think that, in Australia, the diff

Sustainable Development Goal 6.1 seeks universal access to safe drinking water for all by 2030, yet persistent disparities remain even in high-income countries. Indigenous, remote and small communities are disproportionately affected by poor drinking water quality, but comparable evidence to evaluate performance across communities is very limited due to inconsistent monitoring and reporting. To this end, we constructed a community-level meta-panel dataset of 839 communities (4,137 observations) across 4 Australian jurisdictions (Northern Territory, South Australia, Victoria and Western Australia) and Ontario, Canada, over the period 2018–2022. Drinking water quality was assessed using the Australian Drinking Water Guidelines and Canadian Boil Water Advisories. Logistic regression was employed to estimate the probability of accessing good-quality drinking water, with Indigenous status, remoteness, population size and socio-economic condition as key explanatory variables. Results reveal systematic disparities: Indigenous and very remote communities are statistically significantly less likely to have good-quality drinking water than non-Indigenous and regional communities after controlling for other factors. Our findings indicate that structural inequities – rather than geographic or demographic variation alone – are critical determinants of poor drinking water outcomes in small, Indigenous communities in both Australia and Canada.

BackgroundIndigenous residents living in remote communities in Australia’s Northern Territory experience higher rates of preventable chronic disease and have poorer access to appropriate health services compared to other Australians. This study compared health outcomes and costs at different levels of primary care utilisation to determine if primary care represents an efficient use of resources for Indigenous patients with common chronic diseases namely hypertension, diabetes, ischaemic heart disease, chronic obstructive pulmonary disease and renal disease.MethodsThis was an historical cohort study involving a total of 14,184 Indigenous residents, aged 15 years and over, who lived in remote communities and used a remote clinic or public hospital from 2002 to 2011. Individual level demographic and clinical data were drawn from primary care and hospital care information systems using a unique patient identifier. A propensity score was used to improve comparability between high, medium and low primary care utilisation groups. Incremental cost-effectiveness ratios and acceptability curves were used to analyse four health outcome measures: total and, avoidable hospital admissions, deaths and years of life lost.ResultsCompared to the low utilisation group, medium and high levels of primary care utilisation were associated with decreases in total and avoidable hospitalisations, deaths and years of life lost. Higher levels of primary care utilisation for renal disease reduced avoidable hospitalisations by 82-85%, deaths 72-75%, and years of life lost 78-81%. For patients with ischaemic heart disease, the reduction in avoidable hospitalisations was 63-78%, deaths 63-66% and years of life lost 69-73%. In terms of cost-effectiveness, primary care for renal disease and diabetes ranked as more cost-effective, followed by hypertension and ischaemic heart disease. Primary care for chronic obstructive pulmonary disease was the least cost-effective of the five conditions.ConclusionPrimary care in remote Indigenous communities was shown to be associated with cost-savings to public hospitals and health benefits to individual patients. Investing $1 in primary care in remote Indigenous communities could save $3.95-$11.75 in hospital costs, in addition to health benefits for individual patients. These findings may have wider applicability in strengthening primary care in the face of high chronic disease prevalence globally.

Reports from health workers, school staff and community members in rural NSW suggested that bacterial skin infections are a significant health issue for Aboriginal children and their families, affecting quality of life and contributing to poor school attendance. Current NSW treatment guidelines do not incorporate important sociocultural factors or ways of living in Aboriginal communities. The aim of this qualitative study was to gain a deeper understanding of the experience of parents and carers of Aboriginal children affected by skin infections and of other community members, health workers and school staff, and what actions have been considered successful or unsuccessful in reducing the recurrence of infection. This study used a Participatory Action Research methodology. Interviews and focus groups were conducted with 38 health workers and managers, school staff, community members and parents and carers. Themes that emerged included: (i) skin infections have become normalised; (ii) skin infections are, in part, a consequence of transgenerational trauma; (iii) skin infections are interwoven with social determinants; (iv) families have survived but more could thrive; and (v) something can and should be done about the problem. The findings of this study will inform the development of more effective and acceptable options to reduce skin infections in Aboriginal children.

Purpose:This study aimed to explore risk factors for suicide in Aboriginal andnon-Aboriginal people following hospital admission for suicidal ideation andself-harm in the Northern Territory, Australia to help clarify opportunitiesfor improved care and intervention for these population groups.Methods:Individuals with at least one hospital admission involving suicidal ideationand/or self-harm between 1 July 2001 and 31 December 2013 wereretrospectively recruited and followed up using linked mortality records to31 December 2014. Survival analyses stratified by Indigenous statusidentified socio-demographic and clinical characteristics from indexhospital admissions associated with suicide.Results:Just over half of the 4391 cohort members identified as Aboriginal(n = 2304; 52.4%). By 2014, 281 deaths were observedcomprising 68 suicides, representing a 2.6% and 2.0% probability of suicidefor Aboriginal and non-Aboriginal people, respectively. After adjusting forother characteristics, a higher risk of suicide was associated with male sex(Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76,9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval:[1.98, 17.88]) and repeat hospital admissions involving self-harm(Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21,1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval:[1.10, 1.51]). Severe mental disorders were associated with a four timeshigher risk of suicide (adjusted hazard ratio: 4.23; 95% confidenceinterval: [1.93, 9.27]) in Aboriginal people only.Conclusion:The findings highlight non-clinical risk factors for suicide that suggest theneed for comprehensive psychosocial assessment tailored to Aboriginal andnon-Aboriginal people hospitalised with suicidal ideation or self-harm.Implementing appropriate management and aftercare within a broader publichealth framework is needed to support recovery and reduce long-term suiciderisk in the community, especially for Aboriginal people and males.

Globally, Indigenous populations have been disproportionately impacted by pandemics. In Australia, though national infection rates with COVID-19 infections in Aboriginal and/or Torres Strait Islander people were lower in the first 12 months of the COVID-19 pandemic, there was soon a greater burden in Aboriginal and/or Torres Strait Island people once Omicron was circulating. Uptake of the COVID-19 vaccine was also lower among Aboriginal and/or Torres Strait Islander people. It was imperative to understand the stories of Aboriginal and/or Torres Strait Islander people in WA about their experience of the COVID-19 pandemic and vaccine rollout. Between September 2022 and October 2023, we conducted five face-to-face yarning workshops with Aboriginal and/or Torres Strait Islander people in Noongar Whadjuk Boodja (Perth metropolitan region, Western Australia). Yarns discussed COVID-19 experiences, knowledge and attitudes about COVID-19 and vaccination, reasons for or against COVID-19 vaccination, trusted sources of information, and knowledge of COVID-19 vaccination programmes for Aboriginal and/or Torres Strait Islander people. Data was thematically analysed in an inductive manner on NVivo, followed by a data interpretation forum with study investigators and community members. Across the five yarning workshops, we heard the stories and experiences of 38 Aborginal and/or Torres Strait Islander people. Many described the negative impact that the policies implemented to control COVID-19 had on their ability to connect with their community and practice traditional culture. Very few participants trusted government and any government information due to both historical and contemporary factors. This led participants to be wary of the fact they were among the first to be prioritised for COVID-19 vaccination in Australia. Though most participants (92%) had received at least one COVID-19 vaccine, there were high levels of COVID-19 vaccine hesitancy. The main reason for this was due to COVID-19 vaccine mandates; participants were, in essence, coerced acceptors of what they felt to be an unsafe vaccine that provided little protection against a mild disease. Our yarns identified high levels of COVID-19 vaccine hesitancy and circulation of misinformation amongst Perth-based Aboriginal and/or Torres Strait Islander people. Our findings also demonstrate that there were many unintended consequences of COVID-19 policies on Aboriginal and/or Torres Strait Islander people and culture. Future pandemic policies and vaccine programmes must consider the impact on not only the health of Aboriginal and/or Torres Strait Islander people but also the impact on community and culture.

Background:Implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools.Methods:Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines.Results:The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption.Conclusions:This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes.