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Background Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. Methods/design The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. Discussion The Let’s CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. Trial registration ACTRN12618001485224 . Date of registration: 04 of September 2019

Background Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs’ geographical and demographic characteristics. Methods The study used 2017–2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels. Results There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and ‘other health workers’ combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic ( p values < 0.01). Conclusions Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs’ resources and may also support quality of service delivery due to improved cultural safety and continuity of care.

The individualistic and colonial foundations of neoliberal socio-political ideologies are embedded throughout Australian health systems, services, and discourses. Not only does neoliberalism undermine Aboriginal and Torres Strait Islander collectivist values by emphasizing personal autonomy, but it has significant implications for Aboriginal and Torres Strait Islander health. Aboriginal Community Controlled Health Services (ACCHS) operate within Community-oriented holistic understandings of well-being that contradict neoliberal values that Western health services operate within. Therefore, this paper aims to explore the role of ACCHS in resisting the pervasive nature of neoliberalism through the prioritization of self-determination for Aboriginal and Torres Strait Islander Peoples. Utilizing a critical evaluative commentary, we reflect on Aboriginal political leadership and advocacy during the 1970s and 1980s and the development of neoliberalism in Australia in the context of ACCHS. Community controlled primary health services across Australia are the only remaining government-funded and Aboriginal-controlled organizations. Not only do ACCHS models resist neoliberal ideologies of reduced public expenditure and dominant individualistic models of care, but they also incontrovertibly strengthen individual and Community health. ACCHS remain the gold standard model by ensuring Aboriginal and Torres Strait Islander rights to the self-determination of health in accordance with the United Nations Declaration of the Rights of Indigenous Peoples.

Background Aboriginal and/or Torres Strait Islander people experience dementia at a rate three to five times higher than the general Australian population. Aboriginal Community Controlled Health Services (ACCHSs) have a critical role to play in recognising symptoms of cognitive impairment, facilitating timely diagnosis of dementia, and managing the impacts of dementia. Little is known about the barriers and enablers to Aboriginal people receiving a timely dementia diagnosis and appropriate care once diagnosed. This study aims to explore, from the perspective of healthcare providers in the ACCHS sector across urban, regional and remote communities, the barriers and enablers to the provision of dementia diagnosis and care. Methods A qualitative study involving semi-structured interviews with staff members working in the ACCHS sector. Aboriginal Health Workers, General Practitioners, nurses, practice or program managers, and Chief Executive Officers were eligible to participate. Consenting ACCHS staff completed a telephone interview administered by a trained interviewer. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis. Results Sixteen staff from 10 ACCHSs participated. Most participants perceived their communities had a limited understanding of dementia. Symptoms of dementia were usually noticed by the GP or another healthcare worker at the ACCHS who had an ongoing relationship with the person. Most participants reported that their service had established referral pathways with either hospital-based geriatricians, geriatricians located with aged care assessment teams, or specialists who visited communities periodically. Key enablers to high quality dementia care included the use of routine health assessments as a mechanism for diagnosis; relationships within communities to support diagnosis and care; community and family relationships; comprehensive and holistic care models; and the use of tailored visual resources to support care. Key barriers to high quality care included: denial and stigma; dementia being perceived as a low priority health condition; limited community awareness and understanding of dementia; lack of staff education and training about dementia; and numerous gaps in service delivery. Conclusions Substantially increased investments in supporting best-practice diagnosis and management of dementia in Aboriginal communities are required. ACCHSs have key strengths that should be drawn upon in developing solutions to identified barriers to care.

Background Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), disproportionately impact the Aboriginal and Torres Strait Islander population of Australia. Aboriginal Community Controlled Health Services (ACCHSs) are primary care services, established to provide healthcare in culturally safe environments for Aboriginal people. There is little information about the respiratory services for people with chronic respiratory diseases provided by ACCHSs. Aim To describe current provision of respiratory services of ACCHSs based in New South Wales (NSW), with a focus on identifying barriers and facilitators to providing pulmonary rehabilitation. Methods A researcher-administered survey was conducted via Zoom plus a follow-up email to collect client and health workforce data. Participants were NSW-based ACCHSs, members of the Aboriginal Health and Medical Research Council (AH&MRC). Exclusions were ACCHSs that only delivered drug and alcohol rehabilitation, housing or employment services. The survey collected information related to client numbers, smoking history, COPD diagnoses, health workforce, and respiratory services with a focus on pulmonary rehabilitation programs. Results Forty-one ACCHSs were invited to participate and 18 (44%) completed the survey. Most provided respiratory care, although variation existed in service scope and delivery. The main respiratory services provided were smoking cessation (100%), spirometry (89%) and respiratory clinics (33%). Most ACCHSs (78%), reported some access to respiratory physicians. No ACCHSs provided pulmonary rehabilitation. Main barriers included staff shortages, lack of staff training, financial constraints and lack of space. Several ACCHSs expressed interest in providing a pulmonary rehabilitation program, if appropriate resourcing was available. Ten ACCHS (56%) reported that Aboriginal clients would not access mainstream public health services for pulmonary rehabilitation. Barriers to accessing these externally available pulmonary rehabilitation programs included transportation issues, cultural considerations and geographical location. Conclusions ACCHSs are delivering respiratory services for Aboriginal people living with chronic respiratory diseases within constrained infrastructure and resources. Additional funding is required to improve access to best practice care for Aboriginal people living with COPD including culturally safe, evidence-based and accessible pulmonary rehabilitation programs.

Background Nowhere is optimising healthcare staff retention more important than in primary health care (PHC) settings in remote Australia, where there are unacceptably high rates of staff burnout and turnover. Ensuing consequences for the remote health services and the community are acute – staffing shortfalls in clinics; organisational instability; excessive costs associated with frequent staff recruitment and orientation; diminished access to PHC for patients in need; and lack of continuity of patient care; all of which further entrench poor health outcomes for the community. Optimising remote healthcare staff retention is critical in order to provide high quality and continued PHC. Currently, however, there is paucity of knowledge to inform targeted and effective retention strategies in remote health services. This research program seeks to develop a stronger evidence base to understand (i) what retention strategies are effective in improving morale, job satisfaction, intention to remain in the job, and consequent length of service for remote healthcare staff; (ii) how best to ‘bundle’ these strategies for different health workforce groups; and (iii) how these ‘bundles’ work in different service contexts. Methods This paper describes a five-year implementation research program in partnership with twelve remote Aboriginal and Torres Strait Islander Community Controlled Health Services (ATSICCHS) in the Northern Territory and Queensland, Australia. Overall methodology follows a participatory action research approach which incorporates co-design and realist elements. The program comprises two broad phases involving evidence consolidation and synthesis (Phase 1), and co-design, implementation, and prospective evaluation of ‘bundles’ of retention strategies (Phase 2) to improve retention of healthcare staff in participating ATSICCHSs. Discussion This innovative research program has the potential to develop a comprehensive evidence base required to optimise health workforce retention in remote health services. This new evidence will strengthen understanding of what ‘bundles’ of retention strategies are effective, for which groups of employees, and how they work to improve staff retention.

The study aims to explore the role of mental health care in remote Aboriginal health services in the Kimberley region of Western Australia and provide a more nuanced understanding of the patients presenting for care, their needs, and the clinical response. Little is currently known about primary health care presentations for mental health, suicide, and self-harm for remote dwelling Aboriginal residents of the Kimberley region, despite high rates of psychological distress, self-harm, and suicide across the area. This study was progressed through a retrospective, cross-sectional audit of the electronic medical records system used by three remote clinics to explore the interactions recorded by the clinics about a patient’s mental health. In addition, an in-depth file review was conducted on a stratified purposive sample of 30 patients identified through the audit. Mental ill-health and psychological distress were found to be prominent within clinical presentations. Psychosocial factors were frequently identified in relation to a patient’s mental health presentation. Optimizing patients’ recovery and wellness through service improvements, including an enhanced mental health model of care, is an important next step.

This study explored the process and early outcomes of work undertaken by a program to increase Aboriginal people’s awareness of, and access to, the National Disability Insurance Scheme (NDIS). This ‘Access Program’ was implemented through the Aboriginal Community Controlled Sector in the remote Kimberley region of Western Australia. Access Program staff were interviewed to explore the strengths, challenges, and future directions of the program. The demographics, primary disability types, and NDIS access outcomes for clients who engaged with the program in the first 12 months of its implementation have been described. The Access Program engaged with 373 clients during the study period and assisted 118 of these to achieve access to the NDIS. The program was reported as successful by staff in its aim of connecting eligible people with the NDIS. Vital to this success was program implementation by the Aboriginal Community Controlled Sector. Staff in these organisations held community trust, provided culturally appropriate services, and utilised strengths-based approaches to overcome barriers that have historically hindered Aboriginal people’s engagement with disability services. Our results demonstrate the Access Program is a successful start in increasing awareness of, and access to, the NDIS for Aboriginal people in the Kimberley region. Much work remains to assist the large number of Aboriginal people in the Kimberley region believed to be eligible for NDIS support who are yet to achieve access.

Background This study describes chlamydia and gonorrhoea testing, positivity, treatment, and retesting among individuals aged ≥15years attending an urban Aboriginal Community Controlled Health Service during the period 2016-2021. Method Utilising routinely collected clinical data from the ATLAS program (a national sentinel surveillance network), a retrospective time series analysis was performed. The study assessed testing rates, positivity, treatment efficacy, retesting and trends over time within an urban Aboriginal Community Controlled Health Service. Results Testing rates for chlamydia and gonorrhoea varied between 10 and 30% over the study period, and were higher among clients aged 15-29years and among females. Positivity rates for both infections varied by age, with clients aged 15-24years having higher positivity than older clients. Gonorrhoea positivity rates decreased after 2016. Treatment and retesting practices also showed sex disparities, with men having a slightly higher treatment rate within 7days, whereas females had significantly higher retesting rates within 2-4months, indicating differences in follow-up care between sexes. Conclusion The study emphasises the need for clinical and public health interventions within urban Aboriginal and Torres Strait Islander populations to further reduce chlamydia and gonorrhoea. Prioritising improved access to testing, timely treatment and consistent retesting can significantly contribute to lowering STI prevalence and enhancing sexual health outcomes in these communities.

There is limited evidence on the social and emotional wellbeing (SEWB) needs of staff working at Aboriginal Community Controlled Health Services (ACCHS) in Australia. The current study employed qualitative research methods to explore ACCHS staff's experience during the COVID-19 pandemic and its impact on their SEWB, and to identify factors that provided strength. Yarning Circles and one-on-one Yarns were employed to explore clinical and non-clinical ACCHS staff's experiences. Participants included staff who identified as Aboriginal and/or Torres Strait Islander, or were non-Indigenous. Thirty-one staff from 5 ACCHSs participated in 7 Yarning Circles and 3 one-on-one Yarns, between December 2021 and June 2022. Staff shared their perspectives on (i) ACCHSs' responses, (ii) community and staff reaction, and (iii) impact of service-level changes on their SEWB. Data was analysed using thematic analysis. The main themes identified as impacting ACCHS staff's SEWB were: (1) constant change and prolonged stress, (2) community as a source of strength, (3) leadership safeguarding community and staff, (4) pride in their response, and (5) opportunities to lessen psychological toll. Staff were motivated by the seamlessness of their roles. They were motivated by positive work environment, reliable infection control measures, and resourceful leadership. Major concerns included fear of contracting and transmitting infection, and long-term consequences of disrupted patient care. There was a lack of awareness among staff about formal SEWB support, and if aware they were hesitant to use services due to cultural safety and privacy concerns. A major source of support for ACCHS staff was peer support. During the COVID-19 pandemic ACCHS staff experienced prolonged stress exacerbated by constant changes, inconsistent information, misinformation, and lack of resources. Staff found strength in community, cultural connections, and management's response. Informal peer support was important in upholding ACCHS staff's SEWB, suggesting that structured peer support can provide ongoing support.