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"Torres Strait Islanders."
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Starting the SToP trial: Lessons from a collaborative recruitment approach
Recruitment in research can be challenging in Australian Aboriginal contexts. We aimed to evaluate the SToP (See, Treat, Prevent skin infections) trial recruitment approach for Aboriginal families to identify barriers and facilitators and understand the utility of the visual resource used.
This qualitative participatory action research used purposive sampling to conduct six semi-structured interviews with staff and five yarning sessions with Aboriginal community members from the nine communities involved in the SToP trial that were audio recorded and transcribed verbatim before thematic analysis.
Community members valued the employment of local Aboriginal facilitators who used the flipchart to clearly explain the importance of healthy skin and the rationale for the SToP trial while conducting recruitment. A prolonged process, under-developed administrative systems and stigma of the research topic emerged as barriers.
Partnering with a local Aboriginal organisation, employing Aboriginal researchers, and utilising flip charts for recruitment was seen by some as successful. Strengthening governance with more planning and support for recordkeeping emerged as future success factors.
Our findings validate the importance of partnership for this critical phase of a research project. Recruitment strategies should be co-designed with Aboriginal research partners. Further, recruitment rates for the SToP trial provide a firm foundation for building partnerships between organisations and ensuring Aboriginal perspectives determine recruitment methods.
Journal Article
Speaking back to the deficit discourses : a theoretical and methodological approach
The educational attainment of Aboriginal and Torres Strait Islander students is often presented within a deficit view. The need for Aboriginal and Torres Strait Islander researchers to challenge the societal norms is necessary to contribute to the struggle for self-determination. This paper presents a theoretical and methodological approach that has enabled one researcher to speak back to the deficit discourses. Exemplification of how Indigenous Critical Discourse Analysis identifies the power of language to maintain the inequitable positioning of Aboriginal and Torres Strait Islander peoples within Australian society is provided. Particular focus is placed on the Aboriginal and Torres Strait Islander Education Action Plan 2010-2014 and how policy discourses ignore the historical, political, cultural and social factors that influence the engagement and participation of Indigenous peoples in education today. The paper argues for the need to personalise methodological approaches to present the standpoint of the researcher and, in turn, deepens their advocacy for addressing the phenomenon. In turn, the paper presents the need to build on existing Indigenous research frameworks to continue advocating for the position of Indigenous research methodologies within the Western institution. [Author abstract, ed]
Journal Article
Web-Based Application for Reducing Methamphetamine Use Among Aboriginal and Torres Strait Islander People: Randomized Waitlist Controlled Trial
Digital interventions can help to overcome barriers to care, including stigma, geographical distance, and a lack of culturally appropriate treatment options. \"We Can Do This\" is a web-based app that was designed with input from cultural advisors and end users to support Aboriginal and Torres Strait Islander people seeking to stop or reduce their use of methamphetamine and increase psychosocial well-being.
This study aimed to evaluate the effectiveness of the \"We Can Do This\" web-based app as a psychosocial treatment for Aboriginal and Torres Strait Islander people who use methamphetamine.
The web app was evaluated using a randomized waitlist controlled parallel group trial. Participants were Aboriginal and Torres Strait Islander people aged 16 years or older who self-identified as having used methamphetamine at least weekly for the past 3 months. Participants were randomized on a 1:1 ratio to receive either access to the web-based app for 6 weeks or a waitlist control group. Both groups received access to a website with harm minimization information. The primary outcome was days of methamphetamine use in the past 4 weeks assessed at 1, 2, and 3 months post randomization. Secondary outcomes included severity of methamphetamine dependence (Severity of Dependence Scale [SDS]), psychological distress (Kessler 10 [K10]), help-seeking behavior, and days spent out of role due to methamphetamine use.
Participants (N=210) were randomized to receive either access to the web-based app (n=115) or the waitlist control condition (n=95). Follow-up was 63% at 1 month, 57% at 2 months, and 54% at 3 months. There were no significant group differences in days of methamphetamine use in the past 4 weeks at 1 the month (mean difference 0.2 days, 95% CI -1.5 to -2), 2 months (mean difference 0.6 days, 95% CI -1 to 2.4 days) or 3 months (mean difference 1.4 days, 95% CI -0.3 to 3.3 days) follow-up. There were no significant group differences in K10 scores, SDS scores, days out of role, or help-seeking at any of the 3 follow-up timepoints. There was poor adherence to the web-based app, only 20% of participants in the intervention group returned to the web-based app after their initial log-in. Participants cited personal issues and forgetting about the web-based app as the most common reasons for nonadherence.
We found poor engagement with this web-based app. The web-based app had no significant effects on methamphetamine use or psychosocial well-being. Poor adherence and low follow-up hindered our ability to accurately evaluate the effectiveness of the web-based app. Future web-based apps for this population need to consider methods to increase participant engagement.
Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376088.
RR2-10.2196/14084.
Journal Article
“I feel more comfortable speaking to a male”: Aboriginal and Torres Strait Islander men’s discourse on utilizing primary health care services
Background
Aboriginal and Torres Strait Islander men have the highest morbidity and mortality rates, and lowest rates of health service utilization in Australia. There is a current perception that Aboriginal and Torres Strait Islander men are disinterested in their health. This study aimed to identify the perceived motivators, barriers and enablers of Aboriginal and Torres Strait Islander men’s utilization of primary health care services, explore their experiences and obtain suggestions from them as to how services could be modified to improve utilization.
Methods
This study utilized the principles of Indigenist Research Methods. Semi-structured interviews with Aboriginal and Torres Strait Islander men (
N
= 19) took place in South Australia and far north Queensland. Participants were asked about their experiences with primary health care services, including what they could remember as a child. A thematic analysis of the qualitative data was completed without the use of computer software.
Results
Feelings of invincibility, shame, being uncomfortable, fearful, along with long waiting times, having a lack of knowledge, and culturally inappropriate staff/services were all found to be barriers to service utilization. Enabling factors included convenience, the perceived quality of the service, feeling culturally safe and/or a sense of belonging, and having a rapport with staff. Motivation for attending primary health care services included going when feeling sick/unwell, attending a particular service (dental or sexual health), visiting for check-ups and preventative health and family encouragement.
This study also highlights strategies surrounding logistical factors, promotion of services and improved communications, having culturally appropriate services and providing gender specific services all of which were suggested by the participants to improve service utilization.
Conclusion
Contrary to common misperceptions, this study demonstrated that most of the Aboriginal and Torres Strait Islander men participants were motivated to engage with primary health care services for preventative health care. Even though there were men that fitted the stereo-type who avoid doctors, there were usually underlying reasons and barriers accounting for this reluctance. This study suggests that if primary health care services commit to better understanding the barriers, enablers and motivators their cohort of men face, then utilization could be greatly improved.
Journal Article
\Absolutely it was not safe\ : Indigenous LGBTIQSB+ experiences of education in Australia
Indigenous LGBTIQSB+ individuals occupy a unique intersection of identities that inform their lived experiences and the ways in which they navigate colonial settler educational institutions. Despite a considerable body of evidence demonstrating the importance of inclusion, educational policies in Australia remain outdated. These policies are frequently informed by a deficit approach that justifies the absence of Indigenous and gender/sexuality diverse content within school curricula. This further acts to shore up discriminatory practices and policies. Using interviews and workshops held with young Indigenous LGTBIQSB+ people, this article reports on the ways participants experienced educational institutional settings. First, participants reported on the kinds of policies and curriculum content that discriminated against and marginalised them, as well as highlighting some positive aspects of school and university. Participants also revealed the potentialities for Indigenous and LGBTIQSB+ inclusivity that could be facilitated within educational spaces. The article demonstrates the need for safer and more inclusive educational environments, which could be achieved through the decentring of settler knowledges and heteronormativity, transforming educational spaces at an institutional level to facilitate safety at interpersonal and collective levels.
Journal Article