Search Results (200)

Emergency departments (EDs) are critical points of contact for treating and responding to the needs of Aboriginal and Torres Strait Islander women who have experienced traumatic brain injury (TBI) caused by violence. This study aimed to explore how care, support, and treatment can be improved for Aboriginal and Torres Strait Islander women who have experienced TBI caused by violence by drawing on the perspectives of ED staff in a regional hospital in Queensland (Australia). Using purposeful and snowballing sampling, 24 health professionals (including Indigenous hospital liaison officers and Aboriginal health workers and nursing, medical, and allied health staff) were recruited to participate in the study. Using reflexive thematic analysis, four key recommendations were identified: (1) development of a formalised pathway for head injury from family violence; (2) providing Aboriginal and Torres Strait Islander women with a timely acute-care-to-community pathway; (3) resourcing hospital- and community-based services for all Aboriginal and Torres Strait Islander women and their children; and (4) strengthening responses from health professionals to violence and head injury. The findings inform opportunities to strengthen ED and system-level responses to improve care and support for Aboriginal and Torres Strait Islander women who have experienced this injury. Full article

In Australian education, the challenges and complexities of school leadership and the educational achievement of Aboriginal and Torres Strait Islander young people are frequently debated. Each has been given individual attention, but little attention to how school leadership and educational success for Aboriginal and Torres Strait Islander young people collectively interact. While there are increasing expectations of school leaders enabling the success of Aboriginal and Torres Strait Islander young people and Aboriginal and Torres Strait Islander perspectives embedded in schools, knowledge is required about the role of transformative leadership approaches that enable cultural responsiveness in the actions and practices of school leaders. Framed by Rigney’s Indigenist Research Theory (IRT) and Transformative Leadership Theory (TLT), this paper draws from a collective case study that gathers the lived experiences of school leadership from Aboriginal and Torres Strait Islander families, community, staff and school leader participants. The findings illuminate the actions and practices that school leadership enact to lead culturally responsive and inclusive school communities. The study argues the necessity of school leaders valuing and engaging with Aboriginal and Torres Strait Islander knowledges, perspectives and lived experiences as critical for advancing educational success for Aboriginal and Torres Strait Islander peoples, and education for all young people. Exploring the role of transformative leadership in the advancement of equity and excellence in Aboriginal and Torres Strait Islander education in Australia, this paper culminates in examining the implications for practice that also support the advancement of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), the United Nations Convention on the Rights of the Child (UNCRC), and the United Nations’ Sustainable Development Goal 4 (SDG 4) of equity, inclusion, and quality education and lifelong learning for all. Full article

Background/Objectives: University Department of Rural Health (UDRH) programs were created to address the disparities in rural Australian communities. A large proportion of Aboriginal and Torres Strait Islander people live in rural communities, and the UDRHs work closely with communities to improve outcomes for Indigenous Australians. This narrative review examines the nature of the intervention papers in Australian Indigenous health published by UDRHs and identifies key learnings to improve interventions in Australian Indigenous health. Methods: Intervention papers were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Thirty-three papers were included in the review. Thematic analysis identified four overarching themes from the key learnings identified in the papers: (1) principles of engagement and design; (2) considerations for improving healthcare systems; (3) considerations for improving healthcare workforce; and (4) the sustainability of interventions and improvements in outcomes. Most of the studies employed qualitative or mixed-methods designs. Conclusions: These findings provide practical guidance for strengthening Indigenous health interventions. Effective Indigenous health interventions require meaningful community engagement and co-design, culturally safe practice supported by workforce training, and multicomponent approaches that address social determinants and barriers to access. Sustained impact depends on adequate resourcing, strong organisation leadership and embedding programs within healthcare systems with clear pathways for ongoing care and capacity building. UDRHs should reflect on current and future projects to ensure that engagement principles, system-level considerations, health workforce development, and long-term sustainability are embedded within intervention design and implementation. Full article

Indigenous Australians experience a disproportionate burden of type 2 diabetes mellitus and cardiovascular disease. While clinician-led, community-based exercise programs are effective in general populations, limited peer-reviewed evidence is available describing culturally adapted exercise interventions with Indigenous Australians that transparently reports governance, cultural adaptation, and theoretical design. This paper reports the co-design and development of tools for the Preventing Indigenous Cardiovascular Disease and Diabetes through Exercise (PrIDE) study, an adaptation of the Beat It program that incorporates wearable technology. Using the Co-design Health Research and Innovation Model, four tools were developed with Indigenous governance through a Consumer Advisory Group and a project-specific Consumer User Panel. Three tools were culturally adapted—the PrIDE Exercise Program, the Strong Spirit Strong Self self-efficacy assessment, and Keep Your Heart Strong educational materials—and a newly developed tool, the Success Plan. Cultural adaptations were prospectively documented using the Model for Adaptation Design and Impact, and all tools were assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Behavior change mechanisms were mapped using the COM-B model. This paper provides transparent documentation of culturally adapted theory-informed tool development to support reproducibility and knowledge translation. The evaluation of effectiveness, acceptability, and psychometric properties will be reported following PrIDE implementation. Full article

First Nations children remain dramatically over-represented in Australia’s Out-of-Home Care (OOHC) system, particularly in New South Wales (NSW), which continues to report the highest numbers nationally. This narrative review, grounded in a relational First Nations Standpoint Theory and decolonising research paradigms, to critically examine the systemic, structural, and historical factors contributing to these disproportionalities. Drawing on interdisciplinary evidence across law, criminology, education, health, governance studies, and public policy, the analysis centres Indigenous-authored scholarship and contemporary empirical literature, including grey literature, inquiries, and community-led reports. Findings reveal that the OOHC system reproduces the colonial logics that historically drove the Stolen Generations. Macro-level structural drivers—including systemic racism, Indigenous data injustice, entrenched poverty and deprivation, intergenerational trauma, and Westernised governance frameworks—continue to shape child protection policies and practices. Micro-level drivers such as parental supports, mental health distress, substance misuse, family violence, and the criminalisation of children in care (“crossover children”) must be understood as direct consequences of structural inequality rather than as isolated individual risk factors. Current placement and permanency orders in NSW further compound cultural disconnection, with ongoing failures to implement the Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP). Contemporary cultural rights and Indigenous Cultural and Intellectual Property (ICIP) frameworks highlight the urgency of restoring Indigenous authority in decision-making processes. The literature consistently demonstrates that cultural continuity, kinship networks, and ACCO-led models are sort to produce stronger long-term outcomes for children. The review concludes that genuine transformation requires a systemic shift toward Indigenous-led governance, community-controlled service delivery, data sovereignty, and legislative reform that embeds cultural rights and self-determination. Without acknowledging the structural drivers and redistributing genuine power and authority, the state risks perpetuating a cycle of removal that mirrors earlier assimilationist policies. Strengthening First Peoples governance and cultural authority is therefore essential to creating pathways for First Nations children to live safely, remain connected to family and kin, and thrive in culture. Full article

The study’s aim was to compare the unplanned admission rates and nutrition outcomes in patients with head and neck squamous cell cancer (HNSCC) receiving chemoradiotherapy at two different hospitals with different nutrition support approaches. Hospital Site A used prophylactic tube feeding and Site B used reactive tube feeding. Consecutive HNSCC patients receiving chemoradiotherapy with curative intent over six months in 2015 were eligible for this prospective comparative cohort study. Only patients who were classified as at high nutrition risk using validated guidelines were included. Patients’ weight was recorded at the start, end, and 4–6 weeks post treatment to determine percentage weight loss outcomes. Unplanned hospital admissions (for medical or nutrition related reasons) and associated length of stay (LOS) were collected throughout and up to 1-month post treatment. In total, 88 patients were included in the study (site A n = 58; site B n = 30). The mean age was 60 years, 86–90% were male, and predominantly had oropharyngeal cancer. There was no statistical difference between the groups for percentage weight loss at any timepoint, rates of unplanned nutrition related admissions, or LOS. Stepwise logistic analysis showed that being of an older age was predictive of having an unplanned nutrition-related admission. In summary, there was no difference in the rate of unplanned admissions or percentage weight loss for patients with HNSCC managed under the prophylactic versus reactive tube feeding approach. Decision making regarding the choice of feeding tube should be made in consultation with the patient and the multidisciplinary team. Full article

Background: Childhood Obesity is a significant and growing Public Health threat among Aboriginal and Torres Strait Islander (ATSI) children and adolescents in Australia. Health sectors in Australia have been focusing on health intervention programs across various states to prevent childhood obesity. This review aims to analyse the impact of obesity intervention programs conducted among children and adolescents of ATSI communities across Australia and report on the best practices for conducting future research. Objectives: This scoping review synthesised existing literature on the obesity prevention interventions programs among ATSI Children and Adolescents in Australia and examined their scope, implementation, and outcomes; evaluated their cultural appropriateness; and highlighted critical enablers and barriers. Methods: This scoping review analysed scholarly journal articles that reported on the findings of obesity intervention programs delivered across ATSI children and adolescents. Only Quasi-experimental and Randomized Control Trials (RCTs) were selected for the review. A full search has been carried out in Health databases such as Cochrane Library, Medline, PubMed, and ProQuest Central for the past 15 years. The framework of the Joanna Briggs Institute (JBI) for Scoping reviews was followed throughout this review. Results: Eleven studies met inclusion criteria. Findings were clustered into five themes: (i) community-led, systems-based interventions improved health behaviours and anthropometry; (ii) culturally tailored, community-embedded programs enhanced engagement and health literacy; (iii) early childhood and family-focused approaches showed promise; (iv) community or policy initiatives yielded mixed results; and (v) behavioural interventions were ineffective without addressing social and structural determinants. The most effective programs were community-delivered, multi-stakeholder, and centred on empowerment and capacity building. Conclusions: Obesity prevention efforts targeting Aboriginal and Torres Strait Islander children and adolescents are most successful when community-led, culturally grounded, and supported by multiple stakeholders. These findings underscore the necessity of culturally sensitive, participatory approaches. Further research is needed to strengthen the evidence base and inform sustainable, policy-relevant strategies for childhood obesity. Full article

Out-of-pocket health expenditure (OOPHE) significantly impacts people with chronic and complex diseases (CCDs) and injuries. Aboriginal communities experience a higher burden of CCDs and injury, along with greater OOPHE inequities. This project aims to develop and implement a social prescribing digital platform (Web App) to reduce OOPHE. It is grounded in citizen science approaches that value the lived experience and knowledge of Aboriginal people in shaping solutions. The project uses a citizen science methodology adapted for these communities, using knowledge interface methodology to weave together Indigenous and Western knowledges. Research methods (Indigenous, quantitative, qualitative) explore the relational nature of OOPHE risks and protective factors through co-design and workshops with Aboriginal participants to develop the Web App. A community-centric developmental evaluation guides the trial and refinement of the platform, allowing for ongoing learning and adaptation. Process measures inform a national scale-up and evaluation framework. Addressing OOPHE is essential to improving health and wellbeing for Aboriginal and Torres Strait Islander individuals and families living with or at risk of CCDs. This initiative aims to reduce the impact of OOPHE through digital social prescribing, there by connecting people with essential community services to access healthcare, offering a scalable approach to addressing health inequities nationwide. Full article

Background/Objectives: Cancer is a leading cause of death for Aboriginal and Torres Strait Islander people, with remoteness increasing the risk for poorer outcomes. Primary health care (PHC) clinics have an important role in cancer screening, diagnosis, and post-discharge cancer care, particularly in remote communities, so accurate, timely communication between hospitals, specialists and PHC clinics is vital. This paper analyses the perspectives of Northern Territory health care professionals on communication between PHC and hospital services related to providing care for Aboriginal people with cancer and recommends strategies for improving communication between services. Methods: A qualitative study was undertaken in which semi-structured interviews were conducted with fifty staff from 15 health services (8 regional, remote, and very remote PHC clinics; 3 hospitals; one cancer centre and 3 cancer support services) between 2016 and 2019. Transcripts were thematically analysed, with findings categorized into barriers and enablers to communication. Results: Deficiencies in communication impeded patient care and support. A major barrier was fragmented, inefficient information systems; IT systems across health services were unable to interface, resulting in delayed/missing patient information that impacted discharge and follow up. Other barriers included PHC staff with limited knowledge of cancer, high turnover of PHC staff and tertiary hospital staff with limited understanding of remote health care challenges. Individuals used workarounds to overcome system failures and made substantial efforts around individual patients to improve communication. Specific roles and the use of telehealth between services and centralised cancer care services supported better between-service communication. Conclusions: Communication between hospital services and remote PHC clinics is essential to care for Aboriginal cancer patients; our research identified communication as inadequate in terms of consistency and timeliness. Commitment to more timely communication, health care IT systems that facilitate sharing information, designated staff in PHC clinics to support patients with cancer, dedicated Aboriginal cancer roles and additional resourcing to coordinate telehealth appointments could improve communication and sharing of patient information between services. Full article

Western systems of child protection cannot protect First Nations children. Australia’s current child protection systems were born from a legislated and explicit intention of destroying the culture, language and identity of First Nations children, with the aim of assimilating and eliminating First Nations people. The ongoing overrepresentation of our children in ‘child protection’ systems does not so much reflect inherent risks in our families as it does the systemic failures and harm being imposed on our children and families. To ensure the safety of our children, we need to end the systemic and structural racism within Australia’s child protection systems, empower self-determination and commit to addressing the social, economic and cultural determinants that underpin child safety and protection. To achieve this, we need an effective system of care for our children that is best achieved through First Nations systems of child wellbeing and safety that are leading practice. The Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP), which recognises our systems of kinship care, is one such mechanism. However, it is currently compromised, undermined and underutilised across all Australian jurisdictions. Self-determination requires placing full control and decision-making over the well-being and safety of our children into our hands. Our systems have evolved over 65,000 years and are guided by strict obligations and cultural protocol, and laws. As such, they provide the strong foundation needed for the care and protection of our children. This paper uses a First Nations, rights-based analysis of literature to interrogate the historical foundations and ongoing impact of Australia’s child protection systems on First Nations children and families. It then centres First Nations systems of knowledge and practice as the foundation for a call to replace our current child protection systems with a First Nations Child Safety and Wellbeing system. Full article

This article draws upon the findings of a Churchill Fellowship that the author undertook in 2023 exploring how First Nations people and their communities internationally are reclaiming child protection decision making. From visiting Aotearoa (New Zealand), the United States of America, and Canada as well as the experiences of Queensland and Victoria in Australia, the author will highlight the preconditions to change; the processes that First Nations communities and their community-controlled organisations engaged in; the strengths and limitations of these approaches; and what has maintained and supported long-term change. The findings in this article aim to contribute to the key elements for guiding the development of a roadmap for Aboriginal and Torres Strait Islander communities to engage in their own journey of reclaiming child protection decision making within Australia. Full article

Thursday Island, a remote administrative hub in Australia’s Torres Strait, exemplifies the socio-technical challenges of transitioning to sustainable energy amid diesel dependence and the intermittency of renewables. As Australia pursues Net Zero by 2050, innovative storage solutions are pivotal for enabling green innovation in isolated microgrids. This study evaluates Vanadium Redox Flow Batteries (VRFBs) and Lithium-Ion batteries as key enabling technologies, using a stochastic Monte Carlo simulation to assess their economic viability through Levelized Cost of Storage (LCOS), incorporating uncertainties in capital costs, operations, and performance over 20 years. Employing a stochastic Monte Carlo simulation with 10,000 iterations, this study provides a probabilistic assessment of LCOS, incorporating uncertainties in key parameters such as CAPEX, OPEX, efficiency, and discount rates, offering a novel, data-driven framework for evaluating storage viability in remote microgrids. Results indicate VRFBs’ superiority with a mean LCOS of 168.30 AUD/MWh versus 173.50 AUD/MWh for Lithium-Ion, driven by scalability, durability, and safety—attributes that address socio-economic barriers like high operational costs and environmental risks in tropical, off-grid settings. By framing VRFBs as an innovative green solution, this analysis highlights opportunities for new business models in remote energy sectors, such as reduced fossil fuel reliance (3.6 million litres diesel annually) and enhanced community resilience against energy poverty. It also underscores challenges, including capital uncertainties and policy needs for innovation uptake. This empirical case study contributes to the sustainable energy transition discourse, offering insights for policymakers on overcoming resistance to decarbonization in geographically constrained contexts, aligning with green innovation goals for systemic sustainability. Full article

This paper argues for a conceptualisation of self-determination with respect to Indigenous Peoples’ child protection that is grounded in human rights which are plural, relational, and collective as well as individual. This challenges the idea that human rights are universal and static standards based on a code of enumerated rights with a focus on individual rights. Conceptions of the best interests of the child, permanency in care arrangements, and attachment within colonial institutions such as children’s courts often presume non-Indigenous understandings of family and culture. These child protection concepts, which are often framed as consistent with or even necessary to attain children’s human rights, implicitly embed colonial understandings and values with respect to family and community relations. An acknowledgment of the role of law in structuring relationships is necessary for the human rights of Indigenous children to be upheld. We argue that a relational and distributional conceptualisation of these rights can help to clarify how the law can contribute to strengthening, rather than undermining, Aboriginal and Torres Strait Islander family and community relationships. Full article

Where we find and form identity and belonging, meaning and purpose, is often entangled in the dynamics that play out between people and place, and for Aboriginal and Torres Strait Islander Peoples, the legacy and ongoing experience of invasion and colonisation. Place-based understandings of identity and its importance in shaping young people’s experience of what is possible and probable in their futures might be critical to framing cross-cultural work with young people impacted by violence and trauma. This paper draws on practitioner reflections of work with young Aboriginal women both on, and off Country, highlighting common and distinct themes related to identity formation and migration in navigating new futures. These include connection to Country and spiritual connection, family and kinship relationships, Women’s Business and felt cultural safety. The findings illustrate a meaningful parallel instructive to practice; for both young women and practitioners, access to cultural knowledge and connection is strengthened by endorsement and in turn strengthens understanding and experienced safety. This work emphasises the importance of creating culturally connected opportunities, sensitive to dynamics of place, to support positive identity expression and wellbeing. Full article

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article