NACCHO #Aboriginal Health Special Feature : 20 Indigenous health research papers

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” This study aimed to examine the accuracy of patient self-reported screening status for diabetes, high cholesterol and cervical cancer among Aboriginal and Torres Strait Islander patients when compared with pathology records.

The study was undertaken in an Aboriginal Community Controlled Health Service (ACCHS). ACCHSs are culturally competent primary health care services and represent self-determination in the provision of health care. They are ideal settings for delivering prevention activities to Aboriginal and Torres Strait Islander people.”

From Insights into nutritionists’ practices and experiences in remote Australian Aboriginal communities

The Australian and New Zealand Journal of Public Health is the Journal of the Public Health Association of Australia and is published six times a year, in February, April, June, August, October and December

The current issue features Indigenous health 20 research papers

1.Aboriginal and Torres Strait Islander health: accuracy of patient self-report of screening for diabetes, high cholesterol and cervical cancer

Chronic diseases including diabetes, cardiovascular disease and cancer account for the majority of excess deaths and diseases among Aboriginal and Torres Strait Islander people, despite being largely preventable.1 Prevention activities such as regular screening are likely to produce significant health gains.2 To achieve these gains clinicians need appropriate, valid and reliable measures of a patient’s screening history.

Patient self-report is often used by clinicians as a quick and inexpensive way to obtain information about a patient’s screening status. Self-report is also used to determine the effectiveness of interventions intended to increase screening rates. The accuracy of self-report is therefore critical. Research studies in non-Indigenous primary care settings,3–11 including Australia,12–15 have shown that relying on self-report can result in significant under-estimation of the proportion of people who require screening. Under-estimating the time period since a patient’s last screening has been reported, especially among minority populations16,17 including indigenous native American women.18 Studies have also found that self-reported population survey data often under-estimates the prevalence of screening, particularly among marginalised population groups.9,10,19,20

Few published studies have investigated the validity of self-reported health issues among Aboriginal and Torres Strait Islander people in Australia. One study found self-reported information under-estimated the smoking status of pregnant Indigenous women,21 and another found a modest correlation between self-report and measured physical activity among Aboriginal children.22

This study aimed to examine the accuracy of patient self-reported screening status for diabetes, high cholesterol and cervical cancer among Aboriginal and Torres Strait Islander patients when compared with pathology records. The study was undertaken in an Aboriginal Community Controlled Health Service (ACCHS). ACCHSs are culturally competent primary health care services and represent self-determination in the provision of health care. They are ideal settings for delivering prevention activities to Aboriginal and Torres Strait Islander people.

2.Insights into nutritionists’ practices and experiences in remote Australian Aboriginal communities

Access to and adequate intake of a range of foods to meet the body’s energy and nutrient requirements is a universal cornerstone of good health and wellbeing. Among Aboriginal Australians, nutrition plays a significant direct and indirect role in suboptimal growth and development in children and the excessive burden of preventable chronic disease in adults.1,2 Public health nutrition is an integral part of population health that seeks to promote optimal nutrition status and good health, and prevent illness and associated economic and social costs of disease.3–5

For more than 20 years, public health and community nutritionists have worked in the Northern Territory (NT) within remote Aboriginal communities, both within the government public health sector and non-government organisations, such as Aboriginal Community Controlled Health Organisations. The term ‘public health nutritionist’ refers to practitioners working in population approaches to public health nutrition.

In the remote Aboriginal context, stakeholders within the food landscape can include remote community stores/shops, schools, childcare, aged-care facilities and health centres, community groups, Aboriginal health workers (AHWs) and families and individuals.6 Within these settings, nutritionists ideally work with and through local community members, including AHWs, to jointly address expressed food and nutrition-related priorities. For these reasons, the terms ‘community nutritionist’ and ‘public health nutritionist’ have been used interchangeably. The term ‘dietitian’ tends to refer to practitioners focusing on clinical and individual aspects of nutritional health. Increasingly, dietetic qualifications are mandatory for nutritionists working with remote Aboriginal communities, as many practitioners also provide a clinical service.

In remote Aboriginal communities, nutritionists perform numerous functions calling for a wide range of competencies that require social, communication and relationship building skills3 and cultural adeptness, including a culturally competent7 and culturally safe approach.8 The call for nutrition practitioners, and their training and employment structures, to move towards broader sociological9 and critical10 approaches appears especially relevant in a cross-cultural world where food permeates many aspects of life. This also supports the internationally agreed notion of ‘health’ that recognises the existence of various cultural and world views, and the imperative of supporting the layers of social and ecological factors that underpin one’s state of health by addressing healthcare at multiple levels.11 Across all these skills and levels, one universal and fundamental element is communication. All health workers in cross-cultural settings must communicate across social and cultural world views. Clear health communication is vital to assist with understanding and to empower individuals and groups to make informed decisions.12,13 Community empowerment is one key element of successful community nutrition interventions.14 Nutritionists working in remote Aboriginal communities ideally engage with a range of community stakeholders, including Aboriginal health and local community workers.

Remote health staff and health services speak of numerous challenges in providing remote health services and the complexities of delivering primary and health promotion services.15–19 While high staff turnover is a considerable issue,17 little is understood of the challenges facing nutrition practitioners especially in this cross-cultural context.20,21 We used a qualitative methodology to explore communication methods, education practices and approaches, perceived challenges and the potential role of nutritionists. The study aimed to support nutritionists working in remote Aboriginal communities and inform ongoing efforts to create supportive environments that promote nutritional health and effective communication and facilitate behaviour change.

3.Legally invisible: stewardship for Aboriginal and Torres Strait Islander health

4. The comparative cost of food and beverages at remote Indigenous communities, Northern Territory, Australia (pages S21–S26)

5. Use of electronic visual recording to aid assessment of dietary intake of Australian Aboriginal children living in remote communities

6. Bundap Marram Durn Durn: Engagement with Aboriginal women experiencing comorbid chronic physical and mental health conditions

7.The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

8. Trachoma in remote Indigenous Australia: a review and public health perspective

9. The value of partnerships: lessons from a multi-site evaluation of a national social and emotional wellbeing program for Indigenous youth

10.Hypertension: high prevalence and a positive association with obesity among Aboriginal and Torres Strait Islander youth in far north Queensland

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