RESUMEN
BACKGROUND: Australia provides health care services for Indigenous peoples as part of its effort to enhance Indigenous peoples' wellbeing. However, biomedical frameworks shape Australia's health care system, often without reference to Indigenous wellbeing priorities. Under Indigenous leadership the Interplay research project explored wellbeing for Indigenous Australians in remote regions, through defining and quantifying Indigenous people's values and priorities. This article aimed to quantify relationships between health care access, mental and physical health, and wellbeing to guide services to enhance wellbeing for Indigenous Australians in remote regions. METHODS: Indigenous and non-Indigenous researchers worked with Indigenous people in remote Australia to create a framework of wellbeing priorities. Indigenous community priorities were community, culture and empowerment; these interplay with government priorities for Indigenous development of health, education and employment. The wellbeing framework was further explored in four Indigenous communities through a survey which measured aspects of the wellbeing priorities. Indigenous community researchers administered the survey in their home communities to 841 Indigenous people aged 15 to 34 years from June 2014. From the survey items, exploratory factor analysis was used to develop constructs for mental and physical health, barriers to health care access and wellbeing. Relationships between these constructs were quantified through structural equation modelling. RESULTS: Participants reported high levels of health and physical health (mean scores (3.17/4 [SD 0.96]; and 3.76/4 [SD 0.73]) and wellbeing 8.07/10 [SD 1.94]. Transport and costs comprised the construct for barriers to health care access (mean access score 0.89/1 [SD 0.28]). Structural equation modelling showed that mental health, but not physical health was associated with wellbeing (ß = 0.25, P < 0.001; ß = - 0.038, P = 0.3). Health care access had an indirect positive relationship with wellbeing through mental health (ß = 0.047, P = 0.007). Relationships differed significantly for participants in remote compared with those in very remote communities. CONCLUSIONS: Greater attention to mental health and recognition of the role of services outside the health care sector may have positive impacts on wellbeing for Indigenous people in remote/ very remote Australia. Aggregation of remote and very remote populations may obscure important differences between Indigenous communities.
Asunto(s)
Salud Mental , Nativos de Hawái y Otras Islas del Pacífico/psicología , Satisfacción Personal , Adolescente , Adulto , Australia , Femenino , Accesibilidad a los Servicios de Salud , Servicios de Salud del Indígena , Humanos , Masculino , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Many Indigenous Australians hold cultural, ecological and language knowledge, but common representations of Indigenous Australians focus on social disadvantage and poor comparisons with other Australians in education, employment and health. Indigenous Land Management works with Indigenous people's cultural, ecological and language expertise, employing Indigenous people in activities contributing to biodiversity conservation. The Interplay research surveyed 841 Indigenous people in remote communities. Those employed in land management reported greater participation in cultural activities, language knowledge, and belief that their land was looked after. These related assets provide an opportunity for policy approaches based on Indigenous people's strengths and contribution to Australia.
Asunto(s)
Conservación de los Recursos Naturales/métodos , Agencias Gubernamentales/organización & administración , Nativos de Hawái y Otras Islas del Pacífico/educación , Adolescente , Adulto , Australia , Competencia Cultural , Ecología , Femenino , Estado de Salud , Humanos , Relaciones Interpersonales , Lenguaje , Masculino , Adulto JovenRESUMEN
BACKGROUND: For Indigenous Australians, health transcends the absence of disease, and includes the health and wellbeing of their community and Country: their whole physical, cultural and spiritual environment. Stronger relationships with Country and greater involvement in cultural practices enhance the wellbeing of Indigenous Australians, and those in more remote regions have greater access to their Country and higher levels of wellbeing. However this does not translate into improvements in clinical indicators, and Indigenous Australians in more remote regions suffer higher levels of morbidity and mortality than Indigenous people in non-remote areas, and other Australians. The Interplay research project aimed to explore how Indigenous Australians in remote regions experience high levels of wellbeing despite poor health statistics, and how services could more effectively enhance both health and wellbeing. METHODS: Indigenous Australians in remote regions, together with researchers and government representatives developed a wellbeing framework, comprising government and community priorities: education, employment and health, and community, culture and empowerment respectively. To explore these priorities Indigenous community researchers recruited participants from diverse Indigenous organizations, including Indigenous land management, art, business development, education, employment, health and municipal services. Fourteen focus groups and seven interviews, involving 75 Indigenous and ten non-Indigenous service providers and users were conducted. These were recorded, transcribed and analyzed, using thematic analysis, based on the wellbeing framework. RESULTS: Research participants highlighted Indigenous land management as a source of wellbeing, through strengthened identity and empowerment, access to traditional food sources, enjoyable physical activity, and escape from communities where high levels of alcohol are consumed. Participants described how collaboration and partnerships between services, and recognition of Indigenous languages could enhance wellbeing, while competition between services undermines wellbeing. Indigenous land management programs work across different sectors and promote collaboration between services, serving as a source of comprehensive primary health care. CONCLUSIONS: Developing primary health care to reflect distinctive health needs of Indigenous Australians will enhance their health and wellbeing, which includes their communities and Country. Indigenous land management consolidates aspects of comprehensive primary health care, providing both clinical benefits and wellbeing, and can provide a focus for service collaboration.
Asunto(s)
Conservación de los Recursos Naturales , Asistencia Sanitaria Culturalmente Competente , Servicios de Salud del Indígena/organización & administración , Estado de Salud , Nativos de Hawái y Otras Islas del Pacífico , Atención Primaria de Salud/organización & administración , Australia , Grupos Focales , Humanos , Colaboración Intersectorial , Entrevistas como Asunto , Investigación CualitativaRESUMEN
ISSUE ADDRESSED: Injuries lead to more hospitalisations and lost years of healthy life for Aboriginal people than any other cause. However, they are often overlooked in discussion of relieving Aboriginal disadvantage. METHODS: Four Aboriginal communities with diverse geography, culture and service arrangements participated in the Interplay Wellbeing project. In each community, Aboriginal researchers conducted focus groups and interviews arranged through Aboriginal organisations to explore wellbeing. A total of 84 participants contributed to 14 focus groups and eight interviews, which were recorded, transcribed and coded. This article reports on injury and possibilities for prevention, unanticipated themes raised in discussions of wellbeing. RESULTS: Interpersonal violence, injury and imprisonment emerged as themes that were linked with employment and wellbeing. Employment in Aboriginal ranger programs provides meaningful activity, which strengthens people's identity and cultural integrity. This can avert interpersonal violence through empowering women and reducing alcohol access and consumption. CONCLUSION: Ranger programs may provide a much-needed opportunity to control escalating rates of injury for Aboriginal people in remote communities. SO WHAT?: The manifold benefits of Aboriginal ranger programs include reducing violence and its injury and criminal justice consequences.
Asunto(s)
Empleo , Nativos de Hawái y Otras Islas del Pacífico , Heridas y Lesiones/prevención & control , Australia , Femenino , Grupos Focales , Humanos , Heridas y Lesiones/etnologíaRESUMEN
BACKGROUND: Wellbeing has been difficult to understand, measure and strengthen for Aboriginal people in remote Australia. Part of the challenge has been genuinely involving community members and incorporating their values and priorities into assessment and policy. Taking a 'shared space' collaborative approach between remote Aboriginal communities, governments and scientists, we merged Aboriginal knowledge with western science - by bringing together stories and numbers. This research aims to statistically validate the holistic Interplay Wellbeing Framework and Survey that bring together Aboriginal-identified priorities of culture, empowerment and community with government priorities including education, employment and health. METHOD: Quantitative survey data were collected from a cohort of 842 Aboriginal people aged 15-34 years, recruited from four different Aboriginal communities in remote Australia. Aboriginal community researchers designed and administered the survey. RESULTS: Structural equation modeling showed good fit statistics (χ/df = 2.69, CFI = 0.95 and RMSEA = 0.045) confirming the holistic nature of the Interplay Wellbeing Framework. The strongest direct impacts on wellbeing were 'social and emotional wellbeing' (r = 0.23; p < 0.001), 'English literacy and numeracy' (r = 0.15; p < 0.001), 'Aboriginal literacy' (r = 0.14; p < 0.001), 'substances' (lack thereof; r = 0.13; p = 0.003), 'work' (r = 0.12; p = 0.02) and 'community' (r = 0.08; p = 0.05). Correlation analyses suggested cultural factors have indirect impacts on wellbeing, such as through Aboriginal literacy. All cultural variables correlated highly with each other, and with empowerment and community. Empowerment also correlated highly with all education and work variables. 'Substances' (lack thereof) was linked with positive outcomes across culture, education and work. Specific interrelationships will be explored in detail separately. CONCLUSION: The Interplay Wellbeing Framework and Survey were statistically validated as a collaborative approach to assessing wellbeing that is inclusive of other cultural worldviews, values and practices. New community-derived social and cultural indicators were established, contributing valuable insight to psychometric assessment across cultures. These analyses confirm that culture, empowerment and community play key roles in the interplay with education, employment and health, as part of a holistic and quantifiable system of wellbeing. This research supports the holistic concept of wellbeing confirming that everything is interrelated and needs to be considered at the 'whole of system' level in policy approaches.