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Indigenous health and wellness measurement … considerations from Canada
Alexandra King, MD, FRCPC, Cameco Chair in Indigenous Health and Wellness
Malcolm King, PhD, FCAHS, Scientific Director, Saskatchewan Centre for Patient-oriented Research
This talk will begin with a discussion of the Indigenous peoples in Canada, with a particular focus on aspects relevant to Australia – our racial/ethnic diversity, our varied histories of colonization and colonialism, and our shared values, among the most important of which are notions of self-determination.
Data sovereignty, one assertion of self-determination with various constructs, will be explored in the context of wellness measurement. So will what and how we measure wellness, with consideration of multiple needs, including those of the individual, family, community and nation, as well as public health and the health system. Indigenous health and wellness outcome measures need to resonate with what we, as First Nations, Inuit and Métis peoples, value. Furthermore, our Ways of Knowing, Being and Doing, as well as our values and worldviews, are inherently connected with our territories. Given the diversity of geography and ecology across what has become known as Canada, there are a multitude of community- and nation-specific understandings of wellness; these, in turn, result in multiple ways of understanding and measuring wellness. In terms of health service and system performance, we need ways to synthesize and aggregate at regional and national levels. However, our communities and Knowledge Holders are quite clear – there are other Ways of Knowing than the very young field of Western science. If, how and when these different knowledge systems are combined is a non-trivial task, particularly if we are to not subordinate but rather uplift and privilege Indigenous Ways of Knowing.
Canada is increasingly focusing on Indigenous wellness research and programming. We will present aspects of different wellness research initiatives in which we are involved. We will conclude with a discussion of multi-national collaborations focused on wellness. This will include an overview of the International Group on Indigenous Health Measurement (IGIHM) and their emerging focus on Indigenous wellness and its measurement. Since 2013, IGIHM has worked to explore Indigenous wellness – how it is constructed or defined, how it can be measured, and how wellness measurement can inform Indigenous health policy, programming, and most importantly, outcomes.
Aboriginal and Torres Strait Islander wellbeing: Mayi Kuwayu. Mayi Kuwayu
Associate Professor Raymond Lovett
Most quantitative studies of Aboriginal and Torres Strait Islander wellbeing are based on measures of unknown cultural appropriateness, reliability and validity for this population. Previous studies in this area have been restricted in scope, and have not adequately covered the heterogeneity of language groups and communities within the Aboriginal and Torres Strait Islander population. This presentation will showcase the development processes for measures included in the national study of Aboriginal and Torres Strait Islander wellbeing: Mayi Kuwayu. Mayi Kuwayu (meaning to follow people over time in Ngiyampaa) aims to understand links between culture and wellbeing and required development of measures of importance to Aboriginal and Torres Strait Islander peoples. This included: connection to country, beliefs and knowledge, language use, family, kinship and community, cultural expression and continuity, self-determination and leadership.
STUDENT ABSTRACTS & BIOS
Outcomes of Indigenous patients with ESRF requiring ICU: a retrospective database review
Mr Will Dunlop
Dialysis-dependent Chronic Kidney Disease (CKD5D) is a chronic disease of the kidneys, which requires renal replacement therapy (RRT), either as haemodialysis, peritoneal dialysis or a kidney transplant. In 2015, Australian prevalence of CKD5D was 968 per million population (pmp) with the annual incidence almost four times higher for Aboriginal and Torres Strait Islander people compared to non-Indigenous Australians (380pmp and 98mpm respectively). Aboriginal and Torres Strait Islander people living with CKD5D also demonstrate poorer long-term outcomes compared to non-Indigenous counterparts, possibly due to differential access to RRT. CKD5D increases the risk of requiring hospital admission, including to the intensive care unit (ICU). Despite well-documented long-term outcome disadvantage for Aboriginal and Torres Strait Islander people, little is known about short-term outcomes in ICU and hospital admissions.
This project aims to identify differences in short-term outcomes between Aboriginal and Torres Strait Islander and non-Indigenous patients with CKD5D in ICU. The Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS ADP) has data from >1.3 million ICU admissions across >140 contributing hospitals since 2007.
Will is in his first year of medical school at ANU and has a keen interest in critical care. Before commencing at ANU, he worked in emergency medicine as a medical scribe. He has co-authored a series of papers assessing the role of medical scribes in Australia, including first authorship on a patient experience paper. His undergraduate background in psychology and biological sciences drives his interest in promoting patient cultural safety concurrently with biomedicine. Will is excited to begin focusing efforts on Aboriginal and Torres Strait Islander health issues in the setting of intensive care medicine.
Tobacco smoking and sociodemographic factors, health behaviours, and health status among Aboriginal and non-Aboriginal participants of the 45 and Up Study in New South Wales, Australia
Ms Lucy Kirk
Tobacco smoking is the leading contributor to the burden of disease among Aboriginal and Torres Strait Islander Australians. Smoking prevalence is decreasing among Aboriginal and Torres Strait Islander adults but at 41.4% is still high compared to 14.5% in the total Australian population. To inform policy to support continued smoking prevalence reductions, we investigated factors associated with smoking prevalence among Aboriginal adults, and in comparison with non-Aboriginal adults.
This cross-sectional study used baseline data collected in 2006-2008 from the 45 and Up Study, a cohort study of adults 45 years and older living in New South Wales, Australia. Data from 1,934 Aboriginal participants and 259,401 non-Aboriginal participants were used to calculate age-sex-adjusted prevalence ratios (PRs) for current versus never smoking by sociodemographic factors, health behaviours, and health status.
Lucy Kirk is a current medical student at the ANU and is part of the Indigenous Health Stream. She has an interest in both policy and clinical practice implications of epidemiological research into Aboriginal and Torres Strait Islanders. Lucy has recently completed a project on smoking in Aboriginal and Torres Strait Islander peoples.
Barriers to the Continuum of Care for Aboriginal and Torres Strait Islander Children with Otitis Media and Sequelae
Mr Lucas Quinn
This study aimed to assess the referral process for the sequelae of otitis media in a large Aboriginal and Torres Strait Islander community, and to describe where there was disruption in the continuum of care.
A retrospective audit of the primary health care records was conducted. The setting for this research was Primary Health Care in Yarrabah, North Queensland. The participants were141 children (median age 7.2 years), who were represented by 353 episodes of care.
We collected data on diagnoses, referrals to audiology and ear nose and throat (ENT) specialists, time taken to appointments, and missed appointments. The results were: For audiology, 27.6% of clinic referrals led to appointments. 70.3% of audiology appointments came from sources other than the clinic. 44.7% of these appointments were within the recommended 3 months. Of the 94 ENT referrals, 69 eventuated in booked appointments documented by Gurriny Yealamucka. Of these 69 booked appointments, 26 were attended.
In conclusion we found low attendance rates and long waiting times for appointments are likely contributors to poor outcomes for children with otitis media and sequelae in our study population.
Lucas Quinn is a current medical student at ANU, and has been a registered nurse for 10 years. He has an interest rural medicine, general practice, and the delivery of health equity. He recently completed a research project on the provision of care for chronic middle ear infection in Yarrabah, North Queensland.