Statistical methods to enhance reporting of Aboriginal Australians in routine hospital records using data linkage affect estimates of health disparities

Objective: To investigate under‐recording of Aboriginal people in hospital data from New South Wales (NSW), Australia, define algorithms for enhanced reporting, and examine the impact of these algorithms on estimated disparities in cardiovascular and injury outcomes. Methods: NSW Admitted Patient Data were linked with NSW mortality data (2001–2007). Associations with recording of Aboriginal status were investigated using multilevel logistic regression. The number of admissions reported as Aboriginal according to six algorithms was compared with the original (unenhanced) Aboriginal status variable. Age‐standardised admission, and 30‐ and 365‐day mortality ratios were estimated for cardiovascular disease and injury. Results: Sixty per cent of the variation in recording of Aboriginal status was due to the hospital of admission, with poorer recording in private and major city hospitals. All enhancement algorithms increased the number of admissions reported as Aboriginal, from between 4.1% and 37.8%. Admission and mortality ratios varied markedly between algorithms, with less strict algorithms resulting in higher admission rate ratios, but generally lower mortality rate ratios, particularly for cardiovascular disease. Conclusions: The choice of enhancement algorithm has an impact on the number of people reported as Aboriginal and on estimated outcome ratios. The influence of the hospital on recording of Aboriginal status highlights the importance of continued efforts to improve data collection. Implications: Estimates of Aboriginal health disparity can change depending on how Aboriginal status is reported. Sensitivity analyses using a number of algorithms are recommended.     

Aboriginal mothers in prison in Australia: a study of social,emotional and physical wellbeing

Objective : To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison. Methods : Cross‐sectional survey, including a Short Form Health Survey (SF‐12) and Kessler Psychological Distress Scale (5‐item version) administered to Aboriginal women who self‐identified as mothers. Results : Seventy‐seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty‐three per cent (n=59) of mothers in NSW were in prison for drug‐related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty‐eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF‐12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1). Conclusions : Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health : Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.     

Collecting and using aboriginal health information in New South Wales

OBJECTIVE: To describe the development of guidelines for the management of Aboriginal health information in NSW. The purpose of the guidelines is to promote the ethical management of Aboriginal health information, with appropriate consideration for cultural factors. METHODS: The guidelines were developed collaboratively by the NSW Aboriginal Health Partnership, which comprises NSW Health (the central administrative office, named NSW Department of Health, and the Area Health Services) and the NSW Aboriginal Health and Medical Research Council (AHMRC), the peak body representing member Aboriginal Community Controlled Health Services in NSW. A lengthy and comprehensive consultation process enabled a wide range of interested groups to have input into the guidelines. RESULTS: The project culminated in the production of the NSW Aboriginal Health Information Guidelines, covering the collection, ownership, storage, security, release, usage, interpretation and reporting of information, as well as issues of privacy and confidentiality. The Guidelines formed the basis of a formal Memorandum of Understanding, signed by the NSW Minister for Health, NSW Department of Health and the AHMRC, on 24 August 1998. CONCLUSIONS AND IMPLICATIONS: The Guidelines make an important contribution to meeting a need for protocols on the collection, ownership and use of Aboriginal health information. Their production reflects successful collaboration between government and Aboriginal Community Controlled Health Services in NSW. Future reviews of the Guidelines will ensure their effectiveness and consistency with Aboriginal community principles.     

If the land's sick, we're sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales

Objective: To report Aboriginal communities' views of how prolonged drought in rural NSW has affected their social and emotional well‐being, and of possible adaptive strategies. Design: Content analysis of issues, priorities and adaptive strategies raised in semistructured community forums. Setting: Rural centres across NSW. Participants: Aboriginal people, service providers and other stakeholders. Voluntary participation by invitation with consent to record discussions. Results: Three themes (containing six issues) emerged: (i) impacts on culture (harm to traditional family structure, culture and place; bringing shame to culture); (ii) sociodemographic and economic impacts (skewing of the population profile; loss of livelihood and participation; aggravation of existing socioeconomic disadvantage); and (iii) loss. In addition to continuing well‐being programs that were already successful, proposed adaptive strategies were: capturing the spirit of Aboriginal knowledge and traditions; knowing your land; and Aboriginal arts. Conclusion: Prolonged drought presented substantial and unique adversity for rural NSW Aboriginal communities, compounding existing, underlying disadvantage. Drought‐induced degradation of and, sometimes, the necessity to leave traditional land drove people apart and disrupted Caring for Country activities. Some people reported despair at not being able to discharge cultural obligations. At the same time, the drought prompted increased love of and concern for land and a renewed enthusiasm for expressing connectedness to land through all forms of art. Modern Aboriginal and wider community well‐being programs helped frame a response to drought alongside traditional Aboriginal dreaming and cultural approaches to emotional health and well‐being.     

The oral health care experiences of NSW Aboriginal Community Controlled Health Services

Objectives: Aboriginal people continue to experience a disproportionately heavy burden of oral disease. A range of oral health services may be available to Aboriginal communities, including those provided by Aboriginal Community Controlled Health Services (ACCHSs). This study explored the oral health care experiences and activities of ACCHSs to inform policy and program decision making. Methods: Mixed methods, including an online survey and semi‐structured interviews with senior ACCHS staff, were used. Areas of inquiry included perceived community need for oral health care, oral health care models, accessibility of other oral health services and barriers to providing oral health care. Twenty‐nine NSW ACCHSs participated in the study. Results: The activities of NSW ACCHSs in oral health care are diverse and reflect the localised approaches they take to delivering primary health care. ACCHSs commonly face barriers in delivering oral health care, as do Aboriginal communities in accessing other oral health services. Conclusion: NSW ACCHSs are important but under‐acknowledged providers of a range of oral health services to Aboriginal communities and are well placed to provide this care as part of their comprehensive primary health care model. Implications: ACCHS roles in improving Aboriginal oral health would be strengthened by greater acknowledgement of their contributions and expertise and the development of transparent, long‐term funding policies that respond to community need.     

Pragmatic indicators for remote Aboriginal maternal and infant health care: why it matters and where to start

Objective: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory (NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to inform a set of pragmatic indicators for reporting improvement in remote MIH care. Methods: Scientific databases and grey literature (organisational websites and Google Scholar) were searched using the terms ‘Aboriginal/maternal/infant/remote health/monitoring performance’. Key stakeholders identified omitted indicators sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme. Results: Forty‐two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000 individual indicators. Of these, 656 were relevant for our purpose and were subsequently organised into 300 topics and 16 themes for antenatal, birth and postpartum, and infant care by indicator type. Conclusion: There are many measures for monitoring health care delivery to mothers and infants. Few are framed around remote MIH services, despite poorer health outcomes of remote mothers and infants and the specific challenges with providing care in this setting. Establishing relevant indicators is vital to support relevant data collection and the development of appropriate policy for remote Aboriginal maternal and infant care.     

Improving the mental health of rural New South Wales communities facing drought and other adversities

Objective: NSW has just experienced its worst drought in a century. As years passed with insufficient rain, drought‐related mental health problems became evident on farms. Our objective is to describe how, in response, the Rural Adversity Mental Health Program was introduced in 2007 to raise awareness of drought‐related mental health needs and help address these needs in rural and remote NSW. The program has since expanded to include other forms of rural adversity, including recent floods. Setting: Rural NSW. Design, participants, interventions: Designed around community development principles, health, local service networks and partner agencies collaborated to promote mental health, education and early intervention. Strategies included raising mental health literacy, organising community social events and disseminating drought‐related information. Priority areas were Aboriginal communities, older farmers, young people, women, primary health care and substance use. Results: Over 3000 people received mental health literacy training in the four years of operation from 2007 to 2010. Stakeholders collaborated to conduct hundreds of mental health‐related events attended by thousands of people. A free rural mental health support telephone line provided crisis help and referral to rural mental health‐related services. Conclusion: Drought affected mental health in rural NSW. A community development model was accepted and considered effective in helping communities build capacity and resilience in the face of chronic drought‐related hardship. Given the scale, complexity and significance of drought impacts and rural adjustment, and the threats posed by climate change, a long‐term approach to funding such programs would be appropriate.     

The Chronic Care for Aboriginal People program in NSW

Aboriginal people living in NSW continue to experience greater health risks, poorer health and shorter life expectancies than non-Aboriginal Australians. The NSW Health-funded program, Chronic Care for Aboriginal People, was established from existing initiatives to rethink the way chronic care services were delivered to Aboriginal people in NSW. Refocusing and building on existing projects led to NSW Health providing an evidence base of what was working in Aboriginal communities. A model of care for Aboriginal people with chronic disease has been developed. Recommendations from two evaluations have allowed further improvement for the delivery of chronic care services for Aboriginal people. The Local Health District Service Agreements include relevant indicators and strategic priorities relating to the chronic care program.     

Developing an Aboriginal Health Plan for NSW: the consultation process

In partnership with the Aboriginal Health and Medical Research Council of NSW (AH&MRC), the NSW Ministry of Health is developing a 10-year Aboriginal Health Plan for NSW. Recent reports have highlighted the need for significant systemic and structural change, coupled with genuine engagement with Aboriginal people. A whole health-system approach has been adopted and is examining all the interdependent and influencing elements that impede or facilitate effective health outcomes for Aboriginal people. The collaboration will develop a new strategic framework that will provide clear direction concerning how we address Aboriginal health in NSW. We have done this by seeking genuine engagement and partnership with Aboriginal people, organisations and communities. A phased approach has been used to develop the Plan. This paper describes the first phase of a two-phased approach. A discussion paper was released on National Close the Gap Day, 22 March 2012.     

Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa

Objective: Access barriers to health care for minority populations has been a feature of medical, health and social science literature for over a decade. Considerations of cultural barriers have featured in this literature, but definitions of what constitutes a cultural barrier have varied. In this paper, data from recent interviews with Aboriginal and Torres Strait Islander people, Aboriginal Health Workers and other non‐Indigenous health professionals in north‐west Queensland assist to refine the meaning of this term and uncovered other issues disguised as ‘cultural’ difference. Design: Semistructured interviews with community and health professionals. Setting: Mount Isa, Queensland, Australia. Participants: Aboriginal and Torres Strait Islanders, Aboriginal Health Workers and other health professionals in Mount Isa between 2007 and 2009. Results: Cultural barriers were considered differently by Aboriginal patients and health practitioners. While Aboriginal patients focused heavily on social relationships and issues of respect and trust, most practitioners seemed more focused on making Aboriginal people feel comfortable with changes to physical environments and systems, with less emphasis on creating strong interpersonal relationships. Conclusions: For Aboriginal patients the focus on interpersonal relationships between themselves and health practitioners is paramount. Creating comforting physical environments and systems that are easier to navigate do assist in overcoming cultural barriers, but are often seen as little more than token gestures if trusting interpersonal relationships are not formed between patient and practitioner.     

Chronic disease prevention programs offered by Aboriginal Community Controlled Health Services in New South Wales,Australia

Objectives : To identify and describe chronic disease prevention programs offered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia. Methods : ACCHSs were identified through the Aboriginal Health and Medical Research Council of NSW website. Chronic disease programs were identified from the Facebook page and website of each ACCHS. Characteristics, including regions, target population, condition, health behaviour, modality and program frequency were extracted and summarised. Results : We identified 128 chronic disease programs across 32 ACCHSs. Of these, 87 (68%) programs were broad in their scope, 20 (16%) targeted youth, three (2%) targeted Elders, 16 (12%) were for females only and five (4%) were for males only. Interventions included physical activity (77, 60%), diet and nutrition (74, 58%), smoking (70, 55%), and the Aboriginal and Torres Strait Islander Health Check (44, 34%), with 93 programs (73%) of ongoing duration. Conclusions : Chronic disease prevention programs address chronic conditions by promoting physical activity, diet and nutrition, smoking cessation and health screening. Most target the general Aboriginal community, a few target specific groups based on gender and age, and more than one‐quarter are time‐limited. Implications for public health : Chronic disease programs that are co‐produced with specific groups, based on age and gender, may be needed.     

Maternal smoking during pregnancy among Aboriginal women in New South Wales is linked to social gradient

Objective: Social gradients in Aboriginal health are seldom explored. This study describes social gradients and trends in smoking during pregnancy among Aboriginal mothers in NSW. Methods: This was a secondary analysis of the NSW Midwives Data Collection (MDC) 1994–2007, covering all births in NSW. Analyses examined associations between socio‐demographic characteristics and smoking during pregnancy. Results: Data from 1,214,206 pregnant women showed that 17.4% smoked during pregnancy. The rate of smoking during pregnancy among all NSW women declined from 22.3% in 1994 to 12.8% in 2007; the rate among Aboriginal women remained high, declining from 61.4% in 1994 to 50.2% in 2007. Smoking was substantially higher among Aboriginal mothers compared to non‐Aboriginal mothers. Socio‐economic analyses showed that the smoking rate among low SES Aboriginal mothers was approximately two and a half times that of high SES Aboriginal women, a similar gradient to non‐Aboriginal women. Conclusions: Indicators of socio‐economic position are a consistent, independent correlate of smoking during pregnancy for Aboriginal and non‐Aboriginal women. Implications: There is a need for a social inequalities approach to smoking during pregnancy, specifically targeting more disadvantaged Aboriginal mothers and all teenage mothers for smoking prevention. Strategies to access more disadvantaged mothers should not be missed through broadly focused Aboriginal tobacco control strategies.     

Measuring what matters in delivering services to remote-dwelling Indigenous mothers and infants in the Northern Territory, Australia

Problem: In the Northern Territory, 64% of Indigenous births are to remote‐dwelling mothers. Delivering high‐quality health care in remote areas is challenging, but service improvements, informed by participative action research, are under way. Evaluation of these initiatives requires appropriate indicators. Few of the many existing maternal and infant health indicators are specifically framed for the remote context or exemplify an Indigenous consumer perspective. We aimed to identify an indicator framework with appropriate indicators to demonstrate improvements in health outcomes, determinants of health and health system performance for remote‐dwelling mothers and infants from pregnancy to first birthday. Design: We reviewed existing indicators; invited input from experts; investigated existing administrative data collections and examined findings from a record audit, ethnographic work and the evaluation of the Darwin Midwifery Group Practice. Setting: Northern Territory. Process: About 660 potentially relevant indicators were identified. We adapted the Aboriginal and Torres Strait Islander Health Performance Framework and populated the resulting framework with chosen indicators. We chose the indicators best able to monitor the impact of changes to remote service delivery by eliminating duplicated or irrelevant indicators using expert opinion, triangulating data and identifying key issues for remote maternal and infant health service improvements. Lessons learnt: We propose 31 indicators to monitor service delivery to remote‐dwelling Indigenous mothers and infants. Our inclusive indicator framework covers the period from pregnancy to the first year of life and includes existing indicators, but also introduces novel ones. We also attempt to highlight an Indigenous consumer.     

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing,EAr health and Language Services (HEALS) project

Objective : To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. Methods : A case‐study involving a mixed‐methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi‐structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. Results : To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech‐language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. Conclusions : HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health : HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the ‘no research without service’ philosophy.     

Partnerships to promote mental health of NSW farmers: the New South Wales Farmers Blueprint for Mental Health

Objective: To describe the process and outcome of development of a framework for planning and implementation of a range of interventions aimed at improving the mental health and wellbeing of farmers and farm families in New South Wales (NSW). Design: In response to a major drought in New South Wales (NSW), key agencies were invited to participate in a longer-term collaborative program aimed at improving the mental health and well-being of the people on NSW farms. These agencies became the NSW Farmers Mental Health Network. Setting: The Australian National Action Plan for Promotion, Prevention & Early Intervention for Mental Health 2000 proposed a population health approach base encompassing the range of risk and protective factors that determine mental health at the individual, family and community and society levels. It incorporated three traditional areas of health activity into programs aimed at achieving improved mental health for the Australian population – mental health promotion, prevention activities and early intervention. Although the farming population was not identified as a priority population, research has identified this population to be at high risk of suicide, and of having difficulty in coping with the range of pressures associated with life and work in this industry. Participants: Participants were agencies providing services across rural NSW in the fields of farmer and country women's organisations, financial counselling services, government departments of primary industries and health, mental health advisory and support services, charitable organisations and others. Results: The NSW Farmers Blueprint for Mental Health ( http://www.aghealth.org.au/blueprint ) was developed to be ‘a simplified summary of key issues that need to be addressed, and the major actions that we can be confident will be effective in achieving our purpose’. It has identified ‘steps’ along ‘pathways to breakdown’ from the range of known mental health and suicide risk factors that are relevant to the NSW farming population, and 23 areas of current and potential action that would contribute to improving mental health, as key steps along ‘pathways to health’. For each of the areas of action there is described the rationale and basis for action, and the lead agency or individual who has accepted responsibility for coordinating and reporting further activity to the Network. Conclusion: It is suggested that the NSW Farm Blueprint and the activities being implemented by the NSW Farmers Mental Health Network partners represent a model for implementation of a mental health promotion in identified at-risk Australian populations.     

Socioeconomic correlates of mortality and hospital morbidity differentials by Local Government Area in Sydney 1985–1988

Abstract: Objective: To determine the magnitude of differentials in mortality and hospital morbidity by Local Government Area (LGA) in Sydney (1985–1988), and to correlate these with LGA indicators of socioeconomic status. Design: Cross-sectional group-based comparative study of mortality and hospital separations, and a group-based correlations analysis in relation to socioeconomic indicators. Outcome measures: Mortality—life expectancy at birth, infant mortality, 0- to 4-year mortality, age-standardised 15- to 64-year mortality (all-cause and various causes), sex-specific (except infant and 0- to 4-year mortality). Hospital morbidity rates—0- to 4-year hospital separations, age-standardised 15- to 64-year hospital separations (all-cause and various causes), sex-specific. Study factors: Census-derived LGA proportions of immigrants, Aborigines, professionals, unskilled workers, unemployed persons, those with a university degree and those having no qualifications, and the composite Ross Indicator. Results: Considerable differences in mortality and hospital morbidity by LGA in Sydney were found. Males had higher mortality and lower rates of hospital separation than females. LGA differentials were most obvious for adults, with little variation noted for infants or children. Most socioeconomic indicators were highly correlated with adult mortality and hospital morbidity in the expected direction, particularly indicators of low socioeconomic status. The unemployment rate, proportion Aboriginal, proportion unskilled, proportion unqualified, and the Ross Indicator were the most highly correlated variables. Conclusions: There are persistent differentials by LGA in mortality and hospital morbidity in Sydney which are strongly associated with socioeconomic status. The Ross Indicator was found to be a useful composite indicator. The high correlations of mortality and hospital morbidity with the unemployment rate raise the question of to what extent this is due to illness and premature mortality in the unemployed. Monitoring of health status differentials needs to continue if progress towards Health For All targets is to be evaluated.     

Children overdue for immunisation: a question of coverage or reporting? An audit of the Australian Immunisation Register

Objective : Vaccinations in Australia are reportable to the Australian Immunisation Register (AIR). Following major immunisation policy initiatives, the New South Wales (NSW) Public Health Network undertook an audit to estimate true immunisation coverage of NSW children at one year of age, and explore reasons associated with under‐reporting. Methods : Cross‐sectional survey examining AIR immunisation records of a stratified random sample of 491 NSW children aged 12≤15 months at 30 September 2017 who were >30 days overdue for immunisation. Survey data were analysed using population weights. Results : Estimated true coverage of fully vaccinated one‐year‐old children in NSW is 96.2% (CI:95.9‐96.4), 2.1% higher than AIR reported coverage of 94.1%. Of the children reported as overdue on AIR, 34.9% (CI:30.9‐38.9) were actually fully vaccinated. No significant association was found between under‐reporting and socioeconomic status, rurality or reported local coverage level. Data errors in AIR uploading (at provider level) and duplicate records contributed to incorrect AIR coverage recording. Conclusions : Despite incentives to record childhood vaccinations on AIR, under‐reporting continues to be an important contributor to underestimation of true coverage in NSW. Implications for public health : More reliable transmission of encounters to AIR at provider level and removal of duplicates would improve accuracy of reported coverage.     

Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service

Objective: In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co‐morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co‐morbid D&A and mental health disorders. Design: Current literature on co‐morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. Setting: A rural Area Health Service in NSW. Participants: Rural health and welfare service providers, consumers with co‐morbid D&A and mental health disorders. Results: Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug‐taking. Information gathered from the focus groups indicated a reasonable level of awareness of co‐morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Discussion: Significant gaps in the provision of appropriate care for people with co‐morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co‐morbid care can be provided.     

Building a strategic approach to improve Aboriginal health research and evaluation in NSW

A 5-year strategic plan for Aboriginal health research and evaluation has been developed to support the NSW Ministry of Health in its efforts to create the evidence for what works in addressing the health disparity between Aboriginal and non-Aboriginal people. The plan has the following objectives: that all Aboriginal health policies and programs are evidence informed; that programs and strategies are rigorously evaluated and contribute to building the evidence for improving Aboriginal health outcomes; that new research evidence is generated for improving Aboriginal health outcomes; and that robust monitoring and accountability mechanisms in Aboriginal health are in place, with improved data quality. This paper describes the development of the NSW Ministry of Health's Aboriginal Health Research and Evaluation Strategic Plan 2011-15, including a review of the evidence and policy documents, facilitated planning sessions, and consultation with staff within the Population and Public Health Division of the Ministry.     

A qualitative evaluation of a mentoring program for Aboriginal health workers and allied health professionals

Objective: Effective partnerships between Aboriginal Health Workers and non‐Aboriginal health professionals are essential to achieve Aboriginal health outcomes. This study aimed to evaluate a mentoring workforce development strategy for Aboriginal Health Workers and non‐Aboriginal allied health professionals. Methods: Thirty‐four Aboriginal Health Workers and non‐Aboriginal health professionals were recruited to the mentoring program where they were paired and established a learning relationship for approximately six months. A qualitative evaluation with thirty of the participants was undertaken involving in‐depth interviews at the completion of the program. Results: A total of 18 mentoring partnerships were formed across Victoria. The data revealed three key themes in relation to the evaluation of the program: (1) The mentoring program facilitated two‐way learning, (2) The Aboriginal Health Workers and non‐Aboriginal health professional participants reported being able to meet their identified learning needs through the partnership, (3) The capacity to improve practice was facilitated through readiness to learn and change practice and personal attributes of the participants, as well as organisation and management support. Conclusions: Peer mentoring between Aboriginal and non‐Aboriginal health workforce was found to be a powerful mechanism to promote two‐way learning that has the capacity to meet learning needs and promote practice improvement. Implications: Peer mentoring may be part of a multi‐strategy approach to the development of the Aboriginal health workforce.